Dry Eyes (Keratoconjunctivitis sicca - KCS)
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Who gets dry eyes?
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What is keratoconjunctivitis sicca (KCS)?
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What
are the tear layers?
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What
happens in KCS?
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How do I know if I have dry eyes?
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How
is the diagnosis made?
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What are the causes of KCS?
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What is the treatment for KCS?
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What is Sjogren's syndrome?
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How do I get more information?
Dry eye is a condition that can develop
under many circumstances and affects millions of people of all ages and races
worldwide. In some, it may be associated with underlying medical problems. The
dry eye syndrome is caused by the alteration in one's natural tear film, a thin
layer of tears protecting the surface of our eyes. Damage to the surface of the
eyes (cornea and conjunctiva) is responsible for the symptoms of dry eyes.
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Keratoconjunctivitis sicca (KCS) or "dry
eye" describes the changes in the eye which result from lack of tear production.
To understand "dry eye" it is helpful to know how tears help keep the cornea
healthy. The cornea is the optically clear portion of the eye that allows entry
of light into the eye. Like all living tissue, the cornea requires a supply of
oxygen and energy to remain healthy. Oxygen and nutrients are supplied to most
tissues by the blood that moves through the area in blood vessels. The healthy
cornea has no blood vessels, if it did it wouldn't be clear, so the oxygen and
nutrients are supplied through the three-layered 'tear film.'
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The outer most layer of the tear film is an
oily layer supplied by glands in the eyelids. This layer helps prevent
evaporation of the next aqueous layer. The middle layer is the liquid aqueous
layer produced by the main tear gland and a gland in the third eyelid. This is
the layer that is decreased in dry eye. The innermost layer in direct contact
with the cornea is a mucous layer produced by glands located in the folds of the
eyelid. The mucus layer helps the aqueous layer adhere to the surface of the
cornea.
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A breakdown in the tear film and a loss of
the aqueous layer causes dry eye. This loss results in dryness to areas of the
corneal surface or in more advanced cases, drying to the entire corneal surface.
When the cornea is deprived of oxygen and nutrients through the tear film, it
rapidly undergoes destructive changes. These changes result in brown
pigmentation, scar tissue growth, ulcer development, and blood vessel growth
across the cornea leading to partial vision loss.
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If you feel a foreign body sensation in
your eyes, then an eye physician (ophthalmologist) can tell you if you have dry
eyes by examining your eyes and testing for the amount of tears that your eyes
make. The eyes of a patient with KCS sting constantly just as ours do on a very
windy day. The stinging we feel is due to the wind drying our eyes quicker than
tears can be provided. The patient with dry eye is uncomfortable almost all the
time. When a patient has "dry eye" where there is a lack of the watery layer of
the tears, the oil and mucus layers are increased. This leads to a thick, mucoid,
greenish discharge that sticks to the hairs around the eye. Often this is the
main reason that a patient is presented to the ophthalmologist. The discharge
will clear up whenever appropriate medication is used but will return when the
medication is stopped.
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Diagnosis is made by collecting a history
about the condition, an examination, and a number of testing procedures. These
tests include the Schirmer tear test which measures the production of watery
layer. Fluorescein stain is used to define possible breaks in the corneal
surface and the rate of the tear breakup. In addition, Rose Bengal stain may be
used to evaluate the health of the outer layer of the cornea called the
epithelium. Lissamine Green is also now available for staining purposes.
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A number of causes have been reported for
dry eye. These include hypothyroidism, infections of the tear glands such as
canine distemper virus and immune-mediated diseases that attack the tear glands.
Another frequent cause of dry eye is a toxic effect produced by certain
sulfa-containing drugs and certain anti-inflammatory drugs. Some of these drugs
may be necessary for the treatment of other diseases. In some cases, changing or
stopping the medication may result in improvement of the dry eye, while in
others the toxic damage is done and the KCS is not reversible, and must be
managed medically. In many cases the cause of dry eye remains unknown yet
treatment can still be instituted. Loss of nerve impulses to the gland due to
long-standing ear infections and other nerve disorders will cause a unilateral
(one sided) dry eye often combined with a dry nose in some cases.
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There are several objectives in treating
dry eye. These include: tear replacement, lubrication, bacterial overgrowth
reduction, reduction of inflammation, stimulation of natural tear production.
Since the aqueous tear fraction is absent or reduced, tear replacement is very
important. Natural tear production is continuous, so it is very difficult to
replicate this with drops. Application of commercial tear replacement products
such as often as needed is suggested. Artificial tears, which may be purchased
at a local drug store, are the first line of therapy for dry eyes. Artificial
tears come in several different brands. Some solutions are thicker than others.
The ones which are preservative-free are recommended. The thicker solutions
might relieve symptoms for a longer period of time; however, they may cause
slight blurriness of vision for a short time after they are applied. A
humidified environment also helps dry eyes. Several other modalities of
treatment, including occlusion of the tear drainage system with a plug, exist
for people with severe dry eyes. Most importantly, people with dry eyes should
be examined by an eye physician to be treated for any possible causes of their
symptoms.
|
 Punctal plug
placed at the inferior punctum.
Photo courtesy of
StLukesEye.com |
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The dry eye patient frequently has a
buildup of mucus in the folds of the eyelids that is no longer being washed with
liquid tears. This mucus is food for bacterial growth. These bacteria may not be
disease-causing bacteria but need to be controlled. In most cases an antibiotic
and acetylcysteine (an ingredient which will help break down the mucus) are
added to the artificial tear solution to help keep the mucus discharge and the
bacterial overgrowth under control.
The newest drug used for the treatment of
dry eye is an immune-suppressing medicine called cyclosporine. This medication
has provided relief of symptoms in some patients while other patients have had a
marked increase in tear production. The compounded forms of cyclosporine may be
ordered online via
LeiterRx.com.
Soon, a major pharmaceutical company will market this product.
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Sjögren's
syndrome is an autoimmune disease in which the body's immune system mistakenly
attacks its own moisture producing glands. Sjögren's is one of the most
prevalent autoimmune disorders, striking as many as 4,000,000 Americans. Nine
out of ten patients are women. The average age of onset is late 40s although
Sjögren's occurs in all age groups in both women and men.
About 50% of the time Sjögren's syndrome
occurs alone, and 50% of the time it occurs in the presence of another
connective tissue disease, such as rheumatoid arthritis, lupus, or scleroderma.
Sometimes researchers refer to the first type as "Primary Sjögren's" and the
second as "Secondary Sjögren's." All instances of Sjögren's syndrome are
systemic, affecting the entire body.
The hallmark symptoms are dry eyes and dry
mouth. Sjögren's may also cause dryness of other organs, affecting the kidneys,
GI tract, blood vessels, lung, liver, pancreas, and the central nervous system.
Many patients experience debilitating fatigue and joint pain. Symptoms can
plateau, worsen, or go into remission. While some people experience mild
symptoms, others suffer debilitating symptoms that greatly impair their quality
of life.
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There are several ways of reaching the ophthalmologists of EYE REPUBLIC Ophthalmology Clinic:
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ONLINE ACCESS
WEBSITES.
http://www.EyeRepublic.com.ph - EYE REPUBLIC
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http://www.OCP.com.ph - Ophthalmic
Consultants Philippines Co. -
http://www.LASIK.com.ph - Refractive
Surgery Resource
http://www.Cataract.com.ph - Cataract Surgery Resource
http://www.Eye.com.ph - Eye
Information Online
http://www.EyeDoc4Kids.com.ph - Eye Information for Kids
http://www.Retina.com.ph - Retina
Surgery Resource
http://www.Glaucoma.com.ph - Glaucoma
Online
http://www.Uveitis.com.ph - Uveitis Online
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EYE REPUBLIC
Ophthalmology Atlas
CLINIC INFORMATION
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EYE REPUBLIC Ophthalmology Clinic
Manila
3/F Don Santiago Building Units 309-310
1344 Taft Avenue, Ermita
Manila, 1000 Philippines
Direct and Fax: (632) 536-2398
Trunk Line: (632) 523-8271 to 79 local 30
Mobile: (63917) 899-2020
Map and directions
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EYE REPUBLIC
Ophthalmology Clinic
Asian Hospital
and Medical Center
5/F Medical Office
Building (MOB) Suite 509
2205 Civic Drive,
Filinvest, Alabang
Muntinlupa City,
1781 Philippines
Direct:
(632) 771-9253
Direct and Fax:
(632) 771-9254
Mobile: (63917) 795-2020
Map and Directions
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EYE REPUBLIC Ophthalmology Clinic
Medical City
6/F Medical Arts Tower Inc (MATI) Suite 602
MERALCO Compound, Ortigas Avenue
Pasig City, 1604, Philippines
Direct and Fax: (632) 632-7846
Mobile: (63917) 537-2020
Map and directions
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EYE REPUBLIC
Ophthalmology Clinic
St. Luke's
Medical Center
6/F
Cathedral Heights Building Complex (CHBC)
North Tower Suite 614
279 E. Rodriguez
Sr. Boulevard
Quezon City, 1102
Philippines
Direct and Fax:
(632) 407-3883
Mobile: (63917) 855-2020
Map and directions
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CLINIC HOURS
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Monday to Saturday 9:00 AM to 6:00 PM
All clinics are closed on Sundays and Holidays
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DRY EYE information compiled by
Dr. Manolette R.
Roque and initially uploaded on May 1, 2005.
Last updated on
September 13, 2007. |
