Chronic Dry Eye: Underestimated, Underdiagnosed, and Frustrating

Ask anyone who suffers from chronic dry eye disease about trying to get a diagnosis. They will probably tell you it was a long and frustrating journey. They may tell you about multiple visits to the eye doctor. They may have had many tests. They may have tried and failed many treatments. Doctors may have diagnosed people with other conditions before they were diagnosed with chronic dry eye.

Ask a doctor about diagnosing someone with chronic dry eye. They will probably tell you it is a long and frustrating journey. They may tell you about multiple appointments with a person. They may describe many tests to diagnose dry eye. Do you see a pattern?

Chronic dry eye diagnosis can be as frustrating for doctors as it is for people living with the condition. There are many reasons for this frustration. Understanding the biggest issues in diagnosing and treating chronic dry eye can help you talk to your doctor about your issues and improve your symptoms.

Why is diagnosing chronic dry eye so difficult?

One of the biggest challenges that doctors face is that there is no one test to diagnose chronic dry eye. Unlike other diseases that can be diagnosed with a blood test or biopsy, chronic dry eye is much harder to diagnose.¹

Doctors have created committees to come up with a tool to help them diagnose the condition. These committees have come up with definitions of chronic dry eye, but these definitions can be confusing for some doctors. This confusion does not help the diagnosis of the condition.²

Chronic dry eye can be caused by many different factors. People may have issues with their tear film. They can have structural issues with their eyelids or eyes that do not close completely. They can have glands in their eyes that do not work properly and do not produce enough tears. Some people simply do not blink enough.^1,2

To make things more difficult, chronic dry eye can be caused by other diseases. People with autoimmune diseases such as Sjörgen syndrome and rheumatoid arthritis may also suffer from dry eye. Rosacea around the eyes and sarcoidosis may also cause chronic dry eye.¹

Why is treating chronic dry eye so difficult?

Because chronic dry eye is difficult to diagnose, it can also be difficult to treat. Doctors have problems with rating the severity of a person’s dry eye.

Every person can have different symptoms of dry eye. Some may have poor tear film, others may have pain, and others may have swelling.²

Doctors may run tests on a person and diagnose mild dry eye, while the person thinks their condition is severe. They may also decide a person has severe chronic dry eye, while the person thinks their symptoms are mild.³

Some doctors believe that treatment should start with simple methods. This may include warm, wet compresses and artificial tears. Other doctors feel that treatment should be aggressive. They may prescribe cyclosporine eye drops or even steroid eye drops. Other doctors feel it is important to understand why the person is having dry eye symptoms so that the underlying disease can be treated.¹

Certain medicines can lead to chronic dry eye. People taking antihistamines for allergies, antidepressants, and even some stomach medicines called anticholinergics can cause dry eyes.^1-3

Preservatives in over-the-counter artificial tears can also lead to chronic dry eye. Doctors find that people who are taking artificial tears too often may actually be making their symptoms worse.^1-3

Talking to your doctor about chronic dry eye

It is important to understand that chronic dry eye is not simple. Doctors should want you to know that the process of diagnosing and finding the best treatment for your dry eye will take time. You will probably be treating your dry eye for most of your life. Treatments may change as your symptoms change.^2,3

Be ready to talk to your doctor about your chronic dry eye at your next appointment. Explain your symptoms. Are your eyes painful? Do they itch? Does it feel like you have something in your eyes when there is nothing there?

Let your doctor know what you have done to treat your dry eye so far. How often are you using artificial tears? Have you tried warm compresses on your eyes? Have you tried lid scrubs or eyewashes?

Tell your doctor about any other medicines you are on. Let them know if you have any other diseases or have had any other recent illnesses. Let your doctor know if you have had any eye infections or have noticed anything different about your eyes. Are your eyelids drooping? Do you feel like your eyes do not close completely when you sleep? Do you work on a computer all day? Do you find yourself not blinking as much?

There are eye specialists you can see for a second opinion if you feel your doctor is not able to help your dry eye. Many large universities have eye centers if you are willing to travel to one. You can also ask your doctor to refer you to a dry eye specialist.

You are your own best advocate for your health. Remember, diagnosing and treating chronic dry eye will not be a quick process. By working with the right doctor, you should be able to find a successful treatment for your needs.