Dry Eye Syndrome: Neglecting It Increases Risk of Vision Loss and Glaucoma

During seasons when the air becomes cold and dry, such as autumn and winter, symptoms of dry eye syndrome (dry eye) can easily worsen. According to a lecture by Professor Kim Jae-yong of Asan Medical Center conducted recently on the medical channel After the Rain, dry eye syndrome goes beyond simple discomfort from gritty eyes; if neglected, it can cause vision loss or delay the discovery of other ophthalmic diseases.

The Three Layers of the Tear Film and Causes of Dry Eye Syndrome

The surface of our cornea and conjunctiva is protected by the 'tear film.' The tear film consists of three main layers. At the innermost layer is the 'mucin layer' secreted by the goblet cells of the conjunctiva, above which sits the 'aqueous layer' secreted by the lacrimal glands. The final outermost layer is the 'lipid layer' secreted by the meibomian glands, which are the oil glands of the tears, preventing the tears from evaporating.

According to the video, these three components must be properly maintained for tears to function correctly. In particular, if the lipid layer is insufficient, tears evaporate quickly, causing dry eye syndrome. Dry eye syndrome refers to a state where the homeostasis of the tear film is lost, and it is caused by various factors such as tear film instability, hyperosmolarity, inflammation and damage to the ocular surface, and abnormalities in nerve sensation. Traditionally, it can be broadly classified into cases with low tear secretion and cases with high evaporation.

The prevalence of dry eye syndrome is reported to be between 5% and 50% worldwide, and studies in South Korea also show a significantly high prevalence. In particular, among the elderly aged 65 and older, a prevalence of nearly 30% is reported. It is predicted that the number of dry eye syndrome patients has increased further during the recent COVID-19 pandemic due to increased smartphone usage.

Risks of Vision Loss and Complications such as Glaucoma if Neglected

Dry eye syndrome is a condition that is difficult to cure completely, so it is important to receive appropriate treatment tailored to the patient's condition. If severe dry eye syndrome is neglected without proper treatment, irreversible damage can occur to the eye, leading to permanent vision loss. Additionally, if the tear layer is unstable, light scattering can occur, causing symptoms such as glare or blurred vision. If blinking is inadequate, vision may decrease further.

A particularly noteworthy point is the fact that other serious ophthalmic diseases may be discovered during the dry eye syndrome diagnosis process. According to the results of an analysis of patient sample data from the Health Insurance Review & Assessment Service by the Korean Ophthalmological Society, the group of patients who were properly diagnosed and treated for dry eye syndrome showed a significant increase in the occurrence of glaucoma, diabetic retinopathy, cataracts, and wet macular degeneration compared to the untreated group. This suggests that these serious diseases may be discovered coincidentally or through regular checkups during the process of visiting a hospital for dry eye syndrome symptoms.

For diagnosis, after checking the patient's risk factors (smoking, use of medications, contact lens use, etc.) and symptoms, an ophthalmologist checks the stability of the tear film, osmotic concentration, and whether there is damage to the corneal surface using a slit-lamp microscope. Additionally, the amount of tear secretion is measured using strips, and the condition of the meibomian glands is also checked.

Step-by-step Treatment Methods, the Role of Artificial Tears, and Economic Burden

The treatment of dry eye syndrome follows a 'Staged Management' approach, which proceeds in stages according to the severity of the symptoms. According to the Korean Dry Eye Guidelines, treatment is categorized into tear secretion deficiency type, tear evaporation predominant type, and tear distribution change type. The most basic first-stage treatment is artificial tears. Artificial tears help lubricate the ocular surface, dilute inflammatory substances, and reduce increased osmolarity.

In South Korea, eye drops containing hyaluronic acid and carbomer/carboxymethylcellulose ingredients are mainly used. However, caution is required as the indiscriminate long-term use of hyaluronic acid eye drops can cause 'toxic keratitis,' where the corneal epithelium peels off. If symptoms do not improve, it moves to the second stage, combining anti-inflammatory agents or steroid treatments, and the intensity of treatment is adjusted while confirming the effectiveness at each stage. In the case of the tear evaporation predominant type, treatment is carried out while observing whether symptoms improve without separate stage classification.

Meanwhile, the economic burden on dry eye syndrome patients was also pointed out as a major issue. According to a Gallup survey by the Korean Ophthalmological Society, 78% of dry eye patients receive help from treatment medications, and they responded that they would feel a significant economic burden if medical insurance support were discontinued. In particular, the frequency of artificial tear prescriptions tends to increase as the age group rises. The survey results showed that more than 90% of patients who have experienced a dry eye diagnosis have used hyaluronic acid eye drops, and 88% of them purchase the medication through a doctor's prescription. 42% of patients who have not been diagnosed also purchase eye drops at pharmacies following a pharmacist's recommendation.