Most Dry Eye Patients Experience Intermittent Symptom Flares

young man opens red eyes with fingers
young man opens red eyes with fingers.
A study reveals the treatment habits of patients who experience flares with dry eye disease.

This article is part of Optometry Advisor’s conference coverage from the 2021 meeting of the American Academy of Optometry, held in Boston from November 3 to 6, 2021. The team at Optometry Advisor will be reporting on a variety of the research presented by the primary eye care experts at the AAO. Check back for more from the AAO Optometry 2021 Meeting..

Like other chronic inflammatory conditions, patients with dry eye disease experience episodic flare ups in which signs or symptoms, of both, of the disease are exacerbated. However, unlike with asthma, rosacea, or rheumatoid arthritis, flares in dry eye disease are not well understood. Research presented at the American Academy of Optometry meeting in Boston, November 3-6, was geared toward correcting that. They found that the flare ups are exceedingly common. The study also provided insight into how patients attempt to manage these events.

The research team conducted 3 studies, spanning nearly 2 years, in the findings. Data included comes from surveys conducted in May 2018 (​​297 participants), August 2018 (751 participants), and April 2020 (774 participants). All 3 studies described “dry eye flares” to their participants as “a period of time when your eyes bother you and feel worse than they typically feel. This period of dry eye symptom worsening (which may include increased dryness, itchiness, discomfort, redness) may last from a few days to a few weeks at a time.”

The research monitored the occurrence, duration, frequency, and severity of participants’ flares as well as treatment usage, effectiveness and satisfaction using online questionnaires. 

In all 3 surveys, 77% to 79% of participants reported experiencing dry eye flares, while 45% reported experiencing intermittent flares alone without continuous dry eye symptoms. They reported experiencing a median of 5.5 flares per year, which lasted on average less than a week. Of the flares experienced in the May 2018 survey, 49% were ranked as “moderate” and 7% “severe”. In the August 2018 survey, 57% were “moderate” and 7% were “severe.” In the April 2020 survey, 54% of flares were “moderate” while 12% were called “severe”. 

Patients reported treating these flares with artificial tears, cyclosporine, lifitegrast, and topical corticosteroids with increasing frequency during flare days, compared with regular days. Among all the drops used, patients rated the topical corticosteroid drops as the highest in both satisfaction and perceived effectiveness, according to the study.

The researchers who presented these findings concluded that “increasing frequency of dosing of eye drops is the primary way these patients self-manage their flares with a varying degree of effectiveness and satisfaction. An FDA-approved, short-term treatment option for DED may improve dry eye disease management.”

Disclosure: Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


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Owen D, Holland E, Nichols K, Kline K, Brazzell RK. Patient reported outcomes for symptomatic dry eye flares: results from multiple patient surveys. Poster presented at the American Academy of Optometry 2021 meeting; November 3-6; Boston. Board #86.