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Dry Eyes

Dry Eyes

Dry Eyes

Introduction

Dry eye is a common presenting complaint, especially in older patients. It affects 15-30% of people aged over 50. It is usually not indicative of any serious underlying disease, but be aware of Sjögren’s syndrome – an autoimmune disorder causing dry eyes, often associated with another underlying autoimmune diagnosis.

As we age, the natural tears we produce become less oily. As a result, they are less able to keep the surface of the eye moist. As a result, dry eyes can occur – particularly in dry or arid conditions (including air conditioned environments) or when outdoors – especially when windy. Patients may paroxysmally present with watery eyes – as there is compensation for the dry eye and production of excessively watery tears.

The typical presentation will be purely dry eyes, without pain and without visual acuity being affected. In severe cases the yes may become red, but this is not common.

Differentials might include allergy, conjunctivitis (especially if viral and not purulent), glaucoma, herpes simplex or zoster infection, thyroid disease and, as mentioned above, Sjögren’s Syndrome. In some patients deformities of the eyelids preventing proper closure may exacerbate or be the undying cause of the issue.

Often simple measures such as use of artificial tears is all that is required for management.

Physiology

Tears are more complex than it might first appear. The lacrimal glands produce much of the liquid and electrolytes, but mebomian glands produce oils and fats, and the conjunctival goblets cells produce mucins which all come together to format eh constituent parts of the tears.

Once inflammation has been established it can contribute to a vicious circle of ongoing dry eyes and further inflammation if one of the three producers of tears constituents is not able to performs its function to the best of its ability.

Causes

Presentation

Red flags that suggest a more serious cause include:

Examination

Examination is often normal. There may be come conjunctival inflammation or in severe cases there could be evidence of corneal ulceration.

A thorough examination of the eyes should be performed including:

Also consider checking for signs of thyroid eye disease and checking any painful joints.

Investigations

Treatment

Consider ophthalmology referral or discussion of case via telephone if any red flags or other concerns.

Be aware that dry eyes predisposes to conjunctivitis, keratitis, ulceration and other eye infections

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