Issue 14 Winter 2006 A Quick Guide to Dry Eye (80-95%). It is associated with dry dry with isassociated It (80-95%). female being majority the 0.4-1%, deficiency having a prevalence of tear aqueous severe causes also syndrome Sjogren’s factors. menopausal with associated possibly females in prevalent Aqueous tear deficiency is more close work and computer use. with associated concentration humidity, wind and intense conditioning, dry heat, low to irritants including air- eye isdry exposure worsened with contributing factors . Evaporative be also may lidlaxity lower and proptosis, lagophthalmos, facial palsies, nocturnal entropion,ectropion, pterygia, to due patterns blink abnormal and lid closure Incomplete dermatitis. seborrhoeic and is associated with acne rosacea and cause is another Meibomitis evaporation. increased and film tear an unstable eye causing dry prevalentthe cause of evaporative is dysfunction gland Meibomium deficient dry eye. and tear evaporative categories; caneye be classified into two Dry isimportant. management diagnosisAppropriate and and corneal morbidity. disease surface ocular progressive severe cases, in and, infection intolerance, increased risk of blurred vision, contact lens ocular surface irritation can cause Chronic dry eye and associated Tear deficient eye dry Evaporative eye. dry

not specific. Symptoms include include Symptoms specific. not Primary symptoms dry eye are symptoms. and signs descriptive similar with conditions ocular distinguish dry eye from other will history The increases. signs as present are severity different and symptoms with correlate may not Signs diagnosis. most tool useful dry for eye the is associations and factors History based on known risk benzalkonium chloride. particularly film, tear eyedrops may affect the aqueous others. Preservative build-up from among agents inflammatory topical non-steroidal anti- systemic pills, contraceptive oral blockers, beta systemic antidepressants, topical and tricyclic antihistamines, systemic and topical include film tear aqueous the affecting medications Common surgery. deficient dry eye, as can refractive Contact lens wear can cause tear tears. adequate and quality good with associated andrate the blink tearing reflex both reducing sensitivity loss of corneal significant causes Diabetes dry eye. deficient tear of cause isaprimary Diabetes disorders. tissue connective eye, dry mouth, autoimmune and Dry eyeDry diagnosis you for better eye health in the community” community” the in eyehealth better for you with “Your work to isavailable optometrist local

position, lid margin defects and defects margin lid position, punctal irritation, ocular allergic dysfunction, gland meibomium film, tear the in particles tear film meniscus, mucous and assess will Slit lamp evaluation secretion. tear of atest required, general health history and, when environmental evaluation, validated eye questionnaire, dry includes medication history, a Specific evaluation ofdry eye and as alcohol as well caffeine. environments, weather conditions controlled temperature dehydrating heating, central smoke, smog, air-conditioning, dietary factors including cigarette environmental by caused and are symptoms dry eye Secondary secretion due to eye closure. decreased cornea and the tear to next mediators inflammatory lids releasing inflamed due the to in mornings the worse a gritty sandy sensation, usually using is described also Meibomitis months. many for persist may Symptoms irritation. subsequent and osmolarity film tear during the day causes increased closure but evaporation oftears lid with recovers surface corneal progresses. This is because the day asthe worse becomes that report a sandy gritty irritation Patientsblurry vision. often grittiness, burning, stinging and dryness, scratchiness, soreness, ests dry e y e y r d r o f s t s Te

Dry eye conditions affect a significant number of people positioning. Corneal staining using fluorescein, rose bengal or lissamine green aids this assessment. The staining location and pattern can indicate the cause of dry eye with reasonable sensitivity and good predictive value.

Dry eye treatment The primary goals of dry eye treatment are reducing and improving symptoms by management of environmental factors affecting tear quantity and quality. Newer treatments are aimed at reducing tear osmolarity, improving tear film stability and reversing and improving ocular surface damage as opposed to simply providing more tears.

If drops are used frequently then non-preserved drops are more appropriate. Preserved drops may exacerbate ocular surface damage due to compromised epithelial barrier function or inhibited tear clearance increasing Punctal occlusion will improve objective signs of tear ocular surface-preservative exposure. deficient dry eye. Punctal occlusion can be a permanent or temporary measure, reversible as symptoms improve Lubricating gels and ointments are thicker than eyedrops and remain on the corneal surface longer. Meibomium gland dysfunction is mainly treated using Due to visual disturbances, ointments are best used at lid hygiene methods. Oral tetracyclines are effective in night and are useful for people who sleep with their longstanding chronic meibomitis improving the eyes slightly open. consistency of meibomium gland oil production, promoting tear film stability and reducing tear Omega-3 and omega-6 essential fatty-acids are evaporation. relevant to both dry eye and meibomitis. Omega 3 fatty-acids are provided mostly by fish oils, castor oil, flaxseed oil and walnuts Omega 6 fatty-acids produce Summary inflammatory submetabolites. Excessive amounts may Dry eye conditions affect a significant number of people. exacerbate inflammation in the body. A diet rich in Differential diagnosis of dry eye is best achieved by a omega-6 may worsen dry eye disease for people prone thorough history and slitlamp evaluation with corneal to meibomitis and blepharitis. Omega 3 fatty acids staining. Diagnosis, treatment and management can be provide a balancing anti-inflammatory effect to omega performed by an optometrist. Successful treatment and 6 fatty acid intake. Omega 3 fatty acids also affect the management of dry eye and meibomium lid disease meibomium gland lipid production. prevents chronic corneal changes which may affect

vision.

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