Transcript
KERATOCONJUNCTIVITIS SICCAParas Shah
Tear Film
Lipid layer:- Meibomian gland Aqueous layer:- Lacrimal gland and Accessory lacrimal gland of Krause and Wolfring Mucin layer:- Conjunctival goblet cell
HistoryWhat short of things bother your eyes? Intolerance
to air conditioner Sensitive to winds Intolerance to driving in the car with open window Difficulty in reading Nighttime is worst Smoke is intolerable
Do you have any skin disease? Scleroderma Scurvy Thrombotic
thrombocytopenic purpura Facial rush in lupus Skin lesion pemphigoid Old scar of Steven-Johnson syndrome Acne Rosacea
What medication do you take? Chlorpheniramine Isotretinoin Hydrochlorothiazide Propranolol
hydrochloride
Categories of Dry Eye SyndromeHolly and Lamp divided into 5 categories;1.Aqueous Deficiency 2.Mucin Deficiency 3.Lipid Abnormalities 4.Lid Surfacing Abnormalities 5.Epitheliopathies
Causes for Aqueous DeficiencyCongenitalRiley-Day syndrome Anhidrotic ectodermal dysplasia Alcrima secondary to congenital absence of the lacrimal gland Cri du chat syndrome Absence of lacrimal gland Congenital familial sensory neuropathy with anhidrosis Adies syndrome Multiple endocrine neoplasia
Causes for Aqueous DeficiencyAquired
Trauma to lacrimal gland
Surgical removal Injury Radiation damage Sjogrens syndrome Primary amylodosis Mumps Trachoma Sarcoidosis Lymphoma, leukemia Amyloidosis
Inflammation of lacrimal gland
Infiltration
Drugs
Antihistamines Thiabendazole Antimuscarinics General anesthetics
Neuroparalytic
hyposecretion
Brainstem lesions Middle fossa floor lesions Lesions of the sphenopalatine ganglion Cerebellopontile angle and petrous bone lesion
Mucin Deficiency diseases
Produced by goblet cells of conjunctiva Goblet cell dysfunction: vitamin A deficiency Goblet cell destruction
Alkali burns Cicatricial pemphigoid Steven-Johnson syndrome Trachoma Practolol Echothiophate iodide
Drug-induced
Lipid AbnormalitiesSevere anhidrotic ectodermal dysplasia is a true lipid deficiency Occurs when the meibomian gland congenitally absent
Lipid abnormalityChanges in composition of meibomian secretion (Blepharitis) Invade bacteria which secrete lipase Lipase hydralyze normal lipid to produce Various type of fatty acids Fatty acids are extremely surface active and directly toxic to corneal epithelium Damage corneal epithelium or formation of dry eye Superficial Punctate staining
Lid Surfacing AbnormalityLid resurfaces the eye with tears through constant blinking During blink, eyelid sweeps the eyes surface, brushing away exogenous contaminates as well as lipidcontaminated mucin strands Fresh mucin is thereby distributed over the cornea and conjunctival surface Any break in the integrity of lid or ocular surface which lead to dryness on that area
CausesLid problemsExposure keratitis Entropion Ectropion Symblepharon Large lid notch Lagophthalmos Keratinized lid margin
Surface irregularitiesDellen formation with limbal lesions 3 and 9 oclock stain in hard lens wearers Topical anesthetic epitheliopathy
EpitheliopathiesIt dependent on a smooth, uninterrupted epithelial surface, Any irregularity in the surface will cause an associated irregularity in the tear film, Irregular or elevated area will predispose the tear film to break up instantly at that spot, At least important
SymptomsIrritation Redness Discomfort Watering Foreign body sensation
SignsFilaments Meniscus Height Meniscus floaters Mucous strands Papillary conjunctivitis
FilamentsShort (
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