Clinical Review From Drug and Therapeutics Bulletin

The management of dry eye

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2333 (Published 04 May 2016) Cite this as: BMJ 2016;353:i2333

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  1. Drug and Therapeutics Bulletin
  1. 1Drug and Therapeutics Bulletin Editorial Office, London WC1H 9JR, UK
  1. dtbeditor{at}bmjgroup.com.

Dry eye disease (also called keratoconjunctivitis sicca) is a common condition, with a prevalence ranging from 8 to 34%, depending on the criteria used.1 It becomes more common with increasing age and affects more women than men. Artificial tears and ocular lubricants are considered the mainstay of treatment, and there is a very wide range of these products available. In England in 2014, over 6.4 million prescription items for artificial tears, ocular lubricants, and astringents were dispensed in the community at a cost to the NHS of over £27 million.2 In this article we review the management of dry eye disease, focusing on artificial tears and ocular lubricants.

About dry eye

The tear film, which covers the cornea and exposed conjunctiva, is composed of three layers: a mucin layer that sits on the epithelial surface; a middle aqueous layer; and an outer lipid layer that plays a role in preventing tear evapouration.3 Dry eye has been defined as a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.4

There are two main types of dry eye: aqueous insufficiency (due to reduced aqueous secretion from lacrimal glands) and evapourative (due to a deficient lipid layer).

Aqueous insufficiency is divided into two main groups: Sjögren's syndrome-related dry eye and non-Sjögren's syndrome-related dry eye (which includes the use of systemic medication). Dry eye in Sjögren's syndrome (an autoimmune disease) is often severe and requires more aggressive treatment.5

Evapourative dry eye is most commonly a result of meibomian gland dysfunction.4 External causes include allergy, topical medication use (including preservative content), and contact lens wear.

Risk factors associated …

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