Ординатура / Офтальмология / Английские материалы / The Dry Eye A Practical Approach_Patel, Blades_2003
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80 The Dry Eye
irritated, cytokines are released leading to inflammation and neuronal impairment. Thus, in severe dry eyes we normally find:
i)chronic inflammation of the lacrimal glands, ocular surface and lids;
ii)a breakdown in the neuronal control of tear secretion.
Drugs that can combat inflammation and stimulate tear production by reversing or by-passing the neuronal breakdown have been used in these patients. For example, anti-inflammatory agents such as oral tetracyclines are useful for treating severe blepharitis particularly where there is corneal involvement (Frucht-Pery et al., 1993) and topical cyclosporin A is useful because of its immunomodulating properties (Sall et al., 2000; Stevenson et al., 2000). Though widely used for other ophthalmic purposes, Botulinum toxin injected into the eyelids appears to decrease tear drainage and increase tear flow (Spiera et al., 1997; Sahlin et al., 2000) and may prove more popular in the future.
REFERENCES
Blades K.J., Patel S. and Aidoo K.E. (2001). Oral antioxidant therapy for marginal dry eye. Eur J Clin Nutrition, 55: 589–597.
Carney L.G. and Fullard R.J. (1979). Ocular irritation and environmental pH.
Aust J Optom, 62: 335–336.
Craig J., Blades K.J. and Patel S. (1995). Tear lipid layer structure and stability following expression of the meibomian glands. Opthal and Physiol Opt, 15: 569–574.
Fayat B., Assouline M., Hanush S. et al. (2001). Silicone punctal plug extrusion resulting from spontaneous dissection of canicular mucosa. Ophthalmology, 108: 405–409.
Frucht-Pery J., Sagi E., Hemo I. and Ever-Hadani P. (1993). Efficacy of doxycycline and tetracycline in ocular rosacea. Am J Ophthalmol, 116: 88–92.
Golding T.R., Efron N. and Brennan N.A. (1990). Soft lens lubricants and prelens tear lens tear stability. Optom Vis Sci, 67: 461–465.
Johnston C.S. and Thompson L.L. (1998). Vitamin C status of an outpatient population. J Am Coll Nutr, 17: 366–370.
Milder B. (1975). The lacrimal apparatus. In: Adler’s Physiology of the Eye (Moses R.A., ed.). St. Louis, CV Mosby.
Patel S., Plaskow J. and Ferrier C. (1993a). The influence of vitamins and trace element supplements on the stability of the precorneal tear film. Acta Ophthalmol, 71: 825–829.
Patel S., Asfar A.J. and Nabili S. (1993b). Effects of vitamin A on the stability of the precorneal tear film. Optom Vis Sci 70(12 suppl): 64.
Sall K., Stevenson O.D., Mundorf T.K., Reis B.L. and the CsA Phase 3 Study
Group. (2000). Two multicenter, randomized studies of the efficacy and safety
Treatment of Dry Eye 81
of cyclosporin ophthalmic emulsion in moderate to severe dry eye disease.
Ophthalmology, 107: 631–639.
Sahlin S., Chen E., Kaugesaar T. et al. (2000). Effect of eyelid botulinum toxin injection on the lacrimal drainage. Am J Ophthalmol, 129: 481–486.
Spiera H., Asbell P.A. and Simpson D.M. (1997). Botulinum toxin increases tearing in patients with Sjogren’s syndrome: a preliminary report. J Rheumatol, 24: 1842–1843.
Stevenson D., Tauber J. and Reis B.L. (2000). The Cyclosporin A Phase 2 study group: Efficacy and safety of cyclosporin A ophthalmic emulsion in the treatment of moderate-to-severe dry eye disease. A dose-ranging, randomized trial.
Ophthalmology, 107: 967–974.
Index
Note: Page numbers in italics refers to figures and tables.
acne, 48
adsorbed mucoid layer, 3 air conditioning, 14
punctal plugs, 73 air travel, 73 amethocaine, 38 anesthetic, 35, 38, 77
anti-inflammatory agents, 80 anti-oxidants, 4
oral, 70–1
aqueous layer, 3, 5, 6–7 epithelial surface contact, 29 eyelid opening, 27 functions, 7
thinning, 29 viscosity, 28
artificial tear drops (ATDs), 67–70 in-eye wetting, 68
pH range, 69–70 preservative-free, 68, 69 preservatives, 68 refractive index, 68–70 tear stability, 68 viscosity, 69
vitamin A supplementation, 71
bacteriostatic protection, 7 bandage lenses, 76 Bandeen–Roche system, 14, 17 Begley system, 17
benoxinate hydrochloride, 35, 38, 77 beta-blockers, 40, 51
blepharitis, 75 chronic, 9 severe, 80
blink/blinking, 2, 3, 5 compromised, 9
corneal epithelium damage, 76 mucus spreading, 8
refraining from, 35 shear force, 7
tear film reforming, 27
tear stability assessment, 34–5
Botulinum toxin, 80
canthi, 48, 49, 50 cataract surgery, 40, 51 catheter, balloon, 78–9 CCLRU scale, 58, 60 chromatin, snake-like, 63 cigarette smoke, 14
Clifton nanoliter osmometry, 26 clinical tests, 23–5
cut-off values, 24 features, 25
grading schemes, 24 collagen plugs, 72–3, 74 conjunctiva
cell nuclei, 63
cellular status assessment, 61–4
epithelium, 2, 7
aqueous layer contact, 29 exposure, 30
protection, 8 quality, 28 staining, 61–2
goblet cells, 7, 8, 9 anti-oxidant supplements, 71 count, 63, 64
hyperemia, 57–8, 59 keratinization, 63 non-wetting, 8, 9 nutrients, 70
snake-like chromatin, 63 squamous metaplasia, 62, 63 staining, 25, 60
tear film, 1
84 Index
conjunctival impression cytology (CIC), 61–4
conjunctivitis, bacterial, 9 contact lens
bandage, 76
conjunctival cell count, 63, 64 lipid layer, 51–2
ocular surface degradation, 58 patients, 14
slit lamp investigations, 47 post-lens debris, 47
prediction of success/failure, 62 soft, 51
conjunctival cell count, 63, 64 lipid layer, 76
tear film, 51 disruption, 53
tear meniscus height, 43 contact lens-induced dry eye
(CLIDE), 48, 52, 53 cornea
damage, 1 epithelium, 2, 7
aqueous layer contact, 29 damage, 76
exposure, 30 protection, 8 quality, 28
non-wetting, 8, 9 sensitivity, 38 staining, 25, 60 tear film, 1
anchoring, 10 corneal topographers, 32
cornea–tear film water flux, 6 cotton thread test, 26, 38–40 crypts of Henlé, 7 cyclosporin A, topical, 80 cytokines, 80
dacryologists, 2, 24 diagnostic cut-off values, 24 discomfort, 13
rating, 14 dry eye
aqueous deficient, 9, 11 classification, 10, 11 definition, 1
gold standard test, 26, 55
mucus deficient, 9 syndromes, 9–10, 11 tear-deficient, 10 tear-sufficient, 10
dry eye comforter, 75 Dry Eye Test (DET™), 31
Efron Scale, 58
elderly patients, 42, 43 epitheliopathy, 10 evaporimetry, 26, 53 eye drainage, 76
see also naso-lacrimal drainage; tear fluid, drainage
eyelashes, 47 eyelid, 5
deformations, 57, 58 hot compresses, 75 inflammation, 80
lid scrubs, 75 manipulation, 52, 75 margin, 48, 49, 50
irregularity, 42, 43 massage, 75
muscle paresis, 9
tonus loss, 9, 79 opening, 27
tear film reforming, 27 therapy, 75
first Purkinje image, 32, 33, 34 flow cytology, 26
fluorescein, 25, 47, 60 break up, 48, 49 time, 30–1
tear meniscus height measurement, 42
fluorophotometry, 41
foreign material, removal, 7, 75 Foster punctum dilator, 72, 77 fractal analysis, 54
free energy, solid surface, 27 Freeman plug, 72
GCU 9 point scale, 59 GCU thread, 39–40 glands of Manz, 7 glaucoma, treated, 40, 51
glycocalyx, 3, 7–8 glycoproteins, mucous, 8 goggles, 75
grading schemes, 24
Hamano thread, 38–40 Herrick plug, 72, 73 high performance liquid
chromatography (HPLC), 26 HIRCAL grid, 32, 33
hot compresses, 75 Hydron™, 58
hyperemia assessment, 25, 57–8, 59 scale, 58–9, 60
immunoglobulin reservoir, 8 impression cytology, 26, 63 infection, 58
inflammation, 80
Jones’ test, 77
Keeler Tearscope™, 33–4, 50 keratitis, 9
keratometer, 25, 32 mires, 31, 32
tear meniscus curvature measurement, 44
laboratory tests, 23–5 features, 25–6
Lacramedics questionnaire, 20–1 Lacricath™, 78–9
lacrimal glands accessory, 6 inflammation, 80 main, 6 metabolism, 13
neuronal control of secretion, 6 nutrients, 70
lacrimation reflex, 40
see also tear flow lactoferrin, 53, 54
Lactoplate™ test, 7, 53 laser-assisted surgery, 79 LASIK surgery, 51
lens, surface deposits, 58 lid scrubs, 75
Index 85
lipid layer, 4–6, 50–2 abnormalities, 9 contact lens, 51–2 coverage, 28 deficiency, 57 eyelid opening, 27 refractive index, 50 soft contact lens, 76 thickening, 75 thickness, 50
liposomal sprays, 75 Lissamine Green, 47, 60
Loveridge grid, 32 lubricants, 74–5 lysozyme, 53
McMonnies’ questionnaire, 14, 15, 18–19
meibometry, 52–3 meibomian glands, 5, 6
blocked, 57, 58 dysfunction, 48 lid scrubs, 75 lipid release, 52 nutrients, 70 observation, 52–3 oils, 52–3, 75 secretions, 48, 49
meibomitis, 75 molybdenum, 70 mucins, ocular surface, 7 mucus deficiency, 9 mucus islands, 29 mucus layer, 3, 5, 7–8
adequate, 28 anchoring, 8, 10
conjunctival goblet cells, 63 deformation, 29
dissolving, 8 roles, 8 rupture, 29 self repair, 8
mucus strands, 8
naso-lacrimal drainage, 73, 77–9 blockage, 41
neuronal impairment, 80 non-invasive break up time (NIBUT),
25, 34
86 Index
ocular lubrication, 5, 7 inflammation, 80
ocular surface
cellular damage, 47 damage, 1, 10, 13
defense against pathogens, 6 erosion, 76
evaporation control, 5
friction damage prevention, 74–5 health, 24, 57–64
irritation, 38 meibomian oils, 75
persistent irritation, 79–80 protection, 75–6 sensitivity, 50
staining, 60–1
symptom assessment, 24 oculoplastic surgery, 79 ointments, 69, 74–5
vitamin A supplementation, 71, 79
optical doubling devices, 41–2 optical interferometry, 50 osmometry, 54–5
automated, 26
patient self-assessment, 13–21 patient–practitioner communication,
15
phenol red thread test (PRT), 26, 38–40, 41
Placido disc, 32
polar lipid monolayer, 3 pollutants, air, 52, 75 preservatives, 68 proteins, tear, 8, 54 pseudophakia, 40 psoriasis, 48
puncta, 72–3 closed, 76, 77 dilation, 77, 79
dimensions, 77, 78 drainage, 77, 78–9 narrowing, 76, 77 sealing, 73
two lower, 74 vascularization, 79
punctal plugging, 72–4
questionnaires, 14–15, 17–21
refractive index, 53–4 artificial tear drops, 68–70
refractive surgery, 51 refractometry, 53–4 retinyl acetate, 79
Rose Bengal, 25, 47, 60
saponification, 48, 49 Schirmer test, 24, 25, 37–8, 39 scoring systems, 15–17 selenium, 70
silicone plugs, 73, 74
Sjögren’s syndrome, 10, 11 slit lamp
corneal and conjunctival staining, 60
tear meniscus curvature measurement, 44
tear quality assessment, 47–8 tear volume assessment, 44 video capture, 42
slit lamp examination, 25 sodium chloride, 54
spectacles, flexible side shields, 75–6 surface tension, 27
tarsorrhaphy, 76
tear break up time (TBUT), 25 invasive, 30–1
tear ferning, 54 tear film
anchoring, 8, 10 break up, 27–30 closed eye, 6 composition, 4–8 contact lens, 51, 53 debris, 50 deficiencies, 1 destabilizing, 50 disorders, 10, 11 distortion, 32 formation, 27
hydrophilic basement, 8 integrity, 10
layers, 3, 4–8 model, 2–3 osmotic pressure, 6 precorneal, 1, 2, 75 preocular, 1, 2 quality, 2
reformation, 29 role, 1–2 rupture, 28–30
stability, 2, 6, 8, 10, 27–35 anti-oxidants, 71 artificial tear drops, 68 assessment, 24
decrease, 9, 10 high, 35
non-invasive tests, 31–4 optimal, 28
punctal plugs, 73 racial differences, 15 tests, 30–5
structure, 2–4 thickness, 3 thinning, 3–4, 32
two-step double film mechanism, 29–30
tear flow, 38 fluorophotometry, 41 increase, 80
neuronal control breakdown, 80
reflex, 40
thread wetting, 40 tear fluid
anti-oxidants, 70–1 biochemistry changes, 48 composition assessment, 26 drainage, 76
decrease, 80 impairment, 79
evaporation
control deficiency, 9, 10 measurement, 53 reduction, 75
evaporation rate, 5–6, 41 lipid layer, 52 reduction, 50
osmolality, 26, 54–5 proteins, 7
quality assessment, 47–55 refractive index, 53–4 retention impairment, 79 saltiness, 26
turnover rate, 41 viscosity, 8
see also naso-lacrimal drainage tear foam, 48, 49
Index 87
tear meniscus, 51 curvature, 41, 44 radius, 44
tear meniscus height (TMH), 25, 39, 41–2, 43, 44
artificial tear drops, 69 closed puncta, 77 punctal drainage, 77, 78 punctal plugs, 73, 74
tear production test, 25 tear proteins, 8, 54
tear substitutes, 67–70, 71
tear thinning time (TTT), 25, 32, 34,
73
artificial tear drops, 69 non-invasive, 24 punctal plugs, 74
tear volume, 2 assessment, 24, 37–44 basal, 39
invasive tests, 37–41 non-invasive tests, 41–2, 43, 44 racial differences, 15
testing, 25
tearing, basal/reflex, 38 Tearscope™, 25, 33–4, 50–1
interoperator variation, 52 use, 52
tetracyclines, 80 thread wetting, 38–40
trace elements, tear film, 4 treatments, 67–80
artificial tears, 67–70 bandage lenses, 76 lid scrubs, 75
lid therapy, 75 lubricants, 74–5
ocular surface protection, 75–6 ointments, 69, 71, 74–5, 79 oral anti-oxidants, 70–1 pharmacological intervention,
79–80
punctal plugging, 72–4 sprays, 75
watery eye, 76–9
Tseng’s squamous metaplasia scale, 62
van Bijsterveld’s scoring system, 60–1 video-capture technique, 44 videokeratoscope, 32
88 Index
VisionACE™ anti-oxidant mixture, 71 Vislube™, 68, 69
Vistakon™, 58
visual performance, impaired, 1 visual scales, 15–17
vitamin(s), tear film, 4 vitamin A, 70, 71, 79
deficiency, 9 vitamin C, 70, 71 vitamin E, 70
watery eye, 76–9 referral criteria, 79
work-place related symptoms, 52 air conditioning, 14, 73
wound healing, 7
zinc, 70 Zone-Quick™, 39