⚡ Essay On Dry Eye Syndrome

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Essay On Dry Eye Syndrome

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Dry Eye Disease MoA Animation

Pathophysiology Many of the scientific papers presented at the Academy meeting added to our understanding of the pathophysiology of dry eye disease. The complexity at a clinical level may be overwhelming. No matter; as eye care clinicians, the better we understand the diseases that we are dealing with, the better we will manage them. Too often, we lump all forms of dry eye together and skip the differentiation of phenotype by ignoring the Schirmer test or phenol red thread test. Meadows, OD, and colleagues found that T-helper cells 1, 2 and 17 are active in dry eye disease regardless of etiology. On a practical level, this suggests that topical corticosteroids may be more effective as an initial treatment of ADDE than in other forms of dry eye syndrome.

In earlier work in mice, Nancy A. In this study, researchers performed impression cytology of the bulbar conjunctiva of human subjects with and without SS to analyze the level of PAX This molecule may serve as a biomarker for SS as well as a target for treatment. Vitamin D is believed to play a major role in modulating inflammation. In human corneal epithelial cells in vitro, vitamin D lessened inflammation induced from toll-like receptors, which activate immune cell responses.

Also, vitamin D influences gene expression to increase proteins that are used in innate immunity. Meibomian gland disease is an important factor in dry eye, and some evidence suggests that contact lens wearers have greater meibomian gland loss than non-lens wearers. Two papers put these worries to rest. Pucker, MS, OD, each studied contact lens wearers and non-contact lens wearers and, using meibography, found no difference in meibomian gland dropout in the two groups.

Diagnosis is a tricky business in clinical practice. There are many questions: Which patients do we test, and which tests do we use? How many tests are needed? Who should have a full tear film and ocular surface disease work-up? What does this cost? So, symptoms of any kind do play a big role in clinical practice. Speaking of symptoms, an interesting paper presented by Eric Li, OD, suggested that we temper our rating of dry eye disease by learning the global pain sensitivity of our patients.

This understanding may help to explain the very real clinical dilemma of painfully sore eyes with few signs vs. When a patient presents with ocular discomfort and epiphora, dry eye is usually at the forefront of our differential diagnosis. The diagnosis: conjunctivochalasis, which is characterized as redundant conjunctival tissue that often presents with symptoms similar to dry eye including epiphora, foreign body sensation and ocular irritation. Ophthalmic dyes highlight the redundant folds in the otherwise transparent conjunctiva, and can alert us to an early presentation along the lower fornix.

So, be sure to add conjunctivochalasis in your differential for dry eye, especially in the presence of normal osmolarity. Treatment Our treatment of dry eye is becoming more focused. Anti-inflammatory therapies include pulse-dosed steroids and Restasis cyclosporine A, Allergan , as well as oral doxycycline, minocycline and azithromycin. It has been suggested recently that Restasis may be more efficacious when used with greater frequency more than twice daily in certain patients with severe dry eye.

Blockage of the meibomian glands is a major cause of increased tear evaporation. An interesting paper by Paul Karpecki, OD, and colleagues reported on Phase III results using lifitegrast as an anti-inflammatory treatment for dry eye. In this study, half of the subjects enrolled received topical lifitegrast 5. The main outcome measures were inferior corneal staining and reduced symptoms on a visual analog scale. Although there was no difference found in the staining scores, there was significant reduction in dryness symptoms with the use of lifitegrast. The secondary outcomes were total corneal staining, nasal lissamine green staining of the conjunctiva and symptoms.

The treatment group had reduced ocular discomfort and decreased itching and foreign body sensation. These and other efforts to create unique and better anti-inflammatory drops continue to be an important area of dry eye research. More to Come We still have a good deal to learn about dry eye, but we are making progress. The various phenotypes of dry eye are being elucidated. The pathophysiology is better understood. Diagnostic testing is improving, and some of the more innovative tests may become commonly used in private practice.

Also, the effort to discover better treatments is well under way. Meanwhile, we have groups of specialists in North America and around the world that are working to create clinical guidelines and important summaries that will serve to update all of us on evidence-based care and management of dry eye disease. There are still so many questions. Can we prevent meibomian gland dropout? Are non-preserved drops really better? Can dry eye disease be a pure neuropathy? For now, I am determined to take a thorough case history, perform the appropriate testing, consider the inflammatory process associated with dry eye, and to explain the disease clearly to my patients.

Caffery is in group practice in Toronto, teaches part time at the University of Waterloo School of Optometry, and is secretary-treasurer of the board of the American Academy of Optometry. The new tools of the trade in diagnosis help us to determine if dry eye is present and what the core dry eye mechanism is in a particular patient. Blurred vision. Another common symptom is a foreign body sensation — the feeling that grit or some other object or material is "in" your eye. And as odd as it may sound, watery eyes also can be a symptom of dry eye syndrome.

This is because dryness on the eye's surface sometimes will over-stimulate production of the watery component of your tears as a protective mechanism. But this "reflex tearing" does not stay on the eye long enough to correct the underlying dry eye condition. In addition to these symptoms, dry eyes can cause inflammation and sometimes permanent damage to the surface of the eye. Thankfully, there are effective treatment options if you suffer from chronic dry eye. In many cases, routine use of artificial tears and minor behavioral modifications taking frequent breaks during computer use, for example can significantly reduce dry eye symptoms.

In other cases, your eye doctor might recommend prescription eye medications to help your body create and secrete more tears and to decrease eye irritation and inflammation. Home Guide to common eye disorders and conditions Common eye irritation types In Hindi. Dry eyes can become red and irritated, causing a feeling of scratchiness. Schedule an exam Find Eye Doctor.

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