Keratoconjunctivitis Sicca

Symptoms

• Irritation, foreign body sensation, burning, a stringy mucus discharge and transient blurring of vision.
• Less frequently - itching, photophobia and a tired or heavy feeling
• Px w/filamentary keratitis may complain of severe pain brought on by blinking
• Symptoms frequently exacerbated on exposure to conditions assoc w/increased tear evaporation - aircon, wind or prolonged reading.
• Symptoms may be improved by lid closure

Tear Film Abnormalities

• Mucus strands and debris are an early sign. In the normal eye as the tear film breaks down the mucin layer becomes contaminated w/lipid but washes away. In dry eye the lipid contaminated mucin accumulates in the tear film and tends to move w/each blink
• Tear meniscus becomes concave, irregular and thin
• Froth in the tear film or along the eyelid margin occurs if MGD also present.
• Examine the tbut w/slit lamp or schirmer
  

Keratopathy

• Punctate epithelial erosions in the inferior cornea
• Filaments are small comma shaped mucus strands lined w/epithelium attached at one end to the corneal surface. The unattached end moves w/each blink
• Mucus plaques. Stain w/rose bengal and are seen in conj. w/mucus plaques.

Treatment

• Preservation of existing tears by reducing room temp, room humidifiers
• Art. tears w/hypromellose (tears naturale)
• Art tears w/PVA (liquifilm tears)
• Art tears w/sodium hyaluronate
• Art tears w/NaCl
• Art tears w/povidone
• Gels - viscotears, gel tears. Carbomer gels
• Ointments
• Reduction of tear drainage w/punctal plug