Aqueous Tear Deficiency

Aqueous deficient dry eye is characterized by an inadequate wet layer of the tear film that is produced by the lacrimal gland. The risk of aqueous deficiency increases with age.

Corneal sensory loss is a contributing factor to aqueous deficiency because corneal sensitivity plays an important role in the blink feedback loop. During a blink, a message is sent to the lacrimal gland to produce tears. When the sensation is diminished the feedback loop is interrupted. Corneal sensory loss has many causes including:

Aging
Cataract surgery (limbal incision)
Contact lens wear
Refractive surgery (LASIK, LASEK, PRK)

Obstructions in the lacrimal glands or ducts, or other diseases of the lacrimal glands can cause aqueous deficiency.

There is a suspected correlation between aqueous deficiency and hormonal imbalances — rising estrogen levels and dropping testosterone levels — that occur with the onset of menopause. Antihistamines, anti-depressants, chemotherapy drugs, and others drugs can contribute to aqueous deficiency. Aqueous deficiency can be caused by Sjögren’s Syndrome, an autoimmune disorder with sufferers complaining of dry eyes and dry mouth among other symptoms. Other autoimmune diseases can also play a role in aqueous deficiency.

Common Symptoms:

Dry eyes
Gritty eyes
Red eyes
Burning
Scratchy or sandy eyes
Foreign body sensation
Increased blinking
Watery eyes
Eye pain

Behaviors to watch for:

The slightest wind is bothersome or excruciatingly painful to the eyes
Difficulty or no reading
Keeping eyes closed for long periods and even all day
Difficulty or no driving
Frequent use of eye drops (more than once every 2 hours)
Not participating in normal daily activities
Thoughts of suicide
Thoughts of enucleation (removing the eyes)

View all eye symptoms and behavioral signs

 

Reference

The Definition and Classification of Dry Eye Disease: Report of the Definition and Classification Subcommittee of the International Dry Eye Workshop (2007)
The Ocular Surface, 5(2), 75-92.
View the full report Go to: The Definition and Classification of Dry Eye Disease