Dry eye disease (DED) causes discomfort for millions of people worldwide. Around US$2.2 billion will be spent by people to combat the symptoms of DED (itching, redness, pain and blurred vision) by 2020.1 However, the pathophysiology and etiology of DED is complex and remains unclear.

DED is one of the most common ocular complaints but it's not as simple as it sounds. DED is a disorder of the tears and ocular surface that results in eye discomfort, visual disturbance, and often ocular surface damage. Producing insufficient tears is only one of several possible causes.

  • Five to 30 percent of adults aged 50 years or older have some degree of DED.2 It is more common in women than men and the prevalence is higher in Hispanic and Asian populations.2
  • Possible symptoms of DED include sore, watery, red eyes and scratchy, burning/stinging sensations on the eye.
  • Common risk factors of DED have been identified. Examples of these include: older age, female gender; post-menopausal oestrogen therapy; a diet low in omega 3 essential fatty acids; refractive surgery; vitamin A deficiency; radiation therapy; some systemic conditions, and certain classes of medications.

Ointment for dry eye disease

While the tiny meibomian glands in our eyelids secrete a substance (meibum) to protect and prevent our eyes from drying out, when they aren’t functioning properly dry eye disease (DED) can be the result. In fact, meibomian gland dysfunction (MGD) is the leading cause of DED.

Our researchers are now investigating whether bacteria might be the key to unlocking the mystery of DEDand developing better treatments. They are looking into the microbial community, the ‘ocular microbiome’, that inhabits the eye’s surface, to determine if it plays a role in the development of MGD. A change to the balance of this ‘commensal’ community may lead to eyelid inflammation, changes to the composition of the eye’s tears or to the quality of meibum produced by the gland.

We are developing a bacterial lipase inhibitor ointment that can work to rebalance a healthy ocular microbiome and deliver increased ocular comfort and reduced DED.

Dr Judith Flanagan
(Project Manager) BSc (Hons), Dip Ed, PhD, ELS

Judith is Leader of the Ocular Comfort program and Science Writer at Brien Holden Vision Institute and a Senior Visiting Fellow at the School of Optometry and Vision Science, University of New South Wales Sydney (UNSW).

Judith completed her BSc Honours degree in Genetics and Biochemistry at Sydney University before moving to California to participate in the International Human Genome Consortium that published the first complete human genome sequence. She returned to Australia to complete her PhD in Medicine in 2003 at the Garvan Institute of Medical Research, then undertook a Postdoctoral Fellowship at the University of California at Berkeley, followed by an Assistant Professorship in the Department of Anaesthesiology at the University of California, San Francisco.

In 2007, she moved back to Australia to work as Science Writer for the Brien Holden Vision Institute.
Her research interests arise from the translation of microbial ecology to the realm of human health and disease, with her current research in the area of dry eye disease. Judith is a member of various professional science writing organizations and is an accredited editor from the Board of Editors in the Life Sciences USA. She is a regular reviewer for a range of journals, has over 40 peer-reviewed publications, including Science, Nature and Lancet articles, and one book chapter.

Technology developed by Brien Holden Vision Institute and used in this project include:
  • Liquid Jet Aesthesiometer
  • Electronic Vision Charts
  • Custom Clinical Database



Efforts to diagnose, treat and understand the underlying causes of ocular discomfort have been hindered by a lack of suitable methods to quantify ocular sensitivity. Traditional instruments are either inaccurate, difficult to use or not generally available. Our technology group has developed a new instrument, based on the liquid jet concept, to measure ocular sensitivity, which can potentially enable practitioners to quickly measure discomfort and inform their diagnosis and treatment recommendations.3

The instrument does this by propelling small droplets of sterile liquid through a micro-valve onto the surface of the eye. The instrument conveniently attaches to any slit lamp and is easy to use by unskilled operators. A complete measurement takes 2-3 minutes. With both the patient and the operator being masked to the applied stimuli, more reliable results can be achieved. This new method of corneal stimulation with its well defined stimulus location and options to stimulate thermal and chemical receptors in the eye, opens a wide range of new applications, ranging from detecting abnormalities in corneal sensation to diagnosing corneal diseases and monitoring the effectiveness of treatment options.


1. Global Industry Analysts, Artificial tears – a global strategic business report, 2016.
2. International Dry Eye WorkShop Subcommittee, 2007, ‘The epidemiology of dry eye disease: Report of the epidemiology subcommittee of the International Dry Eye WorkShop (2007), The Ocular Surface, April 2007, Vol 5 (2).
3. Klaus Ehrmann, Mou Saha, Darrin Falk, 2017, A novel method to stimulate mechanoreceptors and quantify their threshold values. Biomedical Physics & Engineering Express. In press: https://doi.org/10.1088/2057-1976/aa9b8d