Aqueous-Deficient Dry Eye Demands Early Identification and Treatment

Up to a third of patients with dry eye disease have aqueous-deficient dry eye (ADDE), a subtype of dry eye disease that can cause irreversible damage if not appropriately diagnosed and treated, according to a review article published in the Indian Journal of Ophthalmology.

“Since ADDE can be a source of long-term suffering and severe visual impairment, early identification and adequate treatment are imperative,” wrote corresponding author Sayan Basu, MBBS, MS, of the LV Prasad Eye Institute, Hyderabad, Telangana, India, and coauthors. “Multiple etiologies can underlie ADDE, and it is critical to identify the underlying cause to not only improve the ocular health but also to improve the overall quality of life and well-being of affected individuals.”

The article provides an overview of various ADDE etiologies and potential contributors. Dryness associated with dry mouth, dry skin, and joint pain in patients with a history of associated systemic diseases or allogenic hematopoietic stem cell transplantation should prompt a high degree of suspicion for ADDE, the authors advise. In patients with ADDE associated with underlying systemic disease, multidisciplinary care with a rheumatologist, dermatologist, or hemato-oncologist is often necessary.

The review covers various diagnostic tests for comprehensive examination. Management options include therapeutic and surgical approaches to treat symptoms. Whenever possible, the authors advise referral of patients with ADDE to an ocular surface clinic, where they have access to systemic evaluation and specialist consultation.

“It is critical to understand that adequate care of many cases of ADDE is not possible through symptomatic or palliative treatment with topical lubricants and anti-inflammatory medications alone,” the authors warn. “This is particularly true for conjunctival cicatrizing diseases like mucus membrane pemphigoid that can progress relentlessly without systemic therapy and lead to devastating keratopathy and blindness.”

Reference: 
Donthineni PR, Doctor MB, Shanbhag S, et al. Aqueous-deficient dry eye disease: preferred practice pattern guidelines on clinical approach, diagnosis, and management. Indian J Ophthalmol. 2023;71(4):1332-1347. doi:10.4103/IJO.IJO_2808_22