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DRY EYE SYNDROME OIPJ4H9SD0X (PATHOPHYSIOLOGY (This in turn stimulates:…
DRY EYE SYNDROME
DEFINITION
Insufficient production of aqueous components.
PATHOPHYSIOLOGY
Patient is exposed to intrinsic and extrinsic factors.
Changes in tear composition occur.
Inflammatory process is initiated.
This causes ocular surface epithelial disease.
Acute desiccation activates stress signalling pathways.
This also occurs in resident immune cells.
Production of innate inflammatory mediators gets stimulated.
This in turn stimulates:
Production of matrix metalloprotease
Inflammatory cell recruitment
Dendritic cell maturation
These mediators lead to T cell-mediated response.
Cornea barrier disruption develops by protease-mediated lysis.
Accelerated death of epithelial junctions occurs.
Poorly lubricated cornea results.
CAUSES
Decreased tear production due to:
Certain medical conditions eg diabetes mellitus.
Laser eye surgery.
Aging
Tear gland damage from radiation.
Inflammation of tear gland.
Increased tear evaporation due to:
Less blinking.
Ectropion, the out-turning of eyelids.
Prolonged exposure to dry air, smoke
Entropion, the in-turning of eyelids.
Imbalance in the composition of tears
CLINICAL MANIFESTATIONS
Itching of he eye.
Excessive mucous secretion.
Foreign body sensation.
Inability to produce tears.
Scratchy, stinging sensation.
Burning eye sensation
Difficulty in moving the eyelids.
Sensitivity to light.
NURSING INTERVENTIONS
Implement wraparound protective eyewear.
Encourage patient to take breaks during tasks.
Humidify environment of the patient.
Encourage patient to position computer below eye-level.
Discourage blowing air into the eye.
Place warm cloth over the patient's eyes.
DIAGNOSTIC TESTS
Slit-lamp examination showing:
Thickened conjunctiva.
Oedematous conjunctiva.
Absent and interrupted tear meniscus.
Hyperaemic conjunctiva that has lost its luster.
Comprehensive eye examination.
Measurement of volume of tears
Special dyes in eyedrops determining quality of tears.
PHARMACOLOGICAL THERAPY
Antibiotics relieving inflammation.
Eyedrops controlling cornea inflammation.
Cyclosporine
Eye inserts working like artificial tears.
Hydroxypropyl cellulose
Tear stimulating drugs.
Cevimeline
Pilocarpine
Autologous blood serum drops
COLLABORATIVE MANAGEMENT
Prescription for aqueous ointment used at night.
Hydration of the eye for stimulation of tears.
Installation of artificial tears during the day.
Encourage moisture chamber spectacles.
Prescribing anti-inflammatory drugs.
Encouraging swimming goggles.
Punctual occlusion.
Uniting the edges of eyelids-lateral tarsorrhaphy.
