Dry eye disease: Clinical evidence for a public sector intervention strategy

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Abstract
Background: Dry eye disease (DED) is a common, yet largely underdiagnosed, disorder of the eye encountered in healthcare facilities. It disrupts the tear film, causing ocular discomfort symptoms such as itching, tearing and irritation. Aim: This study aimed to determine the clinical profile of DED patients at a tertiary eye hospital to inform a public sector intervention strategy. Setting: The study was conducted at McCord Provincial Eye Hospital (MPEH). Methods: A quantitative, descriptive study design was undertaken and included 602 patients. The standardised patient evaluation of eye dryness (SPEED) questionnaire was administered, after which the tear break-up time (TBUT), Schirmer 2, blink rate, tear meniscus height (TMH) and meibography clinical tests were done. Data were managed using Statistical Package for Social Sciences (SPSS) version 28.0. Results: The prevalence of DED was 83.2%, with the majority being in the age group 41 years – 55 years (mean = 48.54 ± 18.76) and female (84.1%). The disease increased significantly with age (p = 0.02) and the prevalence of aqueous deficient, evaporative and mixed DED was 3.2%, 62.7% and 34.1%, respectively. Irrespective of the associated risk factors, the majority had either moderate (45.3%) or severe (30.9%) DED, with those with a history of glaucoma, hypertension and post-cataract surgery mostly having severe DED (p < 0.001). Conclusion: Noting the chronic discomfort and other complications of DED, the high prevalence found among public sector hospital patients warrants a strategic intervention. Interventions could include a DED management protocol with clinical guidelines for interventions from primary to tertiary levels of care. Further, as most older patients presented with systemic diseases such as diabetes and hypertension, DED clinical guidelines should be extended to multidisciplinary teams managing systemic diseases. Contribution: In addition to contributing to the scholarship of DED, the study provides empirical data to assist the provincial hospital and its eleven catchment district facilities in developing a comprehensive DED management strategy. Although conducted in the eThekwini District, the guideline has generic features which may be applied to health districts throughout the province of KwaZulu-Natal.

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