KERATOCONJUNCTIVITIS SICCAParas Shah

Tear Film

Lipid layer:- Meibomian gland Aqueous layer:- Lacrimal gland and Accessory lacrimal gland of Krause and Wolfring Mucin layer:- Conjunctival goblet cell

HistoryWhat short of things bother your eyes? Intolerance

to air conditioner Sensitive to winds Intolerance to driving in the car with open window Difficulty in reading Nighttime is worst Smoke is intolerable

Do you have any skin disease? Scleroderma Scurvy Thrombotic

thrombocytopenic purpura Facial rush in lupus Skin lesion pemphigoid Old scar of Steven-Johnson syndrome Acne Rosacea

What medication do you take? Chlorpheniramine Isotretinoin Hydrochlorothiazide Propranolol

hydrochloride

Categories of Dry Eye SyndromeHolly and Lamp divided into 5 categories;1.Aqueous Deficiency 2.Mucin Deficiency 3.Lipid Abnormalities 4.Lid Surfacing Abnormalities 5.Epitheliopathies

Causes for Aqueous DeficiencyCongenitalRiley-Day syndrome Anhidrotic ectodermal dysplasia Alcrima secondary to congenital absence of the lacrimal gland Cri du chat syndrome Absence of lacrimal gland Congenital familial sensory neuropathy with anhidrosis Adies syndrome Multiple endocrine neoplasia

Causes for Aqueous DeficiencyAquired

Trauma to lacrimal gland

Surgical removal Injury Radiation damage Sjogrens syndrome Primary amylodosis Mumps Trachoma Sarcoidosis Lymphoma, leukemia Amyloidosis

Inflammation of lacrimal gland

Infiltration

Drugs

Antihistamines Thiabendazole Antimuscarinics General anesthetics

Neuroparalytic

hyposecretion

Brainstem lesions Middle fossa floor lesions Lesions of the sphenopalatine ganglion Cerebellopontile angle and petrous bone lesion

Mucin Deficiency diseases

Produced by goblet cells of conjunctiva Goblet cell dysfunction: vitamin A deficiency Goblet cell destruction

Alkali burns Cicatricial pemphigoid Steven-Johnson syndrome Trachoma Practolol Echothiophate iodide

Drug-induced

Lipid AbnormalitiesSevere anhidrotic ectodermal dysplasia is a true lipid deficiency Occurs when the meibomian gland congenitally absent

Lipid abnormalityChanges in composition of meibomian secretion (Blepharitis) Invade bacteria which secrete lipase Lipase hydralyze normal lipid to produce Various type of fatty acids Fatty acids are extremely surface active and directly toxic to corneal epithelium Damage corneal epithelium or formation of dry eye Superficial Punctate staining

Lid Surfacing AbnormalityLid resurfaces the eye with tears through constant blinking During blink, eyelid sweeps the eyes surface, brushing away exogenous contaminates as well as lipidcontaminated mucin strands Fresh mucin is thereby distributed over the cornea and conjunctival surface Any break in the integrity of lid or ocular surface which lead to dryness on that area

CausesLid problemsExposure keratitis Entropion Ectropion Symblepharon Large lid notch Lagophthalmos Keratinized lid margin

Surface irregularitiesDellen formation with limbal lesions 3 and 9 oclock stain in hard lens wearers Topical anesthetic epitheliopathy

EpitheliopathiesIt dependent on a smooth, uninterrupted epithelial surface, Any irregularity in the surface will cause an associated irregularity in the tear film, Irregular or elevated area will predispose the tear film to break up instantly at that spot, At least important

SymptomsIrritation Redness Discomfort Watering Foreign body sensation

SignsFilaments Meniscus Height Meniscus floaters Mucous strands Papillary conjunctivitis

FilamentsShort (