eye disorders
Keratoconjunctivitis Sicca
Treatment of Keratoconjunctivitis Sicca
Artificial tears Sometimes occlusion of nasolacrimal punctum or tarsorrhaphy Frequent use ofartificial tearscan be effective for both types. Low-viscosityartificial tearsare useful for replacing volume in aqueous tear-deficient keratoconjunctivitis sicca. More viscousartificial tearscoat the ocular surface longer, andartificial tearsthat contain polar lipids, such asglycerinor nonpolar lipids (eg,mineral oil), reduce evaporation; both types ofartificial tears—viscous and lipid—are particularly useful in evaporative keratoconjunctivitis sicca. Artificial tear ointments applied before sleep are particularly useful when patients have nocturnal lagophthalmos or irritation on waking. Most cases are treated adequately throughout the patient’s life with such supplementation. Staying hydrated, using humidifiers, and avoiding dry, drafty environments can often help. Not smoking and avoiding secondary smoke are important. Most evidence shows that neither diet nor supplements, such as omega-3 fatty acid, improve dry eye disease. In recalcitrant cases, occlusion of the nasolacrimal punctum may be indicated. In severe cases, a partial tarsorrhaphy can reduce tear loss through evaporation. Natural tear volume can be augmented by a device that uses soft-tip probes placed into the nose several times a day to apply electrical impulses to stimulate tear production or by applying a nasal spray twice a day that contains a highly selective cholinergic agonist that binds to cholinergic receptors with high affinity, activating the trigeminal parasympathetic pathway to stimulate tear production. Cyclosporineandlifitegrastdrops that decrease the inflammation associated with dryness of the eye are available. They can lead to meaningful improvement in a fraction of patients of both types. These drops sting and may take months before an effect is noticed. Patients with evaporative keratoconjunctivitis sicca often benefit from treatment of concomitant Blepharitis and associated For blepharitis with meibomian gland dysfunction: Gel-filled microwavable warm compresses applied for 10 to 15 minutes 1 to 2 times a week, infrared or automated heating and massaging devices, and/or systemicdoxycycline50 to 100 mg orally once or twice daily (contraindicated in pregnant or nursing patients) to help increase oil flow onto the eye surface and increase the amount and effectiveness of lipids in the tear film, thereby decreasing tear evaporation For seborrheic blepharitis: Eyelid margin scrubs and/or intermittent topical eyelid antibiotic ointments (eg,bacitracinat bedtime) Because of the variability of symptoms, validated questionnaires can help monitor response to therapy. 