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You’re not still using these words in dry eye disease?

Don't call it Dry Eye Syndrome

A syndrome is a cluster of symptoms (what the patient is feeling) and signs (what you as the eye care specialist sees) but where the underlying mechanism that joins them together is not understood. 

A disease is where we understand the process that causes symptoms and signs. This may be a single organism such as the bacterium Mycobacterium tuberculosis in TB or in Malaria where the Plasmodium protozoan is the type of organism. Or it may be understanding the disease process such as the changes in insulin resistance in diabetes.

*see end of the blog for more words never to use again!

In 2007 with the publication of the TFOS DEWS report (Tear Film and Ocular Society Dry Eye Workshop report) a clear disease process that resulted in the symptoms and signs of dry eye disease. From the publication of that report researchers in this field have stopped using the term dry eye syndrome and kerato conjunctivitis sicca as a diagnosis.

In 2006 I developed dry eye disease. I was in the final years of my training and I wanted to understand the disease that I had been diagnosed with. I took 3 months unpaid leave and dived deep into the research. There were 5 different classification systems, no single definition of the condition, names and descriptions were being used interchangeably. People at the time were diagnosing kerato-conjunctivitis-sicca based on symptoms alone, or just the presence of crusting of the eyelashes - a condition that we now correctly call 'Anterior Blepharitis'. 

It was impossible to compare two published papers with each other as what the one paper was calling meibomitis the other was calling blepharitis.

Eventually I returned to work more confused than when I started, but my passion for this disease had been ignited. Fortunately for me, 58 of the world's leading researchers from the most eminent universities from 12 countries had spent 3 years reviewing over 10,000 peer reviewed published articles. They published a 140 page detailed report on dry eye disease. Suddenly it all made sense. 

There was a single agreed definition of dry eye disease, a clear classification system, a model of the disease process and advice on the best diagnostic approach. I obviously joined the group and they have subsequently published a report on Meibomian Gland Dysfunction and one on Contact lens discomfort.

There was a rigorous selection process and I was fortunate enough to be selected to be a co-author of the TFOS DEWS II report. This was with 150 of the worlds leading professors from the most eminent universities from 23 countries and we reviewed more that 20,000 peer reviewed publications. Our report that was published at the end of 2017 is 400 pages long and is the most comprehensive description of this - the most common disease in ophthalmology. 

This is a different series of videos to the 'Dry eye chat' videos where I record short, information rich, and tips of real life management of dry eye disease in our busy clinics. These are conversations I have had with other dry eye thought leaders from around the world. Please join our FREE MEMBERSHIP by signing up to watch these videos...

Here is a few more terms that I feel we should not be using:

1) Kerato-conjunctivitis sicca - Use the term dry eye disease

2) Dry eye syndrome - use the term dry eye disease 

3) Blepharitis - this is a general umbrella term for all forms of inflammation of the eye lids. This may include inflammation from a tumor, allergy or infection. I think it is too broad to use as a diagnosis. Rather use the terms Anterior Blepharitis and Meibomian Gland Dysfunction. Anterior blepharitis for infection of the base of the eyelashes, and term meibomian gland dysfunction refers to the condition where the meibomian glands become obstructed and inflamed.

Never say Dry Eye Syndrome again! Then there is the archaic Kerato-conjunctivits sicca - Never use these old dry eye words again see https://bit.ly/2qe5tHg

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