Objective: Dry eye is a common side effect of PD/PSP and easily manageable, yet its occurrence and debilitating ramifications are often unrecognized. The aim of this paper is to explore and thus provide a comprehensive overview of symptoms, consequences and very general treatment options for colleagues and patients alike.

Background: Patients with Parkinson’s disease (PD) and progressive supranuclear palsy (PSP) suffer from keratoconjunctivitis sicca, also called dry eye (DE) due to rare blinking, reduced tear production and altered composition of tear fluid. This is caused by a physiological dysfunction of the tear drainage. In later stages this can lead to severe visual disturbances with a profound negative impact on quality of life. Therefore early intervention is paramount. If dry eye symptoms are properly recognized during neurological examination patients can be informed accordingly.

Method: Symptoms of dry eye, especially visual disturbances, where identified during admission interviews and examinations of patients with PD and PSP. The questionnaire on non-motor symptoms in Parkinson’s (Nonmotor Symptoms Questionnaire/ (NMSQuest) can be employed to identify dry eye. Treatment was initiated and included artificial tear substitute, ointments or gels. Cases of chronic inflammation of the eyelids were counselled on self-care measures. Frequent check-ups with an ophthalmologist (Sicca Consultation) were always recommended.

Results: Symptoms had a severe negative impact on the quality of life in both patient groups. Artificial tear substitute was already a big relief for many patients and this treatment alone even led to a significant improvement in regards to the spontaneous occlusion of the eyelids (apraxia of the eyelid) in on case of PSP. The negative impact on everyday functioning and quality of life was most notably caused by sensory impairments, visual disturbances and affected edges of the eyelids.

Conclusion: Consistent treatment with artificial tear substitutes, heat, cortisone/cyclosporine or surgery (in severe cases) as well as eye (muscle) training can lead to significant improvements in everyday functioning and overall quality of life.  In addition to heightened attention in neurological diagnostic, close collaboration with ophthalmic colleagues is imperative.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dry-eye-in-parkinsons-disease-symptoms-consequences-and-treatment-options/