DRY EYE

Dwi Yunia Ningsih

Anatomy
Lacrimal
The lacrimal
drainage
system
consists of
the:
punta,
canaliculi,
lacrimal sac

nasolacrimal
duct (NLD)

Tear
Tears form a thin

layer
approximately 710
m thick that covers
the corneal and
conjunctival
epithelium.

The functions of this ultrathin layer are:

(1) to make the cornea a smooth
optical surface by abolishing minute
surface epithelial irregularities;

(2) to wet and protect the delicate

surface of the corneal and

conjunctival epithelium;
(3) to inhibit the growth of

microorganisms by mechanical
flushing and antimicrobial action;
and
(4) to provide the cornea with

necessary nutrient substances

Tear Production

The tears are produced by

the lacrimal gland and the

accessory lacrimal tissue
(glands of Krause and
Wolfring) and are swept over
the eye surface with each
blink.

Methods of Tears Product

Slow, steady (basal) rateresponsible for

normal eye lubrication.

Excessive (reflex) rateproducing large
quantities of tears in response to eye
irritation or emotions.

Composition of Tears
The normal tear volume is

estimated to be 7 2 ul in
each eye.
Albumin accounts for 60% of
the total protein in tear fluid.
Immunoglobulins IgA, IgG,
and IgE
Tear lysozymes form 2125%
of the total protein and
acting synergistically with
gamma globulins and other
nonlysozyme antibacterial
factorsrepresent an
important defense
mechanism against infection.

K+, Na+, and Cl occur in higher

concentrations in tears than in

plasma
Tears also contain a small amount of

glucose (5 mg/dL) and urea (0.04

mg/dL), and changes in blood
concentration parallel changes in
tear glucose and urea levels.
The average pH of tears is 7.35,

although a wide normal variation

exists (5.208.35).
Tear film osmolarity ranges from

295 to 309 mosm/L.

Dry-Eye Syndromes
(Keratoconjunctivitis Sicca)
Dryness of the eye may result from any

disease associated with deficiency of the

tear film components (aqueous, mucin, or
lipid), lid surface abnormalities, or epithelial
abnormalities.
Although there are many forms of
keratoconjunctivitis sicca, those connected
with rheumatoid arthritis and other
autoimmune diseases are commonly
referred to as Sjgren's syndrome.

Epidemiology
Prevalensi:

- 17% of Women
- 11% of Men
Increasing Incidence With Age
5% In Younger Patients (Lin, et al)
35% In Older Patients (Lin, et al)
14.6% of Patients Older Than 65 Years

(Schein)

Classification

Tear deficient dry eye

Keratoconjunctivitis sicca (KCS)
Sjogrens syndrome:
Autoimmune disease in which the body's immune system
mistakenly attacks its own moisture-producing glands
Autoimmune disorder with a triad of dry mouth, dry eye
and arthritis
Non-Sjogrens
Ageing Gradual deterioration of lacrimal gland tissue
occurs with ageing
Menopause At the time of menopause, levels of
androgens drop down
Neurotrophic keratitis Corneal sensitivity decreases
after LASIK, contact lens wear and diabetes
Medicamentosa Anti histamines, anti-depressants
Cicatricial Diseases Trachoma, chemical burns,
Stevens Johnson syndrome

Mechanism of ocular
surface inflammation in dry eye

EVAPORATIVE DRY DISEASE

Meibomian gland disease: Most prevalent

(65%). Obstruction of meibomian gland

Lid surfacing anomalies: Lid closure
affected, blinking affected
Ocular surface toxicity: Long term use of
topical antiglaucoma medications
Contact lens related
Allergy

Chronic Allergy
Dry eye is commonly associated with

chronic allergic conjunctivitis.

An allergic history has been reported by

36% of dry eye patients.

Chronic allergy results in loss of goblet

cells, destabilization of the tear film &

damage to ocular surface.

Environmental Influences
Ocular irritation, poor tear film stability and

ocular surface desiccation is associated

with poor indoor air quality in temperature
controlled office environments
35-48% of individuals working in such

environments are affected.

Dry climate
Growing air pollution

Symptoms
redness
dryness
burning
Grittiness
tired eyes
blurry vision
sensitivity to light

Diagnostic
Case History
Slit Lamp

Evaluation
Other Tests
Schirmers test

Schirmer Test
This test involves

placing a strip of
filter paper over
part of the eye
(conjunctival sac)
for up to five
minutes
Less than the
normal amount of
wetting, on
repeated
examinations,
indicates

Without Anesthesia
Measures Reflex

Tear Secretion (dry

eye = < 6mm
wetting)
With Anesthesia
Measures Basal

Tear Secretion (dry

eye =< 3mm
wetting)

Treatment
Eyedrops (artificial
tears)
Artificial tears, similar
to your own tears,
lubricate the eyes
and help replace the
natural moisture
layer of the tear film.
Available without a
prescription; can be
used as often as
necessary.

Treatment
If the problem is

environmental, wear
sunglasses when
outdoors, to reduce
exposure to sun,
wind and dust
When indoor heat is
on, keep a humidifier
or pan of water in
the room to add
moisture to dry air

Treatment
Lacrimal plugs or punctal plugs plugs in

the lacrimal (tear) ducts keep tears in your

eye from draining away as quickly

Thank You