1chp6 ocular surface diseases

7/22/2019 1Chp6 Ocular Surface Diseases

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Ocular Surface

Diseases

The Fourth Affiliated Hospital ofCMU

Eye Centre



Overview

http://www.virtualcancercentre.com



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

conjunctivacornea

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 fromforniceal 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 tearfilm.



Classification

• Corneal, conjunctival lesionSquamous epithelization type

Limbal stem cell deficiency type

• Tear film disorders Aqueous tear deficiency

Lipid tear deficiency

Mucoprotein deficiencyKinetic 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 filmcalled the aqueous.

• Meibomian glands

Producing lipids which keep the tear filmfrom evaporating.

• Goblet cells of the conjunctiva

Producing mucin which allows the wettingof 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

burningophthalmalgia

light sensitivity

pink-eye

• Do you regularly experience one or several symptoms above?

• Some diseases and conditions (like rheumatoidarthritis, lupus and Sjögren’s 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 glanddysfunction; 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 ofthe 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 pressureincreasing.

• Lupus, brandy nose etc.



Clinical Manifestation

• Common in aged people and who lived in cold

region.

• No specific symptoms.

•

Lid-margin mostly thickening; abnormal secretionwhile pressurizing.

• Disorder in Meibomian

gland, eyelid, conjunctiva.

Figure: Notching of the lid caused

by loss of meibomian glands.

http://www.eyehealthnutrition.com



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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1chp6 ocular surface diseases

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