Dry eye is more than just a nuisance. It can cause a ripple effect impacting quality of life, work, and mood.
15%
of the world’s population are affected by dry eye disease(DED).
17%
in females, significantly higher prevalence of DED compared to males (11.5%).
27%
in Asia, the highest prevalence of DED among all regions. [1]
15%
of the world's population are affected by dry eye disease(DED).
17%
in females, significantly higher prevalence of DED compared to males (11.5%).
27%
in Asia, the highest prevalence of DED among all regions - Europe (16.4%), Africa (14.2%), South America (12.8%), North America (7.4%).[1]
What is Dry Eye?
Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.(TFOS DEWS II) [2] (Key words: Ocular surface, Tear film, Inflammation.)
Symptom of Dry Eye
People with DED report redness, burning and stinging, ocular dryness, photophobia, foreign body sensation, grittiness, and visual disturbance, all of which significantly affect quality of life, such that up to 34 % of sufferers report impairment in daily activities.[3]
Cause of DED?
Despite the multifactorial nature of dry eye disease (DED), evidence has clearly shown tear evaporation is a leading cause of the disease.[4,5]
Risks of dry eye disease
A number of modifiable lifestyle factors have been evaluated for their potential association with dry eye disease, including environmental factors, exposure digital screen, sleep quality, diet, and periocular cosmetic application. [6]
Environmental Factors
In environments with low relative humidity, such as air-conditioned rooms, or outdoor environments with high wind speeds, the increased water vapour pressure gradient results in greater tear evaporation.
Digital Screen Time
A study shown that every one hour per day increase in digital screen time was found to be associated with a 1.14 higher odds of dry eye disease
Diet
Several studies have shown the contribution of diets and nutrients in the management and prevention of DED, such as vitamin D and vitamin A.[7]
Sleep
A survey found that, compared to those achieving 6–8 h of sleep per night, those who sleep for less than 6 h per night had between 1.19 and 1.26 higher odds of having symptoms of dry eye disease.
How to Break the Dry Eye Vicious Cycle
Inflammation has been identified as a critical contributor that can initiate dry eye’s vicious cycle. The vicious cycle refers to a malignant development interacted among inflammation, hyperosmolarity, cell apoptosis, and tear film decline that deteriorates dry eye syndrome. [8]
Treatments for Dry Eye
Artificial Tears
The first line treatment of DED consists of artificial tears to nourish the ocular surface, increase lubrication while concomitantly diluting the concentration of inflammatory cytokines. Topical corticosteroids are effective to control ocular surface inflammation, but their use is associated with potentially serious adverse effects, such as glaucoma, cataract, increased risk of infection and delayed wound healing.
Nutraceuticals
Anti-inflammatory and anti-oxidative therapies are considered as causative therapeutic approaches for DED, since they aim at interrupting the underlying vicious circle, rather than providing just a symptomatic temporary relief. In this regard, several nutraceuticals have been explored such as vitamin D, carotenoids, n-3 long-chain fatty acids, anthocyanins, curcumin and antioxidants in the prevention and treatment of DES. [9]
Vitamin D
Low serum vitamin D levels are found to be associated with DES, and tear secretion and tear breakup time (TBUT) were positively correlated with serum vitamin D concentrations. Furthermore, vitamin D receptor is found in the corneal epithelium, endothelium, and retinal pigmentary epithelium and also enhances corneal epithelial barrier function.
Carotenoids
Lutein and zeaxanthin are xanthophyll carotenoids found in high concentrations in the macula of the eye which absorb high energy blue light and protect the retina from phototoxicity. These ingredients also act as antioxidants and scavenge free radicals. Furthermore, lutein and zeaxanthin are known to inhibit inflammatory pathways including lipopolysaccharide-induced secretion of IL-8 and hyper-osmotically induced secretion of IL-6 in corneal epithelial cells.
Curcumin
Studies have demonstrated the beneficial effects of curcumin in multiple anterior segment eye diseases such as corneal disease, dry eye condition, conjunctivitis and anterior uveitis. Curcumin inhibits pro-inflammatory cytokines, IL-4 and IL-5, expression in the conjunctiva in mice. A study showed that curcumin to be protective against hyper-osmotically induced IL-1β upregulation in corneal epithelial cells through p38 MAPK/NF-κB pathways. [10]
Reference: [1] Wan Y, et, al. The global prevalence of dry eye disease and its association with economy: a systematic review. Research Square. 2019. [2] Craig JP, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017. [3] Stapleton F, et al. Dry eye disease in the young: A narrative review. The Ocul Surf. 2024. [4] Lemp MA, et al. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012. [5] Craig JP, et al. TFOS DEWS II report executive summary. Ocul Surf. 2017. [6] Alexis Ceecee Britten-Jones, et al. Epidemiology and Risk Factors of Dry Eye Disease: Considerations for Clinical Management. Medicina (Kaunas). 2024. [7] Nutrition and diet for dry eye disease: Insights toward holistic management. [8] Anti‐Oxidative and Anti‐Inflammatory Micelles: Break the Dry Eye Vicious Cycle. [9] Marco Pellegrini, et al. The Role of Nutrition and Nutritional Supplements in Ocular Surface Diseases. Nutrients. 2020. [10] Omer Ersin Muz, et al. A Novel Integrated Active Herbal Formulation Ameliorates Dry Eye Syndrome. Pharmaceuticals (Basel). 2020.