Dry Eye

Causes and management of
Dry eye
Dr. J Natasha Maria

Dry eye
• 50% of ALL red eyes and irritable
eyes are due to Dry Eye related
conditions ………..
Overview
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Roles and Characteristics of the eyelids
• Eye protection
• Regular blink: protection and stability of the tear
film
• Rich of glands
• Adequate blood supply
The Anatomy
• Corneal epithelium
• Conjunctival epithelium
• Tear film
• Clinical ocular surface consist of
conjunctiva
cornea
eyelids
lacrimal gland
lacrimal passages
Concept
•The ocular surface is a complex biological

continuum responsible for the maintenance of
corneal clarity, elaboration of a stable tear film for
clear vision, as well as protection of the eye
against microbial and mechanical insults.
Tear Secretion
• Lacrimal gland
Producing the watery part of the tear film
called the aqueous.
• Meibomian glands
Producing lipids which keep the tear film
from evaporating.
• Goblet cells of the conjunctiva
Producing mucin which allows the wetting
of the ocular surface as well as stabilizes the
tear film.
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Tear Film in relation to Cornea
Tear and the Tear Film
• Function :
1.Cleaning
2.Wetting ocular surface
3.Bacteriostasis
4.Supporting the cornea
(oxygen supply)
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Dry Eye
Healthy tear film Dry eye
http://www.chronicdryeye.com
Dry Eye Disease Workshop
Etiological factor & Classification
 Aqueous tear deficiency

 Lipid tear deficiency
 Mucoprotein deficiency
 Kinetic disorders of lacrimal fluid
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• Dry eye - is a chronic lack of sufficient
lubrication and moisture in the eye.
• Its consequences range from subtle but
constant irritation to ocular inflammation
of the anterior (front) tissues of the eye.
Clinical Manifestation
• Dry eye symptoms
asthenopia
irritation, grittiness
dryness
burning
light sensitivity
pink-eye
• Do you regularly experience one or several symptoms above?
• Some diseases and conditions (like Rheumatoid arthritis, Lupus

and Sjögren’s Syndrome) also cause chronic Dry Eye in many
patients.
• Activities like Reading, Wearing contact lenses or Working on the
Computer may cause Dry Eye.
Diagnostic Tests for Dry Eye
• Dry Eye questionnaire
• Lacrimal river width
• Schirmer test – uses paper strips under eyelid to
measure the wetness that collects over a specific period of
time.
• Break-up time of tear film (BUT)
• Staining – uses special dyes to highlight areas of possible
damage to the eye surface.
• Tear lab – measuring tear osmolarity
• Tear ferning test
• Lactoferrin contents
• Corneal tonographic map
• Impression cytology
Diagnosing
• Schirmer test, BUT, Staining

• Tests- types
1) Tear secretion assessment
2) Tear volume assessment
3) Tear clearance tests
4) Evaluation of tear film stability
5) Ocular surface damage assessment
Schirmer Test
• Normal ：≥ 10mm/5min
Tear break-up time, BUT
Staining
• Using special dyes to highlight areas of
possible damage to the eye surface.
0
1
分
分
2 3
分分
Tear meniscus height
Tear Osmolarity measurement
Meibomian Gland Dysfunction
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Etiological Factor
• Failure of the glands to produce or secrete lipids.

• Wax ester declining and cholesterol increasing
make the symptoms worse .
• Lack of tears and tear penetration pressure
increasing.
• Lupus, brandy nose etc.
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Clinical Manifestation
• Common in aged people and who lived in cold
region.
• No specific symptoms.
• Lid-margin mostly thickening; abnormal secretion
while pressurizing.
• Disorder in Meibomian
gland, eyelid, conjunctiva.
Figure: Notching of the lid caused

by loss of meibomian glands.
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Diagnosing
•Absence of Meibomian gland.
•The gland orifices are often compromised due to stenosis or
closure.
•A declining quality and quantity of lipid secretion.
Any one of the physical signs can make the
diagnosis of Meibomian gland dysfunction if the patient
has clinical symptoms.
Figure: No visible meibomian gland orifices:

Eversion of the lower lids in both eyes showed
atresic meibomian glands.
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Treatment
Clearing
• Hot fomentation on eyelids for 5~10mins.
• Massaging the eyelids.
• Swabbing the lid-margin with mild
cleaning solution.
Treatment
• Antibiotics oral administration.

• Local Medication
Antibiotic eye drops
Glucocorticoid eye drops (short term)
Artificial tears
Treatment
• According to the clinical category
For tear deficiency: Maintain moisture in the eyes; reducing
the evaporation; increasing the secretion; controlling inflammation &
immunoreaction.
For excess-evaporation: Therapy of Meibomian gland
dysfunction; controlling inflammation; cleaning eyelid; decreasing
the evaporation; lipid replacement.
• According to the eye conditions
For intermittent symptoms: Artificial tears add volume to
the tear film as long as they remain in contact with the surface of the
eye.
For midrange dry eye: Artificial tears and punctal occlusion.
For Severe dry eye: Appending cyclosporin, surgery.

Treatment
• Avoidance of exacerbating factors
• Eyelid hygeine
• Tear supplementation
• Tear retention
• Tear stimulation
• Biological tear substitutes-
autologous serum, platelet rich
plasma
• Cyclosporine-0.05%
Artificial Tear Groups
• HPMC
• Carboxy Methyl Cellulose
• PVA
• Liquid Polyols
• Hyaluronic acid
• Inserts
• Miscellaneous
Too many choices …..
Treatment pathway
Summary
• Eliminating the etiological factors

• Tears replacement therapy
• Maintain moisture in the eyes
• Increasing the tear secretion
• Immune inhibition therapy
• Re-establish the tear film
• Other supporting treatment
THANK YOU

Dry Eye

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Causes and management of

Dr. J Natasha Maria

•The ocular surface is a complex biological

 Aqueous tear deficiency

• Some diseases and conditions (like Rheumatoid arthritis, Lupus

• Schirmer test, BUT, Staining

• Failure of the glands to produce or secrete lipids.

Figure: Notching of the lid caused

Figure: No visible meibomian gland orifices:

• Antibiotics oral administration.

For Severe dry eye: Appending cyclosporin, surgery.

• Eliminating the etiological factors

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