The Singapore National Eye Centre saw 323 new referrals for dry eye disease last year. ST PHOTO: KUA CHEE SIONG


SINGAPORE - Cannot take your eyes off the screen because you are working from home? More new patients have been referred to the Singapore National Eye Centre (SNEC) for dry eye disease amid the Covid-19 pandemic - with mask-wearing, stress and lack of sleep also contributory factors.

Professor Louis Tong, senior consultant at its corneal and external eye disease department, said SNEC saw 323 new referrals last year - about a 15 per cent increase from 281 in 2019, prior to the pandemic.

Of the 323, 76 were below the age of 50, and of those, 47 were younger than 40 - up from 39 in 2019.

He added that while dry eye disease is an umbrella term for a variety of conditions, a majority of sufferers usually have one or more of these symptoms: irritation of eyes, intermittent blurred vision, tired eyes, watery or teary eyes, or experiencing glare or discomfort around lights.

About 90 per cent of those with dry eye disease fall into this group, and can be considered to have community dry eye disease - a less severe form of the condition, said Prof Tong, who is also principal clinician scientist and head of the ocular surface research group at the Singapore Eye Research Institute.

The remaining 10 per cent have a medically significant form of the disease, which comes not only with the symptoms but also ocular damage, such as loss of the outermost layer of the cornea.

While it is uncommon for this to lead to blindness, Prof Tong said the visual disability experienced by patients can be crippling, preventing them from working, driving or wearing contact lenses.

Patients typically get medically significant dry eye disease as a result of factors such as having undergone a bone marrow transplant, autoimmune disease, multiple eye operations, or longstanding use of glaucoma eye drops, he said.

A multitude of other factors can lead to the community form of dry eye disease, he added, including hormonal issues, ageing, vitamin D deficiency, a lack of exercise and menopause.

Three other factors have also become more prevalent as a result of the pandemic, which contributed to a majority of the increase in new referrals as well. One is linked to an increase in time people spend staring at screens due to work-from-home arrangements.

"You tend to blink a lot less when you're using a computer or staring at something intensively... if you reduce blinking, that means your eyes are exposed to the air for a longer time," said Prof Tong, adding that blinking helps lubricate the eyes and prevent a build-up of oil in the glands of the eye.

The increased use of face masks is also a factor. "When you wear a mask, the airflow goes above the mask and hits the eyes, so they dry up a lot more," said Prof Tong.

Third, the pandemic has resulted in more stress and less sleep. Sleep is important as it reduces the amount of time a person's eyes are exposed to the drying air.

He added that apart from the uncomfortable symptoms mentioned earlier, dry eye disease can impact people's jobs and their ability to do things like drive at night.

It can also negatively impact mental health.

Mental health expert Sharon Sung, assistant professor at the signature programme in health services and systems research in Duke-NUS Medical School, said around the world, rates of depression and anxiety are roughly three times higher in adults with dry eye than those without.

"Dry eye disease itself can lead to difficulties with sleep and reduced quality of life due to interference in daily activities," she added. She noted that when people feel depressed or anxious, they may be more distressed by the symptoms of the disease and may be less resilient in coping with their condition.

Prof Sung said certain treatments like cognitive behavioural therapy are likely to be able to help dry eye disease patients cope, and that doctors and optometrists should ask such patients about their mood, sleeping habits, stress level and quality of life.

"Treating the whole person is important to achieving the best outcomes for both physical and mental well-being," she added.

Having lived with dry eye disease since 1992, Ms Juliana Ang is no stranger to the multitude of symptoms. The deputy director of human resources said she suffers from pain in her eyes, intermittent blurry vision and discharges from the corner of her eyes at times.

Fluorescent lights hurt her eyes, and she needs to wear sunglasses when she drives.

"You feel like there's something in your eye which you can't remove. You keep rubbing it and try to get water to flush it out, but that makes it worse," she said.

Prof Tong said for a majority of patients, the condition can be managed without seeing a doctor, by steps such as getting more sleep and exercise, regulating screen time, using an eye-warming mask regularly and applying eye drops before staring at a screen.

He added that this can be done even if someone does not have the condition, but wants to reduce the risk of developing it.

But if someone has signs of dry eyes, and the condition has not improved despite trying all of these methods, he or she should seek medical attention or consult an optometrist.

Medical professionals can take further action such as prescribing medication and special eye drops, or inserting tiny plugs in the eye's tear ducts - but the problem may never go away completely.

Prof Tong added: "Your body is naturally optimised to take care of your eyes, so take care of your body before it's too late."

Ms Ang manages her condition by applying eye drops three to four times a day, placing hot towels over her eyes every night or so and sometimes using a special gel.

Because she has stuck to her treatment programme, dry eye disease has not stopped her from living an active life, doing well in her career and volunteering regularly.

"Dry eyes is something manageable, if you take ownership in managing it... There is hope, there is a management programme you have to follow. And if you follow it, you'll reduce the problems you face," she said.