Ocular Surface Disease…
Ocular surface disease results from dry eye, or inadequate production of tears It is is a frustrating and chronic, complex disease of the tear glands and surface of the eye that results in tear film instability. This in turn causes damage to the ocular (eye) surface, resulting in eye and eyelid margin redness, and symptoms of discomfort and blurred vision. The goal of treatment is to restore a normal tear film and to eliminate damage to the eye’s surface, and in turn reduce symptoms. Management of this disorder starts with accurate diagnosis. Dry eye is only one of the conditions that can cause discomfort in the eyes. Others include allergies, infections, environmental irritants, like pollution or chemical fumes, and contact lens wear.
Tear difficiency, or “dry eye”, is related to numerous problems, including increasing age, certain medications (particularly those for treating anxiety or depression, hormone replacement, hypertension), gender (women more affected then men, often related to hormonal changes), and environmental factors (wind, hot temperatures, and air conditioning).
Conditions such as arthritis, lupus, multiple sclerosis, thyroid disease, or Sjögren’s syndrome can cause swelling, redness, and pain in the tear glands.
Tests we use to diagnose dry eye include Tear Break-Up Time, temporary staining of the eye’s surface, tear volume production test, biomicroscope examination of tear glands, and tear osmolarity determination.
Tear Break-Up Time:
Special dyes are placed onto the eye that mix with the layer. The doctor observes the tear layer with a special microscope as the eye is held open for several seconds. Eventually the tear film is displaced and dry spots form. The lengh of time, in seconds, for this to happen is the Tear Break-Up time. A normal tear layer stays intact for about 10 seconds. In people with dry eye the time is shorted to as little as 2 to 4 seconds.
Fluroscein and Lissamine dye stain of the eye’s surface:
These dyes will stain only damaged or devitalized cells on the eye that dry eye affects. Commonly people with dry eye show this characteristic staining. Areas of damaged tissue result in eye discomfort such as itching, pain, or foreign body sensation.
Tear Volume tests:
Special test strips are gently touched to the surface of the eye for several seconds. The strip absorbs tears and how much tear is absorbed is related to how much tears is being produced. This is an indication of how fast tears are being made by the various tear glands.
Biomicroscope Exam of Tear Glands:
Oil producing glands (Meibomian glands) are found in the eyelids, with openings on the lid margins. The oil component of the tears slows evaporation of tears. Dysfunction of these glands is a common cause of dry eye, and alterations of these glands can be seen with the biomicroscope.
Tear Osmolarity Determination:
All of the previously discussed methods of dry eye analysis have a high degree of variability, and have made the exact diagnosis of true dry eye difficult to determine. Finally a revolutionary new diagnostic test is available in our office. A special instrument, called the TearLab Osmolarity System, incorporates a small probe that is gently touched to the white of the eye, and absorbs a very small sample of tears. Special electronic sensors determine the level of salinity (saltiness) of the tears. The degree of Osmolarity falls within a certain range. The low end found in normal tears, and the high end found in dry eyes. Not only is the test highly accurate and specific for true dry eye (not other causes of eye discomfort), but it rates the severity of dryness as mild, moderate, or severe. This information is extremely helpful in allowing our doctors to diagnose dry eye, and to taylor a specific treatment program taylored for each patient’s individual needs, and to track improvement over time. More information on Tear Osmolarity Testing
Systemic Auto-Immune Disease: Sjogren’s Syndrome Learn more
Patients with this condition frequently present with a combination of dry mouth and dry eye. Early detection and treatment can help to alleviate the devastating effects of this condition.