MATERIAL AND METHODS
Before authorization by the ethics committee of the National Institute of Perinatology, a retrospective study was carried out in the ophthalmology department of the same institute, in which clinical records created from August 1, 2014, to July 31, 2015, were analyzed. Based on the inclusion criteria, data from Mexican women in climacteric, between 45 and 55 years old, with one or all of the following signs and symptoms were analyzed: DES grades 1 and 2: ocular burning, foreign body sensation or itching, pain, photophobia, and blurred vision, symptoms of dryness, corneal lesions (9), BUT ˂10 sec (10), Schirmer ˂ 10 mm and greater than 5 mm in 5 min (11). The exclusion criterion was the presence of permanent corneal damage, and the elimination criteria were incomplete records, other diseases, and associated ocular treatments. The tear characteristics tests were verified to have been performed by a single optometrist. For the Schirmer test without anesthesia, Schirmer strips were placed on the temporal lower eyelid for 5 minutes, and the moisture length of the paper was subsequently measured in millimeters. For the BUT test, a fluorescent stain was applied on the ocular surface, and the time in which black dots or lines appeared was measured (Figure 1). Similarly, the biomicroscopy tests and the confirmation of corneal lesions typical of DES were determined by a single ophthalmologist.
Dry eye does not understand age or sex.
Almost invisible and turned into a daily disease, one that goes unnoticed due to its difficult diagnosis and that we often consider the temporary, dry eye, explains Dr. Cabanás, occurs when “the eyes are unable to maintain a quality tear film and enough.”
The absence of this film is “a very annoying situation” since they need “sufficient quantity and quality to keep them adequately hydrated,” in addition to being essential to “eliminate particles that have been introduced inside and, even, to maintain good vision.”
In addition, there is no age group or gender discrimination that is free from dry eye, although it does occur more frequently in “elderly people or people who work in environments that may favor its appearance” due to certain hormonal changes. Therefore It also affects menopausal women.
“They cause the eyes to start producing fewer tears or that the tear film is of a lower quality,” he clarifies while confirming the theory that has to do with age: “With aging, the cells that generate tears atrophy constantly and that determine the composition of the tear film. “
In addition to that, Dr. Cabanás lists a series of factors that, beyond age, can turn the dry eye into a silent enemy at any age. “Certain drugs can cause a case of dry eye, especially if we take antihistamines, anticholinergics, isotretinoin, estrogens, or nicotinic acid, antidepressants,” she warns.
dry eye syndrome causes ocular solution ophthalmologist
The percentage of DES cases among the group of postmenopausal Mexican women evaluated here was notably higher (above 48.6%) than postmenopausal women in countries such as the United States (US), 7.8%, and India 32% (12-13). A study in the United States describes that the percentage of DES showed an increase in direct proportion to the increase in age, going from 5.7% in women under 50 years of age to 9.8% in those over 75 years of age (12). This same phenomenon is observed in this study, where DES goes from 40% in women under 47 years of age (pre-menopause) to 66.7% in the group of 54-55 years (post-menopause). This could be associated with a significant decrease in tear production and stability in postmenopausal women, as reported by Pelit A. et al.. This, as a result of a deterioration in the function of the meibomian glands in postmenopausal women, was found associated with elevated serum estradiol levels, a fact also related to a greater presence of corneal staining, which represents damage to this ocular structure, according to that reported by Golebiowski B. et al. (6). A study in Mexico compared the amount of tear production through the Schirmer test in postmenopausal women before and after menopausal estrogen treatment, finding no significant differences. However, it is not possible to compare this work with our study since estrogen treatment was not one of the inclusion criteria; because it does not consider the data of a pre and post-treatment. However, it is useful to confirm that, in the case of hormonal treatment for menopause in the selected files, this characteristic does not modify the results of this work.
From the environment to the screens
At the same time, “certain ophthalmological infections such as viral adenoconjunctivitis can leave a dry eye as a sequel and other systemic diseases such as Parkinson’s, diabetes mellitus or Sjögren’s syndrome,” she confirms. However, the environment that surrounds us or our way of life can also put dry eyes in the trigger: “overexposure to digital screens, with the evaporation of the tear and the lower frequency of blinking, but also pollution, air currents, heating or air conditioning affect its development. “
All this can cause it, regardless of age, and cause symptoms that can range from mild to moderate to severe, some of them even becoming chronic or generating other types of complications if not diagnosed in time. “The consequences of dry eye are highly variable, ranging from mild and temporary eye irritation to more serious and persistent problems,” clarifies the doctor from the Baviera Clinic.
Citing several examples such as ocular inflammation, the appearance of scars on the eye’s front surface, dryness, and inflammation of the cornea (which is known as keratitis sicca), affectations of the cornea and conjunctiva (keratoconjunctivitis sicca), or tear dysfunctions.
What favors its appearance
It seems obvious that limiting the external factors that cause dry eye is the best way to, as far as possible, curb its appearance. Stress, smoking, working in front of a screen, having surgery for other eye pathologies, or abusing contact lenses are symptoms of dry eye.
“A dry environment with excessive wind favors the evaporation of the tear, or the abuse of air conditioning as the cause of punctual dry eye, due to a very high environmental dryness,” she comments. Something that when good weather makes an appearance runs the risk of multiplying, also due to “excessive exposure to the sun,” so it recommends “taking special eye protection measures both on the beach and in the mountains.”