June 30, 2023

Dry eye disease occurs when the eyes fail to properly produce tears or produce tears that evaporate too fast. Many individuals with dry eye also have cornea inflammation. If untreated, it can lead to pain, ulcers, scarring, and even vision loss. Patients with dry eye may find it difficult to perform tasks such as reading and using the computer. They also find it hard to be in areas with dry air, such as airplanes. 

Aqueous Tear-deficient Dry Eye (ADDE/ATD)

There are two main types of dry eye. Aqueous tear-deficient dry eye occurs when the lacrimal glands produce insufficient water. When the water content is too low, it is difficult for the eye surface to remain moist or well-hydrated. When tear glands do not produce enough tears, it can cause eye irritation or damage. ADDE is the less common form of dry eye that can be Sjogren’s or non-Sjogren related. 

Evaporative Dry Eye (EDE)

Tears drying up too fast causes dry eye. Evaporative dry eye is the most common type, occurring when the meibomian glands are blocked or inflamed. The glands along the eyelids are responsible for oil production for the tear film. 

The oil helps keep the tears stable, slowing down evaporation. Meibomian gland dysfunction can be due to lid margin inflammation or blepharitis. Age and hormonal changes also contribute to MGD. 

What Causes Dry Eye Condition?

Dry eye may be due to various factors, including:

• Inflammation of the lacrimal gland, conjunctiva, or eye surface.

• Environmental or systemic diseases that change various tear components. 

• Refractive eye surgery such as LASIK. 

• Cosmetic eyelid surgery that alters the eye surface. 

• An increase in eye surface, as a result of thyroid disease. 

Differences Between Aqueous and Evaporative Dry Eye

ADDE occurs when the lacrimal glands fail to secrete enough water for the tears. It results in low tear volume or hyperosmolarity as the eye surface experiences desiccation. EDE is associated with oil production or lipid levels that lead to MGD, causing fast tear evaporation. Beginning treatment of EDE usually involves the use of artificial tears or punctal plugs. Hot compresses and meibomian gland expression can help treat ADDE. 

Diagnosing Dry Eye Condition 

The two forms of dry eye have similar symptoms as they cause tear instability and increased evaporation. Proper diagnosis of the underlying cause of dry eye is crucial for effective treatment.

Diagnosing dry eye in the early stages can be hard, and the progression is usually slow. Examining the tear film can help determine whether the patient has EDE, EDDE, or both. Diagnostic tests include tear break up time, tear osmolarity, and noninvasive tests such as diagnostic imaging of the glands. 

EDE is the more common type of dry eye, but some people have both conditions, causing severe dry symptoms. Several treatment options can help deal with dry eye. Effective treatment usually depends on the underlying causes and severity of the symptoms. 

Treatment aims to lubricate the eyes and prevent rapid tear evaporation. At East Main Vision Clinic we offer advanced dry eye treatments including Intense Pulse Light Therapy (IPL), iLux®, Blephex™ and Lipiflow™. No matter what type or stage you find yourself in, diagnosing and treating dry eye disease properly is important to healing and getting back to a normal daily routine without dry eye pain.

For more on the differences between evaporative and aqueous dry eye, contact East Main Vision Clinic in Puyallup at (253) 780-0700 or text (253) 785-6580 to schedule an appointment today.