Aqueous tear-deficient dry eye, also known as aqueous-deficient dry eye or tear-deficient dry eye, is a type of dry eye syndrome characterized by inadequate production or secretion of the aqueous component of tears. Tears are essential for maintaining the health and lubrication of the ocular surface, and they consist of three main components: water (aqueous), oils, and mucins. When there is a deficiency in the aqueous component, it can lead to dryness, discomfort, and potential damage to the eyes.

Aqueous tear production refers to the secretion of the watery component of tears, known as the aqueous layer. Tears are composed of three main layers: the aqueous layer, the lipid (oil) layer, and the mucin layer. The aqueous layer, produced by the lacrimal glands, forms the majority of tears and plays a crucial role in maintaining the hydration, lubrication, and nourishment of the ocular surface.

• Lacrimal Glands: These glands, located above each eye, are responsible for producing the aqueous component of tears. They continuously secrete a watery fluid into the tear film to keep the ocular surface moist and protected.
• Composition: The aqueous layer contains various electrolytes, proteins, and other substances that help nourish the cornea, conjunctiva, and other structures of the eye. It also serves as a carrier for oxygen and nutrients to maintain the health of ocular tissues.
• Regulation: Aqueous tear production is regulated by a complex interplay of neural, hormonal, and environmental factors. Stimulation of the lacrimal glands occurs in response to sensory input, such as blinking, ocular surface irritation, or emotional triggers.

Aqueous tear deficiency occurs when there is inadequate production or secretion of the aqueous component of tears. Several factors can contribute to this condition:

• Age: Tear production tends to diminish with age, leading to a higher prevalence of dry eye symptoms in older individuals.
• Medical Conditions: Systemic autoimmune diseases, such as Sjögren’s syndrome, rheumatoid arthritis, lupus, and thyroid disorders, can affect tear production by causing inflammation or damage to the lacrimal glands.
• Medications: Certain medications, including antihistamines, decongestants, antidepressants, hormone replacement therapy, and isotretinoin (used for acne treatment), can decrease tear production as a side effect.
• Environmental Factors: Dry or windy environments, air conditioning, indoor heating, and prolonged screen time can contribute to evaporative tear loss and exacerbate aqueous tear deficiency.
• Eye Surgery: Previous eye surgeries, such as LASIK (laser-assisted in situ keratomileusis) or cataract surgery, can disrupt tear production or distribution, leading to dry eye symptoms in some individuals.

Aqueous tear-deficient dry eye can manifest with a range of symptoms, which may vary in severity from mild to debilitating. Common symptoms include:

• Persistent Dryness: Individuals may experience a persistent sensation of dryness or grittiness in the eyes, often described as feeling like something is “in the eye.”
• Burning or Stinging Sensation: The eyes may feel irritated, burning, or stinging, especially in dry or windy environments or after prolonged screen time.
• Redness and Irritation: The ocular surface may appear red or inflamed, and individuals may experience increased sensitivity to light (photophobia).
• Blurred Vision: Vision may become intermittently blurry, particularly during activities that require prolonged visual focus, such as reading or using digital devices.
• Discomfort with Contact Lenses: Contact lens wearers may experience discomfort, irritation, or intolerance to lenses due to inadequate tear film lubrication.
• Excessive Tearing: Paradoxically, some individuals may experience excessive tearing as a compensator

• Comprehensive Eye Examination:
  • A thorough evaluation by an eye care professional is essential for diagnosing aqueous tear-deficient dry eye.
  • The examination typically includes a review of symptoms, medical history, and medications.
  • Visual acuity testing and assessment of the ocular surface may be performed.
• Tear Assessment Tests:
  • Tear osmolarity measurement: This test evaluates the saltiness of tears, with higher osmolarity indicating tear instability and potential dry eye.
  • Tear film breakup time (TBUT): Measures how long it takes for tears to break up on the ocular surface after a blink. A shorter TBUT suggests tear film instability.
  • Schirmer’s test: Measures the quantity of tears produced over a specified time by placing paper strips under the lower eyelid.
  • Ocular surface staining: Special dyes like fluorescein or lissamine green may be used to assess corneal and conjunctival staining, indicating damage or inflammation.
• Other Assessments:
  • Evaluation of meibomian gland function to assess the quality of lipid (oil) layer in tears.
  • Assessment of eyelid structure and blink dynamics.

• Environmental Modifications:
  • Avoid environments with dry or windy conditions.
  • Use a humidifier to maintain adequate indoor humidity levels, especially during the winter months or in air-conditioned spaces.
• Eye Care Practices:
  • Take regular breaks during prolonged screen time to reduce eye strain.
  • Practice the 20-20-20 rule: Every 20 minutes, look at something 20 feet away for at least 20 seconds to give your eyes a rest.
  • Stay well-hydrated by drinking plenty of water throughout the day.

• Artificial Tears:
  • Lubricating eye drops or ointments can provide temporary relief from dryness and discomfort by supplementing natural tears.
  • Use preservative-free formulations if using eye drops frequently.
• Prescription Medications:
  • Anti-inflammatory medications, such as cyclosporine (Restasis) or lifitegrast (Xiidra), may be prescribed to reduce inflammation and improve tear production in moderate to severe cases.
• Punctal Plugs:
  • These tiny silicone plugs can be inserted into the tear ducts to block drainage and help retain natural tears on the ocular surface longer.
• Management of Underlying Conditions:
  • Treating any underlying medical conditions contributing to dry eye, such as autoimmune diseases or hormonal imbalances, is crucial for managing aqueous tear-deficient dry eye effectively.

• Persistent Symptoms:
  • If symptoms of dry eye persist despite using over-the-counter artificial tears or home remedies.
  • Symptoms worsen or interfere with daily activities such as reading or driving.
• Changes in Vision:
  • Any sudden changes in vision, such as blurred vision or difficulty focusing.
  • Sensitivity to light (photophobia) that is persistent or severe.
• New or Worsening Symptoms:
  • Development of new symptoms such as eye pain, redness, or discharge.
  • If symptoms worsen or become more frequent over time.
• Underlying Health Conditions:
  • Individuals with autoimmune diseases such as rheumatoid arthritis or Sjögren’s syndrome should be vigilant about monitoring their eye health and seek prompt medical attention if symptoms occur or worsen.

Psoriatic arthritis can have a significant impact on ocular health, leading to various eye-related complications ranging from uveitis and dry eye syndrome to scleritis and conjunctivitis. By understanding these potential manifestations and implementing preventive measures, individuals with PsA can effectively manage their ocular health and minimize the risk of vision-threatening complications. Collaboration between healthcare providers, regular eye examinations, and proactive management strategies are essential for preserving vision and optimizing overall quality of life in individuals living with Psoriatic Arthritis.

World Eye Care Foundation’s eyecare.live brings you the latest information from various industry sources and experts in eye health and vision care. Please consult with your eye care provider for more general information and specific eye conditions. We do not provide any medical advice, suggestions or recommendations in any health conditions.