Ophthalmology >>>> Dry eye syndrome

Dry eye syndrome.

Dry eye syndrome is considered as a sign of latent or overt xerosis (increased dryness) of the cornea and / or conjunctiva caused by a violation of the stability of the tear film.

The tear film in a normal state is a layer of mucins (epithelial and goblet cells) that holds the film on the surface of the cornea, the thinnest layer of lipids (produced by the meibomian glands), which prevents it from drying out from the outside and between these layers, the liquid located between these layers, which makes up 98% of the volume of the entire film. Mucin gives the film a mirror-like shine, smoothing out all irregularities, and the lipid layer makes the outer surface of the film smooth.

The stability of the tear film is provided by tear secretion, healthy (not damaged) state of the corneal epithelium and the conjunctiva of the inner surface of the eyelids in contact with the tear film. It is the rupture of the tear film that ensures the blinking of the eyelids and renews the composition of the fluid that forms a new tear film.

Dry eye causes:

Pathologies that contribute to increased evaporation of fluid,
Decreased secretion of the lacrimal glands,
Rare blinks of the eyelids,
Avitaminosis (for example, a lack of vitamin A results in increased keratinization of epithelial cells),
Metabolic disorders (including endocrine dysfunctions),
Autoimmune diseases (such as Sjogren syndrome),
Menopausal changes in the goblet cells of the conjunctiva,
Electromagnetic radiation of electronic equipment (computer, TV, office equipment),
Conditioned air,
Smoke and / or smog
Cosmetical tools,
Violation of the rules for wearing lenses or improper lens design,
Operations performed in the area of the cornea or conjunctiva of the eye.

Xerosis of the cornea or conjunctiva can occur in various forms of severity and is sometimes accompanied by increased compensatory tearing. Dry eye syndrome can also occur with blepharitis. Clinically severe forms of corneal - conjunctival xerosis are manifested in the form of keratoconjunctivitis, filamentous keratitis, recurrent corneal erosion. A particularly difficult condition develops with partial or complete non-closure of the eyelids. Possible complications in the form of perforation of the cornea of the eye.

Dry eye signs are:

Burning and itching in the eye area,
Redness of the eyes,
In a decrease in the clarity of vision,
In the rapid fatigue of the eyes,
In poor tolerance of the moving air stream (with wind, fans),
In sensations of drying out of the surface of the eyeball, "covered with sand" of the eyes.

Treatment of dry eye syndrome is possible with therapeutic and surgical methods. Therapeutic treatment involves the use of drops - tear substitutes , which create a stable film, prevent too rapid outflow of fluid from the conjunctival cavity. For these purposes, the drugs "Artificial Tear", "Natural Tear", Oftagel, Korneregel, Lacrimin, Lakrisifi, Vidisik are used.

In addition, metabolites are used to inhibit degenerative processes in the cornea, immunotropic and anti-inflammatory drugs.

Surgical treatment is indicated in severe cases:

with pathologically complex changes in the cornea (represented by thinning, corneal ulcers, filamentous keratitis),
with a pronounced decrease in the secretion of lacrimal fluid.

Initially, collagen obturators (plugs to close the lacrimal duct) are used, which dissolve within a week. In the case of a positive clinical effect, obturators made of silicone are used (in the upper and, if necessary, the lower lacrimal canal). Other methods of reducing the outflow of tear fluid are also possible: laser coagulation, suturing, plastics of the lacrimal openings (entrance openings of the lacrimal tubules). The above methods of treating dry eye syndrome are considered minimally invasive and do not cause irreversible changes in the structure of the cornea.

In severe cases, for the treatment of corneal xerosis, lateral tarsorrhaphy (Tarsorrhaphy) is performed - a surgical operation for complete or partial suturing of the edges of the eyelids, carried out under local anesthesia and with the goal of protecting the cornea of the eye with full or partial non-closure of the eyelids. A new method in the treatment of dry eye syndrome is transplantation into the conjunctival cavity of the salivary glands.