What is Dry Eye Disease?Disease of ocular surface caused bydisturbances of natural function andprotection of external eye leading to anunstable tear film when eye is open
Prevalence of Dry Eye DiseaseAverage age of a dry eye patient is 54; most are women.Dry Eye Syndrome affects 75% of people over age 65.Common reason for ophthalmologist visits.
Normal tearing depends on a neuronal feedback loop Secretomotor Nerve ImpulsesLacrimal Glands Tears Support and Maintain Ocular Surface Ocular Surface Neural Stimulation
Inflammation disrupt normal neuronalLacrimal Glands: control of tearing.• Neurogenic Interrupted Secretomotor Inflammation Nerve Impulses• T-cell Activation• Cytokine Secretion into Tears Tears Inflame Ocular Surface Cytokines Disrupt Neural Arc
A complex mixture of proteins, mucin, and electrolytes Antimicrobial proteins: Lysozyme, lactofer rin Growth factors & suppressor s of inflammation: EGF, IL-1RA Soluble mucin 5AC secreted by goblet cells for viscosity Electrolytes for proper osmolarity
Decrease in many proteins Decreased growth factor concentrations Altered cytokine balance promotes inflammation Soluble mucin -5AC g reatly decreased Due to goblet cell loss Impacts viscosity of tear film Pr oteases activated Increased electrolytes
AQUEOUS TEAR DEFICIENCY: also known as KCS seen in 1.congenital alacramia 2.paralytic hyposecretion 3.1˚& 2˚ sjogrens disease 4.Riley day syndrome 5.Idiopathic• MUCIN DEFICIENCY: occurs when goblet cells damaged 1.hypovitaminosis A 2.trachoma 3.chemical burns & radiations 4.ocular pemphigoid, SJS
LIPID DEFICIENCY:Rare phenomenaCongenital anhydrotic ectodermal dysplasia with absence of meibomian glandsChronic blepharitis and chronic meibomitisIMPAIRED EYELID FUNCTION:.Bells palsy .Lagophthalmus.Exposure keratitis .ectropion.Dellen.Sympblepheron
EPITHELIOPATHIES:Alteration in cor neal epithelium
Medications T hat MayContributeto Dr y Eye DiseaseSystemic Antihyper tensives • Topical Antiandr ogens – Preservatives in Anticholiner gics Tears Antidepr essants Antiar rhythmic Dr ugs Par kinson’s Disease Agents Antihistamines
SYMPTOMSIr ritationFor eign body sensationItchingNon specific ocular discomfor tChr onicall y sor e eyes not responding to variety of dr ops instilled
SIGNSString y mucus and par ticulate matter in tear filmLustureless ocular surfaceConjunctival xer osisCor neal changes - punctate epithelial er osions and filaments
Patient Types with HighIncidence of Dr y EyeDisease Women aged 50 or older Women using postmenopausal hor mone replacement therapy T hose with ocular comorbidities Contact lens wearer s Smoker s 1 Schaumberg et al. Am J Ophthalmol. 2003; 2 Schaumberg et al. JAMA. 2001; 3 Lemp. CLAO J. 1995; 4 Multi-Sponsor Surveys, Inc. The 2005 Gallup Study of Dry Eye Sufferers. 2005.
DRY EYESYNDROMES XEROSIS(XEROPHTHALMIA) Dry lustureless condition of conjunctiva due to deficiency of mucin LOCAL OCULAR GENERAL DISEASE AFFECTIONa) Trachoma , burns, Deficiency of vitamin A pemphigoid, diphtheriaCicatricial degeneration Occurrence of bitots of conjunctival spots epitheliumb) Ectropion or proptosis
KERATOCONJUNCTIVITIS SICCA: deficiency of aqueous component of tear s i.e lacrimal tear s primar y secondar ykcs & xer ostomia kcs & rheumatoid ar thritis Pathologically focal accumulation & infiltr ation with l ymphocytes & plasma cells Tear lysozyme r atio of 0.1 -> KCS
DIAGNOSIS1.TEAR FILM BREAK UP TIME(BUT): interval between complete blink & appearance of first randomly distributed dry spot on corneaAfter instilling drops of fluorescein dye, examintion under SLE is carried out with cobalt blue light NORMAL – 15 -35 SECONDS <10 SECS- UNSTABLE TEAR FILMBUT- an indicator of adequacy of mucin component
Schirmer Test: 5 * 35 mm strip of w hatman 41 filter paper folded 5mm fr m one end kept in lower for nix at jn of lateral 1/3 rd & medial 2/3 rd NORMAL >15mm MILD TO MODERATE KCS 5-10 mm
ROSE BENGALSTAININGUseful for detecting even mild cases
4. Restasis ™ Ophthalmic emulsion of cyclosporine 0.05%. Prescription therapy for dry eye disease. Restasis™ is FDA approved to increase tear production in patients whose tear production may be reduced by inflammation of the eye associated with keratoconjunctivitis sicca.
5.PRESERVATION OF EXISTING TEARS BY REDUCING DECREASING EVAPORATION DRAINAGE: 1. Room temperature 1.Collagen implants 2. Moist chambers 2.Electrocauterisation 3. Protective glasses 3.Cyanoacrylate tissue adhesives 4.Argon laser & surgical occlusions.