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Dry Eyes Basics
Dry Eyes Basics
Clinical Pearls
Dry eyes can also be referred to as Keratoconjunctivitis Sicca
The Tear film is composed of 3 layers that work together
Lipid Layer: Outermost layer that prevents evaporation
Aqueous Layer: Middle layer that provides most of the volume
Mucin Layer: Innermost layer that adheres to the eye surface
Dry Eyes have 2 major classifications
1) Aqueous Deficiency
Decreased production of watery (aqueous) component of tear film
Sjogren's Disease
Lacrimal Gland Deficiency/Obstruction
PO Medications (antihistamines, antidepressants, beta blockers, OCPs)
2) Evaporative
Tears evaporate quickly due to decrease in oil component of the tear film
Intrinsic Causes: MGD, eyelid disorders, low blink rate
Extrinsic Causes: Vitamin A def, CTL wear, allergies, topical preservatives
Note:
LASIK/PRK can be classified as both aqueous def and evaporative
It is best for patient to sleep with their fans and air conditioning off, as this can worsen dry eye symptoms
MGD (Meibomian Gland Dysfunction)
MGD (Meibomian Gland Dysfunction)
Meibomian glands are responsible for secreting the lipid component of the tear film and are a major cause of dry eyes when their function is inhibited or decreased
If they are blocked or damaged, the lipid component will be deficient and the tears will evaporate very quickly!
Treatments include warm compresses, fish oil supplements, meibomian gland expression, Lipiflow, and IRPL
Lagopthalmos
Lagopthalmos
This is when you sleep with your eyelids partially or completely open
Dry Eye Drops
Dry Eye Drops
Artificial Tears are the first line of therapy for dry eyes and there are many types that have different benefits
"Regular" drops
"Regular" drops
These "regular" drops contain preservatives (usually Benzalkonium Chloride) to prevent bacteria from proliferating
These preservatives can sometimes cause dry eyes, allergic reactions, and/or inflammation themselves, so are usually not recommended for extended or heavy use
Preservative- Free (PF) Drops
Preservative- Free (PF) Drops
These drops usually come in single- use vials and should be thrown out after use
Note that some preservative- free drops come in large bottles as they are specially designed to not let air back in after use (IVIZIA)
Gel Drops & Ointments
Gel Drops & Ointments
These drops are much thicker and should be used before bed only
If they are used during the day it will blur your vision
Ointments come in tubes like this and they are the thickest of all drops
These must only be taken at night
Prescription Dry Eye Drops
Prescription Dry Eye Drops
Self Test
Self Test
What are the 3 layers to the tear film
What do the Meibomian glands do?
Name 2 treatments for meibomian gland disease
True of False: LASIK is not a cause of dry eyes, but PRK is
What is Keratoconjunctivitis Sicca?
What is Lagophthalmos?
You give a patient gel drops to take home and the patient asks when they should take them. What do you say?
A patient states they use a new vial of PF tears every 3 days. What do you tell them?
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