KERATOCONJUNCTIVITIS SICCA


I. Clinical characteristics and pathophysiology
  1. aka "dry eyes"
  2. Symptoms include:
    1. Itching, burning, irritation, and redness of eyes, often worse wiwth activities like reading, watching TV, or working on a computer
    1. Blurred vision that improves with blinking
    2. Sometimes, excessive tearing caused by stimulation of lacrimal glands by the irritation
    3. Symptoms often worse in air-conditioned or dry environments
  3. Associated with some inflammatory diseases, including Sjogren's Syndrome (of which it is the hallmark), Rheumatoid arthritis, and Systemic Lupus Erythematosus
  4. More common in the elderly
  5. Poor lid hygeine and blepharitis can contribute
  6. Many medications can contribute, e.g. tricyclic antidepressants and antihistamines
II. Management
  1. Home humidification
  2. Avoidance of cigarette smoke
  3. Wraparound sunglasses (to prevent exposure of eyes to wind)
  4. Lid hygeine; treat blepharitis if present
  5. Consider potential contribution of meds and make changes in regimen as appropriate
  6. Omega-3-fatty acid supplements may be helpful
  7. Use of tear lubricants
    1. Artificial tears (require instillation up to Q2h)
    2. Polyvinyl alcohol-containing drops (may cause blurring of vision)
  8. Topical steroids for short-term use
  9. Cyclosporin A (Restasis)-An anti-inflammatory that suppresses CD3-positive T cells in the conjunctiva, and also increases mucin production
  10. Secretagogues e.g. pilocarpine (tend to cause systemic symptoms)
  11. Punctal plugging (to try to preserve the tear film)-Can be temporary or permanent
(Sources include Core Content Review of Family Medicine, 2012)