FPN – Dry Eye

Sep 15, 2019 admin NHÃN KHOA 0

Dry Eye

Aka: Dry Eye, Xerophthalmia

II. Epidemiology

  1. As many as 30% of over age 50 years old complain of dry, irritated eyes

III. Causes

  1. Sjogren’s Syndrome
  2. Allergic Conjunctivitis
  3. Blepharitis
  4. Decreased blinking with prolonged reading or driving
  5. Chronic exposure to dry, dusty conditions
  6. Rosacea
  7. See Medication Causes of Dry Eyes (e.g. Anticholinergic Medications, Diuretics, Estrogen Replacement)

IV. Management

  1. General measures
    1. Sunglasses
    2. Room humidifiers
    3. Tobacco Cessation
    4. Take computer breaks
    5. Protect eyes from fan
    6. Avoid drying, Anticholinergic Agents (Antihistamines, Tricyclic Antidepressants, Diuretics)
  2. Artificial tears or ointments
    1. Preservative-free solutions are preferred (e.g. Refresh Plus), esp. if used more than 4x/day
    2. Contact Lens users may try rewetting drops (e.g. Renu rewetting, Blink Contacts)
    3. Consider eye lubricants (e.g. lacrilube) for moderate symptoms (esp. at night), but may blur vision
    4. Avoid agents with Decongestant (e.g. Visine original)
  3. Consider Muscarinic Agonists and other agents in Sjogren’s Syndrome refractory to other measures
    1. Cyclosporine (Restasis)
    2. Pilocarpine (Salagen)
    3. Cevimeline (Evoxac)
  4. Other options in refractory cases
    1. Lifitegrast (Xiidra)
      1. Lymphocyte function-associated antigen-1 (LFA-1) antagonist ophthalmic solution
      2. One drop instilled every 12 hours
      3. Expensive (>$400/month), with risk of eye irritation, altered Taste Sensation
      4. Contact Lenses must be out of eye for installation for at least 15 minutes after administration

V. 9

VI. Diagnosis

  1. See Schirmer’s Test

VII. References

  1. (2016) Presc Lett 23(9)
  2. (2015) Presc Lett 22(1): 5
  3. Ono (2004) Am J Ophthalmol 138(1): 6-17 [PubMed]
  4. Whitcher (2004) Br J Ophthalmol 88(5): 603-4 [PubMed]

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