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The Definition and Classification of Dry Eye Disease

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Dry Eye

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Dry eye diseases are a group of disorders that share a mechanism by which tear hyperosmolarity at the surface of the eye leads to inflammatory ocular surface damage. The disease is conveniently classified according to how tear hyperosmolarity is brought about, either by reduced lacrimal secretion, ADDE, or by increased tear evaporation, EDE, measured under standard conditions. Because both conditions are the result of evaporative water loss, they may be triggered or worsened by exposure to desiccating stress, such as low ambient humidity or high wind speed or personal factors that increase evaporative loss from the eye. A compensatory lacrimal response driven by the Lacrimal Functional Unit (LFU) may maintain tear volume in EDE but with progression; in either form of disease, a point is reached when tear instability leads to tear break-up in the blink interval so that dry spots occur in either condition. This is thought to greatly amplify the local level of tear hyperosmolarity at the site of break-up. Together with symptoms, tear osmolarity plays a central role in diagnosis, usually with a cluster of other signs that characterise the disease. Symptoms can be thought of as arising in a number of ways including tear hyperosmolarity, the release of inflammatory mediators and an absence of surface mucins. Because dry eye disease is multifactorial, it is also likely that in different circumstances, symptoms of dry eye may overlap with those of the initiating conditions or with secondary events associated with the disease. This may explain in part the mismatch sometimes found between the symptoms and signs of dry eye. Although dry eye is usually a symptomatic disease, in some individuals the disease may be asymptomatic despite the presence of clinical signs.

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Conflict of Interest

Professor Bron declares the following relationships:

  • Diagnostear: Consultation

  • Redwood Pharma: Consultation

  • Santen: Consultation

  • TearLab: Advisory Board; ownership of stocks

  • Thea: Meeting travel and accommodation; honorarium

No animal or human studies were carried out by the author, for the preparation of this article.

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Authors and Affiliations

  1. Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford and Oxford Eye Hospital, Oxford, UK

    Anthony J. Bron BSc, FRCOphth, FMedSci, FARVO

  2. Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK

    Anthony J. Bron BSc, FRCOphth, FMedSci, FARVO

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  1. Anthony J. Bron BSc, FRCOphth, FMedSci, FARVO
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Correspondence to Anthony J. Bron BSc, FRCOphth, FMedSci, FARVO .

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Editors and Affiliations

  1. Vision Eye Institute, School of Optometry & Vision Science, University of New South Wales, Sydney, New South Wales, Australia

    Colin Chan

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Bron, A.J. (2015). The Definition and Classification of Dry Eye Disease. In: Chan, C. (eds) Dry Eye. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44106-0_1

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