A review for medical students

1. DRY EYE
DIAGNOSIS AND
MANAGEMENT
By: Qurat-ul-ain
Ophthalmic Medical
Technologist/ MBA Health
& Hospital management

2. DRY EYE
 It is a condition in which a person does not have
enough quality tears to lubricate and nourish the eye.
Tears are necessary for maintaining the health of the
front surface of the eye and for providing clear vision.
 It is a common and often chronic condition in older
adults.

3. ROLE OF TEARS IN DRY EYE SYNDROME
 With each blink of the eye lids, tears spread across the
front surface of the eye, known as the cornea.
 Tears provide lubrication, reduce the risk of eye infection,
wash away foreign matter in the eye and keep the surface of
the eye smooth and clear. Excess tears in the eyes flow
in to a small drainage ducts in the inner corners of the
eyelids which drain into the back of the nose.
 Dry eye occurs when tear production and drainage is not
balance.

4. ETIOLOGY
 Idiopathic
 Lifestyle related
 Connective tissue disorders
 Conjunctival scarring
 Drugs
 Infiltration of lacrimal glands
 Post-radiation fibrosis of the lacrimal
glands
 Vitamin A deficiency
 After corneal refractive surgery

5. SYMPTOMS
Patient with dry eyes may experience:
 Irritated, gritty, scratchy or burning eyes
 Foreign body sensation
 Excess watering and blur vision
 Light sensitivity
 Stringy mucous near the eye

6. WORK-UP
 History and external examination
 Slit lamp examination with fluorescein
stain
 Schirmer test
 Measurement of tear osmolarity & level
of matrix metalloproteinase-9 (MMP-9)
 Consider screening for Sjogren
syndrome.

7. SIGNS
 Scanty or irregular tear meniscus seen
at the inferior eye lid margin.
 Decreased tear break-up time
 Punctate corneal or conjunctival
fluorescein, rose Bengal usually inferiorly
or in the inter-palpebral area.
 Excess mucous or debris in the tear film
and filaments on the cornea.

8. TREATMENT
Mild dry eye
Artificial tears q.i.d
Moderate dry eye  It takes 1-3 months for
significant clinical
improvement.
 To hasten improvement
& lessen side effects treat
pts concomitantly with a
mild topical
corticosteroid drop (e.g.
loteprednol 0.5%) b.i.d to
q.i.d for 1-month while
beginning cyclosporin
therapy.
 If these measures does
not work consider punctal
occlusion.
 Collagen inserts:
temporary
 Silicone or acrylic plug:
reversible
 Any inflammatory
component is treated
prior to punctal occlusion.
 Artificial tears q1-2h,
use preservative free
artificial tears.
 Lubricating ointment
or gel q.h.s
 Lifestyle modification
 Cyclosporin 0.05%
b.i.d is effective for
patients with chronic
dry eye and decrease
tears secondary to
ocular inflammation.

9. Severe dry
eye
 Cyclosporin 0.05%
 Punctal occlusion
 Preservative free
artificial tears q1-2h.
 Consider permanent
occlusion by thermal
cautery if plugs fall out.
 Add lubricating
ointment or gel b.i.d to
q.i.d
 Moisture chamber or
goggles with
lubrication at night.
 If mucous strands
present remove with
forceps and consider
10% acetylcysteine
q.i.d.
 Other therapies: oral
flaxseed oil, oral
omega 3 fatty acid,
autologous serum
tears, topical vitamin
A, BCL, or a scleral
lens.
 Permanent laser
tarsorrhaphy,
 If all measures fail
consider adhesive
tape tarsorrhaphy,
pending a surgical
tarsorrhaphy.

10. PREVENTION
Following steps can be taken to reduce symptoms of dry eyes.
• Blink regularly when doing near work for a long period of time.
• Increase the humidity in air.
• Wear sunglasses outdoor
• Take nutritional supplements containing essential fatty acids
• Drink plenty of water
• Avoid air getting blown in your eyes
• Avoid environments drier than normal.

11. RESOURCES
• South Asian edition of The Wills Eye Manual, 7th edition.
• https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/dry-eye?sso=y
• https://www.aao.org/eye-health/diseases/what-is-dry-eye

12. THANK YOU!