Dry eye syndrome

Dry eye syndrome is also known as keratoconjunctivitis sicca (KCS) or keratitis sicca or xeropthalmia is an eye disease caused by dryness of eye which in turn is caused by either decrease in production of tears or due to increased evaporation of tears.

dry eye syndrome

 

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Commonly seen in

Keratoconjunctivitis sicca is especially seen in older people those aged 40 or older.
People who suffer from autoimmune diseases have a high likelihood of having dry eye syndrome.
Dry eye syndrome is more common in women because of hormonal changes that occur during pregnancy, menstruation, and menopause leading to decreased production of tears.

Causes of Dry eye syndrome ?

The two major causes linked to decreasing in level of adequate tear levels for eyes are as follows
• Deficient production of tears that is aqueous deficiency state
• An evaporation state leading to evaporation of tears

Aqueous tear deficiency (ATD) is the most common cause of dry eye and due to insufficient tear production. Causes of deficient aqueous production include the following
• Deficiency of lacrimal gland
• Reflex hyposecretion
• Systemic drugs
• SS (Sjogren disease) dry eye
• Lacrimal gland duct obstruction

Causes behind the evaporative loss of tears are as follows
• Disorders of the lid aperture
• Low blink rate of eyelids
• MGD ( Meibomian Gland Dysfunction)
•Deficiency of vitamin A
• Contact lens wearing
• Ocular surface disease
There are different conditions which can lead to less formation of aqueous in the eyes and conditions are as follows
Non-Sjogren syndrome
There are different types of lachrymal gland deficiencies leading to dry eye syndrome and they are as follows
• Age-related dry eye
• Congenital alacrima ( lacrimal secretory disorders)
• Familial dysautonomia (its a genetic disorder that affects the development and survival of certain nerve cells. It disturbs cells in the autonomic nervous system, which controls involuntary actions such as digestion, breathing, production of tears, and the regulation of blood pressure and body temperature).

Secondary lacrimal gland deficiencies that hamper the aqueous duct formation are as follows
• Sarcoidosis
• Lymphoma
• AIDS
• Graft vs host diseases
• Lacrimal gland infiltration
• Amyloidosis
• Trachoma
• Lacrimal gland ablation
• Lacrimal gland denervation
• Systemic vitamin A deficiency

Lacrimal obstructive diseases which impair the formation of tears in the eye are as follows
• Chemical or thermal burns
• Endocrine imbalance
• Trachoma
• Ocular cicatricial pemphigoid
• Postirradiation fibrosis
• Erythema multiforme

Medications which may impair aqueous production include the following
• Beta-blockers
• Anxiolytics
• Diuretics
• Anticholinergics
• Antiarrhythmics
• Antihistamines
• Atropine
• Topical Anesthetics
• Isotretinoin
Evaporation of tears is also a major factor for dry eye syndrome.
Causes for evaporative loss can be further classified as intrinsic or extrinsic

Intrinsic causes are related to meibomian gland diseases such as
• Meibomian seborrhea
• Retinoid therapy
Evaporative loss may also result from the following diseases of eyelid aperture and eyelid globe congruity and they are as follows
• Lid palsy
• Lid coloboma
• Ectropion

Other factors leading to abnormal evaporation of tears from eyes are as follows
• Vitamin A deficiency leading to developmental disorder of goblet cells
• Lacrimal acinar damage

Other extrinsic causes are as follows
• Contact lens wear
• Ocular surface disease

Sign and symptoms of Dry eye syndrome ?

Following are the most common symptoms found in patient suffering from dry eye syndrome
• Hyperemia
• Mucoid discharge
• Ocular irritation
• Excessive tearing
• Photophobia
• Fluctuating or blurry vision

How to investigate Dry eye syndrome ?

Tests to be done are as follows
• Tear break up time
• Epithelial staining
• Schirmer test
• Test to quantify tear components

How to treat Dry eye syndrome ?

Pharmacologic therapies given to the patients with dry eye syndrome are as follows
• Artificial tear substitutes
• Gels and ointments
• Umbilical cord serum or autologous
• Systemic immunosuppressants

Along with all these eye protection is very important in dry eye syndrome and can be done by the use of following
• Use silicone rubber lenses
• Highly oxygen-permeable lenses

Complications of Dry eye syndrome

Complications of dry eye syndrome are as follows
• Sterile or infectious corneal ulceration
• Occasionally corneal perforation may occur
• Vision loss may occur

Prognosis of Dry eye syndrome

The prognosis of dry eye syndrome varies with the severity of the condition. Dry eye syndrome can be treated symptomatically with lubricants, providing good relief of symptoms.

Differential diagnosis of Dry eye syndrome

• Bell’s palsy
• Allergic conjunctivitis
• Superior limbic conjunctivitis
• Contact lens complications
• Neurotrophic keratopathy
• Ocular rosacea
• Thyroid ophthalmopathy
• Adult blepharitis
• Floppy eyelid syndrome

How to manage Dry eye syndrome with homoeopathic medications ?

Veratrum album
• Surrounded by dark rings
• Staring turned upwards without luster
• Lids dry heavy
• Lachrymation with redness

Belladonna
• Throbbing deep in eyes on lying down
• Exophthalmus
• Ocular illusions, fiery appearance
• Eyelids swollen
• Fundus congested
• Pupils dilated
• Eyes feel swollen and protruding staring, brilliant, conjunctiva red, dry, burn, photophobia, shooting in eyes.

Asarum europium
• Eyes feel stiff, burn, feel cold
• Dryness of eyes
• Better in cold air or water, worse sunlight, and wind
• Asthenopia
• Dryness of eyes

Causticum
• Cataract with motor disturbances
• Sparks and dark spots before eyes ptosis
• Vision-impaired as if film before eyes
• Paralysis of ocular muscles after exposure to cold
• Well indicated medicine for dryness of eyes.
• Helps in formation of adequate water level needed for eyes

Chamomilla Vulgaris
• Well indicated medicine for dry eye
• Lids smart
• Yellow sclerotic eyes
• Spasmodic closing of lids
• Very well indicated remedy for the treatment of dryness of eyes.

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