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Dry Eye :


What is Dry Eye Disease?:

What is Dry Eye Disease? Disease of ocular surface caused by disturbances of natural function and protection of external eye leading to an unstable tear film when eye is open

Prevalence of Dry Eye Disease:

Prevalence of Dry Eye Disease Average 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.

The Healthy Eye:

Lacrimal Glands Secretomotor Nerve Impulses Tears Support and Maintain Ocular Surface Ocular Surface Neural Stimulation The Healthy Eye Normal tearing depends on a neuronal feedback loop

Dry Eye Disease:

Lacrimal Glands: Neurogenic Inflammation T-cell Activation Cytokine Secretion into Tears Interrupted Secretomotor Nerve Impulses Tears Inflame Ocular Surface Cytokines Disrupt Neural Arc Inflammation disrupts normal neuronal control of tearing. Dry Eye Disease

Healthy Tears:

Healthy Tears A complex mixture of proteins, mucin, and electrolytes Antimicrobial proteins: Lysozyme, lactoferrin Growth factors & suppressors of inflammation: EGF, IL-1RA Soluble mucin 5AC secreted by goblet cells for viscosity Electrolytes for proper osmolarity

Tears in Chronic Dry Eye:

Tears in Chronic Dry Eye Decrease in many proteins Decreased growth factor concentrations Altered cytokine balance promotes inflammation Soluble mucin -5AC greatly decreased Due to goblet cell loss Impacts viscosity of tear film Proteases activated Increased electrolytes



PowerPoint Presentation:

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 phenomena Congenital anhydrotic ectodermal dysplasia with absence of meibomian glands Chronic blepharitis and chronic meibomitis IMPAIRED EYELID FUNCTION: .Bells palsy . Lagophthalmus .Exposure keratitis . ectropion . Dellen . Sympblepheron


EPITHELIOPATHIES: Alteration in corneal epithelium

Medications That May Contribute to Dry Eye Disease:

Medications That May Contribute to Dry Eye Disease Systemic Antihypertensives Antiandrogens Anticholinergics Antidepressants Antiarrhythmic Drugs Parkinson’s Disease Agents Antihistamines Topical Preservatives in Tears


SYMPTOMS Irritation Foreign body sensation Itching Non specific ocular discomfort Chronically sore eyes not responding to variety of drops instilled


SIGNS Stringy mucus and particulate matter in tear film Lustureless ocular surface Conjunctival xerosis Corneal changes - punctate epithelial erosions and filaments

Patient Types with High Incidence of Dry Eye Disease :

Patient Types with High Incidence of Dry Eye Disease Women aged 50 or older Women using postmenopausal hormone replacement therapy Those with ocular comorbidities Contact lens wearers Smokers 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 EYE SYNDROMES XEROSIS(XEROPHTHALMIA) Dry lustureless condition of conjunctiva due to deficiency of mucin LOCAL OCULAR AFFECTION GENERAL DISEASE Trachoma , burns, pemphigoid , diphtheria Cicatricial degeneration of conjunctival epithelium b) Ectropion or proptosis Deficiency of vitamin A Occurrence of bitots spots

PowerPoint Presentation:

KERATOCONJUNCTIVITIS SICCA: deficiency of aqueous component of tears i.e lacrimal tears primary secondary kcs & xerostomia kcs & rheumatoid arthritis Pathologically focal accumulation & infiltration with lymphocytes & plasma cells Tear lysozyme ratio of 0.1 -> KCS


DIAGNOSIS 1.TEAR FILM BREAK UP TIME(BUT): interval between complete blink & appearance of first randomly distributed dry spot on cornea After instilling drops of fluorescein dye, examintion under SLE is carried out with cobalt blue light NORMAL – 15 -35 SECONDS <10 SECS- UNSTABLE TEAR FILM BUT- an indicator of adequacy of mucin component

Schirmer Test::

Schirmer Test: 5 * 35 mm strip of whatman 41 filter paper folded 5mm frm one end kept in lower fornix at jn of lateral 1/3 rd & medial 2/3 rd NORMAL >15mm MILD TO MODERATE KCS 5-10 mm SEVERE KCS <5mm


ROSE BENGAL STAINING Useful for detecting even mild cases


TREATMENT 1.ARTIFICIAL TEAR DROPS: 0.25 -0.7% methyl cellulose 0.3% hypromellose polyvinyl alcohol 2.MUCOLYTICS: 5% acetylcystine 4times/ day 3.TOPICAL RETINOIDS

4. Restasis™:

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.

PowerPoint Presentation:

5.PRESERVATION OF EXISTING TEARS BY REDUCING EVAPORATION DECREASING DRAINAGE: Room temperature Moist chambers Protective glasses 1.Collagen implants 2.Electrocauterisation 3.Cyanoacrylate tissue adhesives 4.Argon laser & surgical occlusions.

Thank You.:

Thank You.

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