Enfermedad del ojo seco / Dry Eye Disease

El ojo seco es una condición frecuente que tiene un impacto importante sobre la calidad de vida, pues conlleva a una sensación de incomodidad y discapacidad visual. Adicionalmente, puede tener un efecto pernicioso sobre procedimientos quirúrgicos oculares, lo que compromete el resultado de las cirugías de córnea, catarata y refractiva. Este síndrome de disfunción lagrimal es un padecimiento multifactorial, derivado de una deficiencia o evaporación excesiva de la lágrima. Se realizó una búsqueda en la literatura científica, con el objetivo de describir de forma general la enfermedad del ojo seco, brindando información actualizada en relación a su concepto, epidemiología, clasificación, factores de riesgo, fisiopatología, síntomas y signos, retos diagnósticos atendiendo a la complejidad de la entidad y tratamiento. La identificación temprana de los subtipos y el control de la severidad es crucial para mejorar el bienestar del paciente. La carga económica en la sociedad, y el impacto de la enfermedad en el individuo, a través de su efecto sobre la visión, calidad de vida y productividad laboral, así como en su esfera psicológica y física son considerables. Por ello, es importante que los oftalmólogos con el apoyo de los tecnólogos en optometría y óptica diagnostiquen y traten la enfermedad en sus fases iniciales, en la que los signos y síntomas todavía no son graves, lo que permitirá ralentizar su evolución natural, y posiblemente disminuir las consecuencias perjudiciales que provoca(AU)

Dry eye is a common condition that has a significant impact on quality of life, leading to a feeling of discomfort and visual impairment. Additionally, it can have a pernicious effect on ocular surgical procedures, compromising the outcome of corneal, cataract and refractive surgeries. This lacrimal dysfunction syndrome is a multifactorial condition, derived from a deficiency or excessive tear evaporation. A search of the scientific literature was carried out with the aim of describing dry eye disease in a general way, providing updated information regarding its concept, epidemiology, classification, risk factors, pathophysiology, symptoms and signs, diagnostic challenges considering the complexity of the condition and its treatment. Early identification of subtypes and control of severity is crucial to improve patient welfare. The economic burden on society, and the impact of the disease on the individual, through its effect on vision, quality of life and work productivity, as well as on the psychological and physical aspects, are considerable. Therefore, it is important that ophthalmologists with the support of optometrists and ophthalmic technologists diagnose and treat the disease in its early stages, when signs and symptoms are not yet severe, which will slow down its natural progression, and possibly reduce the resulting harmful consequences(AU)

Chemokine tear levels in primary Sjögren's syndrome and their relationship with symptoms.

PURPOSE: To evaluate CCL2, CXCL8, and CXCL10 in the tears of patients with Primary Sjögren's syndrome (PSS) and correlate them with ocular symptoms/discomfort and objective ocular tests. METHODS: We studied 21 patients with PSS. A single ophthalmologist, expert in dry eye, examined the patients and assessed tear film breakup time, Schirmer I test, tear meniscus height, Van Bijsterveld staining score and SICCA Ocular Staining Score. We also assessed the ESSPRI and ocular dryness VAS and the Ocular Surface Disease Index (OSDI), a 12-item scale assessing symptoms associated with dry eye disease and their impact on vision (ocular symptoms/discomfort). Tear samples collected with sterile tear flow strips were frozen at -86 °C until testing. After thawing, tears were extracted from the strips. We tested CCL2, CXCL8, and CXCL10 by luminometry. We also included 21 healthy control subjects without a dry eye. RESULTS: CXCL8 levels were similar in patients and controls. PSS patients had lower levels of CXCL10 (472.8 vs. 1652 pg/µL, p = 0.009) and CCL2 (1.08 vs. 9 pg/µL, p = 0.0001) than controls. Patients with worse ocular sicca symptoms/discomfort had the lowest CXCL10 levels (239.3 vs. 646.2 pg/µL, p = 0.02). CCL2 correlated with tear meniscus height (τ = 0.37, p = 0.02) and with OSS (τ = -0.3, p = 0.05). CONCLUSIONS: We found lower levels of CXCL10 and CCL2 in the tears of patients with PSS, associating the former with worse ocular symptoms and the latter with positive ocular target tests.

Risk factors for ocular surface damage in Mexican patients with dry eye disease: a population-based study.

PURPOSE: To analyze potential risk factors for ocular surface damage in a representative population of Mexican patients with dry eye disease (DED). PATIENTS AND METHODS: A prospective and cross-sectional population-based epidemiologic cohort study was conducted through a survey of patients with symptoms, signs, known preexisting diagnosis, and clinical conditions related to DED. Fluorescein staining, tear break-up time (TBUT), and Oxford lissamine green staining were performed on both eyes of patients enrolled in the study. RESULTS: A total of 2,725 surveys including 1,543 (56.6%) women and 1,182 (43.3%) men were analyzed. Most common pre-existing diagnosis included dry eye (58%), chronic blepharitis (17%), and ocular allergy (15%). More than 70% of patients had a positive fluorescein test, and this prevalence increased proportionally to the number of reasons for consultation. The same was true for gender (P<0.001) and age (P<0.0001), with women showing a strong correlation with age (R2=0.93912, P=0.001). The association between positive fluorescein staining and diagnosis was significant for dry eye (P<0.0001), Sjögren's syndrome (P<0.0001), and glaucoma (P<0.05). No significant association between TBUT and age or gender was found, but the shorter the TBUT, the larger the prevalence of fluorescein staining. Reduced TBUT was seen more frequently in patients with dry eye (57%), ocular allergy (16%), and chronic blepharitis (15%). Most patients (39%) with Oxford grades III and IV were older, complained of red eye (51.0%), foreign body sensation (47.0%), burning (46.0%), and were using eye drops (67%) and systemic medications (47%). CONCLUSION: The Mexican profile of patients with significant ocular surface damage related to DED includes women at older ages, complaining of red eye, foreign body, and burning sensation. Diagnoses of dry eye, Sjögren's syndrome, and glaucoma were also risk factors for significant ocular surface damage, along with long-term use of preserved eyes drops and systemic medications.

Ceratoconjutivite seca - uma enfermidade subdiagnosticada / Keratoconjunctivitis sicca - a subdiagnosticated disease / Ceratoconjuntivite seca - unaenfermedad subdiagnosticada

A ceratoconjuntivite seca é uma inflamação progressiva da córnea e da conjuntiva causada por deficiência/ausência do filme pré-corneal trilaminar, sendo frequente na clínica de pequenos animais, mas muitos clínicos têm dificuldade em diagnosticar esta doença, o que talvez possa ser explicado pela diversidade de apresentações, com sinais comuns a outras enfermidades da superfície ocular e conjuntiva. O diagnóstico precoce da CCS tem relação direta com a remissão e controle dos sinais, pois os animais que recebem precocemente tratamento têm um prognóstico mais favorável. A terapia inclui manter a superfície ocular lubrificada e úmida, próximo ao normal, simultaneamente com a correção ou controle de alguma disfunção sistêmica ou regional identificada na abordagem física e oftálmica. Este texto faz um alerta em relação ao diagnóstico e apresenta uma breve revisão da terapia, com objetivo de evitar sequelas graves e irreversíveis.

Keratoconjunctivitis sicca, a progressive inflammation of the cornea and conjunctiva caused by deficiency/absence of the trilaminar tear film, is frequently observed in the clinical evaluation of small animals, although many clinicians have difficulty in diagnosing this disease, which may be explained by the diversity of presentation, sharing common signs with other diseases of the ocular surface and the conjunctiva. Early diagnostic of KCS is directly related with remission and control of clinical signs as animals that were treated at early stages had a more favorable prognosis. Therapy to KCS consists in keeping the lubrication and humidity of the ocular surface close to its normal and simultaneously correcting or controlling any systemic or regional dysfunction previously observed in the physical and ophthalmological evaluation. This text makes an alert regarding the KCS diagnosis and presents a brief review of its therapeutics, in order to avoid serious and irreversible sequels.

La queratoconjuntivitis seca es una inflamación progresiva de la córnea y de la conjuntiva causada por deficiencia/ausencia de la película precorneal trilaminar. Es frecuente en la clínica de pequeños animales, pero muchos clínicos tienen dificultad en diagnosticar esta enfermedad, 10que talvez pueda ser explicado por la diversidad de presentaciones, con signos comunes a otras enfermedades de la superficie ocular y conjuntiva. EI diagnóstico precoz de Ia QCS tiene relación directa con la remisión y control de las señales, pues los animales que reciben precozmente tratamiento tienen un pronóstico más favorable. La terapia incluye mantener la superficie ocular lubricada y húmeda, cerca de 10 normal, simultáneamente con la corrección o control de alguna disfunción sistémica o regional identificada en el abordaje físico y oftálmico. Este texto hace una alerta en relación al diagnóstico y presenta una breve revisión de la terapia, con el objetivo de evitar secuelas graves e irreversibles.

Ceratoconjutivite seca - uma enfermidade subdiagnosticada / Keratoconjunctivitis sicca - a subdiagnosticated disease / Ceratoconjuntivite seca - unaenfermedad subdiagnosticada

A ceratoconjuntivite seca é uma inflamação progressiva da córnea e da conjuntiva causada por deficiência/ausência do filme pré-corneal trilaminar, sendo frequente na clínica de pequenos animais, mas muitos clínicos têm dificuldade em diagnosticar esta doença, o que talvez possa ser explicado pela diversidade de apresentações, com sinais comuns a outras enfermidades da superfície ocular e conjuntiva. O diagnóstico precoce da CCS tem relação direta com a remissão e controle dos sinais, pois os animais que recebem precocemente tratamento têm um prognóstico mais favorável. A terapia inclui manter a superfície ocular lubrificada e úmida, próximo ao normal, simultaneamente com a correção ou controle de alguma disfunção sistêmica ou regional identificada na abordagem física e oftálmica. Este texto faz um alerta em relação ao diagnóstico e apresenta uma breve revisão da terapia, com objetivo de evitar sequelas graves e irreversíveis.(AU)

Keratoconjunctivitis sicca, a progressive inflammation of the cornea and conjunctiva caused by deficiency/absence of the trilaminar tear film, is frequently observed in the clinical evaluation of small animals, although many clinicians have difficulty in diagnosing this disease, which may be explained by the diversity of presentation, sharing common signs with other diseases of the ocular surface and the conjunctiva. Early diagnostic of KCS is directly related with remission and control of clinical signs as animals that were treated at early stages had a more favorable prognosis. Therapy to KCS consists in keeping the lubrication and humidity of the ocular surface close to its normal and simultaneously correcting or controlling any systemic or regional dysfunction previously observed in the physical and ophthalmological evaluation. This text makes an alert regarding the KCS diagnosis and presents a brief review of its therapeutics, in order to avoid serious and irreversible sequels.(AU)

La queratoconjuntivitis seca es una inflamación progresiva de la córnea y de la conjuntiva causada por deficiencia/ausencia de la película precorneal trilaminar. Es frecuente en la clínica de pequeños animales, pero muchos clínicos tienen dificultad en diagnosticar esta enfermedad, 10que talvez pueda ser explicado por la diversidad de presentaciones, con signos comunes a otras enfermedades de la superficie ocular y conjuntiva. EI diagnóstico precoz de Ia QCS tiene relación directa con la remisión y control de las señales, pues los animales que reciben precozmente tratamiento tienen un pronóstico más favorable. La terapia incluye mantener la superficie ocular lubricada y húmeda, cerca de 10 normal, simultáneamente con la corrección o control de alguna disfunción sistémica o regional identificada en el abordaje físico y oftálmico. Este texto hace una alerta en relación al diagnóstico y presenta una breve revisión de la terapia, con el objetivo de evitar secuelas graves e irreversibles.(AU)