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DRY EYE SYNDROME

  • Background: Dry eye syndrome
  • Types of dry Eye Syndrome
  • Classification of DES.
  • Symptoms
  • Causes & Risk factors of DES
  • Treatment & Medications

DRY EYE SYNDROME Dry eye disease, or keratoconjunctivitis sicca, is among the most frequently established diagnoses in ophthalmology; in India, one in four patients consulting an ophthalmologist complains of the symptoms of dry eye. Although epidemiological studies investigating the prevalence of dry eye disease are rare, published studies indicate that up to 20% of adults aged 45 years or more experience dry eye symptoms. Recent studies have shown that immunologic changes play a role in the pathogenesis of dry eye, not only in Sjögren’s syndrome, but also in postinfectious and age-related conditions. Despite increasing understanding of the pathogenic factors involved in dry eye disease, there has been a lack of consensus on diagnostic criteria, classification of disease states, and the aims and interpretation of specific diagnostic tests. There is a need, therefore, for standardization of disease terminology and diagnostic tests in order to improve the usefulness of epidemiological and clinical investigation of this important ocular disorder.

BACKGROUND:
Dry eye disease (DED) is one of the most frequently encountered ocular morbidities. Twenty-five percent of patients who visit ophthalmic clinics report symptoms of dry eye, making it a growing public health problem and one of the most common conditions seen by eye care practitioners. Historically, the term “Keratoconjunctivitis sicca” can be attributed to the Swedish ophthalmologist Henrik SC Sjögren. He was the first to refer to the triad of Keratoconjunctivitis sicca, dry mouth, and joint pain, which occurs mainly in women (90% of the cases) , and in 1950 Andrew De Roetth introduced the term “dry eye”. For many decades, DED was thought to be limited to dryness of the eyes due to reduction of the aqueous phase of the tear film.

In 2007, the International Dry Eye Workshop (DEWS) revised the original definition and classification scheme of DED and developed a new definition, as well as a three-part classification of DED based on etiology, mechanism, and severity of the disease. The new definition of dry eye is “Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.”

Additionally, DED can be categorized as episodic or chronic. Episodic dry eye occurs when environmental or visual tasks with reduced blinking overwhelm the stability of the tear and produce symptomatic dry eye. Chronic dry eye, although aggravated by the same environmental conditions, persists continuously with symptoms and possible damage to the ocular surface. Because the tear film in dry eye patients is unstable and incapable of maintaining the protective qualities that are necessary for its structure and function, patients experience the discomfort symptoms associated with dry eye, which are burning, stinging, grittiness, foreign body sensation, tearing, ocular fatigue, and dryness. Patients may complain of symptoms of dry eye in the presence or absence of signs of the disease. Additionally, dry eye may be diagnosed based only on the signs observed by a healthcare professional in the absence of symptoms/complaints by the patients.

Dry eye disease is seen with increased prevalence in patients with autoimmune diseases, which affect approximately 8% of the population, of whom 78% are women Dry eye disease also affects postmenopausal women and the elderly The prevalence of DED is estimated to be 7.4% to 33.7% depending on which study is cited, how the disease is diagnosed, and which population is surveyed.

Dry eye syndrome, or dry eye disease, is a common condition that occurs when the eyes don’t make enough tears, or the tears evaporate too quickly. This leads to the eyes drying out and becoming red, swollen and irritated. Dry eye syndrome is also known as keratoconjunctivitis sicca, or simply “dry eyes”.

A complete range of dry eye products from Optho Remedies

Over the last 3 years, Optho Remedies has focused on dry eye syndrome and believes there is a market opportunity for a range of high quality, innovative and competitively priced ocular lubricants. Optho Remedies has identified dry eye syndrome as a significant area of patient need. It is a condition that increases with age, with the over 60s most likely to suffer, but it is also influenced by lifestyle and environmental factors. As many as 50% of us may suffer from dry eye at some point.

It has been defined as a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tears film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface (DEWs Report, 2007). In other words, dry eye is caused when there is too little water, oil or mucus in the tear film.

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The tear film consists of three layers:

  • An oily layer;
  • A watery layer;
  • A layer of mucus.

The condition ranges from mild cases (which often go untreated and are caused by environmental factors) to more severe disorders of the lachrymal tear film which can result in chronic eye disease. Initial symptoms can often be relieved with preservative-free artificial tears.

Types of Dry Eye Syndrome

1) Aqueous tear-deficient dry eye is a disorder in which the lacrimal glands fail to produce enough of the watery component of tears to maintain a healthy eye surface.
2) Evaporative dry eye may result from inflammation of the meibomian glands, also located in the eyelids. These glands make the lipid or oily part of tears that slows evaporation and keeps the tears stable.

Dry eye can be associated with:

  • inflammation of the surface of the eye, the lacrimal gland, or the conjunctiva;
  • any disease process that alters the components of the tears;
  • an increase in the surface of the eye, as in thyroid disease when the eye protrudes forward;

Cosmetic surgery, if the eyelids are opened too widely.

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CLASSIFICATION OF DRY EYE SYNDROME: dry3

SYMPTOMS OF DRY EYES The symptoms of dry eye syndrome are mild for most people, although more severe cases can be painful and lead to complications.

Symptoms usually affect both eyes and often include:

Feelings of dryness, grittiness or soreness that gets worse throughout the day.

dry4
  • Burning and red eyes.
  • Eyelids that stick together when you wake up.
  • Temporarily blurred vision, which usually improves when you blink.

Some people may also have episodes of watering eyes, which can occur if the eye tries to relieve the irritation by producing more tear.

Causes & Risk factors of DES What are the causes of dry eye?

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Dry eye can be a temporary or chronic condition:

  • Dry eye can be a side effect of some medications, including antihistamines, nasal decongestants, tranquilizers, certain blood pressure medicines, Parkinson’s medications, birth control pills and anti-depressants.
  • Skin disease on or around the eyelids can result in dry eye.
  • cDiseases of the glands in the eyelids, such as meibomian gland dysfunction, can cause dry eye.
  • Dry eye can occur in women who are pregnant.
  • Women who are on hormone replacement therapy may experience dry eye symptoms. Women taking only estrogen is 70 percent more likely to experience dry eye, whereas those taking estrogen and progesterone have a 30 percent increased risk of developing dry eye.
  • Dry eye can also develop after the refractive surgery known as LASIK. These symptoms generally last three to six months, but may last longer in some cases.
  • Dry eye can result from chemical and thermal burns that scar the membrane lining the eyelids and covering the eye.
  • Allergies can be associated with dry eye.
  • Infrequent blinking associated with staring at computer or video screens, may also lead to dry eye symptoms.
  • Both excessive and insufficient dosages of vitamins can contribute to dry eye.
  • Homeopathic remedies may have an adverse impact on a dry eye condition.
  • Loss of sensation in the cornea from long-term contact lens wear can lead to dry eye.
  • Dry eye can be associated with immune system disorders such as Sjögren’s syndrome, lupus, and rheumatoid arthritis. Sjögren’s leads to inflammation and dryness of the mouth, eyes, and other mucous membranes. It can also affect other organs, including the kidneys, lungs and blood vessels.
  • Dry eye can be a symptom of chronic inflammation of the conjunctiva, the membrane lining the eyelid and covering the front part of the eye, or the lacrimal gland. Chronic conjunctivitis can be caused by certain eye diseases, infection, and exposure to irritants such as chemical fumes and tobacco smoke, or drafts from air conditioning or heating.
  • If the surface area of the eye is increased, as in thyroid disease when the eye protrudes forward or after cosmetic surgery if the eyelids are opened too widely, dry eye can result.
  • Dry eye may occur from exposure keratitis, in which the eyelids do not close completely during sleep.

Can self-care treatments and remedies help alleviate dry eyes?

  • Use artificial tears, gels, gel inserts, and ointments – available over the counter – as the first line of therapy. They offer temporary relief and provide an important replacement of naturally produced tears in patients with aqueous tear deficiency. Avoid artificial tears with preservatives if you need to apply them more than four times a day or preparations with chemicals that cause blood vessels to constrict.
  • Wearing glasses or sunglasses that fit close to the face (wrap around shades) or that have side shields can help slow tear evaporation from the eye surfaces. Indoors, an air cleaner to filter dust and other particles helps prevent dry eyes. A humidifier also may help by adding moisture to the air.
  • Avoid dry conditions and allow your eyes to rest when performing activities that require you to use your eyes for long periods of time. Instill lubricating eye drops while performing these tasks.

Treatment / Medication Though dry eyes cannot be cured, there are a number of steps that can be taken to treat them. You should discuss treatment options with an eye care specialist. Treatments for dry eyes may include:

  • Artificial tear drops and ointment: The use of artificial teardrops is the primary treatment for dry eye. Artificial teardrops are available over the counter. No one drop works for everyone, so you might have to experiment to find the drop that works for you. If you have chronic dry eye, it is important to use the drops even when your eyes feel fine, to keep them lubricated. If your eyes dry out while you sleep, you can use a thicker lubricant, such as an ointment, at night.
  • Temporary punctal occlusion: Sometimes it is necessary to close the ducts that drain tears out of the eye. This may be done temporarily with a dissolving plug that is inserted into the tear drain of the lower eyelid to determine whether permanent plugs can provide an adequate supply of tears.
  • Non-dissolving punctal plugs and punctal occlusion by cautery (application of heat to tear exit duct): If temporary plugging of the tear drains works well, then longer-lasting plugs may be used. These measures increase the tear level by blocking the “drainpipe” through which tears normally exit the eye and enter the nose. The plugs can be easily removed. Rarely, the plugs may come out spontaneously or migrate down the tear drain. Many patients with particularly bothersome dry eyes find that the plugs or surgical occlusion improve comfort and reduce the need for artificial tears.
  • Other medications and nutrition: Other medications, including steroid eye drops, can be used for short periods of time as an adjunct to other long-term measures. There is growing evidence that increasing the oral intake of fish oil and omega-3 via diet or supplement is very helpful to those suffering with dry eye.