Dry eye effect causes. Dry eye syndrome in ophthalmic practice

Dry eye syndrome (DES), or corneal and conjunctival xerosis, is a complex disease that is common throughout the world and is one of the main problems of modern ophthalmic pathology. According to Russian researchers, up to 12% of ophthalmic patients under the age of 40 and over 67% of patients over 50 suffer from this disease. The term "dry eye" itself appeared in the domestic literature relatively recently. Previously, it was identified exclusively with Sjögren's disease - a severe systemic disease, accompanied by a decrease or complete absence of secretion of all endocrine glands, especially the lacrimal and salivary glands. Currently, the concept of "dry eye syndrome" has been expanded and is defined as a complex of signs of damage to the corneal and conjunctival epithelium due to a decrease in the quality and / or amount of tear fluid. The latter forms a tear film (TP) on the surface of the eye, which performs a number of important functions, including trophic, protective, and optical. Thus, a violation of the composition or production of SP can lead to quite serious damage to the anterior segment of the eye.

There are xerosis of the cornea and conjunctiva due to a number of pathologies. An important role in this process is played by pronounced anatomical disorders of ocular localization, such as incomplete closure or excessive opening of the palpebral fissure due to cicatricial or paralytic lagophthalmos, endocrine ophthalmopathy, and buphthalmos. Corneal-conjunctival xerosis can also develop as a result of a violation of the trophism of the cornea or deformation of its surface, insolvency of the lacrimal gland, additional lacrimal glands after dacryoadenitis and inflammatory diseases of the conjunctiva. Also, a violation of the composition of the joint venture is observed with the so-called climacteric syndrome. A sharp decrease in tear production is observed with disorders of the innervation of the lacrimal gland, such as facial paralysis, multiple sclerosis. Chronic meibomitis, in which the composition of the joint venture is disturbed, also leads to the development of a typical DES picture. Recently, the so-called ocular office and ocular monitor syndromes, which occur in people of different ages as a result of the systematic exposure of their eyes to conditioned air, electromagnetic radiation from office equipment and other similar sources, have become of particular importance. One of the common reasons for the violation of the stability of the joint venture, which has become increasingly important in recent years, are surgical interventions for refractive errors and cataracts. It has been noted that DES can be caused by certain drugs, such as oral contraceptives, tricyclic antidepressants, antihypertensives, corticosteroids, as well as permanent instillations of β-blockers, carried out in the treatment of glaucoma. According to some reports, the development of corneal and conjunctival xerosis can cause the use of cytostatics and anti-migraine drugs.

A typical one of the initial symptoms of dry eye syndrome is the sensation of a foreign body in the conjunctival cavity, which is combined with severe lacrimation, later replaced by a feeling of dryness. Patients complain of burning and stinging in the eye, especially when exposed to wind, smoke, air conditioning and other similar irritants, when using fan heaters. In addition to this, subjective signs of the disease are photophobia, deterioration of visual performance in the evening, fluctuations in visual acuity during the working day. To the above, it is necessary to add pathognomonic signs. In particular, a negative reaction of patients to the instillation of even completely indifferent drops into the conjunctival cavity, for example, a solution of levomycetin 0.25% or a solution of dexamethasone 0.1%, is characteristic. In such cases, patients experience pain, burning, or stinging in the eye.

The most common objective symptom of the disease is the reduction or complete absence of lacrimal menisci at the edges of the eyelids. Their place is usually filled with swollen and dull conjunctiva, "creeping" on the free edge of the eyelid. Somewhat less often, in such patients, the appearance of a variety of "clogging" inclusions in the tear film can be detected. Usually they are represented by the smallest clumps of mucus, remnants of separated epithelial filaments, air bubbles and other microparticles. They float in the thickness of the tear film, lacrimal meniscus and lower conjunctival fornix, move along the corneal epithelium and are clearly visible in the light of a slit lamp. Another objective sign of dry eye syndrome is a characteristic discharge from the conjunctival cavity. When processing the eyelids, due to its high viscosity, it is drawn into thin mucous threads, which cause discomfort in patients. Based on the combination of the above signs, it is advisable to distinguish three degrees of severity of the dry eye syndrome.

For I, mild, degree is characterized by:

• subjective signs - complaints about the feeling of "sand in the eye", burning, photophobia, etc., arising from the influence of adverse factors;
• objective signs - increased tear production, hyperemia and swelling of the conjunctiva, the presence of inclusions in the tear film, the appearance of conjunctival discharge in the form of mucous threads.

II, medium, degree has:

• subjective signs - a greater number of complaints and symptoms that persist for a long time after the cessation of adverse factors;
• objective signs are a pain reaction to instillations of indifferent eye drops, swelling of the bulbar conjunctiva with its creeping onto the free edge of the lower eyelid, the absence of reflex lacrimation and the appearance of signs of tear production deficiency.

III, severe, the degree is distinguished by special forms.

• Filamentous keratitis: multiple epithelial growths in the form of filaments, the free edges of which, moving towards the cornea, irritate the eye, which is accompanied by corneal syndrome. The conjunctiva is intact.
• Dry keratoconjunctivitis: signs of filamentous keratitis are aggravated by degenerative changes in the conjunctival and corneal epithelium. The cornea loses its natural luster, gloss and becomes dull. Subepithelial opacities may be seen. Edema and hyperemia of the conjunctiva at the edges of the eyelids are also observed.
• Recurrent microerosion of the cornea: periodic occurrence of superficial microdefects of the corneal epithelium, which persist for a long time (up to 7 days). A pronounced corneal syndrome is characteristic, the disease recurs after 2-3 months.

Diagnosis of the disease

The diagnostic process in relation to patients with DES is carried out in the traditional sequence. The initial ophthalmological examination of patients at the initial stage includes the following elements.

• Purposeful questioning of the patient, including clarification of the anamnesis of the disease and its possible connection with the professional activity of the subject.
• Standard examination of the organ of vision, but with "targeted" biomicroscopy of the cornea (Nidek, Paradigm), conjunctiva and free edges of the eyelids, including the use of sodium fluorescein 0.1%.

When signs of DES are detected, a clarifying examination is performed, which includes three stages.

• Additional "targeted" biomicroscopy (Nidek, Paradigm) of the anterior segment of the eyeball using various vital stains.
• Functional examination (determination of the stability of the joint venture, the study of total and main tear production).
• Setting up tests aimed at diagnosing pathological changes associated with DES.

Primary ophthalmological examination of patients is performed according to generally accepted rules. More attention should be paid to complaints, which in some cases directly or indirectly indicate xerotic changes in the tissues of the eye. It is also necessary to purposefully collect anamnestic data regarding the general status, past diseases, injuries and operations, treatment received, professional activities of the subject.

When biomicroscopy of the cornea and conjunctiva, it should be borne in mind that signs of DES are often masked by symptoms of other eye diseases, in particular, degenerative or inflammatory ones. To differentiate them, S.C.G. Tseng (1994) proposed a fairly simple rule: if changes suspicious of xerosis are localized in the so-called exposed zone of the surface of the eyeball, then they are associated with DES; when areas of pathology also capture the unexposed zone of the cornea and conjunctiva, their nature is rather not xerotic.

Vital dyes significantly increase the possibilities of biomicroscopy: sodium fluorescein 0.1%, rose bengal 3% or lyssamine green 1%, which allow obtaining various complementary information.

The presence of initial, and even more obvious signs of DES is an indication for the performance of functional tests designed to assess the state of tear production and the strength of the precorneal SP.

Examination of a patient with suspected DES should begin with an assessment of the stability of the joint venture. Since the results of the test used for this according to Norn (1969) largely depend on the "invasiveness" of previous manipulations in the conjunctival cavity, they should be completely excluded. At the same time, studies by L. S. Beer et al. (2001) found that the most reliable results of assessing the stability of the joint venture are obtained using microvolumes (6-7 μl) of sodium fluorescein 0.1%. At the same time, their influence on the stability of the joint venture becomes minimal, in contrast to the whole drop (30-40 µl) of the diagnosticum used in the Norn method.

The next stage of the functional study is to assess the state of the total (basic and reflex) tear production in each eye of the patient. Due to the fact that the insufficiency of one component of tear secretion is often compensated by an excess of another (as a rule, the deficiency of the main tear production is reflex hypersecretion), the volume of total tear production may not decrease, and sometimes even increase. Due to these circumstances, it is necessary to distinguish between the proportions of each component of tear secretion, and not complete the study, limiting itself to measuring only total tear production, as is customary in the practice of most doctors. For these purposes, you should first measure the amount of total, and then the main tear production, and then calculate the amount of reflex secretion of the tear. It should be noted that in patients with a mild form of DES, the clinical picture of which is dominated by micro-signs of corneal-conjunctival xerosis against the background of hyperlacrimia, it is not advisable to conduct such studies. The generally accepted and now widespread clinical test characterizing the state of total tear production was proposed by Schirmer. In order to study the main tear production, one should refer to the Jones test (1966), which is similar to the Schirmer test, but includes preliminary instillation anesthesia.

An important additional information about the state of tear production can be given by the study of the rate of tear secretion. The technique developed by V. V. Brzhesky and co-authors is based on determining the wetting time of a piece of hydrophilic (polyvinyl, cotton, etc.) thread, placed at one end behind the lower eyelid of the subject. The use of local anesthetics or, conversely, irritating substances allows you to selectively evaluate the rate of main or reflex tear production.

In general, the arsenal of diagnostic methods that allow obtaining versatile information about the pathogenesis, clinical course, and features of functional disorders in patients with DES in each specific case is quite large. However, the rational choice of these methods in combination with the correct analysis of their results is not feasible without the appropriate equipment.

Treatment of dry eye syndrome

Treatment of patients with dry eye syndrome is a very complex and still far from optimal problem. It includes the use of both conservative and operative methods. The most widely used are the so-called artificial tear preparations (natural tear, vidisik, korneregel, lacrivit, oftagel, solcoseryl), which include hydrophilic polymers as a base. An artificial tear dripped into the conjunctival cavity forms a fairly stable film on the surface of the eyeball, including the components of the patient's tear, if its production is still preserved. In addition, the increased viscosity of the preparations prevents the rapid outflow of fluid from the conjunctival cavity, which is also a favorable factor.

Drugs used for instillation in the treatment of DES should meet the following characteristics:

• physiological pH should be close to 7.2-7.4;
• optimal viscosity;
• colorlessness and transparency.

When choosing a drug, one should be guided by the initial indicators of the stability of the joint venture and the patient's subjective feelings during trial quadruple instillations of the compared drugs. In the future, the drug (or combination of drugs) that is optimal for each particular patient is instilled with a frequency determined by the time the discomfort resumes behind the eyelids. More detailed schemes for drug therapy treatment are presented in the table.

Currently, among the drugs approved for use in Russia, oftagel, natural tears, vidisik and korneregel are the most effective.

Since ancient times, drops of artificial tears have been used. Among the large number of eye drops of artificial tears registered in Russia, natural tears have received the most widespread and recognition. The active substance of this drug is the original composition - duasorb, a water-soluble polymer system, which, in combination with the natural tear fluid of the eye, improves the condition of the tear film. The scheme of application is selected in each case individually. A natural tear is instilled 3 to 8 times a day. The patient may prefer a combination of eye drops, such as a natural tear (2-3 times) and some kind of gel composition (2 times). A side effect of this drug is a decrease in the quality and quantity of your own tear fluid, but only with prolonged use.

Of great interest among currently used pharmacological agents are preparations containing carbomer. In the domestic market, such a drug is oftagel. This drug is an ophthalmic gel containing carbomer 974P as the main component in an amount of 2.5 mg/g. Auxiliary components: benzalkonium chloride, sorbitol, lysine monohydrate, sodium acetate, polyvinyl alcohol and water. Carbomer, which is part of the drug, is a high-molecular compound, which provides a long-term and strong connection with the cornea, as well as an increase in tear viscosity, thickening of the mucin and aqueous layers of the tear film. The contact of the carbomer with the cornea lasts up to 45 minutes. The positive properties of the drug include its ability to prolong the absorption of other eye drugs while using them. It is not recommended to wear soft contact lenses during treatment. Rigid contact lenses should be applied no earlier than 15 minutes after instillation of oftagel. It is well tolerated, with mild blurring of vision observed within 1-5 minutes after instillation.

Also, the most widely used high-viscosity artificial tear preparations include vidisik, a hydrogel that can be retained for a long time on the surface of the cornea and conjunctiva due to its high viscosity. The positive effect after instillation is provided by the property of the gel, due to the blinking of the eyelids, to move from a gel-like state to a liquid one. After a period of rest, the gel structure again acquires its original state (the so-called thixotropic property, which vidisic possesses). After instillation of the gel, discomfort in the eye almost completely disappears, with keratopathy, corneal epithelization is accelerated. Vidisic has been proven to be retained in the precorneal tear film 7 times longer than conventional tear substitutes and is non-allergenic. Appointment vidisik at night avoids the laying of ointments to protect the cornea. But with prolonged and constant use of the drug, there may be a decrease in the production of one's own tears.

One of the drugs of choice for dry keratoconjunctivitis and dystrophic changes in the cornea is Korneregel, a sterile gel with increased viscosity, which contributes to its prolonged contact with the cornea and conjunctiva. The gel is well tolerated by patients, does not cause visual impairment. In addition to the tear-substituting effect, Korneregel also has a healing property, increasing the ability of the cornea to re-epithelialize. The high viscosity of Korneregel allows you to limit yourself to one, maximum two instillations per day. Also, the positive properties of this drug should include cost-effectiveness, which is relevant for patients with a chronic form of the disease. Calculations carried out by S. Yu. Golubev and A. V. Kuroedov showed that with prolonged use of tear-substituting fluids, vidisik is more economical for the patient. Among the stimulators of the reparative processes of the cornea, the use of Solcoseryl and Actovegin required the highest costs, while Korneregel turned out to be much more economical.

One of the new and very important directions in the treatment of patients with DES involves the creation of temporary or permanent conditions to reduce the outflow of tear fluid from the conjunctival cavity. This problem is now being solved with the help of various means, including purely surgical ones. The most widely used polymeric obturation of the lacrimal ducts. This procedure is indicated for patients with a pronounced decrease in the main tear production (the result of the Schirmer test is less than 5 mm, according to Jones - 2 mm and below) or with severe changes in the cornea (its thinning or ulceration, filamentous keratitis). In the latter case, occlusion is necessary even with a slight decrease in the main secretion of the tear (the result of the Jones test is 8 mm and below).

There are several models of long-term polymeric lacrimal duct obturators, among which two are most widely used: lacrimal punctal plugs and lacrimal canaliculus obturators.

In order to evaluate the effectiveness of the planned long-term obturation of the lacrimal ducts, some experts recommend initially introducing collagen obturators into both lacrimal canaliculi, which dissolve on their own after 4-7 days. If during this period a noticeable clinical effect is noted, the same products are introduced into them, but already from non-absorbable silicone (first into the upper lacrimal canaliculus, and if the effect is insufficient, into the lower one).

Also very effective and relatively less traumatic is the operation of covering the lacrimal opening with a free conjunctival flap (Murubu, 1996-2001). The latter is borrowed from the bulbar conjunctiva or separated from the ciliary edge of the eyelid. The results obtained indicate that the effect achieved in this case is comparable to the polymeric occlusion of the lacrimal tubules.

In conclusion, it should be pointed out that, despite the apparent variety of methods for treating patients with dry eye syndrome, the problem considered has not yet been fully resolved. Further search is needed for new, more effective therapeutic agents aimed at compensating for impaired tear production and tear film stability.

Literature

E. V. Polunina
O. A. Rumyantseva, Doctor of Medical Sciences, Associate Professor
A. A. Kozhukhov, Candidate of Medical Sciences
Russian State Medical University, International Center for Ophthalmic Surgery and Laser Vision Correction, Moscow

Dry eye syndrome (or dry keratitis) is a condition in which tears cannot sufficiently moisten the eyes. This causes discomfort: a burning sensation is felt in the eyes, they may begin to itch. Sometimes the condition arises situationally. For example, when working at a computer for a long time, riding a motorcycle, from a strong cold wind.

1/10

Why do we need tears

They perform several functions at once: they lubricate the eyeball upon contact with the eyelid, act as a barrier medium for dust and allergens, and help deliver substances for tissue nutrition and healing.

2/10

Where do tears come from

They are produced by two glands: the main and additional. The main one is loaded when a person is actively crying. At rest, only the additional one works. To spread the tear fluid over the surface of the eye, we blink.

3/10

Symptoms of dry eye syndrome

• burning, itching, feeling of tension in the eyes;
• sticky mucus in or around the eye;
• photosensitivity;
• noticeable redness of the eyes;
• sensation of something foreign in the eye;
• difficulty wearing contact lenses;
• difficulty concentrating at night;
• inexplicable tearfulness (as an excessive response of the body);
• blurry vision.

4/10

When to See a Doctor

Dry eyes can be a natural condition. For example, if a strong wind blows in your face, or you were forced to spend 8-10 hours at the computer. In this case, it is enough to stop the stress on the eyes, and the symptoms should disappear.

If they remain, or exposure to the environment is repeated, consult a doctor immediately.

Eye clinics

5/10

What causes dry eye syndrome

Dry eye is a syndrome, but not a pathology. Medicine explains its occurrence by three reasons:

1. Decreased production of tears. This condition occurs due to:
   • aging;
   • certain diseases: diabetes, arthritis, systemic lupus erythematosus, scleroderma, vitamin A deficiency, Sjögren's syndrome and thyroid diseases (including Graves' disease);
   • laser vision correction procedures (in this case, the symptom is temporary);
   • damage to the lacrimal gland (possibly due to contact with radiation).
2. Accelerated evaporation of tears. Most often, these symptoms are caused by environmental factors:
   • wind, smoke, smog, dry air;
   • rare blinking; this can happen if you are too focused on reading, working at a computer or driving;
   • problems with the eyelid: ectropion - eversion outward, or entropion - inversion inside.
3. Problems with the composition of tears. If the production of one of the three components - water, fatty secretion and mucus - is impaired, then tears cease to fulfill their function. For example, the oil film is produced by glands located along the upper and lower eyelids closer to the inside of the eye. They are called meibomians. If they are inflamed, they produce little secretion, and the tear is of poor quality. This disease is called meibomian blepharitis. But only an ophthalmologist can diagnose it.

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Predisposition to dry eye syndrome

Medicine identifies several risk groups. If you fit more than one definition, then you most likely have this syndrome.

• You are over 50 years old. The production of tears after this age begins to decrease.
• You are a woman. Especially often the syndrome appears in case of hormonal changes: pregnancy, menopause or oral contraceptives.
• Your diet is low in vitamin A. It can be found in liver, carrots, and broccoli. And also in Omega-3-saturated fats: fish, nuts and vegetable oils.

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How does dry eye syndrome affect quality of life?

Wetting the eyes can be controlled with drops known as "artificial tears," but causes other than environmental factors can be symptoms of other conditions. Therefore, if the discomfort persists, it is better to consult a doctor.

Moisturizing drops may not be at hand, or you will be very concentrated on something - it is not always possible to avoid tearing your eyes. Sometimes this desire becomes irresistible. This can cause inflammation, infection, and damage to the eye.

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What will an ophthalmologist do

First, the doctor will examine you with a slit lamp. The procedure is called biomicroscopy. This will give him an idea of ​​whether there are any changes in the conjunctiva or cornea.

You should also evaluate the composition and properties of tears. The procedure is called "Schirmer's test": a small strip is placed behind the eyelid and assessed how quickly it gets wet.

To evaluate the tear film, the ophthalmologist may do a Norn test. Dye is dripped into the eye and watched as the tear film quickly breaks. This will help determine how stable the covering of the eye is.

In addition, it is necessary to evaluate the osmolarity of the tear - the number of chemical compounds per unit volume of liquid. If the osmolarity is high, then the lack of moisture causes the surface of the epithelium of the cornea and conjunctiva to dry out.

Eye medicines

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Treatment of dry eye syndrome

• The simplest treatment is symptomatic, that is, self-moistening of the eyes. The doctor may advise you to get rid of harmful environmental factors. It happens that dry eye syndrome is caused by some other drug. Each of these cases must be considered separately.
• If the cause is a chronic condition or disease, the ophthalmologist can refer the patient to the right specialist. For example, in the case of rheumatoid arthritis or diabetes.
• With a concomitant infection, antibiotics are prescribed in drops or ointments.
• Sometimes surgical treatment is used. For example, tamponade of the lacrimal ducts. Temporary or permanent tampons (occluders) are placed in the tear ducts. They prevent tear fluid from getting into them, and the eye remains moist.
• If the cause is caused by incomplete closure of the palpebral fissure, then eyelid surgery is used.

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Prevention of dry eye syndrome

In addition to the banal rules of hygiene - flush your eyes with water, wash your hands with soap and water, get enough sleep and work less at the computer - there are several tricks that can avoid or weaken the syndrome.

• Office air conditioners are very dry. If you are sitting in front of this and your eyes are dry, then most likely it is in him. The air conditioner in the car, a hair dryer or a regular table fan can also work. In other words, avoid direct airflow to your face.
• Get a humidifier.
• If your eyes are tired, close them for a couple of minutes or blink frequently.
• Position your computer monitor below eye level. If you look up, the eyes are less moistened. But not too low - this is already bad for posture.
• Quit smoking.

Dry eye syndrome is a common pathological condition in ophthalmology, characterized by insufficient hydration of the conjunctiva and cornea of ​​the eyes, followed by an increase in symptoms of xerosis. According to various sources, the syndrome occurs in 10-20% of all inhabitants of the earth, more often in women (70%) and older people (more than 60%).

In a healthy person, the outer part of the eyes is covered with a tear film 10 microns thick. It is responsible for protecting the eyes from the damaging effects of the environment and small particles of dust and other foreign bodies. In addition, the film ensures the supply of organic nutrients and oxygen to the cornea. The immune complexes dissolved in it create a natural barrier to infectious agents.

The syndrome develops when multiple ruptures of the tear film occur, as a result of which the cornea is not sufficiently lubricated with fluid and does not receive enough nutrients. In this article, we will talk in detail about dry eye syndrome, symptoms and treatment of this pathology.

Causes

Among the conditions that cause a decrease in the amount of tear fluid produced and its qualitative composition, there are such causes of dry eye syndrome as:

• Avitaminosis;
• Endocrine disorders (deficiency in estrogen production), premenopause and menopause in women (see,) endocrine ophthalmopotia;
• Connective tissue diseases, autoimmune conditions (Sjögren's disease). Uncontrolled growth of connective tissue in the body is accompanied by blockage of the excretory ducts of the lacrimal glands by fibrous foci, which leads to insufficient production of tear fluid and its inadequate distribution over the surface of the cornea;
• , severe neurological disorders, inflammatory eye diseases and others (chronic conjunctivitis, lacrimal gland dysfunction), pregnancy, kidney disease, skin and infectious diseases, severe exhaustion can cause dry eye syndrome.
• Any condition in which the eye cannot close completely is a predisposing factor for dry eye syndrome. For uniform lubrication of the eyes with tear fluid, the eyelids must close completely, lubricating the entire surface of the cornea;
• Wearing contact lenses of poor quality or the wrong size;
• Long-term use of certain drugs (antihypertensive, antiarrhythmic) leads to or reduces the production of fluid in the body, which leads to an increase in the viscosity of tears and a decrease in their total volume. Taking oral contraceptives, corticosteroids, antihistamines, uncontrolled long-term use of eye ointments and drops with anesthetics, beta-blockers, anticholinergics leads to a decrease in the production of lacrimal fluid;
• Violation of sleep and rest (long reading, work with small objects, at the computer), environmental factors (dry warm air, strong wind, polluted air).

The development of the disease is more typical for residents of climatic zones that require the use of heating systems and air conditioners. Dry air causes increased evaporation of fluid from the surface of the eyes. Prolonged concentration on a certain object (monitor screen, TV, work related to the observation of certain objects) increases the risk of developing dry eye syndrome due to insufficient blinking frequency.

According to the latest research, wearing contact lenses and dry eye syndrome form a kind of vicious circle. Due to the development of the syndrome, contact lenses begin to cause discomfort, and increased evaporation of fluid from under the lens worsens the symptoms. The innovative materials used to make the new generation of lenses can significantly reduce eye dryness when using them.

Blepharoplasty and Dry Eye Syndrome

More than 25% of patients with a history of blepharoplasty subsequently go to the doctor with complaints characteristic of dry eye syndrome. According to studies, all of them noted certain characteristic symptoms for a long time, but for some reason did not go to the doctor. Many simply did not pay attention to the manifestations of the syndrome. As it turned out, in 26% of patients who underwent blepharoplasty, at the time of contacting a doctor, along with dry eye syndrome, a more severe inflammatory disease, chemosis, was already observed.

At-risk groups

Studies conducted by American ophthalmologists in 2013 revealed a correlation between the incidence of dry eye syndrome and the level of air pollution in the area where patients live. For residents of megacities, where air pollution is much higher than in rural areas, the chances of developing the syndrome increase by 3-4 times compared to residents of rural areas. In addition, residents of high mountainous areas are also more susceptible to this disease.

Dry eye syndrome is diagnosed much more often in office workers who often work with a computer. The development of the disease was noted in more than 75% of women who constantly use a computer. Japanese researchers found that the incidence of reduced function of the lacrimal glands and signs of dry eye syndrome is 76.5% among women and 60.2% among men working in the office. The group of particular risk includes people over 30 years old, as well as employees who work at a computer for more than 8 hours a day.

Women over 50 years of age are included in the high-risk group due to the natural age-related decrease in the level of estrogen in the blood. The influence of these hormones on the development of dry eye syndrome is not fully understood.

Syndrome frequency

Dry eye syndrome is a very common disease. Unfortunately, the frequency of its occurrence continues to grow every year despite the ongoing prevention and improvement of methods of diagnosis and treatment. At the moment, the following statistics are given regarding the syndrome:

• 48% of Americans regularly report certain manifestations of the syndrome;
• In 42% of women with dry eye syndrome, there is a significant deterioration in vision (fuzziness, blurriness);
• 43% of patients with dry eye syndrome have difficulty reading;
• Among patients older than 55 years, 30% of men and 19% of women report symptoms for more than 10 years;
• 19% of respondents use over-the-counter eye drops up to 5 times a week. 63% of them say that such drugs are not effective enough.

Symptoms of dry eye syndrome

For most people, the symptoms of the disease appear in an erased form, but in some cases they can cause serious disturbances in well-being due to severe pain and the development of complications.

For patients diagnosed with dry eye syndrome, the symptoms are characterized by bilateral development and are manifested by:

These symptoms may become more pronounced under the influence of smoke or in conditions of elevated air temperature.

More severe manifestations of the disease are:

• Hypersensitivity to light (photophobia);
• Excessive and prolonged redness of the eyes;
• Unbearable pain in the eyes;
• Visual impairment.

More pronounced manifestations may indicate the development of complications, including trauma to the cornea. If such symptoms appear, you should immediately consult a doctor, otherwise the visual impairment may become irreversible.

For the classic course, the symptoms of dry eye syndrome are characterized by seven categories.

1. Itching. Patients with dry eye syndrome have increased sensitivity and irritability of the cornea. This leads to itching. Allergic reactions are also a common cause of burning and itching in the eyes. Treatment of these conditions is carried out with antihistamines, one of the side effects of which is dry eye syndrome.
2. Burning. One of the functions of the tear film is to moisten the surface of the cornea. If the integrity of the film is violated, the cornea, which contains a large number of nerve endings, dries up and begins to send impulses to the brain, which are recognized by it as a burning sensation.
3. Foreign body sensation. One of the characteristic symptoms is a feeling as if a grain of sand or other object has fallen into the eye. Such sensations occur when the eyeball is not sufficiently hydrated. When such signals appear, the brain begins to send response impulses to the eye, forcing it to produce more fluid in order to wash out the foreign object.
4. Redness. Redness is a sign of inflammation. When the eye is not sufficiently hydrated, it becomes prone to inflammatory diseases. The functions of tears include the transport of nutrients to the tissues of the eye. If transport is disturbed, the eyes react to this condition with inflammation.
5. Blurred vision that disappears when blinking. Tears provide a smooth outer optical layer for incoming light rays. As the surface of the eye dries out, its surface becomes uneven, causing blurring of the image. When blinking, the tear film is renewed, and a smooth optical layer reappears on the surface of the eye, which ensures the correct perception of light waves.
6. Lachrymation. Most patients who experience excessive tearing are perplexed when they are diagnosed with dry eye syndrome. In this case, the system responsible for the production of tear fluid is working in an enhanced mode precisely because of dry eyes. Increased lacrimation can also be a reflex in response to the foreign body sensation that was described above.
7. Increased discomfort after reading or watching TV. Blinking frequency is significantly reduced when a person focuses on a particular task. Since blinking renews the tear film on the surface of the cornea, a decrease in the frequency of blinking will lead to increased dryness of the eyes.

The danger of this disease lies in a significant deterioration of vision with the possibility of its complete loss.

Studies have shown that dry eye syndrome can not only deprive a person of vision, but also of life. French scientists have proven that dry eyes lead to a slower reaction of drivers in response to changes in the situation on the road. Drivers with dry eye syndrome do not pay attention to ½ of road signs and are much slower to respond to signs they see.

Even if the symptoms of the disease seem minor to you and can go away on their own after rest or with frequent blinking, tell your doctor about them. Lack of timely treatment can lead to irreversible consequences. The best solution in this case would be the use of eye drops from the "artificial tear" group. They do not contain harmful medicinal substances and have the most natural composition.

How to treat dry eye syndrome - eye drops, gels, ointments

For the treatment of dry eye syndrome, drugs should be prescribed by the attending physician and ensure the elimination of the cause of the disease, sufficient moisturizing of the eyes, stabilization of the composition of the tear film, combating the manifestations of the disease and preventing complications. How to cure dry eye syndrome?

The most popular drugs:

The most widely used drugs are called "artificial tears". Among eye drops and gels, preparations with low, medium and high viscosity are distinguished:

• For dry eye syndrome, treatment with drops begins with the use of drugs with low viscosity (Lakrisifi 250 rubles, natural tear (340-450 rubles), Defislez (40 rubles)). Before instillation of drops, contact lenses must be removed.
• In severe cases and a pronounced violation of tear production, medium-viscosity drugs (Lakrisin) are prescribed.
• And high viscosity (gels Vidisik 200 rubles, Oftagel 180 rubles, Lacropos 150 rubles).

At the same time, gels with high viscosity tend to pass into the liquid phase when making blinking movements. This ensures sufficient hydration of the cornea for patients with insufficient production and changes in the composition of the lacrimal fluid.

Between blinks, the gel structure of tear substitutes is restored. High viscosity preparations are used for a long time. One application is enough for 1-2 days. The drug is placed behind the eyelid, after which blurred vision may be observed for some time. In this regard, it is recommended to apply moisturizing gels and ointments before bedtime.

Anti-inflammatory drugs can be used to relieve inflammation and normalize eye hydration. For this purpose, Restasis drops with cyclosporine are used (price 3500 rubles). They relieve inflammation and ensure the normalization of the composition of the lacrimal fluid.

Hormonal drops Maxidex (180 rubles), Alrex, Oftan (90 rubles), Dexamethasone (30 rubles) also have an anti-inflammatory effect. They can be used as monotherapy or in combination with other agents. Due to the increased risk of side effects from the use of corticosteroids, the use of these drops should be under the strict supervision of the attending physician.

Antibacterial agents are used to treat inflammatory conditions, which are a common cause of dry eye syndrome. Ointments with erythromycin or tetracycline are prescribed in courses for 7-10 days and are applied at bedtime. They have a bactericidal effect on pathogenic microorganisms and provide a fight against infectious eye diseases, as well as moisturize the cornea. Thus, a combined effect on the cause and symptoms of the disease is achieved.

Another effective solution in the treatment of dry eye syndrome is a small implantable container of tear replacement fluid. The container (Lacrisert) is placed in the lower eyelid and releases liquid, providing wetting of the cornea for a long time.

Surgical treatments

How to treat dry eye syndrome surgically? Treatment of the disease can be carried out with the help of several small operations to ensure the production and maintenance of a normal amount of tear fluid.

To maintain a sufficient amount of tear fluid on the surface of the cornea, occlusion of the tear ducts, which are responsible for draining fluid from the eyes, is used. When they overlap, fluid accumulates on the outer surface of the eye and provides sufficient moisture. Blockage of the ducts is made with special plugs, which can later be removed. This is a simple procedure that can significantly improve the patient's condition.

New generation plugs are small, thin, rope-like objects that, when heated to body temperature, turn into a gel-like form and normally do not cause any sensations on the part of the patient. The advantage of such plugs is a single size for patients of all ages and sizes and the absence of irritating materials in the composition of the products.

Dry eye syndrome is a fairly common pathological condition found in ophthalmology, which is characterized by insufficient hydration of the cornea and conjunctiva, followed by exacerbation of the symptoms of xerosis. Based on data from various sources, a similar syndrome occurs in 10-20% of the world's population, while women make up 70%, and the elderly 60% of this number.

A healthy person has a specific tear film on the outer part of the eye, the thickness of which is 10 microns. This film protects the eyes from damage from dust, small particles that enter the eye, as well as from the adverse effects of the environment. In addition, thanks to this film, oxygen and nutrients enter the cornea. Dissolved immune complexes, which are contained in the film, are a natural barrier against the penetration of infections.

The syndrome can develop with the appearance of multiple breaks in the film. In this case, the cornea ceases to receive a sufficient amount of lubricating fluid and, accordingly, there is a lack of nutrients.

Causes of pathology

Among the conditions that cause a decrease in the qualitative composition and amount of tear fluid produced, experts identify the following causes of dry eye syndrome:

violation of the regime of rest and sleep (work at the computer, with small objects, long reading);

environmental factors (polluted air, strong wind, dry air);

long-term therapy with certain drugs (antiarrhythmic, antihypertensive) leads to a decrease in fluid production and dehydration, respectively, the viscosity of tears increases and their number decreases. Long-term use of antihistamines, corticosteroids, oral contraceptives, uncontrolled use of eye ointments, as well as drops with anticholinergics, beta-blockers, anesthetics leads to a decrease in the production of lacrimal fluid;

wearing contact lenses that do not fit and are of poor quality;

any state of the body that does not allow the eye to close completely is a factor provoking the development of dry eyes, since the eye is washed with tear fluid only when it is completely closed;

Parkinson's disease, infectious and skin diseases, kidney pathologies, pregnancy, lacrimal gland dysfunction, chronic conjunctivitis, inflammatory eye diseases, severe neurological diseases, as well as severe exhaustion of the body can cause dry eye syndrome;

autoimmune conditions, connective tissue diseases. Uncontrolled growth of connective tissue in the body can lead to complete blockage of the tear ducts, respectively, there is insufficient production of tear fluid, the process of its distribution over the surface of the cornea is disrupted;

endocrine disorders that occur in women during menopause and menopause, endocrine ophthalmopathy;

avitaminosis.

The development of such a pathology is more typical for the population of climatic zones that require the use of air conditioners and heating systems. Dry air leads to increased evaporation of fluid from the ocular surface. Prolonged concentration on an object (monitor, TV screen) increases the risk of dry eye syndrome due to insufficient blinking.

The latest research proves that dry eye syndrome and wearing contact lenses are a vicious circle. With the development of such a syndrome, contact lenses begin to cause discomfort, at the same time, wearing contact lenses worsens the condition of the syndrome, since evaporation from the lenses is much more intense. This problem is solved in modern innovative developments in the production of contact lenses.

Blepharoplasty and Dry Eye Syndrome

Over 25% of patients who have undergone blepharoplasty go to the doctor after a while about the onset of symptoms of dry eye syndrome. Recent studies in this area say that almost all patients noted some symptoms of dry eye syndrome after the blepharoplasty procedure, but did not go to the doctor. Most of the study participants did not pay attention to the symptoms of the syndrome. In addition, about 26% of patients at the time of blepharoplasty had not only dry eye syndrome, but also a more serious inflammatory disease - chemosis.

At-risk groups

In 2013, American ophthalmologists conducted a series of studies that established the dependence of the frequency of manifestation of the syndrome on the level of air pollution in the area where patients live. Residents of megacities, in which the situation of air pollution is much more acute than in rural areas, the likelihood of developing dry eye syndrome increases by 3-4 times. At the same time, residents of high mountainous areas are also more susceptible to this pathology.

Much more often, dry eye syndrome is diagnosed in office workers who often work with a computer. More than 75% of women who use a computer have signs of the development of this pathology. Japanese scientists in the course of the study found that the frequency of detection of signs of dry eye syndrome and reduced function of the lacrimal gland among people working in the office was 60.2% for men and 76.5% for women. Employees who work in front of a computer screen for more than 8 hours a day, as well as people over 30 years old, are a particular risk group.

Also at high risk are all women over the age of 50, since at this age the level of estrogen in the blood decreases. The effect of this hormone on the development of tear film pathology has not yet been fully studied.

The incidence of dry eye syndrome

Dry eye syndrome is a very common disease, and, unfortunately, the frequency of its occurrence increases significantly from year to year, even despite the improvement of diagnostic and therapy methods and ongoing prevention. To date, the frequency of development of pathology is displayed in the following statistics:

19% of respondents use eye drops, which are on the market, up to 5 times during the week;

while 63% of them noted the lack of effectiveness of such drugs;

a group of patients over 55 years of age notes the presence of symptoms of the disease for 10 years, while 19% of them are women, and 30% are men;

43% of patients with ocular film pathology experience severe discomfort when reading;

in 42% of female patients, in parallel with dry eye syndrome, there is a noticeable deterioration in vision;

48% of Americans report periodic or regular symptoms of the syndrome.

Symptoms of dry eye syndrome

In most people, the symptoms of the pathology have an erased appearance, however, there are cases when the disease can cause significant disturbances in well-being, against the background of the development of complications and severe pain.

Patients suffering from dry eye syndrome have symptoms characterized by bilateral development, which manifest themselves as:

sticking of the eyelids after sleep;

eye redness;

pain that increases throughout the day, dryness.

These symptoms may be more pronounced with severe exposure to acrid smoke or with a significant increase in air temperature.

More severe symptoms of pathology are:

blurred vision;

severe pain in the eyes;

prolonged and excessive redness of the eyes;

photophobia - hypersensitivity to light.

Pronounced symptoms of pathology may indicate the presence of serious complications, up to a corneal injury. If such symptoms appear, you should immediately consult a doctor, since delay in this case can result in irreversible visual impairment.

The classic course of symptoms of the disease is divided into seven categories.

Itching. Patients suffering from dry eye syndrome are characterized by increased irritability and sensitivity of the cornea, which leads to severe itching. In addition, quite often the cause of itching and irritation in the eyes can be an allergic reaction of the body. Treatment of this category of diseases occurs with the help of antihistamines, one of the side effects of which is precisely the dry eye syndrome.

Burning. One of the main functions of the tear film in the eye is to moisturize the cornea. The cornea has a large number of nerve endings, so when it dries out, impulses begin to flow to the brain, which it recognizes as a burning sensation.

Sensation of a foreign body. One of the most characteristic symptoms of tear film pathology is the sensation of a grain of sand in the eye. Similar sensations occur when the eyeball is not sufficiently moistened. In response to such sensations, the brain activates the process of tearing, in order to flush out a foreign object.

Redness. Any redness is a sign of an inflammatory process. If the eye does not get the moisture it needs, it becomes more prone to various inflammatory diseases. One of the functions of tears is to transport nutrients into the tissues of the eye, and any violation of the transport process leads to inflammation.

Blurred vision that disappears when you blink. Tears create a smooth optical outer layer on the cornea, designed for incoming light rays. If the surface of the eye dries out, the surface becomes uneven, so the picture begins to blur. During blinking, the film is renewed, the smoothness of the layer is restored along with the correct perception of light waves.

Lachrymation. Many patients experience increased tearing, which is puzzling to them, given the fact that they have been diagnosed with dry eye syndrome. However, this feature is the body's standard response to a lack of moisture in the eye. In addition, the sensation of a foreign body in the eye described above can be the cause of increased lacrimation, the appearance of tear fluid is a reflex response of the body.

Increased discomfort after watching TV or reading. When a person focuses their attention on a specific task, the frequency of blinking is significantly reduced. Since blinking provides renewal of the tear film located on the surface of the cornea, therefore, a decrease in the number of blinks leads to an increase in dry eyes.

The danger of this pathology lies in the fact that it can lead to a significant deterioration, or even complete loss of vision.

In addition, studies have confirmed the likelihood that dry eye syndrome can lead to loss not only of vision, but also of life. French researchers have shown that the reaction to a change in the traffic situation in drivers with dry eye syndrome is significantly slowed down. During the study, it was found that a driver with a similar pathology of the tear film does not notice half of the road signs, and reacts much more slowly to information on the noticed signs than healthy drivers.

Even if the symptoms of the pathology are eliminated by frequent blinking or a long rest, it is necessary to consult a doctor. Untimely treatment may not have the desired result, and a neglected syndrome will lead to irreversible consequences. The most correct solution when signs of a disease appear is the use of eye drops from the “artificial tear” category, which have a natural composition and do not contain substances that can harm the body.

Treatment of dry eye syndrome - ointments, gels, eye drops

Treatment of dry eye syndrome should be prescribed by a specialist and provide a complex effect: eliminate the cause of the development of the disease, fight the manifestations of the disease and ensure the prevention of complications, stabilize the composition of the tear film, and provide sufficient eye hydration.

The most widely used drugs that belong to the group of "artificial tears". Among gels and eye drops, products with high, medium and low viscosity are distinguished:

Therapy for dry eye syndrome begins with the use of drugs with a low viscosity coefficient (natural tears, "Lacrisifi"). Before instilling the eyes, it is necessary to remove contact lenses.

If there are pronounced disorders in the production of tears or the disease is severe, medium-viscosity preparations (Lacrisin) are used.

High viscosity gels - Lacropos, Oftagel, Vidisik.

Gels having a high viscosity are able to pass into the liquid phase in the process of making blinking movements. Thus, sufficient hydration of the cornea is achieved in patients who suffer from changes in the composition of the lacrimal fluid or its insufficient production.

Between blinks, the structure of tear substitutes is restored to a gel state. Preparations that have a high viscosity have a lasting effect, and one application of the drug lasts up to 48 hours. Such drugs are laid directly behind the eyelid, so for some time there may be problems with the clarity of vision. Given this feature, the drug is recommended to be used in combination with moisturizing ointments and gels, which should be used before bedtime.

Anti-inflammatory drugs can be used to normalize hydration and relieve inflammation from the eyes. Most often, Restasis drops are used with the active substance - cyclosporine. This remedy is able to relieve inflammation and normalize the composition of the lacrimal fluid.

Anti-inflammatory action is also provided by anti-inflammatory drops "Dexamethasone", "Oftan" and others. These drugs can be used as monotherapy and in combination with other drugs. Since the use of such corticosteroids carries an increased risk of side effects, their use must be carried out under the strict supervision of the attending physician.

Antibacterial agents are used to treat inflammatory diseases, which are a fairly common cause of dry eye syndrome. Ointments with tetracycline or erythromycin are prescribed in courses for a period of a week to 10 days, the application is carried out at bedtime. These funds have a bactericidal effect on existing pathogenic microorganisms and fight against infectious pathologies of the eyes. In addition, they moisturize the cornea. Thanks to this composition, the agents provide a complex effect on the cause and symptoms of the pathology.

A rather effective solution in the treatment of dry eye syndrome is the implantation of a container with a tear replacement fluid. Such a container is installed in the lower eyelid, the released liquid guarantees wetting of the cornea for a significant period of time.

Surgical treatment of dry eye syndrome

Surgical treatment of dry eye syndrome allows, in the course of several micro-operations, to restore sufficient production of lacrimal fluid and maintain its volume in sufficient quantities.

To do this, occlusion of the lacrimal ducts is performed on the surface of the cornea, which perform the function of diverting tear fluid from the eyes. When these ducts are blocked, tear fluid accumulates on the surface of the cornea, respectively, moisturizing the eye is at a sufficient level. Blockage of the ducts is performed using special plugs, which, if necessary, can be safely removed in the future. This procedure is easy to perform and can quickly improve the patient's condition.

New generation plugs are small, thread-like objects that, when heated to body temperature, become gel-like and do not cause discomfort. The main advantage of such plugs is the universal size, which is suitable for patients of any configuration and age, and the plugs are also hypoallergenic (they do not contain materials that can cause irritation).

Do you have tired, faded, dry eyes? The eyes use more than 80% of all energy produced. If your eyes are bothering you, they use even more energy to function. Dry eyes are a problem that can deplete your body's energy reserves. It can also be a symptom of a number of other problems. Determine what causes dry eyes and provide the eyes with nutrients. Very soon you will notice that the dryness of the eyes goes away and the energy returns.

Steps

Part 1

Understand why tears are important. Tears not only moisturize the eyes, but also perform several other important functions. Tears provide essential electrolytes, bacteria-fighting proteins, and enzymes to help keep your eyes healthy. Tears quickly cover the entire eye to provide moisture and nutrients.

• If there is any problem with tears, it becomes a problem with the whole eye. Almost anything can be the cause, but you can try a variety of treatments.

1. Use artificial tear drops. Artificial tears in drops serve as a lubricant for dry eyes and moisturizing their outer surface. Artificial tear drops will not necessarily cure the root cause of your dry eyes. However, they can help relieve symptoms. Some contain preservatives that can irritate your eyes if you use them more than four times a day. If you need to use artificial tears more than four times a day, look for ones that are free of preservatives.

   • Trial and error is usually the only way to find the best artificial tear brand for your particular dry eye condition. Sometimes a combination of several brands may be required. A wide range of brands is available at any pharmacy.

2. Try medicated eye drops. The most commonly used drug for dry, irritated eyes is hydroxypropylmethylcellulose, followed by carboxymethylcellulose. They are also used in drops as a lubricant and can be found in many over-the-counter drops. You can also look for an antibiotic eye ointment, such as tetracycline, ciprofloxacin, or chloramphenicol. This will be helpful if you have eyelid puffiness.

   Check your eyesight. If you have already tried eye drops and prescription drops, but you are still very concerned about dry eyes, see your optometrist. Your doctor will determine the cause of your dry eye and suggest other treatment options.

   Use eye ointment. Your doctor may prescribe an eye ointment for you. Unlike artificial tears, which relieve the symptoms of dry eyes, ointments contain a medicinal substance that will treat the cause of your dry eyes.

   • Eye ointments can provide relief due to their lubricating effect. They help during long periods when artificial tears cannot be used (for example, while sleeping).

3. Have tear duct surgery to block them. You may need longer and more effective treatment. Your doctor may suggest inserting plugs into your tear ducts. They will stop the flow of tears, providing lubrication to the eyes.

   Cauterize the tear ducts. If you have had plugs inserted and your severe dry eyes persist, your doctor may suggest cauterization of your tear ducts. Once your doctor approves this surgery, the ophthalmologist will perform tests and surgery.

   Part 2

   How to prevent dry eyes

   1. Moisturize your eyes to prevent dehydration. There is no cure for dry eye, but there are certain preventive measures that can help when combined with treatment. Like any liquid, tears also evaporate when exposed to air. To keep your eyes moisturized:

      • do not expose your eyes to direct air flow (for example, car heater, hair dryer and air conditioner)
      • keep the humidity level in your home between 30-50%
      • use a humidifier in winter to humidify dry indoor air

   2. Wear glasses. Wear sunglasses when going outside on a sunny day. Wear safety goggles if you plan to go to the pool. In addition, you can order special glasses from an optometrist. These goggles create extra moisture by forming cavities around the eyes.

      Don't irritate your eyes. Avoid smoking as it can lead to a rapid decrease in tears and many other health problems. Also, don't rub your eyes. This will prevent bacteria from spreading from your fingers and nails to your eyes.

      Moisturize your eyes. Put artificial tears in your eyes to lubricate and moisturize them. You can apply an ointment that lasts longer than eye drops. However, due to its viscosity, it can be unpleasant and cause blurred vision. You may decide to use the ointment only during sleep.

      • Use eye drops before rather than after eye strain to prevent dry eyes. Try to blink more often. This contributes to the even distribution of tears or drops.

   3. Reduce your intake of salt in your diet. Dry eyes can result from consuming too much salt. You can see this for yourself, especially when you get up at night to use the toilet. If you have dry eyes, drink about 350 ml of water. See if you feel immediate relief in the eye area. If this happens, reduce your salt intake in your diet and stay hydrated.

   Warnings

   • If you have chronic dry eyes, talk to your doctor. If you suffer from diabetes and hypertension, you should be seen regularly by an optometrist due to complications from these chronic conditions. If you have chronic diseases, then you need to bring this to the attention of all doctors so that no aspect of your condition is left without attention.