DRY EYE SYNDROME IN KERATOCONUS PATIENTS

World KeratoconusCongress

Guilherme Ferrara

Introduction

Changes on the ocular surface• High keratometric values• Scratching & Atopy• Contact lens• Corneal sensation / Innervation

Changes in tears Inflammation

Dry eye syndrome & Keratoconus

Introduction

Changes on the ocular surface• High keratometric values• Scratching & Atopy• Contact lens• Corneal sensation / Innervation

Changes in tears Inflammation

Dry eye syndrome & Keratoconus

Break up Time

0 seconds 1 second 2 seconds 3 seconds

6 seconds4 seconds 5 seconds 16 seconds

Must be higher than blink frequency.

Introduction

Changes on the ocular surface• High keratometric values• Scratching & Atopy• Contact lens• Corneal sensation / Innervation

Changes in tears Inflammation

Dry eye syndrome & Keratoconus

Introduction

Changes on the ocular surface• High keratometric values• Scratching & Atopy• Contact lens• Corneal sensation / Inervation

Changes in tears Inflamation

Dry eye syndrome & Keratoconus

Blepharitis and Contact LensEvaporative Dry Eye

Dry eye syndrome & Keratoconus

Introduction

Changes on the ocular surface• High keratometric values• Scratching & Atopy• Contact lens• Corneal sensation / Inervation

Changes in tears Inflamation

Dry eye syndrome & Keratoconus

Cornea and Conjunctiva staining

Dry eye syndrome & Keratoconus

303 mOsm/l 368 mOsm /l368 mOsm /l

tratamiento

Lipid component: Osmolarity

368 mOsm /l

303 mOsm /l

Hiperosmolarity

Dry eye syndrome & Keratoconus

Lachrymal Functional Unit

Innervation

AferenteEferente ParasimpáticoEferente Simpático

Dry eye syndrome & Keratoconus

Schaumberg DA et al. Development and Validation of a Short Global Dry Eye Symptom IndexThe Ocular Surface 2007;5:50-57

1. Frecuencia de los síntomas: Por favor, ponga una X en la línea para indicar lo frecuente que normalmente siente sus ojos secos y / o irritados

Raramente _______________________________________Siempre

2. Gravedad de los síntomas: Por favor, ponga una X en la línea para indicar la gravedad que normalmente siente sus ojos secos y / o irritados

Muy leve_______________________________________Muy Grave

PsicometríaEscala Visual Analógica

SANDE: Symptom Assessment iN Dry Eye

Dry eye syndrome & Keratoconus

Dry eye syndrome & Keratoconus

Schaumberg DA et al. Development and Validation of a Short Global Dry Eye Symptom IndexThe Ocular Surface 2007;5:50-57

PsicometríaEscala Visual Analógica

1. Frecuencia de los síntomas: Por favor, ponga una X en la línea para indicar lo frecuente que normalmente siente sus ojos secos y / o irritados comparado con su visita de hace dos meses

Raramente _______________________________________Siempre

Ultima visita

2. Gravedad de los síntomas: Por favor, ponga una X en la línea para indicar la gravedad que normalmente siente sus ojos secos y / o irritados comparado con su visita de hace dos meses

Muy leve_______________________________________Muy Grave

Ultima Visita

Treatment

Avoid risk factors

Scratch

Contact lens Hygiene

Preventive treatment

Education of the patient

Avoid tear evaporation

Anti-inflammatory if evidence of inflammation

Dry eye syndrome & Keratoconus

Multidisciplinary approach. Multiple and Protracted

Treatment

Intra corneal ring segments

Improvement of keratometry

Reduction of dry eye symptoms

Reduction of scratch

Reduction of use of the contact lens

Dry eye syndrome & Keratoconus

Conclusions

• Keratoconus patients are more susceptible to develop a dry eye syndrome

• BUT & mucus thin layer healthy are good markers of a normal function of the epithelium of the ocular surface.

• Treatment Protocol of DES in Keratoconus patients.

Dry eye syndrome & Keratoconus

Thank you