Vol. 1, #04   •   Thursday, October 08, 2020

 

Review's Chief Clinical Editor
Paul M. Karpecki, OD, FAAO


Provides you with cutting-edge clinical strategies for optimal management of ocular surface disease and beyond.

 

Predisposing Factors to Dry Eye Disease

A patient with DED and the predisposing factor of Demodex blepharitis.

Looking at risk factors can increase your sensitivity to a dry eye disease diagnosis and improve patient management.

Predisposing factors for dry eye disease are vast, making it difficult to recall all of them during a routine evaluation, but the more common causes are what you need to keep in mind. Some issues are controllable although difficult to discontinue or alter (e.g., smoking or glaucoma medications), while others are outside of our control (e.g., hormonal regulation).

So, whether these underlying concerns need to be addressed or used to identify a proper diagnosis, knowing the more prevalent factors leading to dry eye is helpful. Here is a partial list of some of the more important predisposing factors.

• Older Age (although younger patients are seeing a much higher incidence of DED recently1)
• Gender (females > males)
• Environmental
   • Digital device use
   • Smoking
   • Arid environments
   • Pollution
   • Poor nutrition
• Systemic medications
   • Antihistamines and decongestants
   • Antidepressants (e.g., Zoloft, Paxil, etc.)
   • Diuretics (e.g., hydrochlorothiazide)
   • Beta-blockers
   • Proton pump inhibitors (e.g., Prevacid, Nexium, Prilosec, etc.)
   • Birth control and hormone replacement therapy
   • Chemotherapy medications (e.g., cyclophosphamide)
   • Acne medications (e.g., isotretinoin/Accutane)
   • Twenty-two of the most common systemic medications prescribed list dry eye as a potential side effect2
Topical medications
   • Prostaglandin analogs for glaucoma
   • Any chronic drug containing preservatives such as benzalkonium chloride (BAK)
   • Topical ocular polypharmacy leads to a significantly greater risk of DED2
• Previous ocular surgeries
   • Cataract
   • Refractive
   • Cosmetic eyelid
   • Multiple ocular surgeries of any type
• Contact lens wear
• Systemic diseases
   • Diabetes
   • Thyroid disease
   • Autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus, etc.)
• Lid margin disease
   • Meibomian gland dysfunction (MGD)
   • Blepharitis (Demodex, Staphylococcal, etc.)
   • Lagophthalmos and lid laxity
   • Reduced blink rate or capacity
   • Non-tight lid seal
   • Ectropion/entropion

Knowing these fundamental risk factors can assist you in your dry eye disease diagnosis and, when appropriate, enable you to alter or reduce offending agents. In my opinion, the most common risk factor is lid margin disease, and we’ll visit that subject in the next clinical pearl.


KEY TAKEAWAY: Keep in mind the more common predisposing factors of dry eye disease to assist with diagnosis and management.


 


1. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the Beaver Dam offspring study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014; Apr;157(4):799-806.
2. Fraunfelder FT, Sciubba JJ, Mathers WD. The role of medications in causing dry eye. J Oph-thalmol. 2012; 285851.



Supported by an independent medical grant from Kala Pharmaceuticals

 
 
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