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Dry Eye Syndrome; Diagnosis.

Your ophthalmologist or optometrist can diagnose dry eye syndrome during an eye examination. A complete physical examination may be necessary to diagnose any underlying diseases, such as Sjogren's syndrome. Make sure you tell your health care professional what medications you are taking, as many drugs can aggravate dryness of the eyes. Among those that can contribute to dry eye syndrome are:

some high blood pressure medications, including diuretics

antidepressants

some heart medications

antihistamines

decongestants

Parkinson disease medications

gastric ulcer medications

muscle spasm medications

sleeping pills

some pain relievers

anesthetics

The early symptoms of dry eye syndrome may include:

eye redness

burning, stinging, and/or gritty sensation in the eye, especially in an environment with low humidity

a feeling that something is in the eye

trouble wearing contact lenses

a gritty feeling that may be persistent and painful

In mild cases, these symptoms may come and go. An individual may have only some, or all of these symptoms. As dry eye worsens, the symptoms tend to become more persistent. People who have severe cases of dry eye may find little or no relief for these symptoms from artificial tears, have eyes that are unusually sensitive to light, and may experience severe eye pain or notice changing vision.

In cases of moderate to severe dry eye, a temporary or permanent plug about the size of a sesame seed can be inserted into some of the tear draining channels, or puncta, at the inner corner of the eyelids. Here tears normally drain through the tear duct into the nose and down the throat. Blocking these exit channels helps to keep the tears on the surface of the eye longer. Plugs are inserted by your health care professional in the office setting in minutes using a magnifying instrument to best see the puncta. Collagen punctal plugs eventually dissolve, and often are used to see whether permanent plugs will help the eye retain tears and can be tolerated by the patient. Silicone punctal plugs are considered permanent, although your health care professional can remove them, or they may fall out. Some patients with silicone plugs initially may have a sensation that something is in the eye, but the feeling usually disappears over a few hours to a few days. Many people don't feel them at all after they've been inserted. Plugs can be dislodged by rubbing the eye, so your health care professional may recommend you refrain from doing so. In severe dry eye cases, irreversible surgical closure of the puncta may be recommended.

Because many patients with dry eye syndrome are unable to tolerate contact lenses, they may desire corrective surgery such as laser-assisted in situ keratomileusis (LASIK). But, results of several studies, including a recent study published in the August 2002 issue of the Archives of Ophthalmology demonstrated that although LASIK was safe and as effective in patients with dry eyes as in those without, preoperative dry eye increased the risk of severe postoperative dry eye that could last more than one year. Refresh Liquigel is an extra-strength moisturizing tear that protects against moderate to persistent dry eye symptoms associated with LASIK surgery. It combines the convenience of a liquid eye drop with the long-lasting benefit of a gel.

During your eye examination, your health care professional will look at your eyes with a slit lamp, a lighted, microscope-like instrument that illuminates the eyes. Your health care professional will focus on the front of your eye and check whether it remains moist or quickly develops dry spots. If the eye is deficient in tears, particularly in mucin or lipid parts of tears, dry spots appear quickly. Your health care professional also will look at the pool of tears called the "tear lake" that gather at the edge of the lower lid where tears appear to sit, keeping the eye moist. If the tear pool can't be seen during this slit lamp examination, dry eye is a possibility.

After discussing your symptoms and conducting the initial slit-lamp examination, your health care professional may conduct the following tests for dry eyes:

Fluorescein stain test. Your health care professional will place eye drops containing a fluorescent dye called fluorescein into your eyes and examine them with the slit lamp while shining a blue-colored light on the eyes. You may feel a slight burning sensation in the eyes after receiving the drops, but it will disappear within seconds. Fluorescein stain is used to evaluate tear film. In addition, the dye stains dry areas and shows any erosion on the eye's surface that occurs as a result of dryness. As your tears naturally replace themselves, over several minutes, the dye is washed out of the eye. The test, which is conducted in minutes, does not affect vision.

Rose Bengal stain test. This is another test in which dye is placed in the eyes. It tends to be a subtler test than the fluorescein stain, picking up lighter areas of dryness on the eye. It is used less frequently because it can be quite irritating in the presence of dry eye. Your health care professional may use drops that numb the eyes before performing this test to decrease any irritation. Thin strips of filtering paper that are impregnated with the Rose Bengal dye will be touched to the pool of tears in your eyes, and your health care professional will examine your eyes through the slit lamp. The dye will stain areas of dryness on the eye. As with fluorescein stain, your tears will wash the dye out of your eyes. The test takes a matter of minutes, and does not affect vision. The numbing drops wear off in less than 10 minutes

Schirmer test. This test measures tear production. It is often conducted when your health care professional sees a lack of a tear pool during the initial slit lamp examination and finds dry areas in one of the stain tests. Your health care professional will take a special strip of filter paper, put a tiny fold in it, and place it on the tear pool on the edge of the lower eyelid. The paper remains in place for five minutes, absorbing the tears. The test causes no pain, but some patients find it slightly uncomfortable. It does not affect vision. After the five-minute time period, the paper strip is removed and the area of wetness measured in millimeters (mm). A wetness area of 15 mm is normal. A reading of 10 mm is below normal, but most patients can tolerate it, and may have a few symptoms. A reading of 5 mm is low, and most patients at this level do have some symptoms. Patients with many dry eye symptoms may have a reading of 2 mm or lower.

Lissamine green stain test. Lissamine green dye is actually a color additive in drugs, cosmetics and food. When used for dry eye testing, it has a staining profile nearly identical to Rose Bengal, however, does not cause any ocular irritation. It stains the areas where there is poor protection of surface by the tear film.

References

Bensinger, R, MD, FAAO, spokesman for the American Academy of Ophthalmology, and chief of ophthalmology at Swedish Hospital, Seattle, WA. Direct interview. Nov. 6, 2000.

"Dry Eye Syndromes, Your Questions Answered." The Schepens Eye Institute, Harvard Medical School. http://www.eri.harvard.edu. Accessed Sept. 2002.

"Fact Sheet: The Cornea and Corneal Disease." National Eye Institute. http://www.nei.nih.gov. June 2001. Accessed Sept. 2002.

"Frequently Asked Questions About Dry Eye." Prevent Blindness America. http://www.preventblindness.org. Updated May 2003. Accessed Sept. 2003.

"Hydroxypropyl Cellulose (Ophthalmic)." Medlineplus Health Information, National Library of Medicine. Updated Sept. 2002. http://www.nlm.nih.gov. Accessed Sept. 2002.

Petrauskas, JL, MSPH. "Digging in the Ocular Desert." EyeNet Magazine Online. American Academy of Ophthalmology. http://www.aao.org. July 2000. Accessed Sept. 2003.

"Studies Show Promise for Drug to Treat Dry Eye Syndrome." American Academy of Ophthalmology. http://www.medem.com. News release April 11, 2000. Accessed Sept. 2002.

"Dry Eye Syndrome" EyeMDLink. Updated Oct. 2001. http://www.eyemdlink.com. Accessed Sept. 2002.

"Conjunctival Histologic Findings of Dry Eye and Non-Dry Eye Contact Lens Wearing Subjects" The CLAO Journal. Jan. 2001. http://www.clao.org. Accessed Sept. 2002.

Cross WD et al. "Clinical and Economic Implications of Topical Cyclosporin A for the Treatment of Dry Eye." Managed Care Interface. Vol. 15 (9): 44-9. Sept. 2002.

Sullivan DA et al. "Androgen Deficiency, Meibomian Gland Dysfunction, and Evaporative Dry Eye." Annals New York Academy of Sciences. Vol. 966: 211-22. June 2002.

"LASIK Safe, Effective in Patients With Dry Eyes" Medscape Medical News. Aug. 16, 2002. http://www.medscape.com. Accessed Sept. 2002.

"Hormone Replacement Therapy and Dry Eye Syndrome" JAMA. Vol. 286 No. 17, Nov. 7, 2001. http://jama.ama-assn.org. Accessed Sept. 2002.

"New Dry Eye Therapy Launched" Sjogren's Syndrome Foundation. 2003. http://www.sjogrens.com. Accessed Sept. 2003.

Schaumberg DA, et al. "Prevalence of Dry Eye Syndrome Among US Women" Aug. 2003. American Journal of Ophthalmology, 136:2 : 318-326.

Market Scope. Report on the Global Dry Eye Market. St. Louis, Mo: Market Scope, July 2004.

"Dry Eye Fact Sheet." The Schepens Eye Institute, Harvard Medical School. http://www.theschepens.org. Accessed June 2006.

Keywords: dry eye syndrome, symptoms, punctal plugs, lasik, rose bengal
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Publication:NWHRC Health Center - Dry Eye Syndrome
Article Type:Disease/Disorder overview
Geographic Code:1USA
Date:Jun 21, 2006
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