Selasa, 21 Agustus 2018

Dry eyes

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Dry eye disease is a condition when the eye does not get adequate lubrication from tears. This condition makes the eye unable to remove dust or foreign objects that interfere with the eye. As a result, the eyes feel very uncomfortable.

In a healthy eye, the cornea will continue to be drained by tears when the eyes blink, to nourish the corneal cells and protect the cornea from the outside environment. Tears are a mixture of fat, water, mucus, and more than 1500 proteins that keep the eye surface smooth and protected from the surrounding environment, disturbing elements, or germs that cause infection. When the glands around the eye cannot produce enough tears or when the composition of the tears changes, the outer surface of the eye that acts to forward light into the eye can also be disrupted.

Another name for dry eye disease is keratoconjunctivitis sicca or dry eye syndrome. Dry eyes are more experienced by women than men, and the risk of dry eyes also increases in old age.

Symptoms of Dry Eyes

Symptoms commonly experienced by dry eye sufferers include:
The severity of dry eyes varies, ranging from mild to severe. But in most cases, the symptoms that are felt are still relatively mild.

Symptoms of dry eyes can get worse when the patient is in certain conditions, for example working by looking at the computer screen for hours, too long in an environment where the air is dry, or reading books in time. Dry eye conditions can cause inflammation of the surface of the eye, causing scarring of the cornea or bacterial infection.

Causes of Dry Eyes

Some conditions can cause dry eyes, namely:
  • Reduced tear production. This condition arises because of old age, certain diseases (eg diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren's syndrome, thyroid hormone disorders, vitamin A deficiency), consumption of certain drugs (for example antihistamines, decongestants, antidepressants, hypertension drugs, acne medications, Parkinson's disease medications, or hormone therapy drugs), tear gland damage due to radiation or due to laser eye surgery. 
  • Tears evaporate faster. This condition can be caused by weather (wind, smoke, or dry air), conditions that make it rarely blink (when reading or working too long in front of a computer screen), the eyelids that turn outward (ectropion) or turn in (entropion). 
  • Tear composition is not balanced. Tears consist of 3 compositions, namely oil, water, and mucus, with certain composition. When this composition changes, for example due to blockage of the oil gland, blepharitis, or rosacea, can cause dry eyes.
Besides some of the causes of dry eye, the risk of experiencing dry eyes in a person will also be greater if:
  • Age above 50 years. The older the age, tear production tends to decrease.
  • Hormone changes. This condition often occurs in women who experience hormonal changes due to pregnancy, consumption of birth control pills, and menopause.
  • A diet with low vitamin A content.Wear contact lenses.
Dry Eye Diagnosis

To establish a diagnosis of dry eye, the ophthalmologist will ask about the patient's symptoms and history of the disease, before carrying out a physical examination.

To measure the patient's tear volume, the doctor will perform a Schirmers test. Through this test, the doctor will measure the level of dryness in the eye by attaching a special piece of paper that can absorb the liquid in the lower eyelid for 5 minutes. The eye is classified as dry eye if the paper size is wet less than 10 millimeters in 5 minutes.

Meanwhile, to determine the condition of the eye surface, tests using eye drops containing special dyes (fluorescein dye test) can be done. After giving the eye drops to the patient, the doctor can see the pattern of color changes in the eye to find out how quickly the eyes dry. This fluorescein dye test can also show areas that have damage to the eye surface.

To see damage to the surface of the eyeball can also be seen through the test of lissamine green or special coloring in a paper. Furthermore, the paper will be moistened with saline solution and affixed to the surface of the eye. Through the color pattern attached to the surface of the eyeball, the doctor can see the initial signs of damage to the eye. In addition to eye examination, an overall physical examination will also be carried out to find the cause of dry eyes,

Treatment of Dry Eyes

Dry eye treatment is intended to help sufferers relieve symptoms and overcome the cause of dry eyes. If the cause of dry eyes is related to medical factors, the steps to take precedence are to overcome these causes. For example, if the cause is a side effect of drug consumption, the doctor can recommend the patient to replace drugs that do not cause dry eye side effects.

For dry eyes that are classified as mild or only occasionally occur, the patient can use eye lubricants or known as artificial tears, in the form of eye drops, gels, or ointments that are sold freely in pharmacies. These medicines can moisturize the eyes and function as a substitute for tears.

In addition, other efforts can also be done at home to relieve symptoms or prevent dry eye syndrome, namely:
  • Protect the eyes from the environment that causes dry eyes, such as windy, hot, smoky, or dusty weather. Avoid the environment or use glasses as a protector, and use moisturizers or air filters in the room.Avoid using makeup on the eyes.
  • Quit smoking.
  • Set the working time in front of the computer screen.
  • Maintain eye hygiene by using warm compresses on the glands on the side of the eye, and remove dirt or oil on the eyelids.
  • Eating lots of omega-3 fatty acids can improve dry eye conditions. Omega-3 is widely found in several types of fish, such as mackerel, tuna, sardine, or salmon.
If home treatment has not been successful, the doctor can make several treatment options, including:
  • Drugs. One of the drugs commonly given to treat dry eyes is antibiotics to relieve inflammation at the tip of the eyelids and the body's immune-suppressing drugs (eg ciclosporine or corticosteroids) which are effective in reducing inflammation in the cornea of the eye. Nevertheless, the consumption of corticosteroid drugs for a long time can cause side effects. Meanwhile, to encourage tear production, doctors can give cholinergic drugs, such as pilocarpine. If dry eye is still not resolved, your doctor can recommend using eye drops made and processed from the person's blood (autologous serum eye drops).
  • LipiFlow thermal pulsation. This tool aims to open the barriers of the oil glands that cause dry eyes. During this therapy, a bowl-shaped device will be placed in the eye, and provides a gentle and warm massage on the lower eyelids.
  • Intensed-pulsed light therapy. Light therapy followed by massage on the eyelids can help people with severe dry eyes.
  • Special contact lenses. Contact lenses called scleral lenses are recommended to be used by patients to protect the eye surface and maintain eye moisture.
  • Operation. This procedure can be done for severe dry eye cases and cannot be treated with other therapies. Surgery is done by permanently blocking the tear duct, so that the surface of the eye will always be moist. Another surgery is the salivary gland autotransplantation. In this procedure, the salivary glands from the lower lip are removed to be placed in the skin around the eyes to act as a replacement for the tear glands.
Generally, dry eye symptoms can be controlled after treatment. However, there are also some patients who still experience dry eye syndrome after treatment, even those complaints persist for life.

Dry Eye Complications

Complications that can arise from dry eye diseases include increasing the risk of eye infections due to lack of tear supply, eye surface damage due to dry eye conditions left without treatment so that it triggers conjunctivitis, corneal surface damage, open corneal wounds and visual impairment. Dry eye syndrome also creates difficulties for sufferers in carrying out daily activities, such as reading or driving a vehicle.