Dry eye syndrome affects 15% of people over 40 years of age.
The condition causes discomfort such as burning and itching, in addition to red-eye. Dry eye is caused by a chronic lack of lubrication and moisture to the surface of the eye. It is a syndrome that affects 15% of people over the age of 40 approximately.
This can be produced due to a loss of natural function over the years and, although it affects men and women, it occurs more frequently in postmenopausal women secondary to the hormonal changes of this stage, explains Dr. Felipe Mellado, an ophthalmologist from the Vision Center.
“In general, patients complain of discomfort that affects their daily life, but there is a group of them for whom this condition can pose a threat to their vision,” he says.
Dry eye can be associated with autoimmune diseases, such as rheumatoid arthritis and Sjögren’s syndrome, taking certain medications on a chronic basis, and living in dry climates. “Dry eye can also be seen as a possible side effect of Lasik surgery and as a sequel to some corneal infections,” says the doctor.
Dry eye symptoms
Dry eye symptoms include the sensation of grit inside the eye, burning and itching, watery or mucous discharge, red-eye, lacrimation crisis (due to a reduction in the number of lipids and mucin), and difficulty wearing contact lenses. “Other patients also complain of fluctuating vision because, in addition to lubricating, tears serve an optical function,” he says.
To treat this syndrome, lubricating eye drops, gel, or artificial tear ointments without preservatives are used, in some cases, topical corticosteroids and even topical immunomodulators that stimulate the tear response.
Avoid exposure to drafts or air conditioning, long screen hours, and excessively dry environments. “Eyelid or corneal pathology that could explain this condition must be ruled out. Therefore, all patients with a dry eye sensation should be examined by their ophthalmologist”, adds the specialist.
Most of the time, there is an excellent response to initial treatment. However, there are times when tear secretion is so low that the entrance to the tear evacuation ducts must be impeded so that an adequate amount of tear is retained and a definitive treatment can be offered.
Dry eye is a highly troublesome multifactorial disease that affects up to 60% of the population. It is a chronic disease that affects the ocular surface. A personalized diagnosis and treatment are required, as different types of dry eye vary in treatment.
Itchy and burning eyes
Gritty or scraping sensation.
Contact lens intolerance
Not all dry eyes are the same, and depending on the severity; they can be classified into different degrees, as well as multiple factors can cause it, such as age, hormonal alterations, environmental factors, the use of contact lenses, or some drugs, antidepressants or diseases such as lupus, diabetes, or rheumatoid arthritis. Hence the importance of early diagnosis.
The most common treatments consist of applying artificial tears or gels; there are patients who, despite having a correct treatment, continue with the symptoms.
Currently, some state-of-the-art pulsed light treatments have been incorporated to alleviate the symptoms of evaporative dry eye. Our patients should know that dry eye does not have a definitive cure, but we can minimize the negative effects that this syndrome produces on our vision thanks to this treatment.
It is indicated in patients with evaporative dry eye, in those in which the tear lasts less time on the cornea. They are patients who have good tear production, but this is of poor quality.
It is a painless pulsed light or IPL system (ThermaEye), non-invasive and non-surgical, as it is performed in consultation, which helps the ophthalmologist specialist work the eyelids to stimulate the formation of fat in the meibomian glands and give tear film stability.
This therapy consists of applying flashes of light, with a specific frequency and intensity, on the lower eyelids and the upper part of the cheeks to stimulate blood circulation in this area and activate the nerve endings that surround the cheeks. Meibomian glands. This generates an improvement in the production of the fat that the tear needs. In this way, it is possible to improve the quality of the tear so that it re-lubricates the surface of the eye, avoids the rapid evaporation of the tear film, and improves the supply of nutrients that the cornea needs.
This treatment is carried out in 3 sessions spaced, each one in two or three weeks. Each session lasts around 5 or 10 minutes, and it is completely painless and easy to apply. In this way, we manage to alleviate the symptoms of people who suffer from dry eye.
They are indicated in patients with dry eyes who have a severe decrease in tear production. They produce a small number of tears.
The most serious cases are associated with Sjögren’s syndrome, an autoimmune disease that affects the body’s external secretion (exocrine) glands, especially the lacrimal and salivary glands.
Punctum plugs are small plugs that are inserted into the tear ducts to reduce tear drainage. This ensures that the tear film is preserved for a longer time on the eye’s surface and, in this way, alleviates the symptoms of dry eyes and prevents the damage that it can cause to the cornea.
They are practically invisible to the eye and are usually made of silicone, although in some cases, temporary plugs made of collagen can also be used, a natural substance that dissolves and is reabsorbed by the body after a few weeks.
The procedure is performed under topical anesthesia (drops) and is completely painless for the patient.
Punctum plugs are a safe method, and they are also reversible since they can be easily removed in consultation if necessary.
Level of management by the general practitioner: Diagnosis: Suspicion. Treatment: Initial. Follow-up: Derive.
The causes are divided into two: deficiency in water production and evaporation.
Diagnostic tests include Schirmer’s test, fluorescein test, Rose Bengal stain, and tear break time.
Treatment is etiological and supportive treatment can be added.
TYPE CLINICAL CASE:
A 68-year-old male patient was consulted for burning and foreign body sensations in both eyes. He refers to taking anxiolytics and antidepressants. On examination, ectropion and bilateral whitish secretions are observed. Schirmer test: 5 mm.
The multifactorial disease is characterized by alteration in the tear film, leading to damage to the ocular surface.
ETIOLOGY – EPIDEMIOLOGY – PATHOPHYSIOLOGY:
The exact prevalence of dry eye is unknown due to the difficulty in defining this disease and the lack of a single diagnostic test to confirm its presence. A prevalence of approximately 14.5% (17.9% in women and 10.5% in men) has been reported, while other studies have estimated between 5 to 30% in the population over 50 years of age.
Risk factors include advanced age, female gender, hormonal changes (mainly decreased androgens), systemic diseases, use of contact lenses, systemic medications (antihistamines, anticholinergics, estrogens, nicotinic acid, amiodarone, etc.), ocular drugs, nutritional deficits, decreased corneal sensitivity, ophthalmic surgery, and environments with low humidity.
The tear film is made up of three layers: internal (mucosa), produced by goblet cells; intermedia (watery), produced by the lacrimal glands; and external (oily), produced by the meibomian glands. Dry eye syndrome can be due to disorders in tear production (quantity) or by a functional alteration of the tear layers (quality) and can occur concomitantly.
It can be classified into:
1. Dry eye syndrome due to deficiency in water production: (more frequent)
It is associated with primary and secondary Sjögren’s Syndrome (SS).
Not associated with SS:
Primary tear dysfunction (age-related or congenital) and secondary (amyloidosis, lymphoma, or obstruction).
Drugs: antihistamines, anticholinergics, etc.
Reflex hyposecretion: corneal surgery, diabetes, VII nerve injury.