Ocular Surface

Diseases
The Fourth Affiliated Hospital of
CMU
Eye Centre
Overview
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Roles and Characteristics of the eyelids
Eye protection
Regular blink: protection and stability of the tear
film
Rich of glands
Adequate blood supply
No venous valve
Conception
Corneal epithelium
Conjunctival epithelium
Tear film
Clinical ocular surface consist of
conjunctiva
cornea
eyelids
lacrimal gland
lacrimal passages
Tear and the Tear Film
Function :
1.Cleaning
2.Wetting ocular surface
3.Bacteriostasis
4.Supporting the cornea
(oxygen supply)
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Origin of Epithelium
Stem cells, SC
Corneal epithelium derived from the
Limbal stem cells.
Conjunctival epithelium derived from
forniceal and palpebral regions.
Ocular Surface Disease
Conception
The ocular surface is a complex biological
continuum responsible for the maintenance of
corneal clarity, elaboration of a stable tear film for
clear vision, as well as protection of the eye
against microbial and mechanical insults.
Comprising a variety of disorders on cornea,
eyelid, conjunctiva, lacrimal apparatus and tear
film.
Classification
Corneal, conjunctival lesion
Squamous epithelization type
Limbal stem cell deficiency type

Tear film disorders
Aqueous tear deficiency
Lipid tear deficiency
Mucoprotein deficiency
Kinetic disorders of lacrimal fluid
Treatment
Reconstruction
Epithelium, limbal stem cells
Lacrimal secretion, tear film
Innervation (nerve restore)
Structure and function of eyelid
Surgical operation
To re-establish conjunctiva, cornea,
tear film and eyelid.

Dry Eye
Healthy tear film Dry eye
http://www.chronicdryeye.com
Conception
Dry eye (known by doctors as
keratoconjunctivitis sicca) is a chronic
lack of sufficient lubrication and moisture
in the eye.
Its consequences range from subtle but
constant irritation to ocular inflammation
of the anterior (front) tissues of the eye.
Tear Secretion
Lacrimal gland
Producing the watery part of the tear film
called the aqueous.
Meibomian glands
Producing lipids which keep the tear film
from evaporating.
Goblet cells of the conjunctiva
Producing mucin which allows the wetting
of the ocular surface as well as stabilizes the
tear film.
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Etiological factor & Classification
Aqueous tear deficiency
Lipid tear deficiency
Mucoprotein deficiency
Kinetic disorders of lacrimal fluid
Clinical Manifestation
Dry eye symptoms
asthenopia
irritation, grittiness
dryness
burning
ophthalmalgia
light sensitivity
pink-eye
Do you regularly experience one or several symptoms above?
Some diseases and conditions (like rheumatoid
arthritis, lupus and Sjgrens Syndrome) also cause
chronic Dry Eye in many patients.
On the other hand, activities like reading, Wearing contact lenses or
working at the computer may cause Dry Eye.
Diagnostic Tests for Dry Eye
Dry Eye questionnaire
Lacrimal river width
Schirmer test uses paper strips under eyelid to measure
the wetness that collects over a specific period of time.
Break-up time of tear film (BUT)
Staining uses special dyes to highlight areas of possible
damage to the eye surface.
Tear ferning test
Lactoferrin contents
Tear penetration pressure test
Corneal tonographic map
Impression cytology
Diagnosing
Schirmer test, BUT, Staining
Foundation
Symptom
Instability of tear film
Damage on epithelium
Tear penetration pressure increasing
Treatment
According to the clinical category
For tear deficiency: Maintain moisture in the eyes;
reducing the evaporation; increasing the secretion; controlling
inflammation & immunoreaction.
For over-evaporation: Therapy the Meibomian gland
dysfunction; controlling inflammation; cleaning eyelid; decreasing
the evaporation; lipid replacement.
According to the eye conditions
For intermittent symptoms: Artificial tears add volume to
the tear film as long as they remain in contact with the surface of
the eye.
For midrange dry eye: Artificial tears and punctal
occlusion.
For Severe dry eye: Appending cyclosporin, surgery.
Summary
Eliminating the etiological factors
Tears replacement therapy
Maintain moisture in the eyes
Increasing the tear secretion
Immune inhibition therapy
Re-establish the tear film
Other supporting treatment
Meibomian Gland Dysfunction
http://www.dryeyezone.com
http://www.revophth.com
Etiological Factor
Failure of the glands to produce or secrete lipids.
Wax ester declining and cholesterol increasing
make the symptoms worse .
Lack of tears and tear penetration pressure
increasing.
Lupus, brandy nose etc.
Clinical Manifestation
Common in aged people and who lived in cold
region.
No specific symptoms.
Lid-margin mostly thickening; abnormal secretion
while pressurizing.
Disorder in Meibomian
gland, eyelid, conjunctiva.
Figure: Notching of the lid caused
by loss of meibomian glands.
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Diagnosing
Absence of Meibomian gland.
The gland orifices are often compromised due to stenosis or
closure.
A declining quality and quantity of lipid secretion.
Anyone of the physical signs can make the
diagnosis of Meibomian gland dysfunction if the patient
has clinical symptoms.
Figure: No visible meibomian gland orifices:
Eversion of the lower lids in both eyes showed
atresic meibomian glands.
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Treatment
Clearing
Hot fomentation on eyelids for 5~10mins.
Massaging the eyelids.
Swabbing the lid-margin with mild
cleaning solution.
Treatment
Antibiotics oral administration.
Local Medication
Antibiotic eye drops
Glucocorticoid eye drops (short term)
Artificial tears
The End
Lacrimal river width

Schirmer Test

Normal 10mm/5min
Tear break-up time, BUT
Staining
Using special dyes to highlight areas of
possible damage to the eye surface.

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