Causes of Dry Eye

There are 2 main causes of dry eye, according to the International Dry Eye WorkShop (DEWS): deficient aqueous production and an evaporative condition.

Deficient aqueous production

Sjögren syndrome (1-2% of population, of which 90% are women)
  • Primary (no associated CTD)
  • Secondary (associated CTD); including
    • Rheumatoid arthritis
    • Systemic lupus erythematosus
    • Progressive systemic sclerosis (scleredema)
    • Other diseases
Non-Sjögren syndrome
  • Lacrimal gland deficiency
  • Lacrimal gland duct obstruction
  • Reflex hyposecretion
  • Medications
    • Antihistamines
    • Beta blockers
    • Atropine
    • Oral contraceptives
    • Anxiolytics
    • Antiparkinsonian agents
    • Diuretics
    • Anticholinergics
    • Antiarrhythmics
    • Topical preservatives in eye drops
    • Topical anesthetics
    • Isotretinoin

Evaporative Conditions

Intrinsic causes
  • Meibomian gland dysfunction
  • Disorders of lid aperture
  • Low blink rate
  • Drug action (eg, Accutane)
Extrinsic causes
  • Vitamin A deficiency
  • Topical drugs and preservatives (surface epithelial cell damage)
  • Contact lens wear
  • Ocular surface disease (eg, allergy)