What is dry eye syndrome and why does it occur?
Dry eye syndrome (DES) is a common condition in which the eyes do not produce enough tears or the tears have an improper composition, leading to their rapid evaporation. This causes discomfort, redness, a gritty sensation in the eyes, burning, and even temporary vision impairment. Although many associate DES with prolonged computer use, its causes are much broader and can be linked to various diseases and environmental factors.
When dry eye is linked to other diseases: a focus on the thyroid gland
One of the most significant systemic diseases affecting eye health is thyroid eye disease (TED), or Graves' ophthalmopathy. This is the most common orbital disorder among adults, in which upper eyelid abnormalities frequently occur [5]. Such abnormalities include:
- Eyelid retraction (pulling of the eyelid upward)
- Eyelid lag (delay in eyelid movement when looking down)
- Eyelid edema
These changes not only cause functional and cosmetic problems but can also significantly exacerbate dry eye symptoms, as they disrupt natural eyelid closure and the distribution of the tear film over the eye surface [5].
Treatment for thyroid eye disease aims to address the underlying cause and may include various approaches:
- Basic supportive therapy [5].
- Local injections: botulinum toxin A, hyaluronic acid, and triamcinolone can be used to correct eyelid position and reduce edema [5].
- Systemic drugs: corticosteroids, Teprotumumab (an IGF-1 receptor antagonist), and alpha-1 antagonists [5]. Teprotumumab, in particular, has shown the ability to significantly reduce eyelid retraction and exophthalmos with a better safety profile compared to traditional glucocorticoids [5].
- Tocilizumab, a monoclonal antibody directed against the interleukin-6 receptor, has been proposed as a second-line therapy for TED resistant to glucocorticoids [7].
Successful treatment of the underlying disease, such as thyroid eye disease, often leads to significant relief of the associated dry eye symptoms.
Inflammation and dry eyes: the role of the immune system
Inflammatory processes in the body can also affect eye health and cause symptoms of dryness. For example, conjunctivitis, an inflammation of the mucous membrane of the eye, is a common side effect of certain systemic drugs, such as Dupilumab—a monoclonal antibody targeting IL-4 and IL-13 interleukins, used to treat chronic rhinosinusitis with nasal polyps [1]. Although Dupilumab is not a drug for treating dry eye, this example demonstrates how systemic inflammation or immunomodulatory therapy can affect the ocular surface, causing discomfort and dryness.
Understanding the role of inflammation in the development of DES underscores the importance of a comprehensive approach to diagnosis and treatment, which may include anti-inflammatory components.
Treatment approaches: from local to systemic
Treatment of dry eye syndrome, especially when it is associated with systemic diseases, requires an individualized approach. While supportive therapy, including moisturizing eye drops, is the cornerstone for symptom relief, it is also important to address the root cause.
For patients with thyroid eye disease, as already mentioned, the spectrum of treatment is broad: from basic supportive care and local injections to systemic drugs and surgical interventions [5]. The choice of method depends on the stage of the disease, its severity, and the patient's individual response to therapy. It is important to note that despite the emergence of new biological drugs such as Teprotumumab and Tocilizumab, the optimal timing for their use compared to surgery remains a subject of research, and treatment must be strictly individualized [5].
The importance of a comprehensive approach and follow-up
Given the complexity of dry eye syndrome and its possible link to other diseases, it is crucial to ensure a comprehensive approach to diagnosis and treatment. This means not only relieving current symptoms but also identifying and managing any comorbid conditions.
Long-term follow-up of patients with eye diseases is key. For example, in retinopathy of prematurity, glaucoma can develop significantly later in life, requiring lifelong monitoring [3]. Similarly, patients with DES, especially in the presence of systemic factors, need regular check-ups to assess treatment efficacy and timely adjust therapy. Individualization of treatment and constant monitoring are the keys to successful management of dry eye syndrome and improving the quality of life for patients [5].
Sources
- Dupilumab-Associated Severe Headaches in Chronic Rhinosinusitis With Nasal Polyposis (CRSwNP): A Report of Two Cases With Resolution After Cessation. https://pubmed.ncbi.nlm.nih.gov/42326118/
- Glaucoma in retinopathy of prematurity: A review. https://pubmed.ncbi.nlm.nih.gov/40147616/
- Diagnosis and treatment progress of upper eyelid abnormalities in thyroid-eye disease. https://pubmed.ncbi.nlm.nih.gov/42516758/
- Tocilizumab in Active, Moderate-to-Severe, Glucocorticoid-Resistant Thyroid Eye Disease: An Open-Label Prospective Study in Two Independent Cohorts. https://pubmed.ncbi.nlm.nih.gov/42117357/
The information provided in this article is for reference purposes only and cannot replace professional medical advice. Always consult a specialist for diagnosis and treatment.