Dry Eye Syndrome

 

Dry eye syndrome, a generic term referring to various dry eye conditions, is a chronically progressing multifactorial disease that can cause discomfort of the eyes, visual disturbance and lacrimal film instability.  It may also cause damage to the ocular surface by increasing lacrimal osmolarity.

Although tears form only a thin layer on the eye’s surface, they play an important role in eye health and visual acuity.  In addition to the water component, tears are also composed of lipids and mucous.  The mucous (mucin) layer acts like glue and makes water uniformly attach to (adhere to) the surface of the eye.  The lipid layer, which originates from the meibomian glands, floats above the watery layer and prevents tears from evaporating.  Tears are made from the lacrimal glands; the mucin layer is secreted by the goblet cells located within the conjunctiva of the eye’s surface.  Tear draining (recycling) depends on eye blinking, in which the upper and lower eyelids act like windshield wipers, consistently spreading tears on the eye’s surface.

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(fig. 1)

 

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(fig. 2)

 

Dry eye syndrome is the result of several factors:  deficient tear secretion or rapid evaporation can cause the systemic eye disease, lagophthalmus, which is the inability to close the eyelids completely.  Severe dry eye may also contribute to corneal ulcers or perforation leading to blindness.

 

Generally, artificial eye drops, gel or ointment can be applied to most patients with dry eye syndrome.  In addition to these medications, there are other treatment options.  Trust Me Eye Center offers multi-level and comprehensive treatment plans:

 

1.Artificial Lacrisert: It can be divided into short-term and long-term uses. Lacrisert can be maintained for several weeks or months if used short-term.  It is like a candy slowly dissolved with time.  Lacrisert helps to preserve the natural tears inside the surface of eye and prevents further lose to the lacrimal ducts.  (refer to film https://youtu.be/lhn g2HtPE4)

2.Preservative-free steroids: elevating tear osmolarity from dry eye syndorm results in an inflammatory response in the ocular surface. The proper amount of anti-inflammatory agent can improve dry eye symptom;

3.Topical cyclosporine (Restasis): it is a topical immunomodulator used to reduce inflammation and stimulate lacrimal secretion;

4.Autologus serum eye drops (ASED): the concept of using patients’ own blood serum as eye drops is base on the understanding that pH, osmolarity, and blood serum components of autologus serum eye drops are similar to those of natural tears. The proteins and growth factors in these eye drops, which are lacking in artificial eye drops, can speed up the recovery of the ocular surface. There were several studies has demonstrated the healing effects of ASED.  After consent is granted, blood is collected from a patient himself.  Then blood is centrifuged and separated into serum and plasma.  Blood serum which is diluted and mixed with saline can be used as eye drops.  They are the most natural artificial eye drops.

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(fig. 3)

5.Meibomian gland expression: chronic meibomian gland obstruction causes atropy of the meibomian gland and poor quality of natural tears. Therapeutic regimen incorporates specialized devices to treat the clogged glands and improve dry eye symptom.

6.Natural supplements: fish oil containing omega-3 fatty acids commonly found in salmon, herring and cods is also recommended to patients to relieve dry eye symptoms.

 

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