Today's Topic

Definition of Dry Eye

Dry eye is a multifactorial disease of the tear 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.

Tear Production

Meibomian glands Produces lipids which protects the tear

film from evaporating.

Lacrimal gland Produces the watery part of the tear

film called the aqueous.

Goblet cells of the conjunctiva Produces mucin which allows the

wetting of the ocular surface as well as stabilizes the tear film.

Types

Lacrimal Glands:Lacrimal Glands:• Chronic irritationChronic irritation• T-cell activationT-cell activation• Cytokine secretion into Cytokine secretion into

tearstears

Interrupted Secretomotor Interrupted Secretomotor Nerve ImpulsesNerve Impulses

Tears Damage Ocular SurfaceTears Damage Ocular Surface

Cytokines Cytokines Disrupt Neural ArcDisrupt Neural Arc

Disruption of normal Disruption of normal neuronal control of tearingneuronal control of tearing

Causes of Dry Eye

Lacrimal Damage

Stern et al. Cornea. 1998.Nelson et al. Adv Ther. 2000.

Causes

Prevalence

•Women aged 50 or older

•Women using post menopausal hormone

replacement therapy

•Those with ocular co morbidities

•Contact lens wearers

•Smokers

• Patient undergone LASIK or other Surgeries

Discomfort Dryness Burning, Stinging Foreign-Body Sensation Gritty Feeling, Stickiness Blurry Vision Photophobia, Itching, Redness

Note: Symptoms seldom correlate with clinical signs.

Sign & Symptoms

Dry Eye Severity Dry Eye Severity LevelLevel 11 22 33

General SymptomsGeneral Symptoms Mild Mild SymptomsSymptoms

Moderate Moderate SymptomsSymptoms

Severe Severe SymptomsSymptoms

Symptoms: Itchy, Sandy, Symptoms: Itchy, Sandy, Gritty, DryGritty, Dry

Never to Never to SeldomSeldom SometimesSometimes FrequentFrequent

Discomfort: Stinging, Discomfort: Stinging, Burning, PainBurning, Pain NoNo YesYes YesYes

Vision: Blurring, Vision: Blurring, InterruptedInterrupted NoNo No No SometimesSometimes

Use of Artificial TearsUse of Artificial Tears Less than 2X Less than 2X per dayper day

Several times Several times per dayper day

Several times Several times per dayper day

Dry eye Severity symptom

Triggers of Dry Eye Disease

InflammationInflammation

TearTearDeficiency/Deficiency/InstabilityInstability

IrritationIrritation

EnvironmentMedicationsContact LensSurgery

Rheumatoid ArthritisLupusSjögren’s syndrome

Post menopauseMeibomian Gland Disease

Symptoms of Ocular Surface DiseaseSymptoms of Ocular Surface Disease

Development of Dry Eye

1. Do your eyes feel dry, painful, or sore?

2. Do you experience episodes or periodsof blurred vision?

3. How often are your eyes sensitive to light?

4. Do you have problems with your eyes when you are working on a computer, watching TV, or reading?

5. Do you use artificial tears three or more times a day?

Identifying Potential Dry Eye Patients

Patients who answer “yes” to any one of the previous questions should be evaluated for dry eye disease

Many clinicians use clinical tests plus symptoms and patient history to diagnose1

1Nichols et al. Cornea. 2000.

Diagnosing Dry Eye Disease

Dry eye test

Taking the dry eye test manually: 1.Obtain a stopwatch or clock.2.Blink 2 times, then stare straight ahead, taking care to start timing immediately after your second blink.3.Avoid blinking for as long as possible.4.Note the time on the clock when you begin to feel eye discomfort5.The SBUT is the amount of time (in seconds) that passes between your last complete blink and the moment you experience eye discomfort.

If your SBUT(Symptomatic Tear Break-Up Time) is 5 seconds or less, you may have dry eye, because the tear film on your eyes is breaking up too quickly, leaving the surface of your eyes unprotected.

Dry eye test

Schirmer’s test:

Result interpretation:

1. Normal: ≥15 mm wetting of the paper after 5 minutes.

2. Mild:14-9 mm wetting of the paper after 5 minutes.

3. Moderate:8-4 mm wetting of the paper after 5 minutes.

4. Severe:<4 mm wetting of the paper after 5 minutes.

Dry EyeManagement

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Punctual plug

For severe dry eye treatment

PP have a very high rate of success; and the optometrist can insert

them easily and painlessly. They are also reversible if too much

tearing is produced.

Here’s how they work:

The idea behind punctal plugs is simple. Tiny, dissolvable or non-

dissolvable plugs are inserted into your tear drainage ducts (puncta)

where they act as a dam. Therefore, your precious tears have no

other place go except onto the surface of your eyes. By blocking the

tear drains, more natural infection-fighting tears bathe and soothe

the eye, which may eliminate the need for eye drops altogether.

Punctal Plugs can also reduce or eliminate the major cause of

contact lens discomfort.

Punctual plug

Prescription therapy for dry eye disease.

FDA approved to increase tear production in patients whose tear

production may be reduced by inflammation of the eye associated

with keratoconjunctivitis sicca.

Ref: (Cornea. 2007 Sep;26(8):949-52. And Clin Ophthalmol. 2008

Sep;2(3):629-35)

Ophthalmic emulsion of cyclosporine 0.05%.

Artificial tear like Polyethylene glycol and propylene glycol is unique.

Research has shown this helps to improve not only dry eye

symptoms, but that it also extends the tear film break-up time and

promotes resolution of corneal staining. Polyethylene glycol and

propylene glycol (TEARON ) is tear of choice for patients who

present with moderate dry eye symptoms and notable keratopathy.

In other words, if there is any significant staining of the cornea with

either sodium fluorescein or lissamine green, starting therapy should

be with TEARON.

Ref: (Cornea. 2007 Sep;26(8):949-52. And Clin Ophthalmol. 2008

Sep;2(3):629-35)

Artificial Tear

Artificial Tear

…Good by, Dry Eye

How Tearon Works

TEARON

Rx,Dry Eye

Computer vision syndrome

Ocular discomfort

Rx,Dry Eye

Computer vision syndrome

Ocular discomfort

…Good by, Dry Eye