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‫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  They

are made of collagen and are dissolvable. 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

):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

the number of bacteria that break down the lipid layer of your tear film ointments also lubricate eyes overnight

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

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