Current Concepts about the Etiology of Dry Eye Syndrome

The revolution in understanding the etiology and clinical manifestations of the disruption of the tearing process and the development of dry eye syndrome (CVS) has occurred in last 20–30 years. It has been established that the loss of the tear film homeostasis can occur not only because of a violation of systemic and autoimmune disorders, but also as a result of a blinking disorder and distribution of the tear film over the ocular surface. Therefore, new pathogenetic disease development mechanisms have been identified. The prevalence of diseases of the ocular surface and CVD in recent years has increased significantly. It is mostly caused not only by scientific discoveries in the field of understanding, for example, the etiological and pathophysiological role of the neurosensory mechanism of development of CVS. An important aspect is the emergence of new risk factors that potentiate the development of ocular surface diseases and CVL. These factors include the use of various drugs — antidepressants, antihistamines, hormone therapy, and others; instillation of eye drops — antiglaucoma drugs, etc., as well as the appearance of little-studied factors such as cosmetology procedures (eyelids tattooing, eyelash extensions, botulinum toxin injections for aesthetic purposes, etc.). They are carried out in proximate close to the eye and eyelids, causing multiple pathological reaction. The experience of observing patients, literature data, and the conducted study have showed that various cosmetological effects in the periorbital zone, whose popularity has increased in recent years, may cause the appearance of iatrogenic dry eye syndrome. The following most vivid clinical examples will help, encountered in our practice, to illustrate the data presented. Collecting the anamnesis, it is necessary to identify the presence of risk factors for the development of diseases of the ocular surface and CVD, to eliminate them, if possible, and to carry out adequate pathogenically based therapy.

ophthalmology, dry eye syndrome, cosmetology, botulinum toxin, dermal fillers, eye makeup, eyelash extensions

1. Harboe E., Tjensvoll A.B., Vefring H.K., Gøransson L.G., Kvaløy J.T., Omdal R. Fatigue in primary Sjögren’s syndrome — a link to sickness behaviour in animals? Brain Behav Immun. 2009;23(8):1104–1108.

2. Holly F.J., Lemp M.A. Tear physiology and dry eyes. Surv.Ophthal. 1977;22:69–75.

3. Lemp M.A. Report of the national eye institute/industry workshop on clinical trials in dry eyes. CLAO J. 1995;21(4):221–232.

4. Bron A.J., dePaiva C.S., Chauhan S.K., Bonini S., Gabison E.E., Jain S., Knop E., Markoulli M., Ogawa Y., Perez V., Uchino Y., Yokoi N., Zoukhr D., Sullivan D. A.TFOS DEWS II Pathophysiology report. Ocul Surf. 2017;15:438–510. DOI: 10.1016/j.jtos.2017.05.011

5. Willcox M.D.P., Argüeso P., Georgiev G., Holopainen J., Laurie G., Millar T., Papas E.B., Rolland J.P., Schmidt T.A., Stahl U., Suarez T., Subbaraman L.N., Uçakhan O.Ö., Jones L. TFOS DEWS II Tear Film report. Ocul Surf. 2017;15:366– 403. DOI: 10.1016/j.jtos.2017.03.006

6. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop. Ocul Surf. 2007;2007(5):75–92.

7. Baudouin C. A new approach for better comprehension of diseases of the ocular surface. J Fr Ophtalmol. 2007;30:239–246.

8. Baudouin C., Messmer E.M., Aragona P., Geerling G., Akova Y.A., Benítez-delCastillo J. Boboridis K.G., Merayo-Lloves J., Rolando M., Labetoulle M. Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction. Br J Ophthalmol. 2016;100(3):300–306. DOI: 10.1136/ bjophthalmol-2015-307415

9. Belmonte C., Nichols J.J., Cox S.M., Brock J.A., Begley C.G., Bereiter D.A., Dartt D.A, Galor А., Hamrah P., Ivanusic J.J., Jacobs D.S., McNamara N.A., Rosenblatt M.I., Stapleton F., Wolffsohn J.S. TFOS DEWS II pain and sensation report. Ocul Surf. 2017;15:404–437. DOI: 10.1016/j.jtos.2017.05.002

10. Markova E.Y., Polunina E.G., Ioileva E.E. Аllergic eye diseases in children. modern view on pathogenesis and treatment. Ophthalmology in Russia = Oftal’mologiya. 2017;14(2):125–129 (In Russ.). DOI: 10.18008/1816-5095-2017-2-125-129

11. Nelson J.D., Shimazaki J., Benitez-del-Castillo J.M., Craig J.P., McCulley J.P., Den S. The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):1930–1937. DOI: 10.1167/iovs.10-6997b

12. Chao C., Golebiowski B., Cui Y., Stapleton F. Development of a Chinese version of the ocular comfort index. Invest Ophthalmol Vis Sci. 2014;55(6):3562–3571. DOI: 10.1167/iovs.14-14276

13. Efron N. Contact lens-induced changes in the anterior eye as observed in vivo with the confocal microscope. Prog Retin Eye Res. 2007;26:398–436.

14. Elder G.A., Gama Sosa M.A., De Gasperi R. Transgenic mouse models of Alzheimer’s disease. Mt Sinai J Med. 2010;77:69–81.

15. Nichols J.J., Bickle K.M., Zink R.C., Schiewe M.D., Haque R.M., Nichols K.K. Safety and efficacy of topical azithromycin ophthalmic solution 1.0 % in the treatment of contact lens-related dry eye. Eye Contact Lens. 2012;38:73–79. DOI: 10.1097/ ICL.0b013e31823ff229

16. Nichols K.K., Foulks G.N., Bron A.J., Glasgow B.J., Dogru M., Tsubota K., Lemp M.A, Sullivan D.A. The International Workshop on Meibomian Gland Dysfunction: Executive Sammary. Invest Ophthalmol Vis Sci. 2011;52:1922 –1929. DOI: 10.1167/iovs.10-6997a

17. Lu P., Chen X., Liu X., Yu L., Kang Y., Xie Q., Ke L., Wei X.Dry eye syndrome in elderly Tibetans at high altitude: a population-based study in China. Cornea. 2008;27(5):545–551. DOI: 10.1097/ICO.0b013e318165b1b7

18. Moss S.E., Klein R., Klein B.E. Long-term incidence of dry eye in an older population. Optom Vis Sci. 2008;85(8):668–674. DOI: 10.1097/ OPX.0b013e318181a947

19. Jie Y., Xu L., Wu Y.Y., Jonas J.B. Prevalence of dry eye among adult Chinese in the Beijing Eye Study. Eye (Lond). 2009;23(3):688–693.

20. Tian Y.J. , Liu Y., Zou H.D., Jiang Y.J., Liang X.Q., Sheng M.J., Li B., Xu X.Epidemiologic study of dry eye in populations equal or over 20 years old in Jiangning District of Shanghai. Zhonghua Yan Ke Za Zhi. 2009;45:486–491.

21. Guo B., Lu P., Chen X., Zhang W., Chen R. Prevalence of dry eye disease in Mongolians at high altitude in China: the Henan eye study. Ophthalmic Epidemiol. 2010;17(4):234–241. DOI: 10.3109/09286586.2010.498659

22. Uchino M., Dogru M., Yagi Y., Goto E., Tomita M., Kon T.. The features of dry eye disease in a Japanese elderly population. Optom Vis Sci. 2006;83(11):797–802. DOI: 10.1097/01.opx.0000232814.39651.fa

23. Hashemi H., Khabazkhoob M., Kheirkhah A., Emamian M.H., Mehravaran S., Shariati M., Fotouhi A.. Prevalence of dry eye syndrome in an adult population. Clin Exp Ophthalmol. 2014;42(3):242–248. DOI: 10.1111/ceo.12183

24. Tan L.L., Morgan P., Cai Z.Q., Straughan R.A. Prevalence of and risk factors for symptomatic dry eye disease in Singapore. Clin Exp Optomet. 2015;98(1):45–53. DOI: 10.1111/cxo.12210

25. Viso E., Gude F., Rodríguez-Ares M.T. The association of meibomian gland dysfunction and other common ocular diseases with dry eye: a population-based study in Spain. Cornea. 2011;30(1):1–6. DOI: 10.1097/ICO.0b013e3181da5778

26. Schaumberg D.A., Nichols J.J., Papas E.B., Tong L., Uchino M., Nichols K.K. The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci. 2011;52(4):1994–2005. DOI: 10.1167/iovs.10-6997e

27. Viso E., Rodríguez-Ares M.T., Abelenda D., Oubiña B., Gude F. Prevalence of asymptomatic and symptomatic meibomian gland dysfunction in the general population of Spain. Invest Ophthalmol Vis Sci. 2012;53(6):2601–2606. DOI: 10.1167/iovs.11-9228

28. Schaumberg D.A., Dana R., Buring J.E., Sullivan D.A. Prevalence of dry eye disease among US men: estimates from the Physicians’ Health Studies. Arch Ophthalmol. 2009;127(6):763–768. DOI: 10.1001/archophthalmol.2009.103

29. Ahn J.M., Lee S.H., Rim T.H., Park R.J., Yang H.S., Kim T.I, Yoon K.C.. Seo K.Y.; Epidemiologic Survey Committee of the Korean Ophthalmological Society. Prevalence of and risk factors associated with dry eye: the Korea national health and nutrition examination survey 2010–2011. Am J Ophthalmol. 2014;158(6):1205– 1214.e7. DOI: 10.1016/j.ajo.2014.08.021

30. Jay J. Siak, Louis Tong, Wan Wong, Howard Cajucom-Uy, Mohamad Rosman, Seang Saw, Tien Wong. Prevalence and risk factors of meibomian gland dysfunction: the Singapore Malay eye study. Cornea. 2012;31(11):1223–1228. DOI: 10.1097/ ICO.0b013e31823f0977

31. Uchino M., Dogru M., Uchino Y., Fukagawa K., Shimmura S., Takebayashi T., Schaumberg D.A., Tsubota K. Japan Ministry of Health study on prevalence of dry eye disease among Japanese high school students. Am J Ophthalmol. 2008;146(6):925– 929.e2. DOI: 10.1016/j.ajo.2008.06.030

32. Uchino M., Yokoi N., Uchino Y., Dogru M., Kawashima M., Komuro A., Sonomura Y., Kato H., Kinoshita S., Schaumberg D.A., Tsubota K. Prevalence of dry eye disease and its risk factors in visual display terminal users: the Osaka study. Am J Ophthalmol. 2013;156(4):759–766. DOI: 10.1016/j.ajo.2013.05.040

33. Sahai A., Malik P. Dry eye: prevalence and attributable risk factors in a hospitalbased population. Indian J Ophthalmol. 2005;53(2):87–91.

34. Galor A., Feuer W., Lee D.J., Florez H., Carter D., Pouyeh B., Prunty W.J., Perez V.L. Prevalence and risk factors of dry eye syndrome in a United States veterans affairs population. Am J Ophthalmol. 2011;152(3):377–384.e2. DOI: 10.1016/j. ajo.2011.02.026

35. Vieira A.C., Mannis M.J. Ocular rosacea: common and commonly missed. J Am Acad Dermatol. 2013;69(6 Suppl 1):S36–S41. DOI: 10.1016/j.jaad.2013.04.042

36. Mathers W.D., Lane J.A., Sutphin J.E., Zimmerman M.B. Model for ocular tear film function. Cornea. 1996;15(2):110–119.

37. Bergmann M.T., Newman B.L., Johnson N.C. Jr. The effect of a diuretic (hydrochlorothiazide) on tear production in humans. Am J Ophthalmol. 1985;99(4):473–475.

38. Mathers W.D., Stovall D., Lane J.A., Zimmerman M.B., Johnson S. Menopause and tear function: the influence of prolactin and sex hormones on human tear production. Cornea. 1998;17(4):353–358.

39. Hu Y., Matsumoto Y., Dogru M., Okada N., Igarashi A., Fukagawa K., Tsubota K., Fujishima H. The differences of tear function and ocular surface findings in patients with atopic keratoconjunctivitis and vernal keratoconjunctivitis. Allergy. 2007;62(8):917–925. DOI: 10.1111/j.1398-9995.2007.01414.x

40. Villani E., Strologo M.D., Pichi F., Luccarelli S.V., De Cilla S., Serafino M., Nucci P. Dry eye in vernal keratoconjunctivitis: a cross-sectional comparative study. Medicine (Baltimore). 2015;94:e1648. DOI: 10.1097/MD.0000000000001648

41. Chen L., Pi L., Fang J., Chen X., Ke N., Liu Q. High incidence of dry eye in young children with allergic conjunctivitis in Southwest China. Acta Ophthalmol. 2016;94(8):e727–e730. DOI: 10.1111/aos.13093. Epub 2016 May 26.

42. Akpek E.K., Merchant A., Pinar V., Foster C.S. Ocular rosacea: patient characteristics and follow-up. Ophthalmology. 1997;104(11):1863–1867.

43. Donaldson K.E., Karp C.L., Dunbar M.T. Evaluation and treatment of children with ocular rosacea. Cornea. 2007;26(1):42–46. DOI: 10.1590/S000427492012000500016

44. Ghanem V.C., Mehra N., Wong S., Mannis M.J. The prevalence of ocular signs in acne rosacea: comparing patients from ophthalmology and dermatology clinics. Cornea. 2003;22(3):230–233.

45. Yang W.J., Yang Y.N., Cao J., Man Z.H., Yuan J., Xiao X., Xing Y.Q. Risk factors for dry eye syndrome: a retrospective case-control study. Optom Vis Sci. 2015;92(9):e199–e205. DOI: 10.18240/ijo.2016.10.20

46. Versura P., Profazio V., Cellini M., Torreggiani A., Caramazza R. Eye discomfort and air pollution. Ophthalmologica. 1999;213(2):103–109. DOI: 10.1159/000027401

47. Gupta N., Prasad I., Himashree G., D’Souza P. Prevalence of dry eye at high altitude: a case controlled comparative study. High Alt Med Biol. 2008;9(4):327–334. DOI: 10.1089/ham.2007.1055

48. Gupta N., Prasad I., Jain R., D’Souza P. Estimating the prevalence of dry eye among Indian patients attending a tertiary ophthalmology clinic. Ann Trop Med Parasitol. 2010;104(3):247–255. DOI: 10.1179/136485910X12647085215859

49. Novaes P., Saldiva P.H., Matsuda M., Macchione M., Rangel M.P., Kara-José N., Berra A.. The effects of chronic exposure to traffic derived air pollution on the ocular surface. Environ Res. 2010;110(4):372–374. DOI: 10.1016/j.envres.2010.03.003

50. Yang H., Gu J., Zhu Q., Lu H., Wang K., Ni X., Yu L., Ling L. Protection of acute GVHD by all-trans retinoic acid through suppression of T cell expansion and induction of regulatory T cells through IL-2 signaling. Int Immunopharmacol. 2015;28(2):911–916. DOI: 10.3389/fimmu.2018.02853

51. Vehof J., Zavos H.M., Lachance G., Hammond C.J., Williams F.M. Shared genetic factors underlie chronic pain syndromes. Pain. 2014;155(8):1562–1568. DOI: 10.1016/j.pain.2014.05.002. Epub 2014 May 29.

52. Trubilin V.N., Poluninа E.G., Andzhelova D.V., Kurenkov V.V., Kapkova S.G., Chinenova K.V. Homeostasis Changes of Tear-Producing System with the Background of Cosmetic Procedures in Periorbital Area. Ophthalmology in Russia = Oftal’mologiya. 2018;15(4):424–432 (In Russ.). DOI: 10.18008/1816-5095-2018-4-424-432

53. Trubilin V.N., Poluninа E.G., Andzhelova D.V., Kurenkov V.V., Kapkova S.G., Chinenova K.V. Effect of cosmetic procedures in the periorbital area on the organ of vision. Overview. Ophthalmology in Russia = Ofal’mologiya. 2018;15(3):233–241 (In Russ.). DOI: 10.18008/1816-5095-2018-3-233-241