Please enable JavaScript.
Coggle requires JavaScript to display documents.
Dry eye syndrome is a chronic condition characterised by inflammation of…
Dry eye syndrome is a chronic condition characterised by inflammation of the ocular surface and reduction in quality and/or quantity of tears.
Causes
Dysfunction of the Meibomian gland.
Blepharitis
Age related gland deficiency.
Low blink rate.
Vitamin A deficiency
Malabsorption of the eyelids.
Environmental causes such as low humidity, high wind velocity and allergens.
Latrogenic factors.
Some underlying conditions may contribute to dry eyes – see NICE CKS for specific guidance.
Complications
Severe complications of dry eye disease (such as keratinization of the ocular surface; corneal scarring, thinning, ulceration or neovascularisation; and visual loss) are rare and usually associated with an underlying condition such as Sjögren's syndrome, ichthyosis, or Stevens–Johnson syndrome.
Anxiety and depression due to impact on quality of life on visual disability or discomfort
Assessment
red flag symptoms included in summary of Red Eye. Also consider visual changes, diplopia, weight loss or fever.
Ocular hx- vision, glasses, eye drops, surgery, eye conditions
exacerbating or alleviating factors such as topical treatments, eye drops etc
Ask about any trauma or injury to eyes
Hx signs and symptoms, onset duration and fluctuation over time.
social history including smoking and alcohol status and occupation
Differentials
Allergic, infective or giant papillary conjunctivitis.
Blepharitis.
Keratoconjunctivitis.
Exposure keratopathy.
Nocturnal lagophthalmos (failure to close eyes at night).
Ocular pemphigoid.
Sjogren’s syndrome.
Signs and Symptoms (usually bilateral)
Irritation or discomfort — this may be described as burning, stinging or a ‘gritty’ sensation.
Dryness.
Intermittent blurring of vision.
Redness of the eyelids or conjunctiva.
Itching.
Photosensitivity.
Mucous discharge.
Ocular fatigue.
Examination
The cornea and conjunctiva — abnormalities may indicate an alternative serious cause such as corneal ulcer or keratoconjunctivitis.
signs of associated conditions such as rosacea, acne, seborrhoeic dermatitis, rheumatoid arthritis, Sjogren’s syndrome, systemic lupus erythematosus, Raynaud’s phenomenon, thyroid eye disease, Bell’s palsy or Parkinson’s disease.
eyelids and eyelashes- Look for incomplete closure or malposition of eyelids which can occur with proptosis, ectropion, or entropion. Evert and inspect the eyelids – look for inflammation, abnormal deposits or secretions and signs of other causes of symptoms such as conjunctivitis and blepharitis.
pupils- any abnormality
clinical signs of dry eye syndrome such as mild conjunctival redness – in many cases the eye examination is normal
Visual acuity
Management
Arrange same day assessment by ophthalmology if the person is suspected of having a serious eye condition such as acute glaucoma, keratitis, iritis or cornel ulcer
Urgent referral to ophthalmology is required for children with any corneal change.
Discuss with, or refer to, ophthalmology (with urgency depending on clinical judgement) if uncertain of diagnosis.
Have a low threshold for referral of younger people with dry eye symptom
Arrange referral to ophthalmology or the appropriate medical speciality (with urgency depending on clinical judgement) if the person:Is suspected of having an underlying systemic condition such as Sjogren’s syndrome or Has persistent symptoms that do not respond to underlying systemic condition after 12 weeks or Has abnormal lid anatomy or function.
Investigations
referral to optometry for slit lamp examination of the cornea