4 º. Tissue alteration

Transcription

1 Dry eye

2 What is dry eye? Dry eye is a multifactorial syndrome of the tears and the ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability, with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface [ ]. It is often associated with reduced tear production or increased tear evaporation (DEWS, 2007). 1 º Tear film instability 4 º Tissue alteration 2 º Increased osmolarity 3 º Inflammation What causes it? Dry eye is a syndrome caused by a number of factors, in which aspects such as age, gender, the patient s clinical history and their environment play an important role. 2. Increased cytokine production Low tear production or high evaporation 1. High salt concentration in tears (tear hyperosmolarity) VICIOUS CIRCLE OF DRY EYES 3. Apoptosis + inflammation DETERIORATION IN TEAR FILM 5. Greater tear film instability 4. Loss of mucin and epithelial damage

3 Clinical classification and symptoms Ocular surface disorders 20% 80% TYPE I - REDUCTION IN WATERY DISCHARGE TYPE II - EXCESS OF EVAPORATION SJÖREN S SYNDROME NO SJÖREN S SYNDROME INTRINSIC EXTRINSIC PRIMARY Tear gland disease Meibomian gland hyposecretion Vitamin A deficiency SECONDARY Tear duct obstruction Meibomian gland hypersecretion Drops with preservatives Reduced blink rate Palpebral opening dysfunction Contact lenses Systemic medication Reduced blink rate Allergic conjunctivitis Symptoms (subjective discomfort) The most frequent symptoms are red eyes, stinging and burning. It is important to know how long the patient has had these symptoms in order to assess the degree of dryness. There are procedures and questionnaires that can help to obtain a correct anamnesis (OSDI, McMonnies DEQ-5, SPEED). Levels of dryness Most experts accept the classification of dry eye according to 4 severity levels. Level 1 or 2 cases of dry eye can be improved with the use of lubricating eye drops, daily eye washes, with products containing phospholipids, etc. Level 3 or 4 patients should be referred to an ophthalmologist. LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 Mild or moderate symptoms: Level 1- Level 2 Moderate or occasional symptoms determined by environmental circumstances Mild or moderate conjunctival signs No corneal signs Moderate or severe symptoms: Level 2- Level 3 Tear film and mild signs of conjunctival staining Punctate corneal staining Visual signs TFBUT 10" Schirmer s test (mm/5') 10 Severe symptoms: Level 3 - Level 4 Marked conjunctival and corneal staining Filamentary keratitis TFBUT 5" Schirmer s test (mm/5') 5 Severe symptoms: Level 4 Severe conjunctival and corneal staining Conjunctival erosions and scars Immediate TFBUT Schirmer s test (mm/5') 2 Normal Mild Moderate Severe

4 Recommended treatment As dry eye often progresses in phases, the further the disease progresses, the more difficult it is to treat and the likelier it is to be irreversible. For this reason, it is important to prevent it and take action in the initial phases. LEVEL 1 dry eye: Acuaiss Eye bath + Acuaiss Moisturising drops This category includes cases of normal to mild severity. This group mainly includes people who are affected by adverse environmental circumstances (air-conditioning, pollution ), those who work in front of a computer for a long period of time, etc. For these cases, the use of an eye wash for cleansing and moisturising drops to restore tear balance is recommended. Acuaiss Eye bath Acuaiss Eye bath is a solution containing physiological saline solution with hyaluronic acid. It also comes with an antimicrobial eye bath cap to use the product. Contains hyaluronic acid. One-step cleansing and hydration. The formula is very similar to the tear s composition. Osmolarity close to 300 and neutral ph. Format: 360 ml and 100 ml. Acuaiss Moisturising drops Acuaiss Drops is an artificial tear with hyaluronic acid that provides immediate relief from the symptoms associated with mild dry eye. Sodium chloride solution with hyaluronic acid. Provides immediate symptom relief. Low preservative content in the multi-dose format and preservative-free single-dose format. Formatos: 6 ml and 20 x 0.35 ml.

5 LEVEL 2 dry eye: Acuaiss Ultra Moisturising drops + Disop Zero Spray with liposomes This category includes cases with normal and mild-to-moderate severity. This group includes people who have had a dry eye problem for some time and may need specific preservative-free treatment. In most cases, the lipid layer (hyper-evaporative dry eye) and the aqueous layer are affected, hence a joint treatment to address both aspects is recommended. Acuaiss Ultra Moisturising drops Preservative-free moisturising drops that contain high-molecular-weight hyaluronic acid. The formula is similar to that of the human eye, with phosphates and hyaluronic acid. Preservative-free. Excellent tolerance. Multi-dose container, ideal for long treatments. High-molecular-weight hyaluronic acid for correct concentration. It provides greater comfort for a longer period of time, without blurred vision. Expiry date: 3 months. Format: 10 ml. Disop Zero Spray with liposomes Preservative-free formula with phosphatidylcholine liposomes that are incorporated into the tear film through the interpalpebral space, increasing the thickness of the lipid layer and restoring its anti-evaporative function. Easy to use. It is applied with eyes closed. Specific product to improve hyper-evaporative dry eye. Also contains vitamin A, vitamin E and dexpanthenol. Reduces the sensation of dry eyes in patients who wear silicone hydrogel contact lenses. Format: 10 ml.

6 Bibliography John Sheppard et al - Creating a Dry Eye Center of Excellence. Highligts from a seminar held during the 2014 meeting of the American Academy of Ophtalmology. Ophthalmology Management. January PentaVision LLC. C.Lisa Prokopich et al - Screening, diagnosis and management of dry eye disease: practical guidelines for Canadian optometrists. Canadian Journal of Optometry. Vol. 76. Suppl Tear Film & Ocular Surface Society Report of the International Dry Eye Workshop (DEWS). The Ocular Surface. April Vol. 5, No 2. Gerd Geerling et al - The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction. IOVS, Special Issue 2011, Vol. 52, No. 4. Jennifer P. Craig et al - Suitability of a Liposomal Dry Eye Spray for use in silicone hydrogel contact lens wear. 6th International Conference on the Tear Film & Ocular Surface Florence Jennifer P. Craig, Christine Purslow B, Paul J. Murphy B, James S.W. Wolffsohn C. - Effect of a liposomal spray on the pre-ocular tear film. Contact Lens & Anterior Eye 33 (2010) Dausch Dieter, Lee Suwan, Dausch Sabine, Kim Jae Chan, Schwert Gregor, Michelson Wanda - Comparative study of treatment of the dry eye syndrome due to disturbances of the tear film lipid layer with lipid-containing tear substitutes. Klin Monatsbl Augenheilkd 2006; 223: Bischoff G. Khaireddin - Lipid replacement therapy for contact lens-associated dry eye disease. Aktuelle Kontaktologie 2011: 3/4-2011; Peter Künzel Luitpold Optik, Rosenheim - The treatment of the contact lens related dry eye: a prospective, randomised, controlled study. Die Kontaktlinse 2008; 41 (10): Thierry Pauloin et al - High molecular weight hyaluronan decreases UVB-induced apoptosis and inflammation in human epithelial corneal cells. Mol Vis 2009, 15: (Published on line 2009 March 23). Heiko Pult, PhD, MSc, FAOO, FBCLA, FEAOO - Dry Eye in Contact Lens Wearers. Contact Lens Spectrum. Article Date: 7/1/2011. Dra G. Giannioni, Dr. Nichols Annual Report on Dry Eye Diseases. Contact Lens Spectrum. Article Date: 7/1/2012. J A P Gomes, R Amankwah, A Powell-Richards and H S Dua - Sodium hyaluronate (hyaluronic acid) promotes migration of human corneal epithelial cells in vitro. Br. J. Ophthalmol. 2004;88; P. Aragona, V. Papa, A. Micali, M. Santocono and G. Milazzo - Long term treatment with sodium hyaluronate-containing artificial tears reduces ocular surface damage in patients with dry eye. Br J Ophthalmol February; 86(2): H Mochizuki, M Yamada, S Hato and T Nishida - Fluorophotometric measurement of the precorneal residence time of topically applied hyaluronic acid. Br J Ophthalmol 2008;92: Robert J. Noecker, MD; Lisa A. Herrygers, MD - Effect of Preservatives in Chronic Ocular Therapy. Clinical & Refractive Optometry, 15:2, 2004 W. Bernauer, MA Thiel, UM Langenauer, KM Rentsch - Phosphate concentration in Artificial Tears. Graefe s Arch Clin Exp Ophthalmol (2006) 244: Seth P. Epstein, Michael Ahdoot, Edward Marcus, and Penny A. Asbell - Comparative Toxicity of Preservatives on Immortalized Corneal and Conjunctival Epithelial Cells. Journal of Ocular Pharmacology and Therapeutics Volume 25, Number 2, Heiko Pult et al - Einfluss liposomaler Augensprays auf Tränenfilm und Komfort. DOZ, 07/2012. Sandor Blümle, Hans Jörg Etzler - Funktionsstörungen der Meibomschen Drüsen- häufigste Ursache für Trockene Augen. Die Kontaktlinse, 3/2012. Sandor Blümle - Vergleichende Beurteiling liposomaler Augensprays. Der Augenoptiker, 9/2011. Peter Künzel - Die Behandlung des kontaktlinsenbedingten Trockenen Auges. Eine prospektive, randomisierte, kontrollierte Studie. Die Kontaktlinse, 10/2008. Sandor Blümle - Tränenersatz mit Hyaluronsäure und Liposomenspray plus Lidpflege. Optikum Magazin für Augenoptik und Optometrie, Heiko Pult - Die Meibomsche Drüse. Schlüsselfaktor beim Kontaktlinsentragen? DOZ, 10/2010.