{"id":73,"date":"2019-04-30T10:03:59","date_gmt":"2019-04-30T10:03:59","guid":{"rendered":"https:\/\/www.ojaseyehospital.com\/blog\/?p=73"},"modified":"2019-04-30T10:05:42","modified_gmt":"2019-04-30T10:05:42","slug":"the-dry-eye-syndrome","status":"publish","type":"post","link":"https:\/\/www.ojaseyehospital.com\/blog\/the-dry-eye-syndrome\/","title":{"rendered":"The Dry Eye Syndrome"},"content":{"rendered":"\n<p>Dry eye syndrome or Keratoconjunctivitis sicca  (KCS), is a frequently encountered ocular problem. <strong>Dry eye syndrome<\/strong> is a clinical condition characterized by deficient  tear production or excessive tear evaporation resulting in ocular discomfort.  In addition to the term dry eye, which is now established worldwide, the  specific term \u201c<strong>ocular surface and tear  disorder<\/strong>\u201d has been suggested by Tseng and Tsubota.<\/p>\n  <h2>High Risk Population for Dry Eye Disease<\/h2>\n<ul class=\"list-style\">\n  <li>Advanced age and female gender.<\/li>\n  <li>Inflammatory disease (vascular,  allergy, asthma)<\/li>\n  <li>Autoimmune diseases (RA, Lupus,  colitis)<\/li>\n  <li>Peri and post menopausal women  and Hormone Replacement Therapy patients.<\/li>\n  <li>Diabetes Mellitus.<\/li>\n  <li>Thyroid disease.<\/li>\n  <li>Corneal transplantation<\/li>\n  <li>Previous keratitis or corneal  scarring <\/li>\n  <li>Extra capsular or intracapsular  large- incision <a href=\"https:\/\/www.ojaseyehospital.com\/cataract-treatment.html\" title=\"cataract surgery in Mumbai\"><strong>cataract surgery<\/strong><\/a>.<\/li>\n  <li>Laser in situ keratomileusis  (LASIK) Systemic medications (diuretics, antihistamines, psychotropics,  cholesterol-lowering agents)<\/li>\n  <li>Contact lens wear<\/li>\n  <li>Environmental conditions  (allergens, cigarette smoke, wind, dry climate, air travel chemicals, some  perfumes pollution).<\/li>\n<\/ul>\n<h2>Clinical  Picture:<\/h2>\n<p>  Symptom assessment plays a key role in  dry eye diagnosis In addition, the symptoms agree poorly with the clinical  tests and signs.<\/p>\n<p>  Patients have symptoms like burning  sensation, irritation, itching, redness, blurred vision, photophobia and  dryness. They are rated on a 5 point severity scale:<\/p>\n\n <p> 0 \u2014 no discomfort, 1 \u2014 trace, 2 \u2014 mild, 3  \u2014 moderate, 4 \u2014 severe<\/p>\n\n\n  <p>1.<strong> Tear film meniscus height<\/strong> \u2014 the marginal  tear strip shows a full concave surface.<\/p>\n  <p>2.<strong> Tear film meniscus floaters<\/strong> \u2014 are tiny  bits of debris, consisting of either dead epithelial cells or small fibrils of  lipid contaminated mucin, being carried along the upper and lower lid meniscus.<\/p>\n  <p>3.<strong> Mucous Strands<\/strong> &#8211; are strings of lipid-  contaminated mucin that have been pushed into the cul-de-sac by the shearing  action of the lids.<\/p>\n  <p>4. <strong>Filaments<\/strong> \u2014 corneal filaments are  checked with slit lamp.<\/p>\n  <p>5. <strong>Tear film breakup time (TBUT)<\/strong> is one of  the commonest objective tests, utilized to make diagnosis of dry eye. After  instillation of fluoresce in the tear film is observed with use of a cobalt  blue filtered light of slit lamp and time that elapsed between last blink and  appearance of 1\u201c break in the tear film is recorded. A result of &lt;10 seconds  suggest dry eye. \u00a0<strong>Non-invasive<\/strong> tear break up time (NITBUT) methods have been  developed using instruments like \u2014 keratometer, hand held keratoscope or tear  scope.<\/p>\n  <p>6. <strong>Schirmer\u2019s Test I<\/strong> \u2014 measures the total  tear secretion (basic + reflex). \u00a0<strong>Schirmer\u2019s<\/strong> strip is made from What  man\u2019s no. 41 paper and measures 35x5mm. There is a bent at 5mm mark which goes  into the cul-de-sac, at the junction of the middle and lateral 1\/3 of the lower  lid. After the patient has been described the procedure, gently blot the fornix  and place the test strip at the proposed site. Patient is made to sit in a  dimly light room and allowed to blink normally. The amount of wetting is  measured after 5 min. Interpretation :<\/p>\n<p>\u00a0If wetting is &gt;10mm = Normal.<br>\n  If  wetting is 10mm = Mild dry eye.<br>\n  If  wetting is 5-10mm = Moderate dry eye.<br>\n  If  wetting is 3-Smm = Severe dry eye.<br>\n  If  wetting is &lt; 3 mm = Very Severe dry eye.<br>\n<p>  <strong>7.  Schirmer\u2019s Test II<\/strong> \u2014 is used to ascertain reflex  secretion. The procedure is similar to basal secretion test, but after the  strips are installed, the unanaesthetised nasal mucosa is irritated by rubbing  with dry cotton tipped applicator. The amount of wetting is measured after 2  minutes. Less than 15mm of wetting indicates failure of reflex secretion.<\/p>\n\n  <p>8. <strong>Rose Bengal staining<\/strong> &#8211; <strong>Rose Bengal<\/strong> is a vital dye and stains  dying and desiccated epithelial cells, not protected by mucin layer.<\/p>\n\n<p>Early or mild cases of KCS are  detected more easily with Rose Bengal than fluoresce in staining and the  conjunctiva is usually stained more intensely than cornea. Interpalpebral  staining of the nasal and\/or inferior paracentral cornea is seen in KCS,  whereas a linear pattern of inferior conjunctiva and corneal staining is  characteristics of MGD. Rose Bengal strip is inserted to inferior cul-de-sac.  Patient is asked to blink several times. After 1 min, conjunctiva and cornea  are examined using red free filter of slit lamp. For the purpose of evaluation  eye 1S Divided into 3 zones- nasal conjunctiva, temporal conjunctiva and  cornea. Amount of stain is recorded on the scale of 0 to 3, for a total  possible score of 9 for each eye. Score of 3 or higher are consistent with KCS.<\/p>\n<p>  0- Negative<br>\n  1- Scattered, minute staining.<br>\n  2- Moderate spotty staining.<br>\n  3- Diffuse blotchy staining. <\/p>\n <p>9. <strong>  Lissamine green staining<\/strong> <\/p>\n <p> 10.<strong>  Conjunctival impression cytology (CIC)<\/strong> Impression  cytology is safe, non-invasive, tolerable and repeatable investigation in the  diagnosis and management of <strong>dry eye disease<\/strong>.<\/p>\n<p>  <strong>Impression  cytology<\/strong> of normal human bulbar conjunctival cells  reveals relatively homogenous smaller cells with surface areas ranging from  just 25-25.1m with an average of just over 100 um.<\/p>\n  <h2>KCS  shows following changes:<\/h2>\n\n  <h4>Squamous metaplasia <\/h4>\n\n<p>Stage 0 &#8211; Abundant goblet cell and mucin  spots, small epithelial cells;<br>\n  Stage 1 \u2014 Fewer goblet cells and mucin spots,  small epithelial cells; <br>\n  Stage 2 \u2014 Loss of goblet cells and mucin  spots, enlarging epithelial cells; <br>\n  Stage 3 \u2014 Enlarging or separating  epithelial cells;<br>\n  Stage 4 \u2014 Large separate epithelial cells with  scattered keratinisation, pyknotic nuclei; Stage 5 \u2014 Large keratinized  epithelial cells with pyknotic nuclei or loss of nuclei.<\/p>\n\n  <h4>Loss of goblet cells.<\/h4>\n\n<h4>Replacement of the normal corneal epithelial  phenotype with an involved conjunctival epithelium.<\/h4>\n","protected":false},"excerpt":{"rendered":"<p>Dry eye syndrome or Keratoconjunctivitis sicca (KCS), is a frequently encountered ocular problem. Dry eye syndrome is a clinical condition characterized by deficient tear production or excessive tear evaporation resulting in ocular discomfort. In addition to the term dry eye, which is now established worldwide, the specific term \u201cocular surface and tear disorder\u201d has been<\/p>\n","protected":false},"author":1,"featured_media":74,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[48],"tags":[34,50,49],"class_list":["post-73","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-dry-eye-syndrome","tag-best-eye-hospital-in-mumbai","tag-dry-eye-disease","tag-dry-eye-syndrome"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 4.9.10 - aioseo.com -->\n\t<meta name=\"description\" content=\"Dry eye syndrome or Keratoconjunctivitis sicca (KCS), is a frequently encountered ocular problem. 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