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TREATMENT OF DRY EYE SYNDROME

TREATMENT OF DRY EYE SYNDROME

The treatment aims to eliminate aggravating factors, hydrate the ocular surface, ensure greater retention of tears on the ocular surface, stabilize the tear film, and avoid inflammation of the ocular surface.

It will depend on the symptomatic intensity of the condition, the association or not of systemic diseases, and the exploratory signs found in each patient. It must be an individualized treatment.

An aspect of extreme importance is that the patient understands the chronicity of the condition, that is, that it cannot be cured and that to a large extent, it will have in its hands the measures to adapt according to the intensity of the symptoms.

As measures aimed at improving the environmental factors that worsen the symptoms, it is important to avoid prolonged exposure to air conditioners, avoid strong air currents, do not drive with the car windows open, avoid prolonged exposure to heat sources.

The use of room humidifiers generally favors the treatment.

In patients exposed to computer screens, it is advisable to use glasses (which prevent tear evaporation) over contact lenses. If that is not possible, it is necessary to use artificial tears compatible with contact lenses or use daily contact lenses. The distribution of the office furniture is also very important. Thus, the upper edge of the computer screen must be at the same height or below the level of the eyes. Frequent screen breaks are recommended, as well as voluntary lid closure during these breaks.
Dry eye syndrome, one of the most common eye disorders, is a condition that occurs when tears are unable to lubricate the eyes sufficiently. It is a disease that affects about 30% of the population and “produces discomfort, visual problems and, in some cases, lesions in the cornea and conjunctiva,” they point out from the Institute of Ocular Microsurgery (IMO).
Eye pupil

Tips for taking care of your eyes at work

This problem requires individual diagnosis and treatment, as the causes and types vary depending on the severity.

The most frequent symptoms are usually dry eyes, redness, itching or stinging, eye fatigue, a foreign body sensation inside the eye, irritation, tearing or watery eyes, sensitivity to light, or blurred vision.
What are the causes?

The causes that motivate the appearance of this syndrome can be diverse, but it is generally produced by a low production or excessive evaporation of tears. It also happens because they have low quality “due to problems such as dysfunction of the meibomian glands (lack or alteration of lipids in tears) or blepharitis (inflammation of the eyelid),” they explain from the IMO. In this sense, the frequent causes that can give rise to these problems are the following:

Aging.
Hormonal changes such as those that occur during adolescence or menopause.
Consumption of certain medications such as decongestants, antihistamines, or antidepressants.
Eye infections such as conjunctivitis.
Use of contact lenses.
Previous eye surgery.
Treatment with radiation therapy or chemotherapy.
Vitamin deficiency (such as vitamin A) in the diet.
Autoimmune diseases such as Sjögren's syndrome, rheumatoid arthritis, or fibromyalgia.
Environmental factors: pollution, air conditioning, wind, smoke, dry air, etc.
Eyelid problems.
Reduced flickering when reading or viewing an electronic screen for a long period.

Prevention, diagnosis, and treatment
Congenital nystagmus usually appears during the first weeks of life.
The ‘dancing eyes’ syndrome or nystagmus: when the eyes move on their own without the person noticing

Early detection is key to acting quickly and avoiding possible conditions that can cause this syndrome. For this reason, it is important to go for ophthalmological examinations regularly.

To diagnose this problem, a series of tests such as a complete eye exam, measuring the volume of the tears (Schirmer’s test), and determining the tears’ quality, as indicated in Mayo Clinic, must be performed. Specialized clinics have various tools and technologies to perform these types of tests.

The specialist will determine which treatment is appropriate depending on the cause, the patient’s clinical condition, and the symptoms they suffer. In most mild cases, eye drops (artificial tears) or lubricating ointments are used to moisten the eye’s surface.
The effects of Antipsychotic acids are: decreased visual quality, decreased accommodation, changes in color sensitivity, photophobia, allergic reaction, and dry eye.7,8 Drugs to treat Parkinson’s disease have a similar mechanism in causing eye dry to antidepressants and antipsychotics. The most commonly used are piperidine, benztropine, procyclidine, trihexyphenidyl, levodopa, bornaprine, and pramipexole.2

Benzodiazepines reduce salivary and tear secretion by binding to muscarinic receptors, in addition to the cross-reaction effect that this family of drugs can have and cause Stevens-Johnson syndrome.6

Menopausal and postmenopausal women are at higher risk for dry eye.9 Sex hormones have very important effects on tear secretion, meibomian gland function, and goblet cell density. The combination of progesterone with estrogens has shown a lower risk of causing dry eye than estrogens alone.2

Some isolated drugs that can cause dry eye are amiodarone and flecainide, where it has been observed that 10% of cases may present decreased TRL.2,10

Herbal supplements and complementary medicine are beginning to take more and more ground; in the United States, it is estimated that around 15 million people use some herbal or multivitamin product.11 Niacin (vitamin B3) has been used to treat anorexia nervosa, Depression, hypercholesterolemia, diabetes mellitus, and migraine have been associated with decreased vision, cystic macular edema, and dry eye. Echinacea is popularly used to treat and prevent respiratory symptoms and has been shown to cause dry eye symptoms. Kava is used today for the treatment of generalized anxiety disorder. Climacteric symptoms have also been identified as a causative agent of dry eye.2,12

Polypharmacy (use of five drugs or more) increases the relative risk of presenting iatrogenic dry eye; this mechanism is complex; however, the exact mechanism is not known.6 In addition, the elderly may have more risk factors and be more likely to take multiple drugs.3

TREATMENT AND RECOMMENDATIONS

The first step is to identify the drug responsible for the clinical picture. It is recommended to withdraw the drug, perform a therapeutic test, and introduce it again, observing the clinical response. In some cases, this modality is not possible. In these, the onset of symptoms can be correlated with the start of the drug. Likewise, withdrawing the drug is not always recommended, so the drug must be modified with an alternative mechanism of action and can help improve dry eye symptoms. Another alternative is to reduce the dose of the drug, which allows maintaining a good therapeutic action and reducing symptoms. In case the symptoms are not very serious, you can always opt for topical treatment with eye lubricants or some other local agent.6

The ideal would be to have therapeutic agents with a higher affinity for specific receptors and a lower affinity for non-specific receptors. Other measures would be chemical modifications that reduce permeability to ocular tissues, the development of delivery systems that could affect the amount of drug that reaches the eye, and, finally, changes in administration and dosage that avoid a higher concentration in tissues. eyepieces

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