Defining Flares in Dry Eye Disease - Episode 1

Dry Eye Flares: An Overview

Cynthia Matossian, MD, FACS, provides an overview on dry eye flares, including causes, symptoms, and her experience with dry eye flare patients.

Cynthia Matossian, MD, FACS: We are working hard, as eye care providers, to help our colleagues and our patients understand what a flare is. After all, patients are the ones suffering from dry eye flares. So what is a flare? A flare occurs when the homeostasis of the tear film is disrupted. There are different triggers that precipitate this. There’s an acute change in the amount of symptoms a patient experiences. What they’re looking for, of course, is rapid relief. So it’s an uptick of symptoms in somebody who is asymptomatic or somebody whose symptoms have been well controlled on therapy. A flare can happen to anyone.

There are many causes of flares. Sometimes triggers are known by patients, and sometimes it’s the first time that triggers have caused an uptick or exacerbation of dry eye issues. Common things include, for example, increased screen time. Maybe somebody [a college student] has been cramming for exams. Or, maybe somebody plays video games, was in a competition, and has been spending all night playing a game. Another example is somebody who’s binge watching TV. Maybe over a long weekend all they’ve done is watch a ton of TV or stream videos.

There are many other triggers as well. Wearing contact lenses is a trigger. Now that COVID-19 is a bit more under control and vaccinations are available, people are starting to travel again. Long trips on airplanes, like a trip to Hawaii, can cause a flare in somebody who has preexisting dry eye disease. Seasonal allergies are another factor. Right now it’s spring, at least here in Pennsylvania, where I live. The trees are blooming. There are buds everywhere. Allergies are a big trigger for some people. There are several reasons.

And lastly, wearing a mask may trigger flares. Of course we all have to wear our masks to be safe when we’re outside, or among colleagues at work, in the grocery store. The exhaled air that shoots directly up and hits the ocular surface can also be a trigger. Those are just a few examples of triggers of flare, but there are many more.

When patients come to me, they don’t quite know they’re having a flare. That’s a whole new area that we’re educating our patients on. Established patients know they have dry eye disease, but many times patients come to our offices saying they have on and off blurred vision, or they report their eyes feel like they hurt or they want to close them, or their eyes feel tired, or their vision is changing throughout the day. All of these are classic signs and symptoms of dry eye disease. Patients have not yet connected the dots to say, “Doctor, I am here because I have dry eye disease, and I’m experiencing a flare.” Not too many patients would do that. It’s really our role to help them understand that. Then, patients can say, “I was doing well, but all of a sudden I’m aware of my eyes of again. Trust me, I am using my drops. It’s not because I stopped.”

Discontinuation of maintenance therapy can also be a flare trigger. Again, as their eye care doctors we have to become really good listeners. We have to empower our technicians to know what types of questions to ask to solicit the right types of descriptions from our patients so we can make an appropriate diagnosis of a dry eye disease flare.

Transcript edited for clarity.