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Transcript of Dry eye
Update management of dry eye Definition of Dry Eye Disease Dry eye disease affects more than 100 million people worldwide.
20-30 percent of the population has either chronic dry eye problems or episodic dry eye in response to environmental stress.
65 percent suffer from evaporative dry eye. Dry Eye http://www.virtualcancercentre.com Overview Eye protection
Regular blink: protection and stability of the tear film
Rich of glands
Adequate blood supply
No venous valve Roles and Characteristics of the eyelids Corneal epithelium
Clinical ocular surface consist of
lacrimal passages Conception Risk factors Special attention http://www.drmalcolmmckellar.co.nz Function :
2.Wetting ocular surface
4.Supporting the cornea
(oxygen supply) Tear and the Tear Film http://www.chronicdryeye.com Dry eye Healthy tear film Dry Eye Stem cells, SC
Corneal epithelium derived from the Limbal stem cells.
Conjunctival epithelium derived from forniceal and palpebral regions. Origin of Epithelium Corneal, conjunctival lesion
Squamous epithelization type
Limbal stem cell deficiency type
Tear film disorders
Aqueous tear deficiency
Lipid tear deficiency
Kinetic disorders of lacrimal fluid Classification Reconstruction
Epithelium, limbal stem cells
Lacrimal secretion, tear film
Innervation (nerve restore)
Structure and function of eyelid
To re-establish conjunctiva, cornea, tear film and eyelid. Treatment www.virtualmedicalcentre.com Lacrimal gland
Producing the watery part of the tear film called the aqueous.
Producing lipids which keep the tear film from evaporating.
Goblet cells of the conjunctiva
Producing mucin which allows the wetting of the ocular surface as well as stabilizes the tear film. Tear Secretion Aqueous tear deficiency
Lipid tear deficiency
Kinetic disorders of lacrimal fluid Etiological factor & Classification http://www.drmalcolmmckellar.co.nz Dry eye symptoms Dry eye symptoms
Do you regularly experience one or several symptoms above?
Some diseases and conditions (like rheumatoid arthritis, lupus and Sjögren’s Syndrome) also cause chronic Dry Eye in many patients.
On the other hand, activities like reading, Wearing contact lenses or working at the computer may cause Dry Eye. Clinical Manifestation Screening tests Screening tests Dry Eye questionnaire
Lacrimal river width
Schirmer test – uses paper strips under eyelid to measure the wetness that collects over a specific period of time.
Break-up time of tear film (BUT)
Staining – uses special dyes to highlight areas of possible damage to the eye surface.
Tear ferning test
Tear penetration pressure test
Corneal tonographic map
Impression cytology Diagnostic Tests for Dry Eye Schirmer test, BUT, Staining
Instability of tear film
Damage on epithelium
Tear penetration pressure increasing Diagnosing
Normal ：≥10mm/5min Schirmer Test Tear break-up time, BUT 3分 2分 1分 0分 Using special dyes to highlight areas of possible damage to the eye surface. Staining http://www.dryeyezone.com Meibomian Gland Dysfunction Failure of the glands to produce or secrete lipids.
Wax ester declining and cholesterol increasing make the symptoms worse .
Lack of tears and tear penetration pressure increasing.
Lupus, brandy nose etc. Etiological Factor http://www.revophth.com http://www.eyehealthnutrition.com Figure: Notching of the lid caused by loss of meibomian glands. Common in aged people and who lived in cold region.
No specific symptoms.
Lid-margin mostly thickening; abnormal secretion
Disorder in Meibomian
gland, eyelid, conjunctiva. Clinical Manifestation http://www.ophmanagement.com Figure: No visible meibomian gland orifices: Eversion of the lower lids in both eyes showed atresic meibomian glands. Absence of Meibomian gland.
The gland orifices are often compromised due to stenosis or closure.
A declining quality and quantity of lipid secretion.
Anyone of the physical signs can make the diagnosis of Meibomian gland dysfunction if the patient has clinical symptoms. Diagnosing Clearing
Hot fomentation on eyelids for 5~10mins.
Massaging the eyelids.
Swabbing the lid-margin with mild cleaning solution. Treatment Antibiotics oral administration.
Antibiotic eye drops
Glucocorticoid eye drops (short term)
Artificial tears Treatment Dry eye treatment
Lubricants, including: artificial tears, ointments, and gels
mainstay of therapy in all stages of DED
either alone or in combination Tear stimulation Eliminating the etiological factors
Tears replacement therapy
Maintain moisture in the eyes
Increasing the tear secretion
Immune inhibition therapy
Re-establish the tear film
Other supporting treatment Summary Mohammad Hossein Davari M.D,Assistant Prof. of Ophthalmology
Medicine Faculty, Birjand, Birjand, IRAN. Dry eye is a multifactorial disease of the tears and ocular surface Results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface