dry eye

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Dry Eye

7/17/2019 Dry Eye


Dry eye

http://www.virtualcancercentre.

7/17/2019 Dry Eye


Tear and the Tear Film

• Function :

1.Cleaning

2.Wetting ocular surace !."acteriostasis

#.$upporting the cornea

%o&ygen supply'

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Dry Eye(ealthy tear

)lm

Dry eye

Tear flm disorders *+ueous tear de)ciency ,ipid tear de)ciency

-ucoprotein de)ciency inetic disorders o

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• The dry eye is not a disease entity0ut a symptom comple& occurring asa se+uelae to de)ciency or

anormalities o the tear )lm.

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Etiology

• 1. Aqueous tear defciency. t isalso 3nown as keratoconjunctivitissicca. t is seen in conditions li3e

congenital alacrimia0 paralytichyposecretion0 primary andsecondary $4ogren5s syndrome0 6iley

Day syndrome and idiopathichyposecretion.

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• 2. Mucin defciency dry eye. toccurs when golet cells aredamaged0 as in hypovitaminosis *

%&erophthalmia' and con4unctivalscarring diseases such as $tevens7

8ohnson syndrome0 trachoma0

chemical urns0 radiations and ocularpemphigoid.

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• 3. Lipid defciency andabnormalities. ,ipid de)ciency ise&tremely rare. t has only een

descried in some cases o congenitalanhydrotic ectodermal dysplasia alongwith asence o meiomian glands.

(owever0 lipid anormalities are +uitecommon in patients with chroniclepharitis andchronic meiomitis.

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• 4. Impaired eyelid unction. t is seenin patients with "ell5s palsy0 e&posure3eratitis0 dellen0 symlepharon0

pterygium0 nocturnal lagophthalmos andectropion.

• 5. Epitheliopathies. 9wing to theintimate relationship etween the corneal

surace and tear )lm0 alterations incorneal epithelium aect the staility otear )lm.

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• Symptoms suggestive o dry eye includeirritation0 oreign ody %sandy' sensation0eeling o dryness0 itching0 non7speci)c oculardiscomort and chronically sore eyes notresponding to a variety o drops instilled earlier.

• Signs o dry eye include: presence o stringymucus and particulate matter in the tear )lm0lustureless ocular surace0 con4unctival &erosis0reduced or asent marginal tear strip andcorneal changes in the orm o punctateepithelial erosions and )laments.

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Tear flm breakup !"#T$

• t is the interval etween a complete lin3and appearance o )rst randomly distriuteddry spot on the cornea. t is noted ater

instilling a drop o uorescein and e&aminingin a coalt7lue light o a slit7lamp.

• ";T is an indicator o ade+uacy o mucincomponent o tears.

• ts normal values range rom 1< to !<seconds. =alues less than 1> seconds implyan unstale tear )lm.

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Tear rea37up time0 ";T

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SchirmerI test

• t measures total tear secretions. t is perormed withthe help o a < ? !< mm strip o Whatman7#1 )lterpaper which is olded < mm rom one end and 3ept inthe lower orni& at the 4unction o lateral one7third

and medial two7thirds. The patient is as3ed to loo3up and not to lin3 or close the eyes %Fig. 1<.#'.

• *ter < minutes wetting o the )lter paper strip romthe ent end is measured.

•

@ormal values o $chirmer7 test are more than 1<mm. =alues o <71> mm are suggestive o moderateto mild 3eratocon4unctivitis sicca %C$' and less than< mm o severe C$.

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%ose "engal staining

• t is a very useul test or detecting evenmild cases o C$. Depending upon theseverity o C$ three staining patterns *0

" and C have een descried: AC5 patternrepresents mild or early cases with )nepunctate stains in the interpalperalareaB A"5 the moderate cases with

e&tensive stainingB and A*5 the severecases with conuent staining ocon4unctiva and cornea.

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Treatment

• *t present0 there is no cure or dry eye. Theollowing treatment modalities have een triedwith variale results:

1. Supplementation &ith tear substitutes.*rti)cial tears remains the mainstay in thetreatment o dry eye. These are availale asdrops0 ointments and slowrelease inserts. -ostly

availale arti)cial tear drops contain eithercellulose derivatives %e.g.0 >.2< to >. methylcellulose and >.! hypromellose' or polyvinylalcohol %1.#'.

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2. Topical cyclosporine %>.><0 >.1'is reported to e very eective drug ordry eye in many recent studies. t helps

y reducing the cell7mediatedinammation o the lacrimal tissue.

3. Mucolytics, such as < percent

acetylcystine used # times a day helpy dispersing the mucus threads anddecreasing tear viscosity.

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4. Topical retinoids have recently een reported to euseul in reversing the cellular changes %s+uamousmetaplasia' occurring in the con4unctiva o dry eyepatients.

5. 'reser(ation o e)isting tears by reducinge(aporation and decreasing drainage. Evaporationcan be reduced y decreasing room temperature0 use omoist chamers and protective glasses.

*.'unctal occlusion to decrease drainage can e

carried out y collagen implants0 cynoacrylate tissueadhesives0 electrocauterisation0 argon laser occlusion andsurgical occlusion to decrease the drainage o tears inpatients with very severe dry eye.

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-eiomian land Dysunction%-D'

• Failure o the glands toproduce or secrete lipids.

• Common in aged peopleand who lived in cold

region.• @o speci)c symptoms.

• ,id7margin mostlythic3eningB anormal

secretion whilepressuriing.

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Diagnosing

•*sence o -eiomian gland.

• The gland ori)ces are oten compromised due to

stenosis or closure.

•* declining +uality and +uantity o lipid secretion.

*nyone o the physical signs can ma3e the

diagnosis o -eiomian gland dysunction i the

patient has clinical symptoms.

Figure: @o visile meiomian glandori)ces: Eversion o the lower lids in otheyes showed atresic meiomian glands.

http://www.ophmanagement.

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Treatment

Clearing

• (ot omentation on eyelids or <G1>mins.

• -assaging the eyelids.

•$waing the lid7margin with mild cleaning solution.

*ntiiotics oral administration.

,ocal -edication

• *ntiiotic eye drops

• lucocorticoid eye drops %short term'

• *rti)cial tears

dry eye

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