Indian Journal of Clinical and Experimental Ophthalmology

Print ISSN: 2395-1443

Online ISSN: 2395-1451

CODEN : IJCEKF

Indian Journal of Clinical and Experimental Ophthalmology (IJCEO) is open access, a peer-reviewed medical journal, published quarterly, online, and in print, by the  Innovative Education and Scientific Research Foundation (IESRF) since 2015. To fulfill our aim of rapid dissemination of knowledge, we publish articles ‘Ahead of Print’ on acceptance. In addition, the journal allows free more...


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Maurya and Singh: Sleep and dry eye disease

Dry eye has become the most common ocular surface disease around the world. It is defined by the international TFOS Dry Eye Workshop II (TFOS DEWS II) as a “multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface.”1, 2 Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation that adults should sleep 7 or more hours per night on a regular basis to promote optimal health.3

DED can lower work productivity and interfere with daily activities like reading and driving.4 The burden of DED not only affects a patient during the day but may also play a role in their experience asleep. Poor sleep quality has been associated with DED, where sleep disturbances appear to have an impact on dry eye symptoms.5 The results of closed-eye studies and elevated tear matrix metalloprotease-9 in DED suggest that patients with DED may have more inflammatory processes than controls during sleep.6, 7 Patients with DED have a high prevalence of obstructive sleep apnea,8  and its therapy, continuous positive airway pressure, may worsen DED further.9

In a study conducted by Ayaki et al. it was seen that there was significantly higher prevalence of sleep disorders in dry eye patients compared to other types of patients in eye clinics.10 It is estimated that more than 40% of people with dry eye suffer from poor sleep quality.10, 11 Recent study conducted by Gangwisch JE suggest that a sleep disturbance is associated with circadian rhythm disruption.12 It has also been reported that tear secretion and tear stability have a circadian rhythm,10, 13

It has been seen that sleep deprived dry eye shows unique pathologic features.14 There was a mild increase, although no significant difference, of goblet cell density and MUC5AC expression in the conjunctival tissue after 10 days of sleep deprivation. It could be an adaptive response to the decreased aqueous tear secretion occurring during the early stage of dry eye. Another possibility is that sleep deprivation induced stress which could have promoted the differentiation of goblet cells.14 Therefore further study is necessary to observe the goblet cell differentiation even for longer duration of sleep deprivation to investigate the effect of chronic sleep deprivation on goblet cells. A study conducted by Li S et al. characterized histological lacrimal gland changes induced by sleep deprivation. After 2 days of sleep deprivation, the lacrimal gland underwent hypertrophy, which became more evident at later times without any acinar cell apoptosis. Instead, the acinar cells became enlarged due to lipid droplet accumulation.14 Also sleep deprivation reduces tear secretion and impairs the tear film. It has been seen that sleep deprivation shortens TBUT indicating decrease in tear secretion and also increases the VAS pain score.15

A study conducted by Ayaki et al showed that treatment of DED was more effective in improving sleep and mood problems in patients with newly diagnosed DED than in those with established DED.16 In the same study the new initiative of a sleep service was successfully established for patients with DED and sleep problems and on follow up survey after evaluating the patients a satisfactory outcome was obtained from the patients. A few tips about lighting, bedtime, drinking, and shield eyeglasses seemed helpful in supporting their sleep quality. Another large population based survey in Korea revealed that increase in dry eye symptoms were consistent with declining sleep duration.17 It was also seen that after treatment of dry eye with hyaluronate, steroid and mucin secretagogue their quality of sleep improved, which further strengthens their association. Conventionally, ophthalmology and psychiatry do not have a close assemblage; however, the results of sleep service suggests the new possibility that liaison psychiatry could be beneficial for some patients with ocular disease, especially DED.16 Another DED therapy reported to be effective for sleep and the autonomous nervous system is lid-heating during sleep.18

In summary, dry eye disease is common ocular surface disorder which may be complicated by sleep disorders. We as ophthalmologists, should be aware of sleep distress associated with dry eye disease and thoroughly listen to patient’s complaints and try to relieve their from distress. We can use eye drops, other ophthalmic interventions, sleep hygiene, and psychiatric consultation to further alleviate their symptoms.

Conflict of Interest

None.

References

1 

JP Craig KK Nichols EK Akpek B Caffery HS Dua CK Joo TFOS DEWS II Definition and Classification ReportOcul Surf201715327683

2 

RP Maurya VP Singh S Chaudhary M Roy T Srvastav M Rajan Prevalence of severe dry eye disease in postmenopausal women in North India: A teaching hospital studyIndian J Obst Gynecol Res201961946

3 

NF Watson MS Badr G Belenky DL Bliwise, OM Buxton D Buysse Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research SocietySleep2015386843410.5665/sleep.4716

4 

Q Le L Ge M Li L Wu J Xu L Gong Comparison on the vision-related quality of life between outpatients and general population with dry eye syndromeActa Ophthalmol20149221243210.1111/aos.12204

5 

NH Au R Mather A To MS Malvankar-Mehta Sleep outcomes associated with dry eye disease: a systematic review and meta-analysisCan J Ophthalmol20195421809

6 

M Ayaki K Tsubota M Kawashima T Kishimoto M Mimura K Negishi Sleep Disorders are a Prevalent and Serious Comorbidity in Dry EyeInvest Ophthalmol Vis Sci2018591414350

7 

L Dorennavar RP Maurya VP Singh MK Singh K Sharma R Sharma The role of rebamipide ophthalmic suspension in management of dry eye diseaseIndian J Clin Exp Ophthalmol2015141916

8 

EE Karaca HT Akçam F Uzun Ş Özdek TU Çiftçi . Evaluation of ocular surface health in patients with obstructive sleep apnea syndromeOphthalmol2016461038

9 

E Hayirci A Yagci M Palamar OK Basoglu A Veral The effect of continuous positive airway pressure treatment for obstructive sleep apnea syndrome on the ocular surfaceCornea2012316048

10 

M Ayaki M Kawashima K Negishi K Tsubota High prevalence of sleep and mood disorders in dry eye patients: survey of 1,000 eye clinic visitorsNeuropsychiatr Dis Treat20151188994

11 

M Kawashima M Uchino N Yokoi Y Uchino M Dogru A Komuro The association of sleep quality with dry eye disease: the Osaka studyClin Ophthalmol20161010152110.2147/OPTH.S99620

12 

JE Gangwisch Epidemiological evidence for the links between sleep, circadian rhythms and metabolismObes Rev20091023745

13 

PM Walker KJ Lane GW Ousler MB Abelson Diurnal variation of visual function and the signs and symptoms of dry eyeCornea20102960712

14 

S Li K Ning J Zhou Y Guo H Zhang Y Zhu Sleep deprivation disrupts the lacrimal system and induces dry eye diseaseExp Mol Med2018503e45110.1038/emm.2017.285.

15 

YB Lee JW Koh JY Hyon WR Wee JJ Kim YJ Shin Sleep deprivation reduces tear secretion and impairs the tear filmInvest Ophthalmol Vis Sci2014556352531

16 

M Ayaki I Toda N Tachi K Negishi K Tsubota Preliminary report of improved sleep quality in patients with dry eye disease after initiation of topical therapyNeuropsychiatr Dis Treat20161232937

17 

W Lee SS Lim JU Won J Roh JH Lee H Seok The association between sleep duration and dry eye syndrome among Korean adultsSleep Med201516132731

18 

Y Yamashiro M Igaki I Sakamoto A Suzuki Y Niki Effect on sleep of the application of heat and steam generating sheets to the eyesJpn J Physiol Anthropol2011168591



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© This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article type

Editorial


Article page

452-453


Authors Details

Rajendra P Maurya*, Shivangi Singh


Article History

Received : 08-09-2021

Accepted : 12-09-2021

Available online : 30-09-2021


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