DRY EYE

Agung Triatmojo
I11109007
INTRODUCTION
Dry eye occours when there is inadequate tear
volume or function, resulting in an unstable tear
film and ocular surface disease
Extremely common condition, particulary in
women and the elderly
Dry eye can occur if you are
missing any one!
SYMTOMS
Blurry and/or changeable vision
Transient visual obscuration, visual distress
Irritation, burning, redness
Light sensitive, itchy

Pain (cells falling off the cornea, micro corneal

abration)
Dry eye increase inflammation damage to
surface corneal anesthesia reduce
stimulation to brainstem less lacrimal gland
secreation
CLASSIFICATION
2007 International Dry Eye Workshop (DEWS) :
DIAGNOSIS
Examination
Tear break up time

Schimers test

Ocular surface staining

TEAR BREAK UP TIME
Abnormal in aqueous tear deficiency and
meibuomian gland disorders
Step :
Fluorescein 2% or impregnated fluorescein strip
moistened
The patient is asked to blink several time
Tear film examined at the slit lamp
Break-up time of less than 10 sec. is suspicious
SCHIRMER TEST
Assesment of aqueous tear production
Measuring the amount of wetting a special filter
paper
Performed with or without anaesthetic
Abnormal:
Less than 10 mm of wetting after 5 minutes
without anaesthesia
Less than 6 mm with anaesthesia
OCULAR SURFACE STAINING
Fluorescein
Stains corneal and conjunctival epithelium
where there is sufficient damage to allow
the dye to enter the tissues
Rose Bengal
Shown up clearly corneal filaments and
plaques
Lissamine green
Similar to rose Bengal, less irritation
DRY EYE THERAPY
Artificial tear drops
Stabilize the meibuomian gland

Thermal pulsation treatment

Change environment, eg.humidifier

Punctal plugs

Look at medications

Indentify associated medical problem, eg.

Athritis, gout, autoimmune
Suplement: vit.a, omega 3
BLEPHARITIS
Inflammatory disease of the lids
Anterior : bilateral inflamation on
palpebra caused by bacterial, fungal,
or parasites infection
Posterior : meibomian gland
dysfunction obstruction
Solidfy of oil
BLEPHARITIS (2)
Treatment
Topical and oral antibiotic
Topical steroid for inflamation
Clean the lid
SJGREN SYNDROME
Sjgren syndrome (SS) autoimmune disorder
Lymphocytic inflammation

Destruction of lacrimal and salivary glands

SJGREN SYNDROME (2)
SS Triad : dry eye
dry mouth
parotid gland enlargement

Dry fissured tongue

SJGREN SYNDROME (3)
Symtoms
Feeling of dryness, grittiness and burning
Stringy discharge
Transient blurring of vision Oil globules at
meibomian
Redness and crusting of lids gland orifices

Signs
Posterior Blepharitis :
Meibomian gland dysfunction Lid notching
Conjuntiva :
Redness, keratinization
SJGREN SYNDROME (4)
Tear film :
Normal eye: tear film breaks down the mucin layer
becomes contaminated with lipid
Dry eye: the lipid-contaminated mucin accumulates

in the tear film particles & debris that move with

each blink

Tear film abnormality

w/ Mucous debris
SJGREN SYNDROME (5)
Cornea
Punctate epitheliat erosions that stain well with
flourescein
Filaments consist of strands of mucus and debris,
stain well with rose Bengal
Mucus plaques with similar constituents may occur
in severe dry eye, consist of semi-transparent,
white-to-grey, often slightly elevated lesions of
varying size
SJGREN SYNDROME (6)
Complications
Vision-threatening
Epithelial breakdown
Melting
Melting
Perforation
Bacterial keratitis

Perforation with
iris plugging

Bacterial infection
SJGREN SYNDROME (7)
Investigation
To confirm and quantify a clinical diagnosis of dry
eye
The tests measure the following parameters:
Stability of the tear film as related to its break-up time
(BUT)
Tear production (Schirmer, fluorescein clearance & tear
osmolarity)
Ocular surface disease (corneal stains & impression
cytology)
No clinical test to confirm the diagnosis of
evaporative dry eye. Persumptive diagnosis based on
the presence of associated clinical findings
SJGREN SYNDROME (8)
Treatment
Generally not reversible
Control of symptoms and prevention of surface
damage
TEARS SUBSTITUTES
Drops and gels
Cellulose derivates (hypromellose,
methylcellulose), carbomer gels, polyvinyl
alcohol, diquafosol
Ointments
Paraffin, used at bedtime to supplement daytime
Eyelid sprays
Stabilize the tear film and reduce evaporation
Artificial tear insert
Emplaced once or twice daily
Mucolytic agents
Useful in patients with corneal filaments &
mucous plaque
ANTI-INFLAMMATORY AGENTS
Topical steroids
Supplement for acute exacerbation
Omega fatty acid supplement

Reduction of topical medication

Oral Tetracyclines

Control associated belpharitis,

meibomianitis, reduce tear level of
inflamatory mediator
Topical Ciclosporin

Reduces T-cell mediated infl. of lacrimal

tissue, increase the number of goblet cell
THANK YOU