Fast Five Quiz: Dry Eye Disease (Keratoconjunctivitis Sicca) Etiology and Pathophysiology

Christina R. Prescott, MD, PhD


November 10, 2022

Meibomian gland disease, an intrinsic cause of evaporative dry eye, may involve a reduced number of functioning glands, as in congenital deficiency or acquired meibomian gland dysfunction. Meibomian gland dysfunction is divided into three subtypes:

  • Hypersecretory — Meibomian seborrhea

  • Hyposecretory — Isotretinoin therapy

  • Obstructive — This may be simple; primary; or secondary to local disease (eg, anterior blepharitis), systemic disease (eg, acne rosacea, seborrheic dermatitis, atopy, ichthyosis, or psoriasis), syndromes (eg, anhidrotic ectodermal dysplasia, ectrodactyly syndrome, or Turner syndrome), or systemic toxicity (eg, 13-cis retinoic acid or polychlorinated biphenyls); or it may be cicatricial, primary or secondary to local disease (eg, chemical burns, trachoma, pemphigoid, erythema multiforme, acne rosacea, vernal keratoconjunctivitis, or atopic keratoconjunctivitis)

Vitamin A deficiency, an extrinsic cause of evaporative dry eye, may cause dry eye as a consequence of the development disorder of goblet cells or lacrimal acinar damage. This is very rare in the United States, except in cases of malnutrition, usually occurring after weight loss surgery or in persons who abuse alcohol.

Other extrinsic causes of evaporative dry eye include topical drugs and preservatives that cause surface epithelial cell damage; contact lens wear; and OSD, such as atopic keratoconjunctivitis, chronic anterior blepharitis, chronic conjunctivitis, ocular cicatricial pemphigoid, and Stevens-Johnson syndrome.

Learn more about the etiology of evaporative dry eye.


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