Ophthalmology Book


Dry Eye

Aka: Dry Eye, Xerophthalmia
  1. See Also
    1. Lacrimation
    2. Sjogren's Syndrome
  2. Epidemiology
    1. As many as 30% of over age 50 years old complain of dry, irritated eyes
  3. 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)
  4. 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)
      7. Use 20-20-20 rule
        1. Shift eye focus every 20 min to something 20 feet away for 20 seconds
    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 twice daily (expensive, at $500/month)
        1. Remove contacts before instilling drops (and wait 15 min before reinserting)
        2. Restasis 0.05% emulsion (preferred over Ceqo)
        3. Cequa 0.09% solution
      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
      2. Ophthalmic Corticosteroid
        1. Short-term use only (<2 weeks) for severe Dry Eye flare
        2. Consider consult with ophthalmology
        3. Risk of Glaucoma, Cataracts and infection
        4. Eysuvis (loteprednol) 0.25% suspension is FDA approved for Dry Eyes (but costs nearly $500 per course)
        5. Dexamethasone 0.1% ophthalmic solution is <10% of Eysuvis cost and is used off-label for Dry Eyes
      3. Intranasal Varenicline (Tyrvaya)
        1. Varenicline 0.03 mg used intranasally ($600/month in 2021)
        2. Results in Cholinergic effects to increase tear production (may have a modest effect)
        3. Minimal systemic absorption (8%)
          1. Varenicline used systemically is Chantix
        4. References
          1. (2021) Presc Lett 28(12): 70
    5. Avoid measures that are unlikely to be helpful
      1. HydroEye (Omega-3 Fatty Acid) has no quality studies demonstrating efficacy
  5. Diagnosis
    1. See Schirmer's Test
  6. References
    1. (2021) Presc Lett 28(1): 6
    2. (2019) Presc Lett 26(5)
    3. (2016) Presc Lett 23(9)
    4. (2015) Presc Lett 22(1): 5
    5. Ono (2004) Am J Ophthalmol 138(1): 6-17 [PubMed]
    6. Whitcher (2004) Br J Ophthalmol 88(5): 603-4 [PubMed]

Dry Eye Syndromes (C0013238)

Definition (MSHCZE) Vysychání spojivky a rohovky oka, které může vést k jejich těžkému poškození. Srov. xerostomie, Sjögrenův syndrom, sicca syndrom, vitamin A. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) A syndrome characterized by dryness of the cornea and conjunctiva. It is usually caused by a deficiency in tear production. Symptoms include a feeling of burning eyes and a possible foreign body presence in the eye.
Definition (NCI_CTCAE) A disorder characterized by dryness of the cornea and conjunctiva.
Definition (MSH) Corneal and conjunctival dryness due to deficient tear production, predominantly in menopausal and post-menopausal women. Filamentary keratitis or erosion of the conjunctival and corneal epithelium may be caused by these disorders. Sensation of the presence of a foreign body in the eye and burning of the eyes may occur.
Concepts Disease or Syndrome (T047)
MSH D015352, D014985
ICD10 H04.12
SnomedCT 193980001, 155182003, 1249004, 46152009
English Syndrome, Dry Eye, Syndromes, Dry Eye, dry eye, Dry Eye Syndromes, dry eye syndrome (diagnosis), dry eye syndrome, Keratoconjunctivitis Sicca, Dry Eye Syndromes [Disease/Finding], syndrome dry eye, dry eyes syndrome, dry eye syndromes, Dry eye syndrome (disorder), Dry eye (finding), Dry eye, Dry eye syndromes, EYE(S), DRY, DRY EYE(S), Dry eye syndrome, dry eye; syndrome, syndrome; dry eye, Dry Eye Syndrome
Swedish Torrögdhetssyndrom
Czech xeroftalmie, syndromy suchého oka, Syndrom suchého oka, keratitis sicca, KCS, keratoconjunctivitis sicca
Finnish Kseroftalmia, Kuivasilmäisyysoireyhtymät
Croatian KSEROFTALMIJA, Ceratoconjunctivitis sicca, SUHI KERATOKONJUNKTIVITIS, Sindrom suhog oka
Polish Zespoły suchego oka, Zeschnięcie spojówki i rogówki, Zeschnięcie gałki ocznej
Spanish Síndrome de ojo seco, Síndromes de Ojo Seco
Portuguese Síndrome de olho seco, Síndromes do Olho Seco, Xeroftalmia
Dutch droog oogsyndroom, droge ogen; syndroom, syndroom; droge ogen, Droogoogsyndromen, Droogoogsyndroom, Syndromen, droogoog-, Syndroom, droogoog-
French Syndrome des yeux secs, Xérophtalmie, Syndromes de l'oeil sec
German Trockene Augen-Syndrom, Syndrome des trockenen Auges, Xerophthalmie
Hungarian Száraz szem syndroma
Italian Sindrome dell'occhio secco, Sindromi dell'occhio secco, Xeroftalmia
Japanese ガンカンソウショウコウグン, 眼乾燥症候群
Norwegian Tørre øyne, Xeroftalmi, Tørt øye-syndrom, A-vitaminmangel med konjunktival tørrhet
Derived from the NIH UMLS (Unified Medical Language System)

Xerophthalmia (C0043349)

Definition (NCI) Dryness of the eye due to inadequate production of tears. Causes include vitamin A deficiency, Sjogren syndrome, rheumatoid arthritis, systemic lupus erythematosus, and scleroderma.
Definition (MSH) Dryness of the eye surfaces caused by deficiency of tears or conjunctival secretions. It may be associated with vitamin A deficiency, trauma, or any condition in which the eyelids do not close completely.
Definition (CSP) dryness of the eye surfaces caused by deficiency of tears or conjunctival secretions; may be associated with vitamin A deficiency, trauma, or any condition in which the eyelids do not close completely.
Concepts Disease or Syndrome (T047)
MSH D014985
ICD9 375.15
ICD10 H04.12, E50.7
SnomedCT 193887002, 155167008, 193980001, 46152009, 363677007, 69316005
English Xerophthalmias, DRY EYES, XEROPHTHALMIA, ophthalmoxerosis, xeroma, xerophthalmus, Tear film insuffic NOS, Tear film insufficiency, NOS, Xerophthalmia NOS, Xerophthalmia [Disease/Finding], xerophthalmia, Conjunctival xerosis (& [xerophthalmia]), Conjunctival xerosis (& [xerophthalmia]) (disorder), Tear film insufficiency, Tear film insufficiency (disorder), Xerophthalmia (disorder), xerophthalmia (etiology), xerophthalmia (manifestation), Conjunctival Xerosis, Xerophthalmia, Tear film insufficiency, unspecified
French XEROPHTALMIE, YEUX SECS, Xérophtalmie
Spanish XEROFTALMIA, OJOS SECOS, xeroftalmia (trastorno), xeroftalmia, xeroftalmía, xeroftalmía (trastorno), insuficiencia de la película lagrimal (trastorno), Xeroftalmia
Italian Xeroftalmia
Swedish Ögontorrhet
Czech Xeroftalmie
Polish Kseroftalmia
Hungarian Xerophthalmia
Japanese ガンキュウカンソウショウ, 眼球乾燥症
Dutch xeroftalmie, Xeroftalmie
Derived from the NIH UMLS (Unified Medical Language System)

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