Keratoconjunctivitis Sicca

(Dry eye; keratitis sicca)

The keratoconjunctivitis sicca is a chronic, bilateral desiccation of the conjunctiva and cornea by inadequate tear film. Symptoms include itching, burning, irritation and photophobia. The diagnosis is made clinically. A Schirmer test can be helpful. The treatment is with topical tear substitutes and sometimes with a punctal occlusion.

The keratoconjunctivitis sicca is a chronic, bilateral desiccation of the conjunctiva and cornea by inadequate tear film. Symptoms include itching, burning, irritation and photophobia. The diagnosis is made clinically. A Schirmer test can be helpful. The treatment is with topical tear substitutes and sometimes with a punctal occlusion. Etiology There are two main types: the tear deficiency dry eye syndrome is caused by inadequate tear volume. The evaporative keratoconjunctivitis sicca (more common) is caused by an accelerated tear evaporation due to poor tear quality. The tear fluid deficiency keratoconjunctivitis sicca is usually an isolated idiopathic disease of women in menopause. They also often heard to the symptoms of Sjögren’s syndrome (Sjogren’s syndrome (SS)), rheumatoid arthritis (rheumatoid arthritis (RA)), or systemic lupus erythematosus (Systemic Lupus Erythematosus (SLE)). Less often it is the result of diseases that cause scarring of the tear ducts (z. B. cicatricial pemphigoid, Stevens-Johnson syndrome, trachoma). It can also be caused by a tear glands damage or -funktionsstörung – z. As a result of a “graft-vs-host disease,” HIV infection (diffuse infiltrative lymphocytosis syndrome), a local radiation therapy or family dysautonomia. The evaporative keratoconjunctivitis sicca is based on a loss of the tear film by abnormal rapid evaporation, which is caused by an inadequate oil layer to the aqueous layer tears. The symptoms can be either a result of an abnormal oil quality (in the case of a malfunction of the Meibomian glands) or degradation of normal oil layer (seborrheic blepharitis) be. Patients often have a rosacea acne. The dehydration can also result from exposure due to an insufficient eyes circuit in the night (nocturnal Lagophthalmus or Bell or facial nerve palsy) or an insufficient frequency of repeatedly applying tears to the cornea due to an insufficient blink rate (for. Example, in Parkinson’s disease) , Symptoms and discomfort patients experience itching, burning, a sandy, astringent or foreign body sensation or sensitivity to light. Shooting pains, overexertion or eye fatigue and blurred vision may be added. Some patients register for a strong irritation a flood of tears. Typically, the symptoms vary in intensity and are intermittent. Certain factors can worsen the symptoms: Prolonged visual efforts (. Eg reading, computer work, driving, watching TV) Local environments that are dry, windy, dusty or smoky certain systemic medications (such as isotretinoin, sedatives, diuretics, antihypertensives, oral contraceptives) and all anticholinergics (including antihistamines and many gastrointestinal agent) dehydration on cold, rainy or foggy days or in an environment with high humidity, like in the shower, improve symptoms. Recurrent and persistent blurred vision and frequent intense irritation can affect daily functioning level. However, permanent vision problems are rare. In both forms, the conjunctiva is congested and there are scattered fine, punctate defects of the corneal epithelium (punctate keratitis superficialis- superficial punctate keratitis), the Konjunktivalepithels or both. In a severe form, the affected areas can – mainly between the eyelids (interpalpebral or exposure zone) – stained with fluorescein. Because of the confusion patients blink frequently at a higher frequency. In the lack of tears form the conjunctiva can appear dry and dull and have many wrinkles. In the evaporative form abundant tears and foam may be present on the lid margin. Very rarely a serious, advanced, chronic dehydration can lead to a significant loss of vision due to a keratinization of ocular surface or Hornhautepithelverlust with subsequent scarring, neovascularization, infection, ulceration and perforation. Diagnosis Schirmer test and tear film break-up time (TBUT) Diagnosis is based on the characteristic symptoms and clinical findings. Schirmer test and TBUT make a distinction between the two forms. With the Schirmer test examines whether the tear production is normal. After the closed eye was purged of excessive tears, a filter paper web without local anesthesia is hooked in the region between the central and lateral Unterliddrittel in the conjunctival sac. after 5 minutes if <5.5 mm humidification occurs in two consecutive tests, the patient has sicca a tear deficiency keratoconjunctivitis. In the evaporative keratoconjunctivitis sicca the Schirmer test falls mostly normal. The tear film can be made visible on the slit lamp with cobalt blue light by a small volume of highly concentrated fluorescein (made by wetting a fluorescein strip with brine, followed by shaking of the strip, to remove excess moisture to remove) is instilled. the tear film is completed again by repeatedly blink. Subsequently, the patient looks straight ahead, and there is measured the time until the first dry spot arises in the tear film (TBUT). An accelerated break-up time (break-up time) of the intact tear film (<10 seconds) is characteristic sicca for evaporative keratoconjunctivitis. If a tear deficiency keratoconjunctivitis sicca was diagnosed at a Sjogren's syndrome (Sjogren's syndrome (SS)) should be considered, especially if there is also a xerostomia. perform serological tests and a biopsy of the lip salivary diagnostics. Patients with primary or secondary Sjögren's syndrome have an increased risk of a serious illness (for. Example, primary biliary cirrhosis, non-Hodgkin's lymphoma). As a result, appropriate investigations and follow-ups are required. Therapy Artificial tears Sometimes closure of the punctum or tarsorrhaphy The frequent application of artificial tears can be effective in both types. Höhervisköse artificial tears coat the ocular surface longer and artificial tears that contain polar lipids such as glycerol, reduce evaporation, both types are particularly useful in evaporative keratoconjunctivitis sicca. Wetting eye ointments are particularly helpful before sleep for patients who night have a lagophthalmos or wake up with irritated eyes. Most cases can be treat over the lifetime of the patient enough with this artificial tears. Hydrogenated to stay, humidifier and shunning dry, drafty environments can often help. It is important not to smoke, not passive. In stubborn cases, a closure of the punctum may be indicated. In severe cases, partial tarsorrhaphy can reduce evaporation of tears. In some patients, the local administration of cyclosporine and ?-3 fatty acid supplements can be a useful addition. Punctum plug Image courtesy of Prof. J. Wollensak via the Online Journal of Ophthalmology ( var model = {thumbnailUrl: '/-/media/manual/professional/images/punctum_plug_high_de.jpg?la=de&thn=0&mw=350' imageUrl: '/-/media/manual/professional/images/punctum_plug_high_de.jpg?la = en & thn = 0 ', title:' punctum plug 'description:' u003Ca id = "v37894238 " class = ""anchor "" u003e u003c / a u003e u003cdiv class = ""para "" u003e u003cp u003eZur treatment of keratoconjunctivitis sicca is the blockage of the lacrimal point a way to reduce the tear drainage away from the eye surface u003c / p u003e u003c / div u003e 'credits'. image courtesy of Prof. J . Wollensak via the online Journal of Ophthalmology ( 'hideCredits: false

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