Dry eye is a multifactor disease of the tear film and the eye surface that causes symptoms of discomfort, visual disorders and instability of the tear film, with potential damage on the eye surface. It is accompanied by an increase of tear osmolarity and inflammation of the eye surface.
It can be due to the lack of tear secretion (hyposecretor dry eye), as happens with some immunological diseases, hormonal factors or with age, among many other causes, or due to a bad quality of the tear (evaporative dry eye), due to local alterations such as blepharitis or allergies, among others, which are also influenced by environmental factors, such as heating systems, air-conditioning, working in front of a screen, etc.
Dry eye is the most frequent pathology at Innova Ocular IOA Madrid, as it produces a wide and varied combination of symptoms that alter the patient's quality of life and work performance.
For an appropriate diagnose it requires a good examination and identification of the symptoms and circumstances, and specific tests among which are analysis of the tear osmolarity, essential to identify the type of pathology, severity of the affectation of the eye surface and underlying illnesses.
This pathology should not be trivialised, because in addition to the frequency in which it appears and the deterioration of the quality of life of the patient, it may be the tip of the iceberg of endocrine, hormonal and especially autoimmune diseases, the early diagnose of which is essential.
It is essential to provide a diagnosis protocol for a patient with symptoms and signs of dry eye.
The first and most important is to talk to the patient, define his symptoms, when they appear or when are the more intense, if it is better or worse when he gets up in the morning, if it worsens during the day and the visual activity, habits, cosmetic intolerances, allergies, other symptoms such as dry mouth, pains in the joints, general medication, smoking, previous treatments, etc.
We have surveys aimed at defining and quantifying the severity of the symptoms:
- Osmoloarity test. Analyses the quality of the tear and is currently considered probably the most objective test to diagnose a pathological dry eye and quantify the degree of severity and helps us define the treatment to follow.
- Shirmer test. The amount of tear is measured by placing strips of graph paper under the eyelids. It is left for 5 minutes, with the eyes closed and the millimetres wet by the tear are measured. Under 10 means there is a aqueous decrease of the tear and under 5 is pathological.
- Examination with slit-lamp. The palpebral edge must be examined thoroughly, as well as the inflammation, obstruction of the glands on the edge of the eyelid, flaking, incomplete closure, blinking frequency, blapheroplasty, droopy eyelids, tics, etc.
Dyeing the tear with colorants, such as fluoroscein, that with cobalt-blue light enables evaluating the uniformity of the tear, the breaking time of the lachrymal film, erosions and spots on the surface of the cornea and conjunctiva.
Not all dry eyes are the same, each patient has a different type of dry eye and it is important to differentiate it for the appropriate treatment in each case.
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Dry eye is a multi-factorial disease that causes symptoms of discomfort, visual disorders and instability of the lachrymal film, with potential damage of the ocular surface.