Struggling with dryness and discomfort in your eyes? Aqueous-deficient dry eye (ADDE) is a serious condition resulting from insufficient tear production. Our skilled eye care professionals are here to provide expert diagnosis and personalized treatment plans to help restore your eye health.
If you’ve been dealing with chronic dryness, burning, or blurry vision, you may be experiencing a form of dry eye called aqueous-deficient dry eye (ADDE). This condition occurs when your eyes don’t produce enough of the watery layer of tears, leaving them dry and irritated. Fortunately, with the right diagnosis and treatment plan, you can find lasting relief and protect your long-term eye health.
Aqueous-deficient dry eye (ADDE) is a subtype of dry eye disease in which the lacrimal gland does not produce enough of the watery component of tears, leaving the ocular surface vulnerable to irritation and inflammation. This condition can significantly affect vision and overall eye comfort if left unaddressed, making early identification and proper treatment essential. Our dry eye doctors emphasize that addressing ADDE not only improves the health of your eyes but also enhances your overall quality of life.
Aqueous-Deficient Dry Eye (ADDE) occurs when the eyes don’t produce enough tears, leading to dryness and discomfort. It’s a common condition, especially in older adults and those with autoimmune diseases. Studies show that about 35% of people with dry eye disease have the aqueous-deficient type, while the rest have evaporative or mixed forms. Globally, dry eye affects between 5% and 34% of the population, and up to 70% in older age groups. Women over 50, particularly those with autoimmune conditions, are more likely to experience ADDE.
Lillis, C. (2024, July 5). Aqueous deficient dry eye: Causes, symptoms, and treatment. Medical News Today.
At its core, aqueous-deficient dry eye occurs when there is a reduction in tear production from the lacrimal glands. Unlike evaporative dry eye, which is related more to tear film instability from poor lipid function, ADDE specifically refers to the insufficiency of the aqueous (water) portion of your tears.This type of dry eye is often associated with conditions that affect the lacrimal gland itself, or systemic diseases that cause an immune-mediated attack on tear-producing tissues.
In many cases, ADDE is linked with disorders such as Sjögren’s syndrome, where patients experience not only dry eyes but also dry mouth and skin. Since tears are essential to nourish, lubricate, and protect your eyes, a decreased aqueous production can lead to discomfort, visual disturbances, and, if not managed, even damage to the ocular surface.
Aqueous-deficient dry eye (ADDE) results primarily from dysfunction or destruction of the lacrimal gland, impairing the production of the aqueous layer of the tear film. This leads to increased ocular surface friction, inflammation, and in severe cases, epithelial breakdown and visual impairment.
Sjögren’s syndrome, whether primary or secondary, is a classic autoimmune condition that targets exocrine glands, including the lacrimal glands. It is considered a hallmark cause of ADDE. Other autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and mixed connective tissue disease often overlap with or mimic Sjögren’s syndrome, contributing to lacrimal gland dysfunction.
Graft-versus-host disease (GvHD), especially following hematopoietic stem cell transplantation, can severely affect the lacrimal glands. Sarcoidosis may cause granulomatous infiltration of lacrimal tissue, while lymphoma or leukemia may lead to direct infiltration or paraneoplastic involvement.
Congenital alacrima or lacrimal gland agenesis, although rare, are important causes in pediatric patients and result in complete or partial absence of tear production from birth.
Trigeminal nerve dysfunction, including neurotrophic keratitis, can impair the reflex arc needed to stimulate tear secretion. Diabetes mellitus can also lead to neuropathy and chronic inflammation that reduce tear production.
Menopause is associated with a decline in estrogen and especially androgen levels, both of which influence lacrimal gland secretion. Conditions like androgen insensitivity syndromes and the use of anti-androgen therapies in prostate cancer patients may also impair tear production.
Radiation therapy to the head and neck, such as for nasopharyngeal carcinoma or orbital tumors, can damage lacrimal tissue. Topical medications containing preservatives like benzalkonium chloride may lead to cumulative ocular surface toxicity and reduced tear production.
Several systemic drugs are implicated in causing ADDE. These include anticholinergics, beta-blockers, antihistamines, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), diuretics, and isotretinoin. These medications can interfere with tear production either through direct toxicity or systemic effects on tear-secreting pathways.
As individuals age, basal tear secretion naturally declines. This process is often exacerbated by hormonal fluctuations and chronic health conditions.
Exposure to dry air, wind, smoke, and extended screen time reduces blinking and exacerbates tear evaporation, indirectly contributing to ADDE. Ocular surgeries such as LASIK, cataract surgery, and blepharoplasty may disrupt corneal nerves or ocular surface homeostasis, impacting tear production.
Prolonged contact lens wear may lead to corneal desensitization and altered tear film stability, contributing to tear deficiency and surface damage.
Vitamin A is essential for maintaining the health of goblet cells and epithelial surfaces. Deficiency leads to goblet cell loss and surface keratinization, impairing both mucin and aqueous components of the tear film.
Conditions such as alcoholism, malnutrition, and post-bariatric surgery states can cause systemic inflammation and nutrient deficiencies that adversely affect tear production and ocular surface health.
Elevated levels of pro-inflammatory cytokines, including IL-1, IL-6, and TNF-α, have been detected in the tears and conjunctiva of ADDE patients. This underscores inflammation as both a cause and a consequence of tear deficiency.
Many ADDE patients also exhibit signs of meibomian gland dysfunction, suggesting that a mixed mechanism involving both aqueous deficiency and evaporative components is common.
Emerging evidence points to genetic polymorphisms related to immune regulation and lacrimal gland function as potential predispositions for ADDE. These findings may guide future diagnostic and therapeutic strategies.
Aqueous-Deficient Dry Eye (ADDE) occurs when the eyes do not produce enough of the watery component of tears. This leads to discomfort, visual disturbances, and can affect quality of life. Early recognition of symptoms is essential for effective management and prevention of complications.
One of the hallmark symptoms of ADDE is a constant sensation of dryness. This is often described as a gritty or sandy feeling in the eyes, and may worsen in environments with dry air or wind.
Patients with ADDE commonly experience a burning or stinging feeling. These symptoms are typically more noticeable after extended periods of reading, screen time, or exposure to heating or air conditioning systems.
ADDE can result in increased sensitivity to light, making bright indoor lighting or sunlight uncomfortable. This photophobia may cause individuals to squint or avoid well-lit environments and can interfere with daily activities.
Insufficient tear production may lead to visual disturbances such as blurred or fluctuating vision. In many cases, blinking momentarily restores clarity, as blinking helps spread tears evenly across the surface of the eye.
Chronic dryness can lead to inflammation and visible redness in the whites of the eyes. This redness is typically accompanied by discomfort or a sensation of soreness.
Many individuals with ADDE report a persistent feeling that something is in their eye, like a speck of dust or an eyelash. Despite there being no actual foreign object, this sensation can be very irritating and persistent.
Eye fatigue is a common symptom, especially after engaging in activities that demand visual focus such as reading, working at a computer, or driving. This fatigue may make it difficult to concentrate and can sometimes lead to headaches.
People with ADDE often find it challenging to wear contact lenses. The lack of tear film lubrication can make lenses feel dry and uncomfortable, causing irritation or a burning sensation during wear.
Though it may seem contradictory, ADDE can cause excessive tearing. This is a reflex reaction by the body to eye irritation. However, these tears are usually watery and lack the essential components needed for proper eye lubrication.
In some cases, ADDE is linked with systemic autoimmune diseases such as Sjögren's syndrome. This condition can cause dryness in other areas of the body including the mouth and skin. If you are experiencing dry eyes along with symptoms like dry mouth or skin, it is important to seek medical evaluation.
Take charge of your eye health today! Our experienced dry eye specialists are ready to diagnose and treat your aqueous-deficient dry eye. Find a top optometrist or ophthalmologist near you with Specialty Vision who can provide personalized solutions based on your specific needs.
An accurate diagnosis begins with a detailed patient history. Our dry eye doctors inquire about not only your eye symptoms but also any occurrences of dry mouth, dry skin, joint pain, or other systemic complaints. This information is especially relevant if an autoimmune disease is suspected.
You might be asked to complete a dry eye questionnaire, which provides insight into the severity of your symptoms and helps in distinguishing between aqueous-deficient and evaporative components.
These tests, when combined with your symptoms and history, help differentiate ADDE from other types of dry eye disease. In particular, a positive diagnosis of ADDE guides our dry eye doctors to pursue treatment strategies that focus on boosting tear production and reducing inflammation. Several clinical tests help determine the extent of aqueous deficiency:
This involves placing a thin strip of filter paper in the lower eyelid and measuring the extent of wetting over five minutes. Values below certain thresholds can indicate a problem with tear production.
Evaluated with a slit lamp or anterior segment optical coherence tomography (OCT), TMH is a useful indicator of tear volume. A reduced TMH suggests aqueous deficiency.
Vital dyes such as fluorescein, rose bengal, or lissamine green may be applied to reveal damage to the ocular surface. In ADDE, staining patterns typically occur in the interpalpebral zone and help reveal the extent of epithelial damage.
In some cases, advanced imaging modalities such as confocal microscopy or OCT may be employed to evaluate lacrimal gland structure and function. These technologies can assess lacrimal gland acinar units and even detect subtle signs of gland dysfunction. While not always necessary in routine examinations, such tools may be invaluable in complex or refractory cases.
The first line of treatment for ADDE is often the use of artificial tears. These formulations aim to replenish the aqueous layer of the tear film and provide temporary relief from discomfort. However, many over-the-counter artificial tears only address the aqueous component and lack the lipids needed to stabilize the tear film.
For patients with ADDE, our dry eye doctors may recommend a balanced artificial tear that targets both the aqueous deficiency and any evaporative component, especially in cases where patients exhibit a mixed dry eye picture. For example, SYSTANE COMPLETE has been highlighted for its ability to combine both aqueous and lipid-based relief in one drop, reducing the need to guess which single type of drop will work best for your particular situation.
Since inflammation plays a key role in ADDE, many patients benefit from anti-inflammatory agents. Prescription medications such as topical cyclosporine (available in various strengths) help reduce ocular surface inflammation and stimulate tear production over time. In addition, lifitegrast is another prescription option that addresses the underlying inflammatory processes contributing to dry eye symptoms.
Topical corticosteroids may be used in the short term to quickly reduce inflammation; however, care is taken due to potential side effects. With these options, treatments are typically personalized to your specific needs and tolerability.
For patients with significant aqueous deficiency due to lacrimal gland dysfunction, medications that stimulate tear production may be considered. Cholinergic agents such as cevimeline or pilocarpine are examples of medications that act on the autonomic pathways controlling tear secretion. Although these systemic agents have been used successfully in conditions like Sjögren’s syndrome, they require careful dosing and monitoring by your healthcare provider.
Innovations in drug delivery, such as intranasal formulations that stimulate lacrimal gland activity, represent promising new approaches for treating ADDE and are being explored further in ongoing research studies.
Reducing tear drainage is another strategy employed by our dry eye doctors. Punctal plugs can be inserted into the tear drainage ducts to help retain your natural tears on the ocular surface. This intervention is typically reserved for patients whose tear production is markedly low, as it allows the small amount of tears produced to remain on the surface for longer periods, thus reducing symptoms.
When conservative treatments have not provided lasting relief, certain in-office procedures may be recommended to help manage symptoms and improve eye health. These may include thermal therapies designed to clear blocked meibomian glands, particularly when examination reveals a combination of dry eye components. Additionally, micro-exfoliation treatments can gently cleanse the eyelid margins and stimulate the ocular surface, promoting better gland function. In some cases, advanced imaging techniques may be used to evaluate the function of the lacrimal glands, helping guide further treatment decisions.
While these procedures are often associated with evaporative dry eye, they can also play an important role in managing aqueous-deficient dry eye (ADDE), especially when inflammation or meibomian gland dysfunction is also present.
One of the most important aspects of managing aqueous-deficient dry eye is recognizing that treatment must be personalized. Our dry eye doctors take the time to understand your full medical history, lifestyle habits, and any systemic conditions that could be contributing to your dry eye problems. This comprehensive assessment helps in selecting the most appropriate combination of therapies.
For example, if a patient presents with ADDE rooted in an autoimmune condition like Sjögren’s syndrome, treatment plans generally incorporate not only topical therapies but also collaboration with other healthcare providers, such as rheumatologists. This multidisciplinary approach addresses both the ocular and systemic components of the disease.
While artificial tears can offer immediate relief from symptoms, they do not address the root causes of aqueous-deficient dry eye (ADDE). Long-term improvement requires a more comprehensive approach that targets the underlying issues, such as glandular dysfunction and chronic inflammation.
A typical treatment plan may begin with the regular use of balanced artificial tears to help maintain moisture on the surface of the eye. To address inflammation, prescription anti-inflammatory eye drops are often introduced. If an autoimmune condition is contributing to reduced tear production, systemic medications or tear-stimulating agents may be recommended. In some cases, punctal occlusion, a procedure that helps preserve natural tears by blocking tear drainage, can be beneficial.
Managing ADDE is an ongoing process, and regular follow-up appointments are essential. During these visits, our dry eye doctors will re-evaluate tear production using repeat tests like Schirmer strips and tear meniscus height measurements. They will also monitor ocular surface staining and assess any progression in inflammatory signs.
This ongoing dialogue allows for adjustments in your treatment plan based on changes in your symptoms, ensuring that you always receive care that is best suited to your condition at that time. Establishing a care schedule also emphasizes an important message: Dry eye, especially ADDE, is a chronic condition that requires management over the long term rather than a one-time fix.
Empowering patients with knowledge about evaporative dry eye is essential for effective long-term management. Through tailored education and environmental modifications, patients can significantly reduce symptoms and improve their overall eye health.
Beyond medications and procedures, lifestyle modifications can play a powerful role in managing ADDE. Our dry eye doctors advise patients to become aware of environmental factors such as wind, smoke, or prolonged exposure to air conditioning that may worsen dry eye symptoms. Taking simple steps, such as wearing wraparound sunglasses or using a humidifier indoors can dramatically reduce discomfort.
Regular blinking, especially during extensive screen time, helps in spreading the aqueous layer evenly across the eye, and following a routine that includes scheduled breaks can preserve tear film stability. These small adjustments, when implemented consistently, provide an added layer of protection for your eyes.
What you eat and drink can also influence your dry eye condition. Foods rich in omega-3 fatty acids like fish, walnuts, and flaxseeds are known to have anti-inflammatory properties and support healthy tear production. Drinking ample water throughout the day is equally important, as overall hydration supports the natural function of the lacrimal glands.
Our dry eye doctors might also discuss dietary supplementation for certain patients, particularly those with chronic ADDE related to systemic autoimmune conditions. Taking an active role in your own care is a key part of the long-term management strategy.
Future approaches are focusing on regenerative therapies, lipid-based nanodrugs, and thermal pulsation technologies to restore gland function and improve long-term outcomes. These advancements aim to shift treatment from temporary relief to sustainable, root-cause solutions.
Current research is exploring exciting new methods to restore the function of damaged lacrimal glands. Studies involving mesenchymal stem cell therapy and bioengineered lacrimal glands aim to rebuild and regenerate tear production capacity. Although these therapies are still under investigation, early results offer hope for patients with severe or refractory ADDE.
Such regenerative approaches not only target the symptoms of dry eye but may also address the root cause by repairing lacrimal tissue damaged by autoimmune processes or environmental insults.
Researchers continue to innovate in drug delivery systems that improve the penetration and effectiveness of topical therapies. Novel nanoformulations and sustained-release formulations of anti-inflammatory agents promise to reduce dosing frequency while providing consistent therapeutic levels on the ocular surface. In the near future, these advancements may become an integral part of treating ADDE, reducing the long-term complications associated with chronic inflammation.
Furthermore, improved imaging and diagnostic technologies will allow our dry eye doctors to more accurately assess the state of the lacrimal glands and ocular surface. This objective data will be essential for tailoring treatment plans and monitoring the efficacy of new therapies.
The future of ADDE management is moving toward more personalized and precise interventions. By integrating patient feedback, emerging diagnostic techniques, and novel treatment strategies into your care, our dry eye doctors aim to provide the most effective solutions available. This patient-centered model not only improves visual outcomes but also helps ensure that your long-term comfort and quality of life are preserved.
Staying informed about the latest research and developments can empower you as a patient. We encourage you to ask questions and be proactive in discussions with our dry eye doctors, as this partnership is fundamental to managing a chronic condition like ADDE.
Take charge of your eye health today! Our experienced dry eye specialists are ready to diagnose and treat your aqueous-deficient dry eye. Find a top optometrist or ophthalmologist near you with Specialty Vision who can provide personalized solutions based on your specific needs.
Aqueous-deficient dry eye (ADDE) leads to chronic dryness and discomfort. Find out the symptoms, causes, and effective treatments today.
