DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20183873

Effect of medical and surgical management and dry eyes in Eastern Odisha

Tarun Kumar Panda, Suchitra Kumari

Abstract


Background: Dry eye condition has multi-factorial origin and most of the times missed or left untreated leading to resistance in its treatment modalities. Various studies had been conducted with conflicting outcomes. Dry eyes condition being more prevalent in Odisha, there is very limited published data on its management. Hence this study was conducted to evaluate the efficacy and outcome of medical and surgical management of dry eye cases due to different aetiologies.

Methods: Patients were selected from those who attended ophthalmology, Skinand VD, O and G and Paediatrics OPD. Their tear film parameters like Tear film breakup time, tear meniscus height, Schirmer test, Rose Bengal stain were assessed at baseline level. Thereafter they were put on medical therapy for 6 weeks followed by appropriate surgical intervention like amniotic membrane graft, punctual occlusion, use of Symblepharon shell in resistant cases -which again was reviewed by analysis of tear film parameters.

Results: Majority of patients (75% approx.) responded well to medical therapy. non responders were due to Steven Johnson syndrome, Vitamin A deficiency, KCS and systemic association. These patients underwent surgical management with follow up after 6 weeks. After 6 weeks of surgical therapy 80% cases showed improvement, while few cases due to SJS showed poor response.

Conclusions: The medical modality of treatment was found to be the primary approach with better efficacy in majority of dry eye cases predominantly in mild to moderate severity. Surgical interventions proved more efficacious in severe degree of presentation.


Keywords


Dry eye, Medical, Surgical management

Full Text:

PDF

References


Farris RL, Gilbard JP, Stuchell RN, Mandel ID. Diagnostic tests in keratoconjunctivitis sicca. CLAO J. 1983;9:23-8.

Nichols KK, Mitchell GL, Zadnik K. The repeatability of clinical measurements of dry eye. Cornea. 2004;23:272-85.

Keech A, Senchyna M, Jones L. Impact of time between collection and collection method on human tear fluid osmolarity. Curr Eye Res. 2013;38:428-36.

Bunya VY, Langelier N, Chen S. Tear osmolarity in Sjogren syndrome. Cornea. 2013;32:922-7.

Yeh TN, Graham AD, Lin MC. Relationships among tear film stability, osmolarity, and dryness symptoms. Optom Vis Sci. 2015;92:e264-e272.

Messmer EM, Bulgen M, Kampik A. Hyperosmolarity of the tear film in dry eye syndrome. Dev Ophthalmol. 2010;45:129-38.

Szalai E, Berta A, Szekanecz Z, Szûcs G, Módis Jr L. Evaluation of tear osmolarity in non-Sjögren and Sjögren syndrome dry eye patients with the Tear Lab system. Cornea. 2012 Aug 1;31(8):867-71.

Sambursky R, Davitt WF, Latkany R, Tauber S, Starr C, Friedberg M, et al. Sensitivity and specificity of a point-of-care matrix metalloproteinase 9 immunoassay for diagnosing inflammation related to dry eye. JAMA ophthalmology. 2013 Jan 1;131(1):24-8.

Schargus M, Ivanova S, Kakkassery V, Dick HB, Joachim S. Correlation of Tear Film Osmolarity and 2 Different MMP-9 Tests with Common Dry Eye Tests in a Cohort of Non–Dry Eye Patients. Cornea. 2015 Jul 1;34(7):739-44.

Xu KP, Yagi Y, Tsubota K. Decrease in corneal sensitivity and change in tear function in dry eye. Cornea. 1996;15:235-9.

Bourcier T, Acosta MC, Borderie V, Borrás F, Gallar J, Bury T, et al. Decreased corneal sensitivity in patients with dry eye. Investigative ophthalmology & visual science. 2005 Jul 1;46(7):2341-5.

Labbé A, Liang Q, Wang Z, Zhang Y, Xu L, Baudouin C, et al. Corneal nerve structure and function in patients with non-Sjögren dry eye: clinical correlations. Investigative Ophthalmology & Visual Science. 2013 Aug 1;54(8):5144-50.

Ohashi Y, Ishida R, Kojima T, Goto E, Matsumoto Y, Watanabe K, et al. Abnormal protein profiles in tears with dry eye syndrome. Ame J Ophthalmol. 2003 Aug 1;136(2):291-9.

Zhou L, Beuerman RW, Chan CM, Zhao SZ, Li XR, Yang H, et al. Identification of tear fluid biomarkers in dry eye syndrome using iTRAQ quantitative proteomics. Journal of proteome research. 2009 Sep 21;8(11):4889-905.

Goren MB, Goren SB. Diagnostic tests in patients with symptoms of keratoconjunctivitis sicca. Am J Ophthalmol. 1988;106:570-4.

Leonardi A, Motterle L, Bortolotti M. Allergy and the eye. Clin Exp Immunol. 2008;153:17-21.

Pflugfelder SC, Solomon A, Stern ME. The diagnosis and management of dry eye: a twenty-five–year review. Cornea. 2000 Sep 1;19(5):644-9.

Barabinos S, Ronaldo M, Nardi M. The effect of an artificial tears with hyaluronic acid with moderate dry eyes. Eur J Ophthalmol. 2014;24:173-8. [PubMed].

Cohen S, Martin A, Sall K. Evaluation of clinical outcomes in dry eyes with lubricating eye drops containing polyethylene glycol or carboxymethylcellulose. Clin Ophthalmol. 2014;8:157-64. [PubMed].

Doughty MJ. Fluorescein-tear break up time as assessment of efficacy of tear substitutes in dry eye patients-Ocul Surf. 2014;12:100-11. [PubMed].

Lee JH, Ahn HS, Kim EK, Kim T. Efficacy of sodium hyaluronate and carboxymethyl cellulose in treating mild to moderate dry eyes. Cornea. 2011;30:175-9. [PubMed].

Foulks GN. Pharmacological management of dry eye in the elderly patient. Drugs & aging. 2008 Feb 1;25(2):105-18.

Cohen EJ. Punctal occlusion. Arch Ophthalmol. 1999;117:389-90. [PubMed].

Dimit R, Gire A, Pflugfelder SC, Bergmanson JP. Patient ocular conditions and clinical outcomes using Scleral device. Cont Lens, Anterior Eye. 2013;36:159-63. [PubMED].

Tseng SC, Di Pascuale MA, Liu DT, Gao YY, Baradaran-Rafii A. Intraoperative mitomycin C and amniotic membrane transplantation for fornix reconstruction in severe cicatricial ocular surface diseases. Ophthalmology. 2005 May 1;112(5):896-903.

Soliman A. Amniotic membrane transplant in pterygia. Ophthalmology. 2001;108(3):449-60.