Dry Eye Syndrome - relevant investigations and treatment

Sindromul de ochi uscat este o afecțiune comună caracterizată de simptome precum iritația oculară, arsura și senzația de corp străin în ochi. Tratamentul adecvat pentru sindromul de ochi uscat poate ameliora aceste simptome neplăcute. Există mai multe opțiuni de tratament disponibile pentru ochii uscați, inclusiv utilizarea de picături oftalmice hidratante și lubrifiante. Este important să se identifice și să se trateze cauza subiacentă a sindromului de ochi uscat pentru a obține rezultate optime în gestionarea acestei afecțiuni oftalmologice.

Introducere

Mai mult de o treime dintre pacienții noștri descriu, înca de la prima consultație, simptome specifice și corelate cu sindromul de ochi uscat.

They complain of "sand in the eye", burning and stinging, a feeling of a foreign body in the eye. The eyes are often congested and red, tear excessively and are associated with feelings of eye fatigue. It almost always occurs bilaterally, in different stages of development, more pronounced in the second half of the day or after prolonged eye strain. The severity of the symptoms is usually assessed according to the intensity of the ocular discomfort and visual blurring and according to the frequency of the onset of symptoms, particularly during exposure to blue light (computer, laptop, telephone, television) as well as during driving, exposure to wind, air conditioning, low humidity.

Relevant investigations

For an objective and accurate screening that is relevant to the staging of the severity of dry eye syndrome, except for the subjective symptomatological assessment of the patient, the following investigations are necessary:

1. Clinical appearance at the biomicroscope

The eyelid appearance, particularly the lid margin, is assessed to detect the association of certain forms of blepharitis, the intensity of conjunctival hyperemia and the corneal appearance. Detailed biomicroscopic examination can reveal valuable aspects for the initiation and modulation of treatment in this pathology. Special attention should be paid to blepharitis associated with Demodex, which is much more frequent and very dangerous due to the local morpho-functional effects produced, as well as to the impairment of the patient's quality of life.

Marked reduction of conjunctival hyperemia is observed at macroscopic level

2. Tear film break-up time

It is one of the standard investigations for determining tear film stability and evaporative dry eye syndrome. It is performed by instilling fluorescein and highlighting the time of occurrence of discontinuities (so-called 'breaks' in the tear film). The tear film is considered to be stable on the ocular surface when its integrity is maintained for more than 10 seconds, between 5 and 10 seconds is considered to be correlated with mild forms of dry eye and below 5 seconds is associated with more advanced forms of dry eye syndrome. The distribution of fluorescein on the ocular surface changes rapidly in dynamics, revealing tear film instability and may be associated with punctate areas of impregnation revealing corneal micro-erosions specific to the evolution of this pathology.

3. Meibography

Glandele meibomiene sunt glande sebacee, localizate la nivelul pleoapelor și responsabile de secreția componentei lipidice a filmului lacrimal, având ca scop prevenirea evaporării componentei apoase și implicit în stabilitatea filmului lacrimal, acționând totodată și ca o barieră hidrofobă protejând suprafața oculară de mediul înconjurător.

Meibomian gland dysfunction is the cause of 65-80% of cases of patients diagnosed with dry eye syndrome.

Meibografia este practic investigația prin care se realizează o radiografie a acestor glande și se scoate în evidență aspectul lor morfologic, unde se pot observa: dilatări, tortuozități, înfundări, scurtări ale glandelor , toate cu semnificație patologică. Procentul de glande afectate se află în strânsă corelație cu gradul de severitate a sindromului de ochi uscat. Este o metodă la ora actuală non-invazivă și extrem de folositoare pentru diagnosticarea și urmărirea în evoluție a sindromului de ochi uscat cât și a eficacității tratamentului .

4. Inflammation index of the ocular surface

Fluorescein impregnation of corneal and conjunctival areas affected by inflammation following dry eye syndrome is a key factor in the follow-up of patients with this condition. The aim is to maintain the inflammatory areas in a small percentage, less than 10 % of the ocular surface, in order to achieve a better control of the evolution of the disease and the remission of the associated symptoms in the shortest time possible.

5. Blink dynamics

With each blink, the pressure exerted on the eyelid causes the meibum secreted by the meibomian glands to be expressed on the ocular surface, the tear film to become uniform, the tear to drain and the cellular debris to be removed from the ocular surface. Incomplete or insufficiently frequent blinking leads to impairment of all the above processes and therefore to uneven and inefficient distribution of the tear film. Therefore, a component of the treatment for this pathology is this very process of 'blink education', whereby the patient is counseled in performing certain intentional and planned blinking exercises.

Therapeutic options

Depending on the severity of the dry eye syndrome, following detailed investigations, an individualised plan is drawn up for each patient, with ongoing monitoring and treatment updates based on response.

Artificial tears when needed (optimized by the doctor according to need)
Moisturising evening gel
Lifestyle changes
Omega 3 food supplement
Cyclosporine
Glasses for treatment of meibomian gland dysfunction
Intense Pulsed Light Treatment
Various interventions in the nasolacrimal ducts

In order to benefit from the right treatment steps, screening by the above mentioned methods is essential and can only be done correctly by a medical specialist in the field. Often in our clinic patients end up exhausted from various long-lasting treatments, most of them with aggressive and totally inappropriate substances for their pathology, which actually further exacerbate their underlying problem.

Descoperiți mai multe informații valoroase despre oftalmologie și sănătatea ochilor vizionând materialele realizate de experți în domeniu de pe canalul nostru de YouTube.

- 12th July 2022

Dry Eye Syndrome