• A normal examination and an absence of discharge makes both conjunctivitis and blepharitis unlikely 

• With no previous trigger, the cause of the irritation is unlikely to be a foreign body

• Office workers are at low risk of industrial causes of eye disease

• Dry eyes are more common in females, older people and when people spend a lot of time in areas with air-conditioning and/or central heating (both common in offices)

• DD: Sjögren's syndrome is characterized by dry mouth and eyes

• W>M. 

• Onset is usually in the 3rd/4th decade, but increases with age

• There is an approximately 20% association with Raynaud’s phenomenon

Case

• A 60-year-old woman with known Sjögren’s syndrome has dry eyes and finds that her current ocular lubricant (e.g. hypromellose 0.3% eye drops) is not helping and asks for an alternative. She wears soft contact lenses.

• Carbomer 980 preservative-free single dose liquid eye gel is likely to be most suitable for her. Preservative-free products coming in single-dose form are preferred for soft contact lens wearers, especially if the person is intolerant of preservative in tear supplements, has moderate to severe dry eye disease requiring drops more than 4 times per day or is using multiple preserved topical medications.

• Acetylcysteine (e.g. acetylcysteine 5% eye drops) is a mucolytic drug which is useful in people with excessive ocular mucus

• Pilocarpine can be used in Sjögren’s syndrome; but is given by mouth, rather than pilocarpine hydrochloride 0.5% preservative-free eye drops

• Eye ointments containing paraffin (e.g. lacrilube) may be uncomfortable and blur vision, so should only be used at night, and not during contact lens wear.

Resources

• Dry eye syndrome (CKS)

• Dry eye syndrome - treatment (NHS Choices)

• Ophthalmic Preparations, Preservatives and Potential Sensitisers as Ingredients (MIMS)

• Tear deficiency, ocular lubricants, and astringents (BNF)