Dry is a relatively common complaint in ophthalmology, particularly in postmenopausal women and the elderly. There are many causes of dry eye but the workup and management follow the same general principles.
Overview
Pathology
- Caused by a problem in the tear film (hyposecretion/instability) or increased evaporation
- Can lead to erosions of the ocular surface, which can be blinding
Certain conditions of the eye predispose to dryness, such as ectropion and lagophthalmos
Diagnostics
Presentation
- More common in the elderly and women of post-menopausal age
- Gritty, irritated red eyes
Investigations
- Schirmer's test positive (<5mm)
- Tear film breakup time <5 seconds
- Ocular surface staining (fluorescein, rose bengal, lissamine green)
Treatment ladder
General management for dry eye is stepwise:
- Lubrication and artificial tears
- Topical steroids and pilocarpine
- Punctal plugs
- Autologous serum drops
- Bandage contact lenses
- Tarsorrhaphy (sewing the lids shut, this is typically a temporary measure)
Pilocarpine promotes lacrimation
Sjogren Syndrome
Autoimmune destruction of the salivary and lacrimal glands
Pathology
- Commonly associated with rheumatoid arthritis and SLE
Sjogren's syndrome can also occur as a primary disease
Diagnostics
Presentation
- Triad: dry eye, dry mouth and parotid gland swelling
- Gritty, burning eyes
Investigations
- Anti-ro and anti-La (autoantibodies)
Dry eyes can lead to erosions of the ocular surface. These erosions can be seen with different dyes such as fluorescein (cornea) and lissamine (conjunctiva)
Management
Treat according to the treatment ladder for dry eyes (above)
Xerophthalmia
A major cause of childhood blindness in Africa
Pathology
- Severe Vitamin A deficiency → lack of tear production → dry eyes
Diagnostics
Presentation
- Characteristic Bitot's spots - triangular conjunctival keratin buildups
Investigations
Standard findings in dry eye:
- Tear film break up time is reduced (<5)
- Schirmer's test is positive
- Ocular surface staining
Management
Treat according to the treatment ladder for dry eyes (above)
