Comprehensive Guide To Keratoconjunctivitis Sicca

Dry Eye Syndrome ( Keratoconjunctivitis Sicca)

Dry eye syndrome is a condition that arises when the eyes fail to generate enough tears, or when tears evaporate rapidly, resulting in inadequate lubrication of the eyes. It is reported that approximately 5% to 30% of the adult population worldwide is affected by dry eye syndrome, but its prevalence is higher in regions with dry climates or high levels of air pollution.

Causative  And Risk Factors

  • Aging
  • Climate variables, such as dryness due to air conditioners, smoke or wind.
  • Autoimmune diseases, for instance, Sjogren syndrome, rheumatoid arthritis and SLE, Graves’ disease
  • Diabetes Mellitus
  • Eyelid conditions, for example, entropion,  ectropion, or blepharitis
  • Medications like antihistamines, decongestants, birth pills, diuretics, and antidepressants
  • Active or passive exposure to smoking
  • Wearing contact lenses for long duration
  • History of refractive surgeries
  • Vitamin A deficiency

Clinical Features

  • Redness or itchiness
  • Foreign body and burning sensation
  • Photophobia ( sensitivity to light)
  • Blurred vision

Diagnosis

Diagnosis is based on the combination of history, thorough clinical examination, and clinical tests.

The tests may include:

  •  Schirmer’s test
  • Tear break-up time test
  • Corneal and conjunctival staining to test for ocular surface condition
  • Tests to check tears’ osmolality
  • Inflammatory markers testing – increased levels of matrix metalloproteinase-9 or diminished lactoferrin in the tear sample

Treatment

Non-pharmacological Management

  • Stop smoking
  • Drink at least eight to ten glasses of water each day
  • Wear protective sunglasses when going out in dry, windy, or dusty weather
  • While reading, watching or using a mobile phone, keep blinking your eyes.
  • Avoid excessive screen time and give your eyes rest. Follow 20 20 20 rule, i-e, after every 20 minutes of using a digital screen, take 20- second break and look at something 20 feet away.
  • Place your computer or laptop screen below your eye level and at your arm’s length
  • Avoid sitting in air-conditioned rooms for a long duration.
  • During winters avoid sitting close to heaters. Add humidifiers to your room.

Pharmacological Management

  • Vitamin A and omega 3 fatty acid supplements after consultation with a doctor
  • Artificial tears and lubricants
  • Prescription ointments and eye drops

Other Treatment Options

  • Punctal plugs
  • Scleral lens and moisture chamber glasses
  • Unclogging and expressing meibomian glands