Ocular Surface Disease

Emergency Eye Care

Ocular surface diseases are those which affect the surface of the cornea. These diseases include most commonly dry eye syndrome, Meibomian Gland Dysfunction, Blepharitis, allergies, and certain immunological conditions, they can severely affect eyesight and quality of life.

Symptoms may include :

  • Fluctuating vision
  • Gritty/Foreign body sensation
  • Itching
  • Discomfort or even pain in severe cases

What is dry eye?

“Dry eye is a multi factorial disease of the ocular surface characterized by instability of the tear film. Accompanied by ocular symptoms, in which tear film instability and poor quality tears, ocular surface inflammation, damage, and neurosensory abnormalities play contributing roles.”

Dry eye occurs when the quantity and/or quality of tears fails to keep the surface of the eye adequately lubricated. Experts estimate that dry eye affects millions of adults. The risk of developing dry eye increases with advancing age. Women have a higher prevalence of dry eye compared with men.

Common forms of dry eye
Symptoms of Dry eye
Dry Eyes Diagram

Dry eye causes a scratchy sensation or the feeling that something is in the eye. Other symptoms include stinging or burning, episodes of excess tearing that follow periods of dryness, discharge, pain, and redness in the eye, fluctuations in vision clarity. People with dry eye may also feel as if their eyelids are heavy and may experience blurred vision.

In a healthy eye, lubricating tears called basal tears continuously bathe the cornea, the clear, dome-shaped outer surface of the eye. With every blink of the eye, basal tears flow across the cornea, nourishing its cells and providing a layer of liquid protection from the environment. When the glands nearby each eye fail to produce enough basal tears, or when the composition of the tears changes, the health of the eye and vision are compromised. Vision may be affected because tears on the surface of the eye play an important role in focusing light.

Tears are a complex mixture of fatty oils, water, mucus, and more than 1500 different proteins that keep the surface of the eye smooth and protected from the environment, irritants, and infectious pathogens. Tears form in three layers:

  • An outer, oily (lipid) layer, produced by the Meibomian glands, keeps tears from evaporating too quickly and helps tears remain on the eye.
  • A middle (aqueous) layer contains the watery portion of tears as well as water-soluble proteins. This layer is produced by the main lacrimal gland and accessory lacrimal glands. It nourishes the cornea and the conjunctiva, the mucous membrane that covers the entire front of the eye and the inside of the eyelids.
  • An inner (mucin) layer, produced by goblet cells, binds water from the aqueous layer to ensure that the eye remains wet.
What causes dry eye?

Dry eye can occur when basal tear production decreases, tear evaporation increases, or tear composition is imbalanced. Factors that can contribute to dry eye include the following:

  • Medications including antihistamines, decongestants, antidepressants, birth control pills, hormone replacement therapy to relieve symptoms of menopause, and medications for anxiety, Parkinson’s disease, and high blood pressure have been associated with dry eye.
  • Advancing age is a risk factor for declines in tear production. Dry eye is more common in people age 50 years or older.
  • Rosacea (an inflammatory skin disease), blepharitis (an inflammatory eyelid disease) and demodex can disrupt the function of the Meibomian glands.
  • Autoimmune disorders such as Sjögren’s syndrome, lupus, scleroderma, and rheumatoid arthritis and other disorders such as diabetes, thyroid disorders, and Vitamin A deficiency are associated with dry eye.
  • Women are more likely to develop dry eye. Hormonal changes during pregnancy and after menopause have been linked with dry eye. Women also have an increased risk for autoimmune disorders.
  • Windy, smokey, or dry environments increase tear evaporation.
  • Seasonal allergies can contribute to dry eye.
  • Prolonged periods of screen time encourage insufficient blinking.
  • Eye surgery may cause temporary dry eye symptoms.

The most common form of Dry Eye is Evaporative Dry Eye, which affects 9 out of 10 (86%) Dry Eye cases. This form results from a shortage of oil in your tears caused by a blockage in your eyelid (Meibomian) glands, leading tears to evaporate faster than normal. This lack of tear oil is often referred to as Meibomian Gland Dysfunction (MGD).

Management Options:

Treatment of ocular surface disease is through management of the underlying cause such as meibomian gland dysfunction, dry eye syndrome, blepharitis etc.

Common remedies:
  • artificial tears or gels
  • hot compresses
  • anti-inflammatory topical eye drops
  • punctal plugs
  • treatment of Meibomian Gland Dysfunction
  • dietary supplements
  • treatment of eyelid conditions with BlephEx
  • Prolonged periods of screen time encourage insufficient blinking.
  • Eye surgery may cause temporary dry eye symptoms.
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