What Is the Best Dry Eye Treatment?

Dry eye disease is a general term for a variety of diseases that cause abnormal tear quality or quantity or kinetic abnormalities caused by any cause, leading to decreased tear film stability, accompanied by eye discomfort and / or ocular surface tissue lesions. Also called corneal and conjunctival xerosis. Common symptoms include dry eyes, easily tired, itchy eyes, foreign body sensation, burning sensation, sticky secretions, fear of wind, light, and sensitivity to external stimuli; sometimes the eyes are too dry and the basic tears are insufficient, but they stimulate the reflex Secretion of tears often causes tears; more severe eyes will be red and swollen, hyperemia, keratinization, corneal epithelium peeling and filiform adhesion. Such damage can cause corneal and conjunctival lesions and affect vision.

Basic Information

nickname

Keratoconjunctivitis

English name

xerophthalmia

Visiting department

Ophthalmology

Multiple groups

Elderly, computer users, contact lens wearers

Common causes

Eye inflammation, Sjogren's syndrome, etc.

Common symptoms

Common symptoms are dry eyes and foreign body sensation

Causes of dry eye

Recent studies have suggested that changes in the ocular surface, immune-based inflammatory responses, apoptosis, and changes in sex hormone levels are related to the occurrence and development of dry eye, and the relationship between these factors has not been known. The causes can be divided into the following four categories:

1. Insufficient secretion of lacrimal glands in the aqueous layer

Is the most common cause of dry eye angle; congenital absence of lacrimal glands, senile lacrimal gland function or some autoimmune diseases cause lacrimal gland inflammation, trauma, infection, autonomic nervous disorders, long-term eye drops or taking certain drugs will Causes insufficient tear secretion; long-term wear of contact lenses.

2. Insufficient secretion of the oil layer

Meibomian gland dysfunction due to eyelid disease.

3. Insufficient secretion of the mucin layer

Those who lack vitamin A ₁ , chronic conjunctivitis, chemical burns, etc.

4. Excessive evaporation of tear fluid and uneven distribution of tear film

Eyelid disease results in poor eyelid closure, reduced blinks, and prolonged stay in an air-conditioned room or an outdoor strong wind and hot environment.

Clinical manifestations of dry eye

Common symptoms are dry eyes and foreign body sensation. Other symptoms include burning, itching, photophobia, congestion, pain, blurred vision and fatigue, and sticky filamentous discharge.

Dry eye examination

Tear secretion test

The normal value is 10 ~ 15mm, more than 10mm is low secretion, and less than 5mm is dry eye.

2. tear film rupture time

The tear film is less than 10 seconds.

3. Tear liquid fern test

People with mucin deficiency, such as ocular pemphigus and Stevens-Johnson syndrome, have reduced or even disappeared their "ferns".

4. Biopsy and Blot Cytology

In dry eye patients, the density of goblet cells in the conjunctiva decreases, the ratio of nuclear to plasma increases, the squamous metaplasia of epithelial cells, and the conjunctiva of corneal epithelium. By calculating the density of goblet cells in the conjunctiva, the severity of the disease can be assessed indirectly.

5.fluorescein staining

Positives represent corneal epithelial defects. You can also observe the height of the tear river.

6.Tiger red staining

Sensitivity was higher than that of fluorescein staining. Corneal and conjunctival inactivated cells stained as positive cells.

7. Tear lysozyme content

If the content is less than 1200 g / ml, or the lysolytic area is less than 21.5 mm ² , dry eye disease is indicated.

8. Tear osmotic pressure

For dry eye and contact lens wearers, tear osmotic pressure increased by 25mOsm / L compared with normal people. If greater than 316mOsm / L, dry eye can be diagnosed.

9. Lactoferrin

Patients younger than 69 years of age can diagnose dry eye if they are lower than 1.04bg / ml, and patients older than 70 years of age are lower than 0.85mg / ml.

10.Tear fluid clearance check

The goal is to understand if there is a delay in tear clearance. Detection using fluorescence spectrophotometry.

11. Dry eye or tear film interference imager

Understand the tear film lipid layer, dry eye disease, especially LTD (lipid deficiency dry eye disease) patients can see tear film lipid layer abnormalities, compared with the standard image can be estimated dry eye severity.

12. Corneal topographic examination

Understanding the regularity of the corneal surface, the regular parameters of the corneal surface of dry eye patients are higher than normal people, and the higher the parameter, the heavier the dry eye is.

13. Serology

Knowing autoantibodies, patients with Sjogren's syndrome often see positive ANA antibodies and rheumatoid factors. This is helpful for the diagnosis of dry eye caused by immune diseases.

Dry Eye Treatment

Dry eye disease is a chronic disease that requires long-term treatment. If the tear is caused by excessive evaporation of tears due to eyelid exposure, eyelid reconstruction should be grasped according to the condition of the eyelid reconstruction surgery.

Local treatment

(1) Elimination of incentives Avoid prolonged use of computers and less exposure to dry eyes such as air-conditioning and smoke and dust; those with meibomian gland dysfunction should pay attention to cleaning the eyelids and applying antibiotics.

(2) Alternative treatment of tear components. Use autologous serum or artificial tears. For severe patients, try artificial tears without preservatives.

(3) Prolong the residence time of tears on the ocular surface. It can be equipped with wet room mirror, silicone eye mask, therapeutic contact lens and so on.

(4) Others Avoid taking drugs that can reduce tear secretion, such as antihypertensive drugs, antidepressants, atropine analogs, etc .; those with immune factors can add immunosuppressants or short-term topical hormones; surgical treatment.

2. Systemic treatment

Mainly to improve the nutritional status of patients and prevent secondary infections. Consume foods rich in vitamin A, such as milk, eggs, carotene-containing vegetables; oral cod liver oil, etc.

At present, there is no effective treatment. In order to reduce the pain, saline, artificial tears or antibiotic eye ointment can be frequently dropped; or the small punctum can be closed by electric cauterization to reduce the outflow of tears. For dry eyeballs due to incomplete eyelid closure, blepharoplasty is feasible.