Dry eye

Question 1

What is the pathology of dry eye?

Answer 1

Problems with tear production of any of the 3 layers:

Lipid layer – stability (meibomian glands)

Aqueous layer – volume (lacrimal gland) (most of the tear film is aqueous layer)

Mucous layer – wet ability (conjunctival goblet cells)

Question 2

What is the structure and function of tears?

Answer 2

Lubricate and oxygenate ocular suface

Spread over cornea by blinking

MORE INFO ON SLIDES

Question 3

What are the causes of dry eye?

Answer 3

Drugs – topical, oral e.g. anticholinergic

Eye disease – blepharitis, after conjunctivitis

Autoimmune disease – Sjogrens syndrome (+ dry mouth etc)

Mechanical problems – 7th nerve palsy (as not blinking), lid notching (on underside e.g. as an ulcer or blephritis)

Contact lenses (may need to have a break from usage

Question 4

How does dry eye present?

Answer 4

Symptoms:
Feel ‘dry’, gritty, buriniing, struggling to open in the morning, sometimes can complain of watering of the eye (epiphora) due to reflex lacrimation kicking in as opposed to the basal level (which is what is affected), blurred vision (need to blink to clear it), recurrent infections, unable to wear contacts

Signs:
Mildly red eye

Question 5

How do you manage dry eye?

Answer 5

Explain mechanism + that it doesn’t necessarily go away but is manageable

Manage any treatable underlying causes

DHx - optimisation

Contact lens guidance

Frequent topical lubricant (but not with preservatives as can be an irritant)

Blinking/longer periods of closed eyes

Eye protection