A Narrative Review of Current Understanding and Classification of Dry Eye Disease with New Insights on the Impact of Dry Eye during the COVID-19 Pandemic

Abstract

Dry eye disease (DED) is a complex, progressive and multifactorial condition that is commonly seen in clinical practice and can be challenging to accurately diagnose. Untreated or suboptimally managed dry eye can progress to severe, chronic disease which may become resistant to treatment. Symptoms include ocular irritation and visual impairment. Patients frequently report negative consequences regarding quality of life (QoL), productivity and psychological wellbeing. Certain lifestyle factors (e.g. use of screen-based devices, air conditioning) can induce or exacerbate symptoms of DED, leading to progressive and debilitating complications. Exposures to such triggers are likely to have increased significantly during the ongoing COVID-19 pandemic with people across the globe living with heightened levels of stress/anxiety while being forced to adapt most aspects of their daily lives (from work and education through to social activities) to accommodate social distancing, primarily through the use digital technologies. This review aims to provide a concise and practical overview of current understanding regarding DED, highlighting proposals for refined diagnostic categories and therapeutic terminologies that are designed to improve identification and management of dry eye as well as reduce or slow disease progression. Finally, the findings of a European survey are shared to illustrate the impact of the COVID-19 pandemic on the lives of people with DED. The survey was conducted during the first lockdown period (March-September 2020) and explored issues relating to psychological wellbeing, QoL and engagement with healthcare services. The results demonstrate the ways in which the pandemic amplified the impact of dry eye on daily life and may be valuable in enhancing understanding among clinicians of the challenges faced by people with DED, which extend beyond the signs and symptoms of disease.

Keywords: COVID-19; Dry eye disease; Inflammation; Ocular surface; Tear film homeostasis.

Fig. 1

Survey responses regarding the emotional impact of dry eye during the COVID-19 pandemic. Response to the question: Please tell us if you have felt any of the below emotions as a direct result of your dry eyes in the past 4 months, since the start of the COVID-19 crisis. Participants were able to provide multiple responses to this question. Base: Total (n = 502)

Fig. 2

Reasons for problematic symptoms or worsening of dry eye symptoms during the COVID-19 pandemic. Response to the question: Why do you think your dry eyes have remained a problem/become worse in the last 4 months, since the start of the COVID-19 crisis? Participants were able to provide multiple responses to this question. Base: All respondents who indicated that dry eye had become worse, or still caused problems (n = 261)