6. Dry eye diagnosis and management.pptx

6. Dry eye diagnosis and management.pptx

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  DRY EYE DIAGNOSIS AND MANAGEMENT By:Qurat-ul-ain Ophthalmic Medical Technologist/ MBA Health & Hospital management
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  DRY EYE  Itis a condition in which a person does not have enough quality tears to lubricate and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye and for providing clear vision.  It is a common and often chronic condition in older adults.
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  ROLE OF TEARSIN DRY EYE SYNDROME  With each blink of the eye lids, tears spread across the front surface of the eye, known as the cornea.  Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye and keep the surface of the eye smooth and clear. Excess tears in the eyes flow in to a small drainage ducts in the inner corners of the eyelids which drain into the back of the nose.  Dry eye occurs when tear production and drainage is not balance.
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  ETIOLOGY  Idiopathic  Lifestylerelated  Connective tissue disorders  Conjunctival scarring  Drugs  Infiltration of lacrimal glands  Post-radiation fibrosis of the lacrimal glands  Vitamin A deficiency  After corneal refractive surgery
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  SYMPTOMS Patient with dryeyes may experience:  Irritated, gritty, scratchy or burning eyes  Foreign body sensation  Excess watering and blur vision  Light sensitivity  Stringy mucous near the eye
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  WORK-UP  History andexternal examination  Slit lamp examination with fluorescein stain  Schirmer test  Measurement of tear osmolarity & level of matrix metalloproteinase-9 (MMP-9)  Consider screening for Sjogren syndrome.
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  SIGNS  Scanty orirregular tear meniscus seen at the inferior eye lid margin.  Decreased tear break-up time  Punctate corneal or conjunctival fluorescein, rose Bengal usually inferiorly or in the inter-palpebral area.  Excess mucous or debris in the tear film and filaments on the cornea.
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  TREATMENT Mild dry eye Artificialtears q.i.d Moderate dry eye  It takes 1-3 months for significant clinical improvement.  To hasten improvement & lessen side effects treat pts concomitantly with a mild topical corticosteroid drop (e.g. loteprednol 0.5%) b.i.d to q.i.d for 1-month while beginning cyclosporin therapy.  If these measures does not work consider punctal occlusion.  Collagen inserts: temporary  Silicone or acrylic plug: reversible  Any inflammatory component is treated prior to punctal occlusion.  Artificial tears q1-2h, use preservative free artificial tears.  Lubricating ointment or gel q.h.s  Lifestyle modification  Cyclosporin 0.05% b.i.d is effective for patients with chronic dry eye and decrease tears secondary to ocular inflammation.
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  Severe dry eye  Cyclosporin0.05%  Punctal occlusion  Preservative free artificial tears q1-2h.  Consider permanent occlusion by thermal cautery if plugs fall out.  Add lubricating ointment or gel b.i.d to q.i.d  Moisture chamber or goggles with lubrication at night.  If mucous strands present remove with forceps and consider 10% acetylcysteine q.i.d.  Other therapies: oral flaxseed oil, oral omega 3 fatty acid, autologous serum tears, topical vitamin A, BCL, or a scleral lens.  Permanent laser tarsorrhaphy,  If all measures fail consider adhesive tape tarsorrhaphy, pending a surgical tarsorrhaphy.
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  PREVENTION Following steps canbe taken to reduce symptoms of dry eyes. • Blink regularly when doing near work for a long period of time. • Increase the humidity in air. • Wear sunglasses outdoor • Take nutritional supplements containing essential fatty acids • Drink plenty of water • Avoid air getting blown in your eyes • Avoid environments drier than normal.
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  RESOURCES • South Asianedition of The Wills Eye Manual, 7th edition. • https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/dry-eye?sso=y • https://www.aao.org/eye-health/diseases/what-is-dry-eye
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  THANK YOU!