Dry Eye Doctor Slides

7/29/2019 Dry Eye Doctor Slides

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DRY EYE
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Dry Eye

Dry eye is a disease of the ocular surface

attributable to different disturbances of the

natural function and protective

mechanisms of the external eye, leading

to anunstable tear filmduring the open

eye state.

Surv Ophthalmol 2001; 45(2), S199-202


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Dry Eye: Prevalence

Study Centre No. of patients Prevalence (%)

Japan 2127 17%

Denmark 504 11%USA 2520 15%

Melbourne,

Australia

926 16.3%

Surv Ophthalmol; 45(2): S203-S210


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Dry Eye : Prevalence

Beaver Dam study

N=3722

3 year study (1993-1995)

Age = 48-91 years (Mean age 65 + 10 years)

Men = 43%, Women = 57%

Arch Oph 2000, 118:1264-1268


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Prevalence of dry eye symptoms by age

05

10

15

20

Age 48-59 Age 60-69 Age 70-79 Age 80-91

Prevalence(%)

Prevalence of dry eye increasessignificantly with age

Dry eye: Prevalence


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Dry eye: Prevalence

Prevalence of dry eye symptoms by age and sex

0

10

20

30

Age 48-

59

Age 60-

69

Age 70-

79

Age 80-

91

Prevalence(%

)

Women

Men

Prevalence of dry eye is higherin women


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Increasing prevalence of dry eye

Increasing life-span of the population

Expansion of consumption of medications

Increase in number of people wearingcontact lenses

Increase in computer usage.

Increase in number of patientsundergoing LASIK.

Increase in pollution.


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SymptomsIrritation

RednessBurning/ Stinging

Itchy eyes

Sandy- gritty feeling (foreign body sensation)

Blurred vision

Tearing

Contact lens intolerance.

Increased frequency of blinking

Mucous discharge.

Photophobia (less frequent symptom)Symptoms worsen in windy or air-conditioned environments.

As day progresses.

After prolonged reading, working on computers

Supl P&T Digest 2003, 28(12), 1-45


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Impact of dry eye symptoms on daily life

Patients who said dry eye symptoms interfered

with activities most or all of the time (%)

Vision-related activitiesNighttime driving

Reading

Working at computers

Watching television

32.3

27.5

25.7

17.9

Suppl P & T 2003; 28(12) 1-45


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Dry eye may be sight-threatening

Bacterial Keratitis Corneal ulcer


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Dry Eye

Affects Quality of Life


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DRY EYE : Classification

DRY EYE

Aqueous tear deficiency (ATD)

(Tear deficient dry eye)keratoconjunctivitis sicca

(KCS)

(Most common)

Evaporative tear

deficiency (ETD)(Evaporative dry eye)

According to the National Eye Institute

Clin Exp Optom 2001; 84: 1: 4-18, Surv Oph 2001: 45, S203-S210


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Dry Eye: Main Causes

TEAR DEFICIENT DRY EYE (KCS) EVAPORATIVE DRYEYE

Sjogrens Non-Sjogrens

Ageing

Menopause Medicamentosa

Cicatricial

disease

Neurotrophic

keratitis

Meibomian gland

disease

Lidsurfacing/blinking

anomalies

Contact lens

related

Chronicallergy/toxicity

Clin Exp Optom 2001; 84: 1: 4-18


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Dry Eye: Multifactorial nature

Elderly woman

Contact lensuser

Postmenopausal

Taking

glaucoma

medications

Working for long

hours in front of

computer

Air-conditioned

environment
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Tear deficient dry eye

Keratoconjunctivitis sicca (KCS)Sjogrens: Autoimmune disorder with a triad of dry mouth, dryeye and arthritis

Non-Sjogrens

Ageing Gradual deterioration of lacrimal gland tissue occurs with

ageing Menopause At the time of menopause, levels of androgens drop

down

Neurotrophic keratitis Corneal sensitivity decreases afterLASIK, PRK, contact lens wear and diabetes

Medicamentosa Anti histamines, anti-depressants,

beta blockers

Cicatricial Diseases Trachoma, chemical burns, StevensJohnson syndrome

Ref: Clin. Exp. Optom 2001: 84: 1:4-18

J. Am. Optom Assoc. 1991; 62: 187-199

Suppl P and T Digest 2003; 28(2): 1-45
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EVAPORATIVE DRY DISEASE

Meibomian gland disease: Most prevalent(65%). Obstruction of meibomian gland

Lid surfacing anomalies: Lid closure affected,blinking affected

Ocular surface toxicity: Long term use oftopical antiglaucoma medications,preservatives like BAK

Contact lens related

Allergy


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Chronic Allergy

Dry eye is commonly associated with chronic

allergic conjunctivitis.

An allergic history has been reported by 36% ofdry eye patients.

Chronic allergy results in loss of goblet cells,

destabilization of the tear film & damage to ocular

surface.

VKC is associated with 38% incidence of dry eye.

Surv Oph 2001, 45(2), S211-20


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Extensions of interblink period due to

intense concentration due to close work and

computer work concentration leads to drying

of ocular surface.

Normal blink rate : 15 times/min

Working on computer: 5 times/min

Clin Exp Optom 2001; 84: 1: 4-18

Abnormal blinking pattern


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Environmental Influences

Ocular irritation, poor tear film stability and

ocular surface desiccation is associated with

poor indoor air quality in temperature

controlled office environments

35-48% of individuals working in suchenvironments are affected.

Dry climate

Growing air pollution.
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McMonnies Questionnaire

Do you experience any of the following eye symptoms?

Soreness

Scratchiness

Dryness

Grittiness

Burning

Symptoms often or constantly

Eyes unusually sensitive to cigarette smoke, smog, air conditioning, central

heating?Do you suffer from arthritis?

Do you suffer from thyroid abnormality?

Eye irritation upon awakening?

Cornea 2002, 21(7), 664-670


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Rose Bengal staining

Rose Bengal solution 1%placed into the conjunctival sac.

After a wait of 2 mins, degree of rose bengal staining onbulbar conjunctiva and cornea is quantitated bymicroscopic exam.

Stains devitalized cells.

Also stains mucous strands (very often present in KCS)

J Am Optom Assoc 1991, 62:187-199
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Rose Bengal staining in

Early, Moderate and Late KCS

EARLY MODERATE LATE


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Schirmer test

Without Anesthesia

Measures Reflex Tear

Secretion (dry eye =

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Dry Eye Doctor Slides