32 - Aqueous Deficiency Dry Eye Syndrome

Abstract

Aqueous tear deficiency dry eye refers to a failure of aqueous secretion by either the lacrimal system or the conjunctiva. Aqueous deficiency dry eye (ADDE) has two major subclasses: Sjögren syndrome dry eye (SSDE) and non-Sjögren syndrome dry eye (NSSDE). Sjögren syndrome is an autoimmune exocrinopathy characterized by lymphocytic infiltration of secretory glands. When the eyes are involved, activated T-cells infiltrate the lacrimal gland, leading to acinar and ductal cell death and hyposecretion of tears. NSSDE disease is another category of aqueous deficiency dry eye disease that is unrelated to systemic autoimmune processes. Age-related changes leading to lacrimal dysfunction are the most common form of NSSDE. There are many diagnostic tools, including analysis of a patient’s tear break-up time (TBUT), and tear film osmolarity testing, available to confirm a diagnosis of dry eye disease and further characterize a patient’s disease as aqueous deficient. The goal of management of patients with ADDE is to improve their ocular comfort level and quality of life by restoring their ocular surface and tear film to the normal homeostatic state.