Ophthalmology Case Reports

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.

Case Report - Ophthalmology Case Reports (2024) Volume 8, Issue 4

Dry Eye Syndrome and the Cornea: Causes, Symptoms, and Management.

Priya Nair*

Department of Clinical Ophthalmology, All India Institute of Medical Sciences, India

*Corresponding Author:
Priya Nair
Department of Clinical Ophthalmology
All India Institute of Medical Sciences, India
E-mail: pnair@aiims.edu.in

Received: 03-Aug-2024, Manuscript No. OER-24-144383; Editor assigned: 05-Aug-2024, Pre QC No. OER-24-144383 (PQ); Reviewed: 19-Aug-2024, QC No. OER-24-144383; Revised: 25-Aug-2024, Manuscript No. OER-24-144383(R); Published: 30-Aug-2024, DOI: 10.35841/oer-8.4.224

Citation: Nair P. Dry Eye Syndrome and the Cornea: Causes, Symptoms, and Management. Ophthalmol Case Rep. 2024; 8(4):224

Visit for more related articles at Ophthalmology Case Reports

Introduction

Dry Eye Syndrome (DES), also known as dry eye disease (DED), is a prevalent condition that affects millions of people worldwide. It occurs when the eyes do not produce enough tears or when the tears evaporate too quickly. This condition can lead to discomfort, visual disturbances, and potential damage to the ocular surface, particularly the cornea. Understanding the causes, symptoms, and management of Dry Eye Syndrome is crucial for effective treatment and improved quality of life for those affected [1].

Dry Eye Syndrome is a multifactorial disease, with various intrinsic and extrinsic factors contributing to its development. These causes can be broadly categorized into two types: aqueous-deficient dry eye and evaporative dry eye. This type occurs when the lacrimal glands fail to produce sufficient aqueous (watery) component of tears. Causes include: Tear production tends to decrease with age. Particularly in women during menopause. Conditions like Sjögren's syndrome, rheumatoid arthritis, and lupus can impair tear production [2].

Certain medications, including antihistamines, beta-blockers, and antidepressants, can reduce tear production. This type is associated with increased tear evaporation, often due to: Dysfunction of the glands that secrete the oily layer of the tear film, leading to increased evaporation. Wind, smoke, dry air, and prolonged screen time can exacerbate tear evaporation. Contact lenses can disrupt the tear film and increase evaporation. Conditions like ectropion (outward turning of the eyelids) or entropion (inward turning of the eyelids) can interfere with tear distribution [3].

The symptoms of Dry Eye Syndrome can vary from mild to severe and may include: A persistent feeling of dryness, burning, or a gritty sensation in the eyes. Inflammation of the ocular surface can cause the eyes to appear red. Temporary blurriness, particularly after periods of reading, watching TV, or using a computer. Photophobia or increased sensitivity to light. Paradoxically, dry eyes can trigger reflex tearing, leading to watery eyes [4].

Difficulty wearing contact lenses or a sensation of them not fits properly. The cornea, the transparent front layer of the eye, plays a critical role in focusing vision. In Dry Eye Syndrome, the lack of adequate lubrication can lead to: Chronic dryness can cause epithelial defects, erosions, and even corneal ulcers. Persistent dryness can lead to inflammation of the corneal surface, worsening symptoms and potentially causing scarring. The protective barrier function of the tear film is compromised, increasing susceptibility to infections [5].

Diagnosing Dry Eye Syndrome involves a comprehensive evaluation by an eye care professional. Key diagnostic tools and tests include: Patient History and Symptom Questionnaires: Detailed patient history and standardized questionnaires like the Ocular Surface Disease Index (OSDI).Tear Film Break-Up Time (TBUT): Measuring the time it takes for dry spots to appear on the cornea after blinking. Schirmer’s Test: Assessing tear production by placing a special strip of paper under the lower eyelid. Staining Tests: Using dyes like fluorescein or lissamine green to highlight damage on the ocular surface [6].

Meibography: Imaging the meibomian glands to evaluate gland structure and function. Managing Dry Eye Syndrome requires a multifaceted approach, often combining lifestyle modifications, medical treatments, and, in some cases, surgical interventions. Avoiding Triggers: Minimizing exposure to dry, windy or smoky environments. Humidifiers: Using humidifiers to add moisture to the air, especially in dry climates or during winter. Regular Breaks: Taking breaks during activities that strain the eyes, such as reading or using digital devices [7].

Proper Hydration: Drinking plenty of water to maintain overall hydration. Artificial Tears: Over-the-counter lubricating eye drops to supplement natural tears. Prescription Medications: Anti-inflammatory medications like cyclosporine (Restasis) or lifitegrast (Xiidra) to reduce inflammation and increase tear production. Omega-3 Supplements: Dietary supplements to improve tear quality. Punctal Plugs: Small devices inserted into the tear ducts to prevent tears from draining away too quickly. Meibomian Gland Expression: Procedures to manually express clogged meibomian glands [8].

Lipid-Based Eye Drops: Eye drops containing lipids to replenish the tear film’s oily layer. Autologous Serum Eye Drops: Eye drops made from the patient's blood, rich in growth factors and nutrients. Thermal Pulsation Devices: Devices like LipiFlow to heat and massage the meibomian glands, improving oil flow. Tarsorrhaphy: Partial sewing of the eyelids to reduce tear evaporation. Amniotic Membrane Transplantation: Using amniotic membrane to promote healing of the ocular surface. Conjunctivochalasis Surgery: Removing excess conjunctival tissue to improve tear film stability [9,10].

Conclusion

Dry Eye Syndrome is a complex condition with a variety of causes, symptoms, and potential complications, particularly concerning the cornea. Timely diagnosis and a comprehensive management plan tailored to the individual’s needs are essential for mitigating symptoms and preventing long-term damage. Advances in diagnostic techniques and treatment options continue to enhance the quality of life for those affected by Dry Eye Syndrome, offering hope for more effective management and improved ocular health.

References

  1. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. J Ocul Pharmacol. 2017;15(3):276-83.

    2. Indexed at, Google Scholar, Cross Ref

  2. Stapleton F, Alves M, Bunya VY, et al. Tfos dews ii epidemiology report. J Ocul Pharmacol. 2017;15(3):334-65.

    3. Indexed at, Google Scholar, Cross Ref

  3. Nelson JD, Craig JP, Akpek EK, et al. Tfos dews ii introduction. J Ocul Pharmacol. 2017;15(3):269-75.

    4. Indexed at, Google Scholar, Cross Ref

  4. Ganesalingam K, Ismail S, Sherwin T. Molecular evidence for the role of inflammation in dry eye disease. Clin Exp Optom. 2019;102(5):446-54.

    5. Indexed at, Google Scholar, Cross Ref

  5. Lemp MA, Crews LA, Bron AJ. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31(5):472-8.

    6. Indexed at, Google Scholar, Cross Ref

  6. Ardan T, Nemcová L, Bohuslavová B, et al. Reduced Levels of Tissue Inhibitors of Metalloproteinases (TIMPs) in UVB Irradiated Corneal Epithelium.

    7. Indexed at, Google Scholar, Cross Ref

  7. Gayton JL. Etiology, prevalence, and treatment of dry eye disease. Clin Ophthalmol. 2009:405-12.

    8. Indexed at, Google Scholar, Cross Ref

  8. Geerling G, Tauber J, Baudouin C, et al. The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2011;52(4):2050-64.

    9. Indexed at, Google Scholar, Cross Ref

  9. Balgos MJ, Piñero DP, Canto-Cerdan M. Comparison of the Cost-Effectiveness of SMILE, FS-LASIK, and PRK for Myopia in a Private Eye Center in Spain. J Refract Surg. 2022;38(1):21-6.

    10. Indexed at, Google Scholar, Cross Ref

  10. Barabino S, Chen Y, Chauhan S. Ocular surface immunity: homeostatic mechanisms and their disruption in dry eye disease. Prog Retin Eye Res. 2012;31(3):271-85.

    11. Indexed at, Google Scholar, Cross Ref

Get the App