‫بسم ال الرحمن الرحيم‬

Dry eye
:Circulation of tears
:Dietary Supplementation-3
 Incorporating essential fatty acids in the diet
may increase the oily portion of the tears,
reduce evaporation and quiet inflammation
associated with dry eyes.

 Omega fatty acids are often effective in

increasing comfort when used to manage Dry
Eye Syndrome.
 Vit A, C & D supplementation.
Artifacial tears
:Punctal plugs-5

 Punctal plugs are inserted into the puncta to block

tear drainage.
 They keep moisture on the eye by keeping tears from
draining too quickly.
 They are reserved for people with moderate or severe
dry eye when other medical treatment has not been
adequate.
 Punctal plugs can be inserted into upper eye lid , lower
eye lid or both acciording to the severity of the
disease.
:Types of Punctal plugs
Temporary punctal plugs. 1.
 These are made of collagen and are
dissolvable.
 They are a useful way to determine
whether you might be a good
candidate for permanent punctal plugs.
 Some patients will experience tear
overflow (epiphora) with punctal plugs.
Permanent punctal
 Non-absorbable plugs are used for long-term occlusion.
 They are most commonly made of silicone or a hydrophilic
acrylic.
 These plugs will last several months, and are suitable for people
who suffer from seasonal dry eye as well as people with a
permanent version of the condition
 Disadvantages:
a. 40% risk of losing a plug within the first six months of use.because plugs
can spontaneously extrude themselves
.b. discomfort at the plug site, which occurs in approximately 10% of cases
.c.There is a risk of eye irritation, excessive tearing
. d. in rare cases, infection
Nonabsorbable punctal plugs with flange to
prevent distal migration. Punctal dilation (A), plug
©insertion (B), and different size plugs
 :Medications-6
):a. cyclosporine A 0.5% (Restasis
 helps decrease any inflammation the surface of your eye.
 work through inhibition of transcription factors required
for cytokine production.

: Common side effects of Restasis

 blurred vision,
 burning and stinging of the eye,
 and excessive tearing
 In most patients, Restasis is well tolerated, and these side
effects resolve within six to eight weeks.
:b. corticosteroids drops
Anti-inflammatory drugs
c. Antibiotics
). Ex.(erythromycin and bacitracin
are used in case of blepharitis or
.meibomian gland dysfunction
:Mechanism
the number of bacteria that break down
the lipid layer of your tear film
ointments also lubricate eyes overnight
:Surgery-5
In severe cases of DES, these openings. 1
are permanently closed, usually by
.cautery (burning) or LASER
:Procedure
a hot cautery, diathermy, or argon laser cause
destruction, shrinkage, and scarring of the punctal
opening and the wall

N.B This accomplishes the same thing as the plugs, but it is

.very difficult, if not impossible, to reverse
:Lateral tarsorrhaphy.2
 In the management of severe ocular
damage with dry eye or if there is lag
ophthalmos causing dry eye
 Procedure :
 The lateral (outside) one-third of
your eyelids are sewn together to
decrease the ability of your eye to
open widely and to help your eye
close more easily.
 :New therapy.3
the secretion product of the salivary glands from de
lower lip is very similar to natural tears. These
glands are easily accessible and can be
transplanted to the eyelids together with the
.overlying mucosa

:Procedure
the patient under general anaesthesia
a specimen of labial mucosa of the lower lip and
underlying glands is dissected with Radiosurgery
transplanted to the inner conjunctival side of the
.eyelid
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