What Is Aqueous Dry Eye?

Your tear glands have a simple responsibility: to produce the watery layer of your tear film. But what happens when these glands stop working as intended?

Your eyes feel dried out, sore, and irritated. This is when you have aqueous deficient dry eye, or ADDE, an uncommon form of dry eye syndrome that accounts for about one-tenth of cases.

But ADDE doesn’t appear out of the blue. It has several underlying causes, like dehydration, eye injury, and autoimmune problems. Knowing about these causes will help you keep the symptoms in check.

Let’s now dive deeper into the symptoms, causes, diagnosis, and management of aqueous tear deficiency.

Types of Dry Eye Syndromes

Two major types of dry eye syndrome are aqueous deficient and evaporative dry eye. These often have overlapping signs and symptoms but come with different underlying causes.

• Aqueous deficient dry eye: This occurs when your eyes don’t produce enough of the watery component of tears. Your lacrimal (tear-producing) glands stop working due to factors like medical conditions, medications, and hormonal changes.
• Evaporative dry eye: When your eyes don’t produce enough oils, you develop evaporative dry eye. This condition makes your tears evaporate very quickly. It occurs when oil-producing meibomian glands get damaged or blocked due to allergies, eyelid inflammation, or even eye makeup.

Since aqueous vs evaporative dry eye syndrome have different treatment options, it’s important to figure out the underlying cause of your dry eyes.

Aqueous Dry Eye Explained

Lacrimal glands are tiny, tear-producing glands above your eyeballs. They make the salty water that keeps your eyes clean, lubricated, and healthy. If these glands don’t make enough tears, you may experience aqueous dry eye.

The condition leads to an unstable tear film. It’s characterized by irritation, inflammation, and soreness in the eye. If ignored for too long, it can also scratch and scar your cornea and cause vision problems.

There are two types of aqueous deficient dry eyes, depending on what’s triggering the condition in the first place.

• Sjögren’s-related: This autoimmune disorder targets your lacrimal and salivary glands. As a result, your body doesn’t produce enough tears, saliva, and other fluids.
• Non-Sjögren’s-related: Aging, medications, hormones, skin conditions, and other underlying medical conditions also affect your tear production. These conditions damage and inflame your lacrimal glands, leading to aqueous tear deficiency.

Aqueous Dry Eye Symptoms

When your eyes don’t make enough tears, you can experience a range of aqueous deficient dry eye symptoms. These can be mild to moderate, depending on the severity of their underlying cause.

• Dry, irritated, and sandy eyes
• Pain in the eye
• Redness
• Burning or stinging sensations
• Itchy and watery eyes
• Sensitivity to light
• Blurry or hazy vision, especially after prolonged screen time or reading
• Eye fatigue
• Difficulty wearing contact lenses

ADDE symptoms are similar to those experienced in non-aqueous deficient dry eye. But apart from eye-related symptoms, you may also have a dry mouth, rashes on your skin, or joint pain.

Aqueous Deficient Dry Eye Causes

There are several reasons why your lacrimal glands may not make enough of the watery component of tears. Autoimmune conditions, age, hormones, and medications are mostly to blame.

These affect the normal functioning of your lacrimal glands and trigger a range of aqueous deficiency dry eye symptoms.

• Autoimmune conditions: Sjögren’s syndrome, lupus, rheumatoid arthritis, and other autoimmune conditions attack your lacrimal glands. Often, these cause inflammation of the glands and reduce tear production.
• Age factor: Your lacrimal glands become less efficient with age, and that's an inevitable process. This leads to a natural decline in the quality and quality of tears.
• Hormone replacement therapy: Hormones play an important role in maintaining the right balance in your tear film. Any changes in the hormone levels due to hormone replacement therapy can affect your tear film quality and quantity, leading to ADDE.
• Skin conditions: Certain skin conditions, like rosacea, seborrheic dermatitis, and psoriasis can also cause ADDE. These affect the areas around the eyes and cause inflammation. Because of this, they may disrupt the normal functioning of your tear glands.
• Medications: Medications, like antihistamines, decongestants, diuretics, and antidepressants can cause ADDE as a side effect. These medications interfere with the functioning of your tear glands and alter the composition of tears.
• Nutritional deficiency: Vitamins and minerals are essential for maintaining the health of your tear glands. For example, vitamin D is essential for the production of healthy tears. It also reduces inflammation on the eye’s surface, research shows.
• Environmental factors: While not a direct cause of ADDE, exposure to dry air, wind, smoke, and air conditioning can dry out your eyes quickly. It’s better to avoid such environments to keep eye dryness at bay.
• Dehydration: Your tears are mostly made up of water. That means if your body is dehydrated, your lacrimal glands produce fewer tears, which can lead to dry eyes.
• Eye injury: Injuries to the eye, like scratches, burns, or trauma, can damage your tear glands. Additionally, eyelid injuries can also interfere with the spread of tears across the surface of your eyes, resulting in dryness.
• Post-LASIK dryness: ADDE can also occur as a complication of LASIK surgery. If your corneal nerves are severed during the procedure, you may experience eye dryness and sensitivity.
• Radiation therapy: Lacrimal glands can get damaged during radiation therapy for head and neck cancers. What’s more, certain chemotherapy medications can also affect the function of the lacrimal glands.

Aqueous Dry Eye Diagnosis

Since Sjogren’s syndrome is closely related to ADDE, your eye doctor will likely test you for it. If the cause of your aqueous dry eyes is non-Sjögren’s-related, your eye doctor may perform a variety of tests to evaluate the quantity and quality of your tears.

These tests may include:

• Blink frequency test: Your eye doctor will note your blinking frequency. If you blink just once every minute, you may have aqueous dry eyes.
• Schirmer’s test: This test involves placing a piece of filter paper inside your lower eyelid to measure tear production.
• Tear analysis: Your doctor may take your tear sample to look for high concentrations of blood or inflammation.
• Tear breakup time test: This test helps evaluate how long it takes for your tear film to break up on the surface of the eye. If your tear film breaks up in less than 8-10 seconds, you may have ADDE.
• Corneal staining: This test involves staining the surface of your eyes with a special dye. Your doctor will then examine your eye through a slit lamp to see if there’s any damage to the cornea or other protective layers.

Aqueous Deficient Dry Eye Treatment

If you are diagnosed with ADDE, there are several treatment options that can help keep your eyes well-lubricated and healthy. The foremost approach is to treat the underlying health condition that may be affecting your lacrimal glands.

You can also apply a warm compress to reduce irritation and swelling in your tear glands. Wiping your eyelids will also reduce the risk of inflammation and debris buildup.

Since your eyes need proper nutrition and fluid intake to produce tears, make sure to focus on your daily diet. You can also take oral supplements, like vitamins A and D and omega-3 fatty acids, for a healthy tear film.

If these home remedies don’t work for you, feel free to opt for in-office treatments. Your eye doctor may recommend the use of punctal plugs or surgery to keep the tears in your eyes for longer.

Take the Dry Eye Test

Aqueous deficient dry eye is when your lacrimal glands don’t produce enough tears. This often happens alongside other conditions, like Sjögren’s syndrome, hormonal issues, and eye injury.

While ADDE can come with a range of uncomfortable symptoms, there are several things you can do to ease them. First, focus on fixing the underlying cause. For instance, if skin inflammation is causing ADDE, look for ways to treat the inflammation.

Other aqueous tear deficiency treatment methods include using a humidifier, wearing protective glasses when stepping outdoors, blinking often, and staying away from windy and polluted areas.

Concerned that you may have developed dry eyes? Our quick and easy online test can help you find out.