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Saturday, 7 June 2014

Taking Control Part 4 - Sjogren's Conference - Dr. Rookaya Mather: Dry Eye

Dr Rookaya Mather is Associate Professor of Opthalmology at the Ivey Eye Institute at the University of Western Ontario and Department of Opthalmology and a researcher specializing in Cornea and External Eye Disease in London Ontario.

She chose Sjogren's Syndrome and Tear Film Dysfunction as her topic. Dr. Mather defined dry eye as a multifactorial disease of the tears and ocular surface that results in 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. This is the definition of dry eye from the International Dry Eye Workshop (DEWS)

This can be very disruptive to your life. It has an effect on your quality of life that is similar to moderate angina. It's possible for dry eye to be caused by drugs or a serious lack of Omega-3 as well as by Sjogren's Syndrome.

Nitro for angina

In Sjogren's patients with severe dry eye researchers have seen on biopsy that 50% of the glandular cells are still present. This emphasizes the importance of immune factors in inducing glandular dysfunction. 

Another contributing cause for dry eye can be Meibomian Gland Dysfunction (MGD). With Sjogren's there is a decrease in expressibility that leaves the lipid layer deficient and lets tear evaporation increase. When this happens your tears become very concentrated. This promotes inflammation. For some people warm compresses and eyelid massage help with MGD.

You may also see redness on the eyelid margin. This is a sign of Ocular Rosacea. The inflammation on the ocular surface is thought to be mediated primarily by CD4 cells.

You need tear film on your cornea at all times for protection or your corneas may break down. When you use eye drops you should avoid drops containing preservatives.  BAK is the worst one and it is also found in glaucoma drops. Autologous serum tears are the closest to natural tears.


She's got Botticelli eyes

As your eyes become more dry, ocular findings worsen. There are some types of eye wear that help reduce the flow of air over the eye that preserve the tear film.  These include wraparound glasses and cycling shields, Panoptx, plano glasses or the scleral contact lens. You need to be especially careful to moisturize at night since tear production drops then.

Dr Mather ended with more good advice. Number one was "Be proactive, not reactive." Sticking to a daily care routine is essential. When you read close your eyes after each page for a few seconds more than a blink.

This is the comprehensive strategy to manage dry eye in 5 points:
1. Tear supplementation
2. Control of inflammation
3. Reduce evaporative loss
4. Support meibomian gland function
5. Prevent disease progression



Omega-3 capsules with fish pictures

Lifestyle factors can help. She suggested 2000mg of fish oil daily, use of lubricating eye drops, lid hygiene, warm compresses, possibly punctal plugs. Also consider flaxseed oil . Another idea that was new to me involved rolling a small bottle (like a pill bottle) full of warm water over the eye for a warm massage.

You can find more information about dry eye here at Dr R. Fox's site and more info on compresses for dry eye at this site which I found through dry.org. It also mentions eyelid massage.


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