Dry eye in the elderly

Dry eye in the elderly population is a condition with a multitude of contributing factors and a wide spectrum of severity. The complex tear film is made up of layers of oil, aqueous and mucin, produced by the meibomian glands, main and accessory lacrimal glands, and by the goblet cells, respectively. Alteration in the normal function of any of these structures by disease, trauma or the environment can cause dysfunction of the tear film and result in the symptoms of dry eye (such as burning, grittiness and blurred vision). Normal lid anatomy and closure is critical to prevent evaporation of the normal tear film. The mainstay of current therapy is augmentation of the tear film with artificial tears and ointment. More severe cases of dry eye may require occlusion of the tear drainage system with plugs or electrocautery scarring. Good lid hygiene is also important for tear film health. A new paradigm of dry eye as a subclinical inflammatory disease has recently been suggested, and preliminary results from treatment with topical cyclosporin formulations are encouraging. The next few years promise exciting advances and relief for patients suffering from this chronic condition.