BUY the eBook: Dry Eye in Clinical Practice

Dry Eye in Clinical Practice May 2007 90 pages, US$14.99

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Dry Eye disease is a public health problem. It happens when the self-lubricating and protection mechanism of the eye, the tear film, underperforms or becomes non functional.

It is not a major cause of blindness, but is a common problem affecting a large cross section of people, specially the aged and women It is one of the diseases of the eye for which understanding is still evolving and at times multiple organ disorders are responsible for its onset.

This eBook is about the clinical practice methodology evolved and adopted by Dr Vinay Agarwal of the Cornea & Ocular Surface Diseases, Clear Vision Eye Center, Mumbai, India, Dr Virender Sangwan and Dr Merle Fernandez of the Cornea Services, L.V.Prasad Eye Institute, Hyderabad, India. The three doctors have used years of hands-on experience to arrive at this methodology.

The eBook has been divided into twelve chapters, each focused on a specific aspect of the patho physiological assessment, ocular surface evaluation, therapy and disease management. The chapter wise synopsis is as follows:

1. Pathology of Dry Eye: A brief overview of the anatomy and physiology of the ocular surface, the tear film that bathes it and the etio-pathogenesis of dry eye.

2. Patient Self-Assessment: The main rubric in dry eye management is alleviation of the patients’ symptoms, hence patient questionnaires like the McMonnies questionnaire or the Ocular Surface Disease Index form the backbone of dry eye assessment. These are useful in assessing the severity of symptoms and the response to treatment.

3. Biomicroscopic Examination to Study Tear Film and Tear Secretions: For the clinician, in addition to the patients’ symptoms, a gamut of clinical signs involving the eyelids, conjunctiva, cornea, tear meniscus and blinking are useful in determining the etiology and severity of dry eye. This well illustrated chapter describes the anterior segment findings in a patient with dry eye.

4. Assessment of Tear Stability: Determination of tear film break up time by non-invasive and invasive methods and determination of the inter-blink interval are simple clinical tests used for evaluating tear film stability.

5. Assessment of Ocular Surface Damage: Dry eye results in ocular surface damage with loss of mucin and epithelial cells. The extent and severity of ocular surface damage may be assessed with a grading scheme by using vital dyes like Fluorescein, Rose Bengal or Lissamine Green.

6. Assessment of Tear Volume: The measurement of tear production is essential in determining the existence of aqueous deficient dry eye or evaporative dry eye.

7. Anti- inflammatory Therapy in Dry Eye: In view of the recent understanding regarding the chronic ocular surface inflammation in patients with dry eye, the role of corticosteroids, cyclosporine A, autologous serum, essential fatty acids and tetracyclines is examined. Treatment guidelines for the use of these drugs have been provided.

8. Tear Substitution: Once the mainstay of dry eye therapy, artificial tears plays an ancillary role in dry eye management. The advantages and disadvantages of various formulations are discussed in this chapter.

9. Tear Preservation: An adjunct to dry eye therapy, punctal occlusion, tight fitting goggles, room humidifiers, hydrophilic bandage contact lenses and tarsorrhaphy are some of the methods for preserving the natural and artificial tears in dry eye patients.

10. Management of Systemic Disease: Guidelines on the judicious use of corticosteroids and immunosuppressive drugs in the management of systemic diseases like ocular cicatricial pemphigoid associated with dry eye.

11. Algorithm for Dry Eye Disease Management: Systematic approach for evaluation of a patient with ocular irritation.