DRY
EYE SYNDROME


   A functioning tear film is important for maintaining a healthy cornea and preserving clear vision. The tear film is an important source of eye nutrition, waste removal, and antibacterial action. It keeps the surface of the eye smooth and clear, giving clear vision. 

Dry eye syndrome is a group of disorders affecting the film of tears over the surface of the eye. People suffering from dry eye have either reduced tear production or excessive tear evaporation that causes discomfort and may damage the surface of the eye. Many times the problem is not with quantity but quality of tear film.


Tear film

Tear in the eye has 3 layers:

Lipid layer: An oily layer is on the surface of tear film. It smoothen the tear film and reduce evaporation of tears. It is produced by meibomian glands situated 
    in eyelid margin.

Aqueous layer: It is middle layer of tear and contains salts and protein in a water base. It is produced by lacrimal gland. It helps cleaning the eye. 

Mucin layer: It is innermost layer, which allows the watery layer to spread evenly over the surface of the eye and helps to keep eye wet. Without this tears 
    will not adhere to the eye.

Symptoms

  Stinging or burning eyes.
  Feeling of scratchiness and dryness.
  Irritation from smoke or wind.
  Excessive tearing.
  Difficulty wearing contact lenses.
  Mucus discharge.
  Redness..
  Light sensitivity.
  Heaviness, stickiness and tiredness.
  Blurred / fluctuating vision
.


Causes
The exact cause is not yet known. However :

Dry eye occurs more often in the elderly, especially women.

It is also associated with :

  1. Exposure to air pollution, high altitude, extremes in humidity, temperature, airflow or other environmental factors.

  2. Systemic diseases such as autoimmune diseases e.g. Rheumatoid arthritis, Sjogren's syndrome.

  3. Inflammatory process affecting both the lacrimal gland, the gland that produces tears, lids and the surface of the eye (Conjunctiva and Cornea).

  4. Contact Lens wear: About 20- 30% soft lens users get dry eye.

  5. Systemic drugs ( antihistamines, some antihypertensives, oral contraceptives, some antidepressants, diuretics, antiparkinsonians, hormones etc ) and preservatives in eye drops.

  6. Eye surgeries specially Lasik and PRK

  7. Poor nutrition: as Vitamin A deficiency, alcoholism leading to poor intestinal food absorption.

  8. Lid defects such as lid paralysis, ectropion , lagophthalomos lead to defective tear circulation.

Treatment

There is no cure for dry eye and, so far, only the symptoms can be relieved. Current treatments include :

Keeping away from direct flow of air, keeping humidifiers in the room, using glasses and avoiding polluted air helps to reduce the disease.

Lid hygiene with warm compress and lid massage decreases lid induced dry eye problems.

Using lubricating eye drops and ointments which replace the moisture that is missing and lubricate the eyes. They temporarily soothe dry eye symptoms.

Tear duct closure allows you to retain your own natural tears and give relief in symptoms. It can be done by inserting a  punctal plug into the tear duct . It is nonsurgical painless procedure.

Cyclosporin A drops: Dry eye is known to be due to inflammatory disease. Because of Anti-inflammatory property Cyclosporin A, if used for minimum of 110 days, helps to some extent to cure the disease and in relieving symptoms.

Topical steroids: Reduce inflammation and helps in severe cases of dry eye that still have irritation after all the above treatments. This is just used for short period.

 



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