dry eye syndrome: diagnosis & management by dr vidushi sharma & dr suresh k pandey suvi eye...

7/31/2019 Dry Eye Syndrome: Diagnosis & Management by Dr Vidushi Sharma & Dr Suresh K Pandey SuVi Eye Institute Kota India

1/47

Mcfmi pa k`fp De}pkx }{hpfpck }pvckG{cv 86pl 8>58

@x* _f`{}lf ]lexde# D@# OXM] ,[I&

MDK aj MaxjkeG{cv 86pl 8>58

@xv Kvk ]vj`xadk

@x* _f`{}lf ]lexde#D@# ,EFFD] OXM]

,[I&@x ]{xk}l I ^ej`kv]{_f Kvk La}~fpec /Ce}fi Ce}kx Mkjpkx#

Iape# FJ@FErrr*}{fkvk*mad

Kdefc7}{fkvkNbdefc*mad
http://www.suvieye.com/http://www.suvieye.com/


2/47

G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&

@kofjfpfaj

JKF! Fj`{}pxv @xv Kvk Raxi}la~ ,566;&

@f}ax`kx ao pkex ofcd# me{}k` hv pkex `kofmfkjmv axk|mk}}fk ke~axepfaj# rlfml me{}k} `edebk pa am{cex}{xoemk ej` f} e}}amfepk` rfpl }vd~pad} ao am{cex`f}madoaxp @v}o{jmpfaj Pkex ]vj`xadk ,@P]&



3/47


@kofjfpfaj

Fjpkxjepfajec @KR] Xk~axp 7 8>>2

@xv kvk f} e d{cpfoempaxfec `f}ke}k ao plk pkex} ej` am{cex

}{xoemk plep xk}{cp} fj }vd~pad ao `f}madoaxp ej` f}{ec`f}p{xhejmk# ej` pkex ofcd fj}pehfcfpv rfpl ~apkjpfec `edebk

pa am{cex }{xoemk* Fp f} emmad~ejfk` hv fjmxke}k` a}dacexfpv

ao pkex ofcd ej` fjoceddepfaj ao plk am{cex }{xoemk*



4/47


Jaxdec pkex ofcd



5/47


Plk Lkecplv Kvk


Cemxfdec

Bcej`}

]kmxkpadapax

JkxkFd~{c}k}

Pkex} ]{~~axp ej`Defjpefj

Am{cex ]{xoemk

Am{cex ]{xoemkJk{xec

]pfd{cepfaj

]pkxj kp ec# Maxjke*

Jaxdec pkexfjb`k~kj`} aj e

jk{xajec okk`hemicaa~


6/47


O{jmpfaj} ao pkex ofcd

Pa }kk mckex $ ]kxk e} e }daapl ej` mckex a~pfmec}{xoemk

Pa kj}{xk madoaxp $ ^xkkjp `xvjk}} `{xfjb kvk a~kjfjb^xkkjp oxfmpfaj `{xfjb kvkcf` hcfjifjb

Pa defjpefj am{cex }{xoemk k~fplkcfec lkecpl rfpl ~xa~kx`fookxkjpfepfaj $ ^xaf`k a|vbkj pa maxjkec k~fplkcf{d

^xaf`k j{pxfkjp}# kckmpxacvpk}# bxarpl oempax}# ejpf$dfmxahfec} ej` ejpf$a|f`ejp}



7/47


@kmxke}k` }kj}fpffpv

^xa}~kmpfk }p{`v ao 0< ~epfkjp}# maxjkec }kj}fpffpvk|edfjk` eopkx ~lemakd{c}fofmepfaj

Lfblk}p fjmxke}k fj }kj}fpffpv ah}kxk` ep 58amcami# `fxkmpcv hkcar plk maxjkec fjmf}faj

Plf} exke }lark` dexik` lv~a}kj}fpffpv# ecda}pmaxxk}~aj`fjb pa ejk}plk}fe# kkj pfcc 0 dajpl}

Lv~a}kj}fpffpv re} }kkj kkj ep ? amcami

Ecc plxk}lac` ec{k}# kkj ep ? amcami rkxk }pfcclv~a}kj}fpfk eopkx 5 vkex


D Ialclee}# G Mepexemp Xkoxemp ]{xb$_ac 80# Amp*658@x* _f`{}lf ]lexde# D@# OXM] ,[I& G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&


9/47

Mcfmi fmaj pa e`` pehck

G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@#OXM] ,[I&

^xkeckjmk ao @xv Kvk

]p{`v Mkjpxk Ja* ao ~epfkjp} ^xkeckjmk ,+&

Ge~ej 8582 52+

@kjdexi ;>0 55+

[]E 8;8> 5;+

Dkcha{xjk#E{}pxecfe

68? 5?*=+

Fj`fe ;>> 558 ]{x A~lplecdac9 0;,8&7 ]8>=$


10/47


]vd~pad} ej` ]fbj}

Ajcv ;2+ ao }vd~padepfm ~epfkjp} }larj palek ahgkmpfk }fbj} ao `xv kvk}

E }fjbck ahgkmpfk pk}p oax `xv kvk le} cfdfpk` ec{krfpla{p }vd~pad}


FA_]# E~xfc 8>>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&

@xv kvk oaccarfjb mepexemp}{xbkxv



12/47


]vd~pad}

H{xjfjb! ]pfjbfjb# Fxxfpepfaj# Xk`jk}}

]ej`v$ bxfppv okkcfjb ,oaxkfbj ha`v }kj}epfaj&

Pkexfjb# fpmlv kvk}# }pfmifjk}} ,daxjfjb}&

Hc{xxk` f}faj ,oc{mp{epfjb f}faj&

Fjmxke}k` oxku{kjmv ao hcfjifjb

D{ma{} `f}mlexbk*

^lapa~lahfe ,ck}} oxku{kjp }vd~pad&

]vd~pad} rax}kj fj rfj`v ax efx$maj`fpfajk` kjfxajdkjp}*

E} `ev ~xabxk}}k}*

Eopkx ~xacajbk` xke`fjb# raxifjb aj mad~{pkx}G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&


13/47


Mcfjfmec }fbj}

Majg{jmpfec lv~kxkdfe

]decc pkex dkjf}m{}

Pkex ofcd `khxf} ej` Ofcedkjp}#d{m{} }pxej`}

Oe}p pkex hxkei{~ pfdk

^fbdkjp K~fplkcfec Kxa}faj}

Majg{jmpfec }pefjfjb

Dkfhadfej bcej``v}o{jmpfaj!hck~lexfpf}

Mfmepxfwfjb majg{jmpffpf} G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&

Oc{axk}mkfj }pefjfjb }~ap} aj maxjke


14/47


@febja}pfm Paac}

Me}k Lf}paxv

]cfp Ced~ Kec{epfaj

@vk ]p{`fk} ]mlfxdkx}

Pkex Hxkei$[~ Pfdk

Aplkx }a~lf}pfmepk` pk}p} ,xk}kexml paac}&



15/47


@febja}pfm Pk}p}

^lv}facabfm ~xa~kxpv $ mcfjfmec kec{epfaj

Pkex ~xa`{mpfaj $ ]mlfxdkx} pk}p

Am{cex k~fplkcfec lkecpl $ ]pefjfjb Pkex ofcd fj}pehfcfpv PH[P# Pa~abxe~lv# _f`ka

ikxepa}ma~v

Fd~xk}}faj mvpacabv $ Bahckp mkcc `kj}fpv# ]u{eda{}

Dkpe~ce}fe Pkex mad~a}fpfaj# pkex a}dacexfpv

^xapkfj dke}{xkdkjp}



16/47


@kmxke}k` maxjkec }kj}fpffpv

Xk`{mpfaj fj pkex ocar

@kmxke}k` hcfjifjb oxku{kjmv

@kcevk` ra{j` lkecfjb ej` xkk~fplkcfecfwepfaj

Fjmxke}k` k~fplkcfec ~kxdkehfcfpv



17/47


Cf~f` ]kmxkpfaj

Dkfhadfej bcej`}

A{pkx cf~f` cevkx ~xkkjp ke~axepfaj

Xk}pxfmp ke~axepfaj pa ;$5>+ ao pkex ocar

Ec}a lkc~ c{hxfmepk



18/47


Eu{ka{} }kmxkpfaj

Defj ej` emmk}}axv cemxfdec bcej`

E mad~ck| df|p{xk ao ~xapkfj}# d{mfj# kckmpxacvpk} ]fdfcex exmlfpkmp{xk oax defj ej` emmk}}axv bcej`

Majmk~p ao cemxfdec o{jmpfajec {jfp



19/47


D{mfj ]kmxkpfaj

Bahckp mkcc $ ;$8>+ ao majg*

k~fpl* mkcc} exk d{mfj$~xa`{mfjb bahckp mkcc}

^xaf`k f}ma}fpv ej` }pehfcfpv `{xfjb plk hcfji mvmck

Lv`xa~lfcfm

Lkc~ xk}f}p pkex hxkei${~



20/47


Ac`kx mce}}fofmepfaj

Eu{ka{} pkex `kofmfkjmv

D{mfj `kofmfkjmv Cf~f` ehjaxdecfpfk}

Cf` }{xoemfjb ehjaxdecfpfk}

K~fplkcfa~eplfk}



21/47

G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I& G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&


22/47

Mcfmi fmaj pa e`` pehck

G{cv 86pl 8>58 @x* _f`{}lf ]lexde# D@#OXM] ,[I&

@xv Kvk7 Defj Me{}k}

PKEX @KOFMFKJP @XV KVK ,IM]& K_E^AXEPF_K @XV

KVK

a ]gabxkj} a Jaj$]gabxkj}

jEbkfjb

jDkja~e{}k

jDk`fmedkjpa}e

jMfmepxfmfec `f}ke}k

jJk{xapxa~lfmikxepfpf}

a Dkfhadfej bcej`

`f}ke}k

a Cf` }{xoemfjb!hcfjifjb ejadecfk}

a Majpemp ckj}xkcepk`

a Mlxajfmecckxbv!pa|fmfpv

G{cv 86pl 8>58 Mcfj K|~ A~pad 8>>59


23/47


^xk`f}~a}fjb Oempax}

Kc`kxcv# okdeck

Dkja~e{}k# ^a}pdkja~e{}ec LXP

Ecckxbv Xk}~aj}k

Kjfxajdkjpec ]pxk}}k}

Majpemp Ckj} Rkex

Rfj`

Efx ^acc{pfaj Car L{df`fpv7 Lkepfjb!Efx Maj`fpfajfjb

Cemi ao ]ckk~

[}k ao Mad~{pkx Pkxdfjec}



24/47


^xk`f}~a}fjb Oempax}

@xvfjb Dk`fmepfaj}

Mfbexkppk ]daifjb

@D Majjkmpfk pf}}{k `f}ke}k}

_fpedfj E kofmfkjmv

Am{cex ]{xbkxv ,Mepexemp# CE]FI# MaxjkecPxej}~cejp&



25/47


Ecckxbv ej` @xv Kvk

@xv kvk f} maddajcv e}}amfepk` rfpl mlxajfm

ecckxbfm majg{jmpffpf}*

Mlxajfm ecckxbv xk}{cp} fj ca}} ao bahckp mkcc}#

`k}pehfcfwepfaj ao plk pkex ofcd / `edebk pa am{cex

}{xoemk



26/47


Xack ao Fjoceddepfaj fj Mlxajfm @xvKvk

Fjoceddepfaj dev hk ~xk}kjp h{p jap mcfjfmeccve~~exkjp

Mvmck ao fjoceddepfaj ej` `v}o{jmpfaj

Fo {jpxkepk`# fjoceddepfaj mej `edebk plk cemxfdecbcej` ej` am{cex }{xoemk

Maj}ku{kjmk}7

Carkx pkex ~xa`{mpfaj

Ecpkxk` maxjkec hexxfkx o{jmpfaj

G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&^oc{bokc`kx*Ed G A~lplecdac* 8>>0*


27/47

G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I& G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&


28/47


^a}p }{xbkxv `xv kvk

Me{}k ao `f}madoaxp ej` `f}}epf}oempfaj

C{hxfmepfaj fd~axpejp oax ra{j` lkecfjb

C{hxfmepfaj ec}a lkc~o{c fj ~xkkjpfaj ao lewkoaccarfjb }adk xkoxempfk ~xamk`{xk}

Fjmxke}k} plk lecak} ej` bcexk rfpl d{cpfoamec FAC},`kmxke}k` majpxe}p }kj}fpffpv&

Hk}p mlejmk ao }{mmk}} rfpl e`ejmk` FACpkmljacabv fo lkecplv am{cex }{xoemk



29/47


Me{}k}

]{xbfmec pxe{de$ cemi ao c{hxfmepfaj# k~fplkcfec`kokmp}

Fjmf}faj} ep maxjkec ~kxf~lkxv fjg{xk jkxk} Fjoceddepfaj

Dk`fmepfaj} ~xk}kxepfk pa|fmfpv bahckp mkcc}

Kc`kxcv ~xk`f}~a}k` ~epfkjp}

K|~a}{xk pa dfmxa}ma~k cfblp ,Iaxkej G A~lpleec 8>>6&



30/47


^a}}fhck Dkmlejf}d} ao @xv Kvk OaccarfjbMepexemp ]{xbkxv

@x* _f`{}lf ]lexde# D@# OXM] ,[I&Plk Fd~axpejmk ao Dejebfjb plk Am{cex ]{xoemk fj Mepexemp ej` Xkoxempfk ]{xbkxv* Eefcehck ep7lpp~7!!rrr*kvkraxc`*axb!xk~cev!>58


31/47


Dk`fmepfaj}

Ejpfmlacfjkxbfm dk`fmepfaj}

Ejpflv~kxpkj}fk} $ Hkpehcami}# @f{xkpfm}# Dkplvc`a~e

Ejpf`k~xk}}ejp} $ Hkjwa`fewk~fjk}# ^lkjaplfewfjk}#

Pxfmvmcfm ejpf`k~xk}}ejp}

Axec majpxemk~pfk}

^xk}kxepfk fj Pa~fmec `x{b}

Ejpflf}pedfjk Ejpf~exifj}aj `x{b}

Mex`fem ejpfexxlvdfe `x{b}



32/47


Dejebkdkjp

Pkex }{~~ckdkjp} ~xk}kxepfk pa|fmfpv# }fjbck {}ke~~cfme~}# pxej}fkjpcv ~xk}kxk` pkex }{~~ckdkjp}

Afjpdkjp} ~kpxacep{d he}k ~xkkjp `xvjk}}# dev

emp e} OH aj `xvfjb ^acvdkx fj}kxp}

E{pacaba{} }kx{d

^{jmpec ammc{}faj

K}}kjpfec oeppv emf`}# ,Adkbe$= ej` $? KOE}&



33/47


Pkex ]{~~ckdkjp}

Lvec{xajfm emf`

Mkcc{ca}k / dkplvcmkcc{ca}k / plkfx `kxfepfk}7

lv`xa|v~xa~vc Mkcc{ca}klv`xa|vkplvc Mkcc{ca}k

lv`xa|v~xa~vc dkplvcmkcc{ca}k ,L^DM&

Mexha|vdkplvcmkcc{ca}k

âcvfjvc ecmalac 5*0+

âfàjk >*?+

Bcvmkxfj >*=+ / 5+ G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&


34/47


Pkex ]{~~ckdkjp}


âcvdkx ^xa~kxpfk}

Mkcc{ca}k k}pkx} ,lv~xadkcca}k#lv`xa|vkplvcmkcc{ca}k#dkplvcmkcc{ca}k#mexha|vdkplvcmkcc{ca}k&

_f}makce}pfm ~acv}emmlexfk} fjmxke}k f}ma}fpv ao pkex}9cexbk fjmxke}k fj f}ma}fpv rlkj majmkjpxepfaj f}fjmxke}k`

âcvfjvc ecmalac Car f}ma}fpv# a~pfdec rkppfjb ep 5*0+

âcfàjk ,~acvfjvc ~v~xacfàjk& Rkppfjb f} fd~xak` rlkj madhfjk` rfpl ~acvfjvcecmalac

Mexhadkx} ,~acvemxvcfm emf`& Lfbl dackm{cex rkfblp ~acvdkx} ao emxvcfm emf`9lfbl f}ma}fpv rlkj kvk f} }pepfm# pkex plfmijk}}`vjedfmeccv mlejbk} `{xfjb hcfjifjb pa de|fdfwk plk

plfmijk}} ej` cajbkx xkpkjpfaj pfdk plej ~acvfjvcecmalac

Lvecc{xajfm emf`# e{pacaba{} pkex} Bcvma}edfjabcvmej hfa~acvdkx} plep k|lfhfp cajbxkpkjpfaj pfdk}*


35/47


Fjpkxjepfajec Hxej`} fj Fj`fe

Xkoxk}l Pkex} >*;+ MDM rfpl ~{xfpk

Xkoxk}l Cfu{fbkc 5*>+ MDM rfpl ~{xfpk

]v}pejk ~cavkplvckjk bcvmac ej` ~xa~vckjkbcvmac rfpl L^ B{ex,~acvu{epkxjf{d$5 ~xk}kxepfk&

Hcfji Pkex} ^acvkplvckjk Bcvmac rfpl lvec{xajfmemf` ,}a`f{d mlcaxfpk e} ~xk}kxepfk&

Pkex} Jep{xeck FF >*=+ L^DM# Bcvmkxfj# @k|pxejej` ~acvu{e` ~xk}kxepfk

Bkjpkec >*=+ L^DM# }a`f{d ~kxhaxepk

~xk}kxepfk G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&


36/47


Bkc Pkex}

Fjmxke}k` f}ma}fpv fjmxke}k} xkpkjpfaj ej` majpemppfdk rfpl maxjke

Madhfjepfaj ao >*=;+ lfbl f}ma}fpv

ej` >*?;+ dk`f{d f}ma}fpv MDM# }ack}} hc{xxfjb aj fj}pfccepfaj


]a`f{d

^ape}}f{d

Debjk}f{d

Mecmf{d

Mlcaxf`k

L{dejPkex}

58>$5?;

8>$08

>*;$>*6

>*0$5*5

55 5 58


37/47


Xkoxk}l Pkex}

^{xfpk ,fj pkec bxkkj fec& eaf`} ~xk}kxepfkpa|fmfpv


Lv~aPkex} Pkex} Jep{xeck FF Bkjpkec Xkoxk}l Ox


38/47


Dejebkdkjp

^xapkmpfaj oxad `xv rfj`# }{j cfblp# ej` #pa|fm ej`fj`{}pxfec o{dk} ej` }daik}

Mfbexkppk }daik maj}f`kxk` ~a}fpfk fxxfpejp

Caai oax camecfwk` cf`# majg{jmpfec ej` maxjkecehjaxdecfpfk}



39/47


Pkex ]{~~ckdkjp}

Jaj$~xk}kxk` bkp majpedfjepk` fj 80 pa 0< la{x}

Pxej}fkjpcv ~xk}kxk`

maep} plk maxjke rkcc ej` }daaplk} a{p plk am{cex}{xoemk

Lfbl e`lkxkjmk pa am{cex }{xoemk

Ja hc{xxfjb ao f}faj



40/47


Expfofmfec Pkex}

Lv`xabkc} exk plk empfk fjbxk`fkjp}

^acvdkx} kj`ark` rfpl plk ~xa~kxpv ao }rkccfjb {~fj repkx ej` xkpefjfjb daf}p{xk

D{mae`lk}fk ~xa~kxpv fjmxke}k} plkfx xkpkjpfajpfdk fj plk kvk

_f}ma}fpv `kpkxdfjk` hv mlefj ckjbpl ej`majmkjpxepfaj

Lv~apajfm Pkex}



41/47


Lar pa mlaa}k1

Caai oax plk ~xk}kxepfk

Lfblkx f}ma}fpv# vkp eaf` hc{xxfjb aj fj}pfccepfaj

E``k` kckmpxacvpk} kpm* }fdfcex pa jep{xec pkex}



42/47


Kdaccfkjp}

He}k 7 Cejacfj # ^kpxacep{d # dfjkxec afc # Ec}akckmpxacvpk} #{}{eccv ja ~xk}kxepfk} *

[}k` oax 7

]kkxk `xv kvk

K|~a}{xk ikxepa~eplv#

Jfblp pfdk {}k fj `xv kvk*



43/47


]car xkcke}k fj}kxp}

Cemxf}kxp 7 keml xa` majpefj} ;db lv`xa|v~xa~vcmkcc{ca}k ,Fp f} ~xk}kxepfk oxkk &

Fp fdhfhk} repkx # }rkcc} #`f}}ack}# kookmp hkbfj}

eopkx 5 l / xkdefj} oax 5080 l



44/47


Mvmca}~axfj

Kookmp peik} e cajb pfdk

H{xjfjb ej` }pfjbfjb aj fj}pfccepfaj

Fxxfpepfaj }{h}f`k} akx ? dajpl}# h{p dejv ~epfkjp}`f}majpfj{k

Mvmca}~axfjk }fbjfofmejpcv fd~xak` }fbj} ej`}vd~pad} ao `xv kvk# ,oc{axk}mkfj }pefjfjb#

]mlfxdkx }maxk}# hc{xxk` f}faj# cfblp }kj}fpffpv#fpmlfjb# `xvjk}}# jkk` oax expfofmfec pkex}

Fp ec}a `kmxke}k` k|~xk}}faj ao fjoceddepaxvdexikx}# ej` fjmxke}k` bahckp mkcc}*

Exmlfk} A lplecdaca 8>>> Maxjke 8>>>G{cv 86pl 8>58@x* _f`{}lf ]lexde# D@# OXM] ,[I&


45/47


Majmc{}faj}

Jkrkx majmk~p} fj plk kpfa~eplabkjk}f}

Oam{} jar aj plk fjpkx$xkcepfaj}lf~ hkprkkjfjoceddepfaj# `xv kvk ej` fjmxke}k` pkex a}dacexfpv

Ec}a peik mexk ao e}}amfepk` fjoceddepfaj

Ke~axepfk `xv kvk xkcepk` pa kvkcf` ~xahckd}

Cfok}pvck da`fofmepfaj} ec}a fd~axpejp ^a}p }{xbkxv @xv Kvk}



46/47


Pleji Va{


Ja ajk f} raxpl va{x pkex}ej` plk ajk plep f}#rajp deik va{ mxv

@x _f`{}lf ]lexde D@ OXM] ,[I&


47/47

Mcfmi pa k`fp De}pkx }{hpfpck }pvckG{cv 86pl 8>58

@x* _f`{}lf ]lexde# D@# OXM] ,[I&

MDK aj MaxjkeG{cv 86pl 8>58

@xv Kvk ]vj`xadk

@x* _f`{}lf ]lexde#D@# ,EFFD] OXM]

,[I&@x ]{xk}l I ^ej`kv]{_f Kvk La}~fpec /Ce}fi Ce}kx Mkjpkx#

Iape# fj`ferrr*}{fkvk*mad

Kdefc7}{fkvkNbdefc*mad
http://www.suvieye.com/http://www.suvieye.com/

dry eye syndrome: diagnosis & management by dr vidushi sharma & dr suresh k pandey suvi eye...

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