Keratoconjunctivitis sicca
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Jump to: navigation, search
Keratoconjunctivitis sicca
Classification & external resources
ICD-10 H19.3, M35.0
ICD-9 370.33, 710.2
DiseasesDB 12155
eMedicine oph/695
MeSH D007638
Keratoconjunctivitis sicca (KCS), also called keratitis sicca,[1] sicca syndrome,[1] xerophthalmia,[1] dry eye syndrome (DES),[1] or simply dry eyes,[1] is an eye disease caused by decreased tear production or increased tear film evaporation commonly found in humans and some animals[2]. Keratoconjunctivitis sicca is Latin and its literal translation is "dryness of the cornea and conjunctiva". It may be helpful to know that "sicca" is part of the English word "desiccate."
Contents
[hide]
* 1 Symptoms
* 2 Pathophysiology
* 3 Causes
o 3.1 Deficient tear production
o 3.2 Abnormal tear composition
o 3.3 Additional causes
* 4 Diagnosis
* 5 Treatment
o 5.1 Rehydration
+ 5.1.1 Artificial tears
+ 5.1.2 Additional options
o 5.2 Environmental control
o 5.3 Supplementation
o 5.4 Medication
+ 5.4.1 Restasis
# 5.4.1.1 Generic alternatives
o 5.5 Conserving tears
+ 5.5.1 Blocking tear drainage
# 5.5.1.1 Punctal plugs
# 5.5.1.2 Cauterization
+ 5.5.2 Customized contact lenses
+ 5.5.3 Surgery
* 6 Prognosis
* 7 Prevention
* 8 Epidemiology
* 9 Occurrence in animals
o 9.1 Dogs
o 9.2 Cats
* 10 See also
* 11 References
* 12 Further reading
* 13 External links
o 13.1 Animals
[edit] Symptoms
Typical symptoms of keratoconjunctivitis are dryness, burning[3] and a sandy-gritty eye irritation that gets worse as the day goes on.[1] Symptoms may also be described as itchy,[3] scratchy,[4] stingy[3] or tired[3] eyes. Other symptoms are pain,[5] redness,[5] a pulling sensation,[3] and pressure behind the eye[3]. There may be a feeling that something,[3] such as a speck of dirt,[5] is in the eye. The resultant damage to the eye surface increases discomfort and sensitivity to bright light.[3] Both eyes usually are affected.[6]
There may also be a stringy discharge from the eyes.[5] Although it may seem strange, dry eye can cause the eyes to water.[5] This can happen because the eyes are irritated.[5] One may experience excessive tearing in the same way as one would if something got into the eye.[5] These reflex tears will not necessarily make the eyes feel better.[5] This is because they are the watery type that are produced in response to injury, irritation, or emotion.[5] They do not have the lubricating qualities necessary to prevent dry eye.[5]
Because blinking coats the eye with tears,[5] symptoms are worsened by activities in which the rate of blinking is reduced due to prolonged use of the eyes[3]. These activities include prolonged reading,[1] computer usage,[1][5][3] driving,[3] or watching television[5][3]. Symptoms increase in windy,[5] dusty[5][3] or smoky (including cigarette smoke[5]) areas,[1][3] in dry environments[1][3], high altitudes including airplanes,[6] on days with low humidity,[3] and in areas where an air conditioner[5] (especially in a car[3]), fan,[3] heater,[3] or even a hair dryer[5] is being used. Symptoms reduce during cool, rainy, or foggy weather and in humid places, such as in the shower.[3]
Most people who have dry eyes experience mild irritation with no long-term effects.[5] However, if the condition is left untreated or becomes severe, it can produce complications that can cause eye damage,[5] resulting in impaired vision or (rarely[3]) in the loss of vision[5].
Symptom assessment is a key component of dry eye diagnosis - to the extent that many believe dry eye syndrome to be a symptom-based disease. Several questionnaires have been developed to determine a score that would allow for dry eye diagnosis. McMonnies & Ho dry eye questionnaire is the one that is often used in clinical studies of dry eyes. There are 14 questions that can give a score from 0 to 45. Scores above 14.5 are consistent with dry eye diagnosis.
[edit] Pathophysiology
Having dry eyes for a while can lead to tiny abrasions on the surface of the eyes.[4] In advanced cases, the epithelium undergoes pathologic changes, namely squamous metaplasia and loss of goblet cells.[1] Some severe cases result in thickening of the corneal surface,[3] corneal erosion,[1] punctate keratopathy,[1] epithelial defects,[1] corneal ulceration (sterile and infected),[1] corneal neovascularization,[1] corneal scarring,[1][3] corneal thinning,[1] and even corneal perforation[1].
[edit] Causes
Any abnormality of any one of the three layers of tears produces an unstable tear film, resulting in symptoms of keratitis sicca.[1]
[edit] Deficient tear production
Keratoconjunctivitis sicca is usually due to inadequate tear production.[1][3] The aqueous tear layer is affected, resulting in aqueous tear deficiency (ATD) or lacrimal hyposecretion.[1] The lacrimal gland does not produce sufficient tears to keep the entire conjunctiva and cornea covered by a complete layer.[3] This usually occurs in people who are otherwise healthy. Increased age is associated with decreased tearing.[1] This is the most common type found in postmenopausal women.[3][7]
Causes include idiopathic, congenital alacrima, xerophthalmia, lacrimal gland ablation, and sensory denervation.[1] In rare cases, it may be a symptom of collagen vascular diseases, including rheumatoid arthritis[3], Wegener's granulomatosis, and systemic lupus erythematosus.[1] Sjögren's syndrome[3] and autoimmune diseases associated with Sjögren's syndrome are also conditions associated with aqueous tear deficiency.[1] Drugs such as isotretinoin,[3] sedatives,[3][6] diuretics,[3] tricyclic antidepressants,[6] antihypertensives,[3] oral contraceptives,[1][3] antihistamines,[1][5][3] nasal decongestants,[5] beta-blockers,[1] phenothiazines,[1] atropine,[1], and pain relieving opiates such as morphine[6] can cause or worsen this condition. Infiltration of the lacrimal glands by sarcoidosis or tumors, or postradiation fibrosis of the lacrimal glands can also cause this condition.[1]
[edit] Abnormal tear composition
Keratoconjunctivitis sicca can also be caused by abnormal tear composition resulting in rapid evaporation[3] or premature destruction of the tears.[1] When caused by rapid evaporation, it is termed evaporative dry eyes.[3] In this, although the tear gland produces a sufficient amount of tears, the rate of evaporation of the tears is too rapid.[3] There is a loss of water from the tears that results in tears that are too "salty" or hypertonic. As a result, the entire conjunctiva and cornea cannot be kept covered with a complete layer of tears during certain activities or in certain environments.[3]
[edit] Additional causes
Aging is one of the most common causes of dry eyes.[5] This is because tear production decreases with age.[5] It may be caused by thermal or chemical burns, or (in epidemic cases) by adenoviruses. A number of studies have found that diabetics are at increased risk for the disease.[8][9]
An eye injury or other problem with the eyes or eyelids, such as bulging eyes or a drooping eyelid can cause keratoconjunctivitis sicca.[4] Disorders of the eyelid can impair the complex blinking motion required to spread tears.[6]
About half of all people who wear contact lenses complain of dry eyes.[5] This is because soft contact lenses, which float on the tear film that covers the cornea, absorb the tears in the eyes.[5] Dry eyes also occurs or gets worse after LASIK and other refractive surgeries, in which the corneal nerves are cut during the creation of a corneal flap.[5] The corneal nerves stimulate tear secretion.[5] Dry eyes caused by these procedures usually resolves after several months.[6] Persons who are thinking about refractive surgery should consider this.[5]
Abnormalities of the lipid tear layer caused by blepharitis and rosacea, and abnormalities of the mucin tear layer caused by vitamin A deficiency, trachoma, diphtheric keratoconjunctivitis, mucocutaneous disorders and certain topical medications are causes of keratoconjunctivitis sicca.[1]
Persons with keratoconjunctivitis sicca have elevated levels of tear nerve growth factor (NGF).[1] It is possible that this ocular surface NGF plays an important role in ocular surface inflammation associated with dry eyes.[1]
[edit] Diagnosis
Dry eyes can usually be diagnosed by the symptoms alone.[3] Tests can determine both the quantity and the quality of the tears.[6] A slit lamp examination can be performed to diagnose dry eyes and to document any damage to the eye.[1][3]
A Schirmer's test can measure the amount of moisture bathing the eye.[3] This test is useful for determining the severity of the condition.[5] A five-minute Schirmer's test with and without anesthesia using a Whatman #41 filter paper 5 mm wide by 35 mm long is performed.[1] For this test, wetting under 5 mm with or without anesthesia is considered diagnostic for dry eyes.[1]
If the results for the Schirmer's test are abnormal, a Schirmer II test can be performed to measure reflex secretion.[1] In this test, the nasal mucosa is irritated with a cotton-tipped applicator, after which tear production is measured with a Whatman #41 filter paper.[1] For this test, wetting under 15 mm after five minutes is considered abnormal.[1]
A tear breakup time (TBUT) test measures the time it takes for tears to break up in the eye.[5] The tear breakup time can be determined after placing a drop of fluorescein in the cul-de-sac.[1]
A tear protein analysis test measures the lysozyme contained within tears.[1] In tears, lysozyme accounts for approximately 20 to 40 percent of total protein content.[1]
A lactoferrin an
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Keratoconjunctivitis sicca
Classification & external resources
ICD-10 H19.3, M35.0
ICD-9 370.33, 710.2
DiseasesDB 12155
eMedicine oph/695
MeSH D007638
Keratoconjunctivitis sicca (KCS), also called keratitis sicca,[1] sicca syndrome,[1] xerophthalmia,[1] dry eye syndrome (DES),[1] or simply dry eyes,[1] is an eye disease caused by decreased tear production or increased tear film evaporation commonly found in humans and some animals[2]. Keratoconjunctivitis sicca is Latin and its literal translation is "dryness of the cornea and conjunctiva". It may be helpful to know that "sicca" is part of the English word "desiccate."
Contents
[hide]
* 1 Symptoms
* 2 Pathophysiology
* 3 Causes
o 3.1 Deficient tear production
o 3.2 Abnormal tear composition
o 3.3 Additional causes
* 4 Diagnosis
* 5 Treatment
o 5.1 Rehydration
+ 5.1.1 Artificial tears
+ 5.1.2 Additional options
o 5.2 Environmental control
o 5.3 Supplementation
o 5.4 Medication
+ 5.4.1 Restasis
# 5.4.1.1 Generic alternatives
o 5.5 Conserving tears
+ 5.5.1 Blocking tear drainage
# 5.5.1.1 Punctal plugs
# 5.5.1.2 Cauterization
+ 5.5.2 Customized contact lenses
+ 5.5.3 Surgery
* 6 Prognosis
* 7 Prevention
* 8 Epidemiology
* 9 Occurrence in animals
o 9.1 Dogs
o 9.2 Cats
* 10 See also
* 11 References
* 12 Further reading
* 13 External links
o 13.1 Animals
[edit] Symptoms
Typical symptoms of keratoconjunctivitis are dryness, burning[3] and a sandy-gritty eye irritation that gets worse as the day goes on.[1] Symptoms may also be described as itchy,[3] scratchy,[4] stingy[3] or tired[3] eyes. Other symptoms are pain,[5] redness,[5] a pulling sensation,[3] and pressure behind the eye[3]. There may be a feeling that something,[3] such as a speck of dirt,[5] is in the eye. The resultant damage to the eye surface increases discomfort and sensitivity to bright light.[3] Both eyes usually are affected.[6]
There may also be a stringy discharge from the eyes.[5] Although it may seem strange, dry eye can cause the eyes to water.[5] This can happen because the eyes are irritated.[5] One may experience excessive tearing in the same way as one would if something got into the eye.[5] These reflex tears will not necessarily make the eyes feel better.[5] This is because they are the watery type that are produced in response to injury, irritation, or emotion.[5] They do not have the lubricating qualities necessary to prevent dry eye.[5]
Because blinking coats the eye with tears,[5] symptoms are worsened by activities in which the rate of blinking is reduced due to prolonged use of the eyes[3]. These activities include prolonged reading,[1] computer usage,[1][5][3] driving,[3] or watching television[5][3]. Symptoms increase in windy,[5] dusty[5][3] or smoky (including cigarette smoke[5]) areas,[1][3] in dry environments[1][3], high altitudes including airplanes,[6] on days with low humidity,[3] and in areas where an air conditioner[5] (especially in a car[3]), fan,[3] heater,[3] or even a hair dryer[5] is being used. Symptoms reduce during cool, rainy, or foggy weather and in humid places, such as in the shower.[3]
Most people who have dry eyes experience mild irritation with no long-term effects.[5] However, if the condition is left untreated or becomes severe, it can produce complications that can cause eye damage,[5] resulting in impaired vision or (rarely[3]) in the loss of vision[5].
Symptom assessment is a key component of dry eye diagnosis - to the extent that many believe dry eye syndrome to be a symptom-based disease. Several questionnaires have been developed to determine a score that would allow for dry eye diagnosis. McMonnies & Ho dry eye questionnaire is the one that is often used in clinical studies of dry eyes. There are 14 questions that can give a score from 0 to 45. Scores above 14.5 are consistent with dry eye diagnosis.
[edit] Pathophysiology
Having dry eyes for a while can lead to tiny abrasions on the surface of the eyes.[4] In advanced cases, the epithelium undergoes pathologic changes, namely squamous metaplasia and loss of goblet cells.[1] Some severe cases result in thickening of the corneal surface,[3] corneal erosion,[1] punctate keratopathy,[1] epithelial defects,[1] corneal ulceration (sterile and infected),[1] corneal neovascularization,[1] corneal scarring,[1][3] corneal thinning,[1] and even corneal perforation[1].
[edit] Causes
Any abnormality of any one of the three layers of tears produces an unstable tear film, resulting in symptoms of keratitis sicca.[1]
[edit] Deficient tear production
Keratoconjunctivitis sicca is usually due to inadequate tear production.[1][3] The aqueous tear layer is affected, resulting in aqueous tear deficiency (ATD) or lacrimal hyposecretion.[1] The lacrimal gland does not produce sufficient tears to keep the entire conjunctiva and cornea covered by a complete layer.[3] This usually occurs in people who are otherwise healthy. Increased age is associated with decreased tearing.[1] This is the most common type found in postmenopausal women.[3][7]
Causes include idiopathic, congenital alacrima, xerophthalmia, lacrimal gland ablation, and sensory denervation.[1] In rare cases, it may be a symptom of collagen vascular diseases, including rheumatoid arthritis[3], Wegener's granulomatosis, and systemic lupus erythematosus.[1] Sjögren's syndrome[3] and autoimmune diseases associated with Sjögren's syndrome are also conditions associated with aqueous tear deficiency.[1] Drugs such as isotretinoin,[3] sedatives,[3][6] diuretics,[3] tricyclic antidepressants,[6] antihypertensives,[3] oral contraceptives,[1][3] antihistamines,[1][5][3] nasal decongestants,[5] beta-blockers,[1] phenothiazines,[1] atropine,[1], and pain relieving opiates such as morphine[6] can cause or worsen this condition. Infiltration of the lacrimal glands by sarcoidosis or tumors, or postradiation fibrosis of the lacrimal glands can also cause this condition.[1]
[edit] Abnormal tear composition
Keratoconjunctivitis sicca can also be caused by abnormal tear composition resulting in rapid evaporation[3] or premature destruction of the tears.[1] When caused by rapid evaporation, it is termed evaporative dry eyes.[3] In this, although the tear gland produces a sufficient amount of tears, the rate of evaporation of the tears is too rapid.[3] There is a loss of water from the tears that results in tears that are too "salty" or hypertonic. As a result, the entire conjunctiva and cornea cannot be kept covered with a complete layer of tears during certain activities or in certain environments.[3]
[edit] Additional causes
Aging is one of the most common causes of dry eyes.[5] This is because tear production decreases with age.[5] It may be caused by thermal or chemical burns, or (in epidemic cases) by adenoviruses. A number of studies have found that diabetics are at increased risk for the disease.[8][9]
An eye injury or other problem with the eyes or eyelids, such as bulging eyes or a drooping eyelid can cause keratoconjunctivitis sicca.[4] Disorders of the eyelid can impair the complex blinking motion required to spread tears.[6]
About half of all people who wear contact lenses complain of dry eyes.[5] This is because soft contact lenses, which float on the tear film that covers the cornea, absorb the tears in the eyes.[5] Dry eyes also occurs or gets worse after LASIK and other refractive surgeries, in which the corneal nerves are cut during the creation of a corneal flap.[5] The corneal nerves stimulate tear secretion.[5] Dry eyes caused by these procedures usually resolves after several months.[6] Persons who are thinking about refractive surgery should consider this.[5]
Abnormalities of the lipid tear layer caused by blepharitis and rosacea, and abnormalities of the mucin tear layer caused by vitamin A deficiency, trachoma, diphtheric keratoconjunctivitis, mucocutaneous disorders and certain topical medications are causes of keratoconjunctivitis sicca.[1]
Persons with keratoconjunctivitis sicca have elevated levels of tear nerve growth factor (NGF).[1] It is possible that this ocular surface NGF plays an important role in ocular surface inflammation associated with dry eyes.[1]
[edit] Diagnosis
Dry eyes can usually be diagnosed by the symptoms alone.[3] Tests can determine both the quantity and the quality of the tears.[6] A slit lamp examination can be performed to diagnose dry eyes and to document any damage to the eye.[1][3]
A Schirmer's test can measure the amount of moisture bathing the eye.[3] This test is useful for determining the severity of the condition.[5] A five-minute Schirmer's test with and without anesthesia using a Whatman #41 filter paper 5 mm wide by 35 mm long is performed.[1] For this test, wetting under 5 mm with or without anesthesia is considered diagnostic for dry eyes.[1]
If the results for the Schirmer's test are abnormal, a Schirmer II test can be performed to measure reflex secretion.[1] In this test, the nasal mucosa is irritated with a cotton-tipped applicator, after which tear production is measured with a Whatman #41 filter paper.[1] For this test, wetting under 15 mm after five minutes is considered abnormal.[1]
A tear breakup time (TBUT) test measures the time it takes for tears to break up in the eye.[5] The tear breakup time can be determined after placing a drop of fluorescein in the cul-de-sac.[1]
A tear protein analysis test measures the lysozyme contained within tears.[1] In tears, lysozyme accounts for approximately 20 to 40 percent of total protein content.[1]
A lactoferrin an
