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Dry Eye Syndrome
 
Dry Eye Syndrome
An abnormality in the rate of production (<1.2 µ1/min) or quality of the tear film. Etiology may be idiopathic, medications (antihistamines,b–blockers, anticholinergics, phenothiazines, psychotropics), Lacrimal gland inflammation (sarcoid, mumps, HIV, Sjögren’s syndrome), lacrimal gland dysfunction (congenital, traumatic, neuropathic), collagen vascular disease (rheumatoid)
 
Figure 3 Conjunctival hyperemia.
arthritis, SLE), pemphigoid, chemical burns, vitamin-A deficiency, blepharitis.
 
Presentation
Symptoms include foreign-body sensation, tearing (increased reflex secretion), burning, blurry vision; often worse after prolonged use of eyes, at the end of the day, and in cold weather. Signs include decreased tear meniscus height, PEK, filaments, bulbar conjunctival staining in exposure palpebral fissure zone, conjunctival hyperemia, papillary hypertrophy, fluorescein tear-film breakup time less than 10 seconds.
 
Differential Diagnosis 
Conjunctivitis, blepharitis, exposure keratopathy.
 
Management
Schirmer’s test: Anesthetize the eye and absorb excess tears and anesthetic with a cotton swab. Place filter paper strips in the outer lower fornix and wait 5 minutes. Wetting of <5 mm is highly suggestive of Sjögren’s syndrome. Less than 10 mm indicates dry eye but is neither highly sensitive nor specific.
 
  • Stain ocular surface with fluorescein, rose begal, or lissamine green dyes.
  • Treat stepwise with preservative-free artificial tears and lubricants, punctal occlusion (temporary or permanent plugs, argon laser, thermal cautery), moist chamber spectacles and humidification of ambient environment, tarsorraphy (temporary orpermanent suturing of the eylids).
 
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