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DRY EYE SYNDROME - Coggle Diagram
DRY EYE SYNDROME
Diagnosis
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Eye irritation/itching /discomfort may be burning,stinging, gritty foreign body sensation
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Assessment
Onset, severity, duration, fluctuation over time, impact on quality of life
Red flags - sudden onset pain /visual loss, persistent or severe visual loss, diplopia, unilateral symptoms or systemic symptoms e.g. weight loss/fever
Exacerbating factors e.g. environmental, allergy or low blink rate
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Exam - Eye, Cranial nerve and General examination. Assess visual acuity. Examine red flags. Examine cornea /conjunctiva for redness. Examine eyelids for signs of proptosis, lid retraction, ectropion or entropion. Assess for signs of associated condition e.g. trigeminal and facial cranial nerve function
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Management
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Urgent referral to ophthalmology if serious underlying cause suspected e.g. Stevens-Johnson syndrome
Arrange referral to ophthalmology /specialist if uncertain diagnosis, suspected Sjogren's syndrome, abnormal lid anatomy or function, persistent or severe symptoms not responding to management after 4-12 weeks
If not required urgent specialist referral -signpost to The NHS information Dry eyes.
Advised warm compress, lid hygiene/lid massage.
Modification of contact lens wear.
Moisture chamber eyewear.
Modification of environmental factors
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Drug treatment may cause or contribute to symptoms. Ensure optimal management of associated ocular or systemic conditions that may cause or worsen symptoms
Advise on use of artificial tears. Advise on chronic nature of dry eye disease and long term treatment usually needed.
Arrange F/U within 4-6 weeks of starting treatment with tear substitutes. Seek specialist advice if uncertainty. If not treatment not responding after 4-12 weeks refer specialist referral.
Causes
Ocular - meibomian gland dysfunction, blepharitis/ age related lacrimal gland deficiency/menopause/lid aperture disorders/ lagophthalmos/lid retraction/Ocular Steven-Johnson syndrome/Herpes Simplex keratitis
Systemic /Inflammatory - Primary Sjogren's syndrome/Secondary Sjogren's syndrome/Sarcoidosis, amyloidosis or lymphoma, HIV
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Environmental/ Other - air conditioning/central heating/ noxious agents e.g. cigarette smoke/ reduced blink interval due to digital device use or reading/Vitamin A deficiency
Latrogenic - contact lens use/ conjunctivitis medicamentosa/systemic drugs e.g. antihistamines, beta blockers. Post ocular surgery/post facial or intracranial surgery/post radiation fibrosis of lacrimal gland