Download Eye Strain and Dry Eyes

‘‘DRY EYE’’
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 an unstable tear film during the open
eye state.
Surv Ophthalmol 2001; 45(2), S199-202
Dry Eye: Prevalence
Study Centre
Japan
Denmark
USA
Melbourne,
Australia
No. of patients
2127
504
2520
926
Prevalence (%)
17%
11%
15%
16.3%
Surv Ophthalmol; 45(2): S203-S210
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
Dry eye: Prevalence
Prevalence of dry eye symptoms by age
20
Prevalence (%)
Prevalence
of
dry
eye
increases
15
significantly with age
10
5
0
Age 48-59
Age 60-69
Age 70-79
Age 80-91
Dry eye: Prevalence
Prevalence (%)
Prevalence of dry eye symptoms by age and sex
30
Prevalence
of dry eye is higher
20
Women
in
women
10
Men
0
Age 4859
Age 6069
Age 7079
Age 8091
Increasing prevalence of dry eye
Increasing life-span of the population
Expansion of consumption of medications
Increase in number of people wearing
contact lenses
Increase in computer usage.
Increase in number of patients
undergoing LASIK.
Increase in pollution…….
Symptoms
Irritation
Redness
Burning/ 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
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 activities
Nighttime driving
32.3
Reading
27.5
Working at computers
25.7
Watching television
17.9
Suppl P & T 2003; 28(12) 1-45
Dry eye may be sight-threatening
Bacterial Keratitis
Corneal ulcer
Dry Eye
Affects Quality of Life
DRY EYE : Classification
According to the National Eye Institute
DRY EYE
Aqueous tear deficiency (ATD)
(Tear deficient dry eye)
keratoconjunctivitis sicca
(KCS)
(Most common)
Evaporative tear
deficiency (ETD)
(Evaporative dry eye)
Clin Exp Optom 2001; 84: 1: 4-18, Surv Oph 2001: 45, S203-S210
Dry Eye: Main Causes
TEAR DEFICIENT DRY EYE (KCS)
Sjogrens
Non-Sjogrens
– Ageing
– Menopause
– Medicamentosa
– Cicatricial
disease
– Neurotrophic
keratitis
EVAPORATIVE DRY
EYE
Meibomian gland
disease
Lid
surfacing/blinking
anomalies
Contact lens
related
Chronic
allergy/toxicity
Clin Exp Optom 2001; 84: 1: 4-18
Dry Eye: Multifactorial nature
Elderly woman
Post
menopausal
Taking
glaucoma
medications
Working for long
hours in front of
computer
Contact lens
user
Air-conditioned
environment
Tear deficient dry eye
Keratoconjunctivitis sicca (KCS)
Sjogrens: Autoimmune disorder with a triad of dry mouth, dry
eye 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 after
LASIK, PRK, contact lens wear and diabetes
– Medicamentosa – Anti histamines, anti-depressants,
– beta blockers
– Cicatricial Diseases – Trachoma, chemical burns, Stevens
Johnson 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
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 of
topical antiglaucoma medications,
preservatives like BAK
Contact lens related
Allergy
Chronic Allergy
Dry eye is commonly associated with chronic
allergic conjunctivitis.
An allergic history has been reported by 36% of
dry 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
Abnormal blinking pattern
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
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 such
environments are affected.
Dry climate
Growing air pollution.
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
Rose Bengal staining
Rose Bengal solution 1%
placed into the conjunctival sac.
After a wait of 2 mins, degree of rose bengal staining on
bulbar conjunctiva and cornea is quantitated by
microscopic exam.
Stains devitalized cells.
Also stains mucous strands (very often present in KCS)
J Am Optom Assoc 1991, 62:187-199
Rose Bengal staining in
Early, Moderate and Late KCS
EARLY
MODERATE
LATE
Schirmer test
Without Anesthesia
– Measures Reflex Tear
Secretion (dry eye = <
6mm wetting)
With Anesthesia
– Measures Basal Tear
Secretion (dry eye =<
3mm wetting)
Impression cytology
Removal of superficial layers of conjunctival epithelium
Application of circular discs of cellulose acetate filter paper
for a certain period of time.
Obtained specimen observed under microscope for signs
and symptoms of squamous metaplasia or presence of
inflammatory cells.
J Am Optom Assoc 1991, 62: 187-99
Dry Eye: Management
Management of Dry Eye
Treatment
Tear replacement
Tear Preservation
Artificial tears
Punctal Plugs
•Topical corticosteroids – fluorometholone, loteprednol (short-term)
•Topical androgen
•Cyclosporine ophthalmic emulsion
Late KCS
Tear substitutes:benefits
Tear substitutes are the mainstay of therapy for
dry eye.
Provide adequate relief
Increase humidity at the ocular surface and
improve lubrication.
Smooth the ocular surface leading to improved
vision.
Intra/post-operative use has shown to help
restore ocular surface after refractive surgery.
Improve patients’ quality of life.
Highlights ophthalmol
Int Ophthalmol Clin 1991, 31: 83-90
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