Rishwanth T, B. Optom
Assistant Professor, Sri Manakula Vinayagayar Medical College and Hospital, Pondicherry, India
Ageing leads to decreased tear production, and individuals with metabolic syndrome exhibit significantly lower tear volume. (1) Dry eyes contribute to ocular discomfort and reduced visual acuity, impacting work efficiency. (1-3) Treatment like P2Y2 agonist, cyclosporine, and punctal plugs exist and yield some patient satisfaction; no fundamental treatment restores normal lacrimal function. (1)
Epidemiologic studies indicate that Dry Eye Disease (DED) affects approximately 30-44% of elderly individuals who experience a high incidence of dry eye, influenced by factors like increased digital display use, longer working hours, reduced sleep, and environmental changes. (2) Dry eyes are common in the elderly, worsened by digital displays, poor blinking, lack of sleep, and environmental changes. Ageing is affected by various lifestyle and environmental factors. Calorie restriction and oxidative stress are identified as critical in preventing and treating conditions like Dry eye, emphasising the importance of exercise and dietary therapy in managing age-related diseases.
Behavioural Interventions
Physical Activity in Enhancing Tear Volume
Exercise may help alleviate Dry eye symptoms; individuals without dry eyes exercised more, leading to increased tear volume compared to those with dry eyes. Animal studies support the idea that physical activity has systemic benefits and raises tear production. (4) Sedentary habits and other health concerns, recommendations for improvement include taking breaks during screen time and practising abdominal breathing exercises to promote tear volume. (4)
Emotional and Stress-Related Factors in Dry Eye
Depression is significantly linked to Dry eye conditions, as psychogenic factors like depression, anxiety, and stress can alter the pain perception of a person concerning the disease, even when the disease and its stage remain unchanged. (4) Exercise therapy benefited those with pronounced symptoms, leading to improvements, and an Enriched Environment (EE) effectively mitigated stress-related reductions in tear secretion. (4)
Calorie Restriction in Ocular Surface Ageing and Tear Function
The effects of Calorie Restriction (CR) on eye disease processes have been analysed in various studies. CR may have potential for preventing or treating Dry eye, although its application has been limited. Research involving CR for dry eye treatment in a rat ageing model indicated a decrease in tear volume in ageing rats. (3)
Dietary Fatty Acids in Dry Eye Disease
Dry eye occurrence is lower in individuals with a higher intake of Polyunsaturated Fatty Acids (PUFAs), whereas a high Omega-6/Omega-3 ratio is associated with increased Dry eye incidence. (3) A diet abundant in Omega-3 sources, such as fish and nuts, may help against dry eye. Additionally, while no significant group differences were found, oleic acid’s anti-inflammatory properties alongside omega-3 PUFAs could potentially aid in reducing ocular inflammation in DED. (3)
Dietary Supplements as Adjunct Therapies
Lactoferrin – probiotics, and functional foods that contain astaxanthin – are effective in improving Dry eye, highlighting the importance of dietary interventions in dry eye patients. It has also been reported that royal jelly intake can lead to increased tear volume. (5)
Figure 1: Image showing royal jelly with nutrients that may provide benefits to the eyes
| Domain | Key Point | Management Implication |
|---|---|---|
| Screen and Environment | Screen use, poor blinking, and sleep loss worsen dry eye. | Lifestyle modification is essential. |
| Physical Activity | Exercise increases tear volume. | Encourage regular exercise and breaks. |
| Mental Health and Stress | Stress and depression intensify symptoms. | Include stress and mood management. |
| Calorie Intake and Oxidative Stress | Calorie restriction affects ageing and tear function. | Possible adjunct; needs validation. |
| Dietary Fats | Omega-3–rich diets reduce dry eye risk. | Advise omega-3 intake. |
| Nutritional Supplements |
Functional foods improve tear parameters. | Use as adjunct therapy. |
Table 1: Lifestyle Influences and Adjunct Approaches in Dry Eye Disease
Conclusion
Dry eye is considered a lifestyle disease, a comprehensive lifestyle intervention approach that includes exercise, diet, and mood interventions for effective management in patients with dry eye.
References
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- Tsubota, K., Kawashima, M., Inaba, T., Dogru, M., Matsumoto, Y., Ishida, R., … & Kawakita, T. (2012). The antiaging approach for the treatment of dry eye. Cornea, 31, S3-S8.
- Chang, L., Guo, Q., Pazo, E. E., Li, F., Zhang, Z., Fang, Z., … & Zhao, S. (2024).Prevalence of dry eye in people over 50 years old in Beichen district, Tianjin city: a cross-sectional population-based survey. BMC public health, 24(1), 2111.
- Tsubota, K., Kawashima, M., Inaba, T., Dogru, M., Ogawa, Y., Nakamura, S., … & Kawakita, T. (2010). The era of antiaging ophthalmology comes of age: antiaging approach for dry eye treatment. Ophthalmic research, 44(3), 146-154.
- Navel, V., Sapin, V., Henrioux, F., Blanchon, L., Labbé, A., Chiambaretta, F., … & Dutheil, F. (2022). Oxidative and antioxidative stress markers in dry eye disease: A systematic review and meta‐analysis. Acta ophthalmologica, 100(1), 45-57.
- Inoue, S., Kawashima, M., Hisamura, R., Imada, T., Izuta, Y., Nakamura, S., … & Tsubota, K. (2017). Clinical evaluation of a royal jelly supplementation for the restoration of dry eye: a prospective randomized double blind placebo controlled study and an experimental mouse model. PloS one, 12(1), e0169069.
About the Author
Rishwanth T
Assistant Professor
Sri Manakula Vinayagayar Medical College and Hospital, Pondicherry, India
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