DRY EYE SYNDROME
TEAR FILM <ul><li>Total thickness </li></ul><ul><li>(7-10 µm) </li></ul><ul><li>Mucus layer </li></ul><ul><li>(0.02- 0.04 ...
ELEMENTS OF OCULAR DEFENCE Stable precorneal tear film Compositional  factors Hydrodynamic factor <ul><li>Lipid </li></ul>...
DEFINITION <ul><li>Dry eye is a  disorder of the tear film due to tear deficiency or excessive tear evaporation  which cau...
VICIOUS CYCLE OF  DRY EYE Loss of goblet cells Absence of mucin Tear film  destabilizes KCS VICIOUS CYCLE
CLASSIFICATION <ul><li>Tear-deficient dry eye: </li></ul><ul><ul><li>There is a disorder of lacrimal function or a failure...
TEAR - DEFICIENT   Sjogren syndrome   Non- Sjogren tear deficient   Primary   Lacrimal  Disease   Lacrimal obstruction Ref...
EVAPORATIVE   Oil  deficient Lid related Contact lens  Ocular surface  disorder  Primary Absent  glands Distichiasis Secon...
EVAPORATIVE Blephritis Meibomian gland dysfunction Allergic conjunctivitis
LID RELATED Lid surface  incongruity Lagophthalmos
CLINICAL MANIFESTATION <ul><li>Burning or itching   </li></ul><ul><li>Fluctuating vision   </li></ul><ul><li>Foreign body ...
DIAGNOSIS <ul><li>Slit lamp examination </li></ul><ul><li>Demonstration of  tear instability  (Tear film break up time, TB...
DIGNOSTIC METHODS   <ul><li>Slit lamp examination </li></ul><ul><ul><li>Tear film meniscus  area (look for a decrease <0.1...
DIGNOSTIC METHODS   <ul><li>Slit lamp examination </li></ul><ul><ul><li>Corneal surface  (look for punctate erosions, cour...
TEAR FILM MENISCUS <ul><li>Evaluate the  height of the prism  at the lower lid margin </li></ul><ul><li>The normal tear me...
<ul><li>A generalized decrease in tear volume will be represented as an  absent or very thin  line of fluorescein  </li></...
TEAR FILM INSTBILTY <ul><li>Fluorescein Tear Breakup time (FBUT) </li></ul><ul><li>Non-invasive   </li></ul><ul><ul><li>Te...
TEAR FILM INSTBILTY <ul><li>Fluorescein Tear Breakup time (FBUT) </li></ul><ul><ul><li>Index of precorneal tear film stabi...
TEAR FILM INSTBILTY <ul><li>Abnormal (FBUT) </li></ul><ul><li>Mucin-deficient states especially cause a rapid BUT   </li><...
TEAR FILM INSTBILTY Tearscope Bad tears
OCULAR SURFACE DAMAGE <ul><li>Schirmer’s test </li></ul><ul><li>Fluorescein Staining  </li></ul><ul><li>Rose bengal stain ...
SHIRMER’S TEST <ul><li>Measurement of the  aqueous layer   quantity  only </li></ul><ul><li>5x30 strips of  Whatman filter...
SCHIRMER’S TEST - I   <ul><li>Measures total reflex and basic tear secretion  </li></ul><ul><li>Results:   </li></ul><ul><...
FLUORESCEIN STAINING  <ul><li>Punctate staining is recorded </li></ul>
ROSE BENGAL STAIN <ul><li>Highlights areas of  desiccation and keratinization  </li></ul>3 and 9’o clock staining Inferior...
LISSAMINE GREEN STAINING
TEAR HYPEROSMALRITY    Aqueous/lipid layer Tear hyperosmolarity Squamous metaplasia Loss of Goblet cells Ocular surface d...
TEAR HYPEROSMALRITY <ul><li>Tear film osmolarity  > 312 mOsm/ L  is considered abnormal  </li></ul>
HISTOLOGICAL TESTS   <ul><li>Cellulose acetate filter  discs are pressed onto the conjunctival surface and then removed  <...
TREATMENT <ul><li>Artificial tear solutions  </li></ul><ul><li>Artificial tear inserts  </li></ul><ul><li>Ointments  </li>...
TREATMENT <ul><li>Artificial tear solutions   </li></ul><ul><li>Main stay of treatment  for dry eyes  </li></ul><ul><li>Ha...
PUNCTAL OCCLUSION <ul><li>Sandy-gritty irritation  </li></ul><ul><li>A rose bengal staining pattern characteristic of aque...
OTHERS <ul><li>Topical cyclosporine (0.05%, 0.1%)  </li></ul><ul><li>Oral cholinergic agents  </li></ul><ul><li>Lateral ta...
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Dry eye syndrome

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Dry eye syndrome

  1. 1. DRY EYE SYNDROME
  2. 2. TEAR FILM <ul><li>Total thickness </li></ul><ul><li>(7-10 µm) </li></ul><ul><li>Mucus layer </li></ul><ul><li>(0.02- 0.04 µm) </li></ul><ul><li>Aqueous layer </li></ul><ul><li>(6.5 µm) </li></ul><ul><li>Lipid layer </li></ul><ul><li>(0.1 µm) </li></ul>
  3. 3. ELEMENTS OF OCULAR DEFENCE Stable precorneal tear film Compositional factors Hydrodynamic factor <ul><li>Lipid </li></ul><ul><li>Aqueous </li></ul><ul><li>Mucin </li></ul><ul><li>Lid blinking </li></ul><ul><li>Lid closure </li></ul><ul><li>Meibomian gland </li></ul><ul><li>Lacrimal gland </li></ul><ul><li>Ocular surface </li></ul><ul><li>epithelium </li></ul><ul><li>Tear spread </li></ul><ul><li>Tear clearance </li></ul><ul><li>Prevents </li></ul><ul><li>evaporation </li></ul>
  4. 4. DEFINITION <ul><li>Dry eye is a disorder of the tear film due to tear deficiency or excessive tear evaporation which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort </li></ul>
  5. 5. VICIOUS CYCLE OF DRY EYE Loss of goblet cells Absence of mucin Tear film destabilizes KCS VICIOUS CYCLE
  6. 6. CLASSIFICATION <ul><li>Tear-deficient dry eye: </li></ul><ul><ul><li>There is a disorder of lacrimal function or a failure of transfer of lacrimal fluid into the conjunctival sac </li></ul></ul><ul><li>Tear-sufficient dry eye: </li></ul><ul><ul><li>Lacrimal function is normal, the tear abnormality is due to increased tear evaporation </li></ul></ul>
  7. 7. TEAR - DEFICIENT Sjogren syndrome Non- Sjogren tear deficient Primary Lacrimal Disease Lacrimal obstruction Reflex Secondary Rh arthritis SLE Wegener’s Granulomatosis Systemic sclerosis Primary Cong alacrimia Primary lacrimal disease Secondary Sarcoid HIV Vit A def Trachoma Pemphigoid Burns Contact lens VII n Palsy Neurop- keratitis
  8. 8. EVAPORATIVE Oil deficient Lid related Contact lens Ocular surface disorder Primary Absent glands Distichiasis Secondary Blepharitis Meibomian gland disease Blink, Aperture abnormal Lid surface incongruity Xerophthalmia
  9. 9. EVAPORATIVE Blephritis Meibomian gland dysfunction Allergic conjunctivitis
  10. 10. LID RELATED Lid surface incongruity Lagophthalmos
  11. 11. CLINICAL MANIFESTATION <ul><li>Burning or itching   </li></ul><ul><li>Fluctuating vision   </li></ul><ul><li>Foreign body sensation   </li></ul><ul><li>Grittiness or irritation    </li></ul><ul><li>Sore or tired eyes   </li></ul><ul><li>History of Styes   </li></ul><ul><li>Ocular discharge   </li></ul><ul><li>Light sensitivity   </li></ul><ul><li>Contact lens discomfort </li></ul><ul><li>Watering or excessive tearing </li></ul>
  12. 12. DIAGNOSIS <ul><li>Slit lamp examination </li></ul><ul><li>Demonstration of tear instability (Tear film break up time, TBUT ) </li></ul><ul><li>Demonstration of ocular surface damage </li></ul><ul><li>Demonstration of tear hyperosmolarity </li></ul>
  13. 13. DIGNOSTIC METHODS <ul><li>Slit lamp examination </li></ul><ul><ul><li>Tear film meniscus area (look for a decrease <0.1 mm in thickness) </li></ul></ul><ul><ul><li>Tear film itself (look for debris) </li></ul></ul><ul><ul><li>Conjunctival surface (look for increased mucous strands) </li></ul></ul>
  14. 14. DIGNOSTIC METHODS <ul><li>Slit lamp examination </li></ul><ul><ul><li>Corneal surface (look for punctate erosions, course mucous plaques, or filamentary keratitis) </li></ul></ul><ul><ul><li>Look for coexisting eyelid disease such as seen in meibomian gland dysfunction </li></ul></ul>
  15. 15. TEAR FILM MENISCUS <ul><li>Evaluate the height of the prism at the lower lid margin </li></ul><ul><li>The normal tear meniscus height is between 0.2 and 0.5 mm </li></ul>
  16. 16. <ul><li>A generalized decrease in tear volume will be represented as an absent or very thin line of fluorescein </li></ul>DECREASED TEAR FILM MENISCUS
  17. 17. TEAR FILM INSTBILTY <ul><li>Fluorescein Tear Breakup time (FBUT) </li></ul><ul><li>Non-invasive </li></ul><ul><ul><li>Tearscope/ Xeroscope </li></ul></ul>
  18. 18. TEAR FILM INSTBILTY <ul><li>Fluorescein Tear Breakup time (FBUT) </li></ul><ul><ul><li>Index of precorneal tear film stability </li></ul></ul><ul><ul><li>Interval between the last blink and the appearance of the first randomly </li></ul></ul><ul><ul><li>distributed dry spot </li></ul></ul><ul><ul><li>BUT of <10sec is abnormal </li></ul></ul>
  19. 19. TEAR FILM INSTBILTY <ul><li>Abnormal (FBUT) </li></ul><ul><li>Mucin-deficient states especially cause a rapid BUT </li></ul>
  20. 20. TEAR FILM INSTBILTY Tearscope Bad tears
  21. 21. OCULAR SURFACE DAMAGE <ul><li>Schirmer’s test </li></ul><ul><li>Fluorescein Staining </li></ul><ul><li>Rose bengal stain </li></ul><ul><li>Lissamine Green Staining </li></ul>
  22. 22. SHIRMER’S TEST <ul><li>Measurement of the aqueous layer quantity only </li></ul><ul><li>5x30 strips of Whatman filter paper </li></ul><ul><li>The amount of moistening is of the exposed paper is recorded at the end of 5minutes </li></ul>
  23. 23. SCHIRMER’S TEST - I <ul><li>Measures total reflex and basic tear secretion </li></ul><ul><li>Results: </li></ul><ul><li>Normals will wet approximately 10 to 30mm at the end of 5minutes. </li></ul><ul><li>If wetting > 30 mm , reflex tearing is intact but not controlled or tear drainage is insufficient </li></ul><ul><li>A value of <5mm indicates </li></ul><ul><li>hyposecretion </li></ul>
  24. 24. FLUORESCEIN STAINING <ul><li>Punctate staining is recorded </li></ul>
  25. 25. ROSE BENGAL STAIN <ul><li>Highlights areas of desiccation and keratinization </li></ul>3 and 9’o clock staining Inferior staining Filaments
  26. 26. LISSAMINE GREEN STAINING
  27. 27. TEAR HYPEROSMALRITY  Aqueous/lipid layer Tear hyperosmolarity Squamous metaplasia Loss of Goblet cells Ocular surface damage
  28. 28. TEAR HYPEROSMALRITY <ul><li>Tear film osmolarity > 312 mOsm/ L is considered abnormal </li></ul>
  29. 29. HISTOLOGICAL TESTS <ul><li>Cellulose acetate filter discs are pressed onto the conjunctival surface and then removed </li></ul><ul><li>Examined for morphological abnormalities such as a determination of goblet cell densities, squamous metaplasia, and keratinization </li></ul>Impression cytology Normal Decreased goblet cells
  30. 30. TREATMENT <ul><li>Artificial tear solutions </li></ul><ul><li>Artificial tear inserts </li></ul><ul><li>Ointments </li></ul><ul><li>Mucolytic agents </li></ul><ul><li>Punctal occlusion </li></ul><ul><li>Bandage contact lens </li></ul><ul><li>Moisture chambers </li></ul>
  31. 31. TREATMENT <ul><li>Artificial tear solutions </li></ul><ul><li>Main stay of treatment for dry eyes </li></ul><ul><li>Have a polymeric agent such as polyvinyl alcohol, methylcellulose, or dextran to increase viscosity </li></ul><ul><li>Ointments </li></ul><ul><li>Petrolatum based ointments relieve the symptoms, primarily through lubrication </li></ul><ul><li>Mucolytic agents </li></ul><ul><li>N-acetylcysteine 5% --- corneal filaments and mucus plaques </li></ul>
  32. 32. PUNCTAL OCCLUSION <ul><li>Sandy-gritty irritation </li></ul><ul><li>A rose bengal staining pattern characteristic of aqueous tear deficiency </li></ul><ul><li>Elevated tear film osmolarity </li></ul>
  33. 33. OTHERS <ul><li>Topical cyclosporine (0.05%, 0.1%) </li></ul><ul><li>Oral cholinergic agents </li></ul><ul><li>Lateral tarsorraphy </li></ul>
  34. 34. Thank you
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