- Description of the disease
- How is dry eye syndrome treated?
- Tear substitutes
- Drugs that stimulate the secretion of tears
- Anti-inflammatory syndrome therapy
- Hardware treatment
- Surgical intervention
- Dry eye video
If the eyes are healthy, a person does not experience any unpleasant symptoms and discomfort, enjoying the beauty of the world around him. With the development of a pathological condition, when the surface of the conjunctiva and cornea does not receive sufficient moisture, a condition called dry eye develops.
Since the disease is complex, it should be treated with a comprehensive method. Therefore, to improve visual function, as well as to get rid of discomfort, treatment will be required not only with eye drops, but also with drugs to restore the tear film.
Description of the disease
Dry eye syndrome (DES) Today, more and more people are suffering, the urgency of the most frequent problem in ophthalmology is associated with the achievements of technical progress and the deterioration of the environment. In medicine, dryness of the mucous membrane of the eyes is called xerophthalmia, and complete drying of the tear film is called xerosis.
DES is a chronic disease of the ocular surface that develops due to a violation of the production of tear fluid (tears). The condition is manifested by a deterioration in the stability of the tear film due to the appearance of certain reasons, and manifests itself in irritating and painful symptoms.
An overview of the underlying causes of the disease and a description of the general symptoms:
|Insufficient production of lacrimal secretions in old age, during menopause in women. Patients with arthritis, patients after undergoing laser vision correction suffer from dry eye membrane syndrome.||First stage. The formation of implicit signs of an incipient disease - fatigue and heaviness in the eyes, their rapid fatigue, the appearance of periodic blurring of the gaze.|
|In young people, xerophthalmia may be associated with a deficiency of vitamin A, a violation of the stability of the tear film. The condition is provoked by working heaters, air conditioners, the environment.||At the next stage, persistent symptoms of tension in the organs of vision, a feeling of heaviness in the eyes and a burning sensation appear. Signs of DES are accompanied by reddening of the cornea, itching.|
|The risk of dry eyes is increased by prolonged use of the computer. With the systemic intake of antidepressants and hormonal drugs, the level of the fat index of the tear drops sharply, and it becomes more fluid.||As the eye disease progresses, patients complain of a sensation of a foreign object in the eye, signs of double vision of contemplated objects. Temporarily or permanently reduced visual acuity.|
|Blockage of the meibomian glands, which produce the lubricant that moisturizes the cornea, results in nutritional deficiencies. As a result, the rapid evaporation of the tear film turns into the development of xerophthalmia.||At a later stage, xerosis of the eye leads to the development of photophobia. In severe cases, pain and a feeling of severe eye fatigue are added to the general symptoms.|
Dry eye syndrome, the treatment of which is aimed at restoring normal tear fluid production, leads to the development of psycho-emotional discomfort due to blurred vision, which creates problems at work and in everyday life. After all, the task of a tear is to wet and wash the outer surface of the organs of vision thanks to the blinking function. As a result, the surface of the cornea is covered with a protective (tear) film that protects the conjunctiva from drying out and damage.
The tear produced by the lacrimal glands is complex and consists of 3 layers:
- lipid (external) keeps tears, blocks its rapid evaporation;
- water (medium) moisturizes and nourishes the eye tissues, protecting against infection;
- mucin (internal) evenly distributes the tear along the cornea, saturating it with oxygen.
With a full coverage of the eyeball, the tear film reliably protects the open eye, in case of drooping of the eyelids, it turns into a natural lubricant so that the eyelid and the eye surface do not stick together. The production of components important for vision is provided by the meibomian (sebaceous) glands located around each organ of vision.
How is dry eye syndrome treated?
It is important to know that the pathological condition cannot be completely cured, therefore, it is necessary to start the struggle for the return of clarity and clarity of vision when the initial symptoms appear. The main task is to establish the cause of the accelerating drying of the tear film.
Then you need to get rid of the influence of factors that provoke the progression of DES:
- spend less time behind a computer screen and phone, watch TV less often;
- equip a room for a long time with a humidifier, which significantly improves the condition of the mucous membranes;
- enrich the diet with foods high in vitamin A (up to 60-100 mg per day;
- contact lens wearers should avoid long-term wear.
When the meibomian glands function is impaired, the composition deteriorates and the amount of tear fluid decreases, which leads to accelerated evaporation of the tear film, and the cornea becomes dry. Maintaining adequate hydration levels and regularly recharging your eyes will no longer be as effective. Therefore, with the appearance of persistent symptoms of dryness of the eye membrane, it is no longer possible to do without the qualified help of an ophthalmologist.
Dry eye syndrome (treatment is prescribed by a doctor after examination, examination and setting an accurate diagnosis) begin to be treated with drops, focusing on individual symptoms and established cause of DES. The action of drops that imitate natural tears is aimed at moisturizing the eyeball with a lack of its own lacrimal fluid. However, artificial tear solutions differ in their characteristics.
|Drug consistency||It is better to use liquid solutions during the day. The dosage form does not cause much discomfort when instilled, but also does not give a long-term effect.|
|Viscous solutions are not always convenient to use, but they last longer. Therefore, thick solutions are best used at night.|
|Features of the release form||Most eye drops come in small dosage vials (5-10 ml) that need to be stored in a cool place. The containers are sterile and supplied with a pipette.|
|Type of active substance||The basis for the manufacture of drugs is different, depending on the direction of the problem being solved. The drip composition may contain hyaluronic acid, povidone, dexpanthenol.|
Drug treatment of dry eye syndrome according to the tear replacement therapy scheme is the initial stage. Until the disease becomes chronic, it is possible to compensate for the missing tear volume on a permanent or temporary basis. The task of the drugs used is to prevent premature rupture of the tear film that protects the eyeball. The action of the latest generation of drugs is aimed at generating artificial tear fluid.
Dry eye syndrome can develop due to congenital anomalies of the meibomian glands, diabetes mellitus, Schengren's disease. If you do not start treatment in a timely manner, eye pathology will be complicated by blepharitis (inflammation of the eyelids), conjunctivitis (inflammatory diseases of the conjunctiva), infection of the eye apparatus.
How to treat the pathology of an uncomplicated form:
- Natural teardrop. The solution for the eyes is produced on the basis of 2 active substances - dextran and hypromellose, which are a polymer system that moisturizes the cornea. Instillations with the drug can compensate for the lack of tear fluid, stabilize the tear film, protecting the cornea from drying out.
- Artificial tear. The active ingredient of the drops is hypromellose. A highly viscous solution, similar in composition to naturally occurring tears, lubricates and softens the surface of the eyeball. You can instill drops 3-8 times a day, the best effect is achieved by combining the solution with a gel composition.
- Cationorm. The product is a preservative-free cationic emulsion that moisturizes and lubricates the ocular surface. The drug, which protects the mucous layer of the eye from drying out, relieves the symptoms of dry syndrome, as well as the influence of intense visual stress and irritating external factors.
- Okutiars. The main component of the ophthalmic solution is hyaluronic acid, which has an ultra-high molecular weight. Substances are part of the eye tissues, bind and retain water molecules. Therefore, the drops, free from preservatives, resemble a natural tear, and stay on the eye for a long time.
- Korneregel. A highly viscous gel substrate based on dexpanthenol copes best with corneal degeneration and dry keratoconjunctivitis, stimulates tissue regeneration. Due to prolonged contact with the conjunctiva and cornea, it allows one to limit one to two instillations per day.
- Oftagel. The presence of carbomer 974P in solution thickens the ophthalmic agent. Thanks to carbomer, the gel firmly and for a long time adheres to the stratum corneum, increasing the viscosity of the tear. The contact effect lasts 45 minutes, and instillations with drops are able to prolong the effect of simultaneously applied drugs.
- Vidisik. This type of tear substitute is a hydrogel, the increased viscosity guarantees long-term retention of the carbomer on the outer surface of the eyeball. To achieve the best effect, it is recommended to blink vigorously after placing it under the lower eyelid, then the gel-like product will become more liquid.
Most gel-type ophthalmic agents have keratoprotective properties. In terms of their composition, drops and gels resemble the natural tear film that protects the human eye as much as possible. It is necessary to use eye solutions and gels strictly following the instructions for each drug and the shelf life of the uncorked bottle.
Drugs that stimulate the secretion of tears
Dry eye syndrome (treatment of dry eye membrane in medicine is considered a difficult problem) is often complicated by the combined form of the course. Therefore, ophthalmologists have to prescribe several drugs for simultaneous use, focusing on the symptoms and factors that caused DES. To restore the full secretion of lacrimal fluid, therapy with lacrimal solutions is enhanced by the addition of drugs that stimulate the secretion of tears.
To date, the only option for eye drops that increase the production of lacrimal secretions is Restasis. The agent based on cyclosporine helps to improve the subjective sensations in patients while reducing the risk of damage to the corneal epithelium. However, the action of the immunomodulatory emulsion has a number of side effects (burning in the eye, headache, blurring of the visible picture, allergies).
To properly stimulate the secretory function of the lacrimal glands, the ophthalmologist prescribes the intake of dietary supplements in capsules or tablets.
Vitamin courses will support visual function and improve eye health:
- lack of vitamin A causes drying of the inner (mucin) and outer (lipid) layers of the tear film;
- a sufficient amount of vitamin D reduces the symptoms of the disease, reduces inflammation, and has preventive properties;
- the antioxidant ability of vitamin E extinguishes signs of the inflammatory process on the surface of the cornea, stimulating the epithelialization of defects;
- omega-3 fatty acids help to reduce symptoms of irritation, but their intake must be agreed with a doctor due to existing contraindications;
- full hydration of the whole body, including the organs of vision with dry syndrome, will provide the connection of ionic minerals.
According to the preliminary conclusions of scientists, taking dietary supplements with chondroitin and glucosamine will have a positive effect on the restoration of connective tissue structures. The pharmacy chain offers a wide range of vitamin complexes to maintain healthy eyes. However, in addition to tablets, a sufficient level of water balance should be maintained - 2 liters of clean water per day.
Anti-inflammatory syndrome therapy
With prolonged xerophthalmia (moderate or severe form), the conservative treatment regimen is not complete without periodic courses of anti-inflammatory drugs. The doctor decides on the specific type of local remedy from a specific group, focusing on the symptoms and methods of additional diagnostics.
Dry eye syndrome (treatment is always complex) with a prolonged course is usually complicated not only inflammatory process, but also the "flowering" of pathogenic microflora, for which the lacrimal liquids.
The duration and dosage of medicines must strictly comply with the instructions of the ophthalmologist, since uncontrolled use of anti-inflammatory drugs has a high risk of developing complications. Among them - a secondary infection, cataracts, foci of corneal ulceration.
|Common name||Action of drugs|
|Group of antimetabolites||Instillations with Restasis manage to block the progress of the inflammatory process in the eye membrane. The active substance has an immunosuppressive effect.|
Dexamethasone in eye solution restores natural tear production, reducing the inflammatory component of dry syndrome.
|Non-steroidal drugs||NSAID eye drops quickly relieve unpleasant symptoms. However, the products are not intended for long-term use due to the high risk of side effects.|
|Antibacterial drugs||The appointment of solutions with antibiotics is justified in case of bacterial infection. The specific type of drug is selected after identifying the causative agent of the infection.|
If local procedures do not bring relief to the patient, ophthalmology clinics offer a pathogenetic method for treating dry eye membranes. The revolutionary Intensive Pulse Light (IPL) technique fundamentally solves the problem of xerophthalmia.
The IPL technology is implemented using the Optima device, which acts on the periorbital zone with a wide beam of light delivered by powerful pulses. Apparatus exposure to bright xenon light allows you to restore the normal functioning of the meibomian (sebaceous) glands.
The radiation radius limited by light filters acts on the principle of selective photothermolysis.
The selective operating principle of the device contributes to:
- deep heating of the greasy secretion;
- facilitating the exit and distribution of tears along the cornea;
- enhancing local blood circulation, which dampens inflammation.
Until 2002 the device was used in dermatology, and after 2008 ophthalmologists began to use modified devices. The most important benefits of a modern IPL procedure for patients are painlessness and comfort. There is no special preparation required for a treatment session that takes only 30 minutes. The procedure works in a complex way - it relieves the cause of dryness of the eye surface and inflammation of the skin, toning the skin around the eyes.
Surgical manipulations on the organs of vision always cause fear in patients, therefore, with xerophthalmia, it is worth contacting a specialist on time. Pharmacotherapy of severe forms of dry eye syndrome with ointments and drops will not be effective, and the symptoms of the disease will significantly complicate the patient's life. Therefore, doctors offer gentle surgical methods that demonstrate high efficiency.
The purpose of obturation (occlusion) of the lacrimal tubules is to create temporary or permanent conditions that reduce the outflow of tear fluid. In the course of a safe operation, the exits from the lacrimal openings (one or both at the same time) are blocked by polymer absorbable obturators for 4-7 days. If the result has brought the desired effect, the lacrimal openings are clogged with non-absorbable silicone plugs-obturators.
No less effective, but also relatively less traumatic, is the operation to close the exit point of the tear with a flap borrowed from the surface of the conjunctiva. In terms of effectiveness, the results of this type of surgical intervention are comparable to the occlusion of the lacrimal tubules with polymer obturators. The most modern method of treatment is considered to be covering the surface of the cornea with a biological material to protect against factors provoking xerosis.
If it is established that the meibomian glands cannot cope with sufficient production of sebaceous secretions, the ophthalmologist may recommend the use of a modern method - laser treatment. On the biological tissue of the glands, the laser beam is scattered, which leads to the transformation of the beam into a speckle field of the red spectrum.
Thanks to laser stimulation, the outflow of tears is reduced, and the liquefied secretion of the glands also occurs, which leads to a decrease in xerosis indicators. In addition, the stability of the tear film improves, the rate of regeneration of the corneal and conjunctival layers increases.
In the practice of treating eye diseases, a complex syndrome is encountered - a combination of two completely opposite conditions of the tear film and tubules. For example, sutra and the first half of the day, the patient suffers from profuse lacrimation due to disruption of the lacrimal canals and overflow of the lacrimal sac (dacryocystitis).
By the evening and at night, the outer shell of the eye becomes so dry that the eyelids stick together with the cornea (xerosis). In this case, the methods of therapy have to be combined - first, thicken the abundantly flowing tear, then fight against excessive drying of the conjunctiva.
Dry eye video
Dry eye syndrome: