There are 4 stages of dry eye disease

If you are one of the estimated 1 in 3 people in the UK who are experiencing tell-tale dry eye symptoms then you need to know two facts about this condition – it is chronic (it will not go away) and progressive (if ignored it will get worse).

What is happening is that the quantity and/or quality of your eyes natural lubricating and moisturising fluids (your tears) are no longer sufficient or they are being lost to rapidly from the surface of the eye. The result is the delicate surface of the eye is becoming more exposed and this is when problems can start.

The severity and type of symptom were reviewed by a world leading group of dry eye experts as part of the internationally respected ‘Dry Eye Workshop’. They looked at how dry eye disease progressed and created 4 stages of symptom management tailored to each level of development – this ranged from mild to the most severe.

Read on to learn about the 4 stages of dry eye disease, the type of symptoms experienced and possible treatments.

MILD - Stage 1 dry eye

At this stage symptoms might only be experienced occasionally, appearing as mild dryness or irritation. Sometimes the symptoms are dismissed as just eye ‘tiredness’.

The symptoms might be triggered by windy weather or long periods of concentration. You might also notice temporary blurring of vision which corrects itself with a blink. Your tears are already becoming unstable, this can be measured by something called your tear break-up-time, typically lasting for less than 10 seconds but at this stage it is variable. You might find yourself blinking or rubbing your eyes more than usual.

Treatment is likely to include the regular use of dry eye drops as well increased eyelid hygiene and heat therapy. Most practitioners will also discuss life style and environment factors which could be making matters worse. This may mean a recommendation to turn down heating and air-conditioning, taking breaks from long periods of screen work and introducing more omega-3 into your diet.

Your eye care professional would like to catch your dry eye at this early stage to help halt its progression.

MODERATE – Stage 2 dry eyeIf left unmanaged your dry eye will progress to stage two, this means the ocular surface inflammation worsens, and the dry, tired, irritated red eye symptoms will become both more severe and more frequent. This means that the symptoms are now becoming more noticeable. Your tear break-up time will likely be less than 10-seconds most of the time.

Your eye care professional will increase frequency of the treatment recommended for stage 1. In addition demodex might be suspected and a cleanser derived from tea-tree oil (but not tea tree oil which contains allergens to the eye) added to the lid-hygiene routine, the frequency of heat therapy increases too, and some practitioners may offer in-practice therapies such as a deep-cleans to clear blocked glands and/or light therapy.

You might also be recommended additional eye drops to help tackle the inflammation and bacterial proliferation[MOU1] . As well as your day time drops you will most likely find yourself needing a night-time ointment too.

Some eye care professionals might also suggest the use of special ‘plugs’ which are used to block the tear ducts and slow the loss of years from your eyes.

It is at this stage sticking to your recommended care routine can become more challenging, but if you do not your dry eye could progress to the next level.

SEVERE – Stage 3 dry eye

Once your eyes reach stage 3 your eyes will have become very dry and your tears will have you may feel like you have something in your eye which causes high levels of irritation. Symptoms could be almost constant with potential damage to the cornea occurring. The sensations experienced might now include burning pain and your tear break-up time will be less that 5 seconds.

Treatment already recommended at stage 2 will continue but will need to become more intense. More regular in-practice treatment might be introduced to help keep symptoms under control. [MOU2] There are also increasing numbers of prescription medications that might be used to help reduce the inflammation.

MOST SEVERE – Stage 4 dry eye

Every eye care professional will be working hard to prevent their patients reaching this stage. However, if treatment routines are not followed this could be a possibility. At this point symptoms will have become constant, interfering with your vision and impacting everyday activities, it is likely to be affecting you emotionally too. Your tear break-up time will be almost immediate.

The symptoms will be at their most severe and frequent, and may include burning, painful, sore, itchy eyes.

It is a possibility that damage to the ocular surface has reached a stage where referral to an eye hospital may become necessary.

Take control of your dry eye now and halt the progression

Do you recognise your level of dry eye here? The DRY EYE ZONE is here to support you and your eye care professional with education and best-in-class products. However, without your commitment to your recommended care routine dry eye will continue to progress. Make sure you follow the advice given by your eye care professional and take control of this chronic progressive eye disease.

If you are at the early stages then now is the time to make an appointment to see an independent dry eye specialist.

You can learn more about all things dry eye related at the DRY EYE ZONE. Don’t forget to subscribe to the regular free information and research updates.

If you are experiencing dry eye symptoms then you should ask the advice of your eye care professional. Why not book your next eye examination with an independent optician today.

Sources:

Vidal-Rohr M, Craig JP, Davies LN, Wolffsohn JS. The epidemiology of dry eye disease in the UK: The Aston dry eye study. Cont Lens Anterior Eye. 2023 Jun;46(3):101837. doi: 10.1016/j.clae.2023.101837. Epub 2023 Mar 30. PMID: 37003925.

Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017 Jul;15(3):575-628. doi: 10.1016/j.jtos.2017.05.006. Epub 2017 Jul 20. PMID: 28736343.

Messmer EM. The pathophysiology, diagnosis, and treatment of dry eye disease. Dtsch Arztebl Int. 2015 Jan 30;112(5):71-81; quiz 82. doi: 10.3238/arztebl.2015.0071. PMID: 25686388; PMCID: PMC4335585.