Dry eyes with menopause

Normally, the epithelium of the cornea of the eye is wetted by a tear film. It is restored involuntarily in the process of blinking and provides easy gliding of eyelids on the surface of the eyeball, protection of the eye surface from drying out, infection, contamination, contains substances that promote the rapid regeneration of the corneal epithelium as a result of microtrauma. Corneal conjunctival xerosis (xerophthalmia or dry eye syndrome) is a pathological decrease in the hydration of the corneal epithelium, triggered by a deficiency of tear fluid or accelerated evaporation. The incidence increases with age, in people older than 45 years this syndrome occurs quite often. This pathology affects about a fifth of the inhabitants of countries with a high level of technology development. During the last thirty years, the frequency of diagnosing xerophthalmia has increased 4.5-fold. This disease is more affected by women (≈70% of all who apply to this problem), most of them are office workers of post-Balzac age.

Causes of the dry eye in menopause

The onset of menopause in women is often accompanied by a feeling of dryness in the eyes. Climacteric syndrome is the second most important and frequency of occurrence among the causes of this pathology.

Changes in the hormonal background lead to an inadequate production of the sebaceous secretion of the basal phase of the lacrimal fluid. Lipid layer of lacrimal foam is external, it reduces surface heat transfer and does not allow evaporating the next, aqueous layer directly produced by lacrimal glands. This is the largest part of the tear film, continuously updated and carrying nutrients to the cornea and conjunctiva, as well as removing metabolic products. The inner layer, mucinous, glues a tear film with the cornea, the factor of development of its insufficiency often acts as a deficiency of retinol (vitamin A), characteristic for the climacteric period. The process of producing components of all layers of the tear film is continuous, which ensures its stability on the external surface of the eye. The pathogenesis of the "dry eye" syndrome is based on the disturbances of this process, the vast majority (85%) of cases is the result of excessive evaporation of the tear film, in 15% of patients tear production is usually reduced.

The likelihood of dry eyes in menopause is aggravated, whose work is related to office work on the computer. Dry air, tobacco smoke, dust, Sjogren's disease, wearing contact lenses, hormone replacement therapy, taking sedatives, diuretics, hypotensive drugs in addition to age-related changes are risk factors for this pathology.

Symptoms of the dry eye in menopause

The first signs of a disturbed physiological renewal of the tear film are the sensation of a grain of sand in the eyes; desire to rub them to get rid of it; the visual load causes fatigue, especially towards evening; visually noticeable slight reddening of the inner surface of the eyelids. Symptoms exacerbate the unfavorable environment - dry air conditioning, windy weather, the presence of contact lenses, activities associated with prolonged exertion of vision. This is an easy degree of dry eye syndrome.

The middle can be characterized by a greater degree of symptomatology. There are persistent sensations of burning, inflammatory vessels of the eyelids create the impression of the constant presence of grains of sand, there is photophobia, compensatory lacrimation, increasing in the street in windy weather.

For a severe degree, frequent inflammation of the cornea, the edges of the eyelids and the outer shell of the eye, microerosion and corneal ulcers, dry keratoconjunctivitis and other complications are accompanied by reduced immunity during hormonal changes in the body.

The consequences of dry eyes are inflammatory and infectious processes, leading to changes, sometimes irreversible, in the structural components of the eyes. In addition, the "dry eye" syndrome is one of the contraindications for laser vision correction.

Diagnostics of the dry eye in menopause

With the symptomatology of a lack of tear film, it is necessary to consult an ophthalmologist who, after an external examination and listening to the patient's complaints, first examines the eye on the slit lamp, the design of which includes a binocular microscope in conjunction with the lighting system. Biomicroscopy allows to study the structure of the anterior ocular region and to detect characteristic changes in the cornea and conjunctiva.

Analyzes that allow to assess the level of lacrimal fluid stability (Norn's test), total tear production (Schirmer's test) and a bacterioscopic examination of the conjunctiva smear (clarification of the presence of secondary infection) are conducted for a more complete clinical picture of the disease. Analyzes of blood and tear fluid (immunological), assessing the state of protective properties of the body and the appointment, if necessary, immunomodulating drugs.
Crystallography of tear fluid, determining the nature of pathology - infectious-inflammatory, dystrophic process, etc.

In addition to this, instrumental diagnostics can be assigned:

• fluorescein instillation test, which determines by the slit lamp the integrity of the corneal epithelium and the nature of the tear film;
• tiascopy - complements the data on the condition of the tear film and the thickness of its lipid layer;
• osmometry - assesses the risk and degree of secondary evaporation and drying of the epithelium of the eye.

Women with climacteric syndrome are prescribed a consultation with a gynecologist, with suspicions of other dysfunctions - an endocrinologist and a rheumatologist.

[1], [2], [3], [4], [5], [6]

Differential diagnosis

Differential diagnosis is performed with the symptoms of inflammatory or degenerative ophthalmic diseases. Starting point for differentiation - the changes associated with xerophthalmia are limited to the edges of normally open eyelids.

Treatment of the dry eye in menopause

Mainly, the treatment of xerophthalmia is reduced to the appointment of artificial disinfectants. These drugs have a proper moisturizing effect and eliminate symptoms of irritation from dryness in the eyes. Pharmacies offer a wide range of droplets with a different degree of viscosity and chemical composition, the attached infection is stopped by antibiotics in drops and ointments. The ophthalmologist prescribes preparations and treatment regimen based on the patient's anamnesis.

Drugs for tear-replacement therapy are selected individually, taking into account the specific features of the disease. Use drops in combination with hygienic procedures for the eyelids (massage, use of hypoallergenic bluff gel and others). Containers for drops are used individually. Immediately after instillation, blurred vision can be observed, which must be taken into account by patients who drive the car.

A wide range of applications have eye drops from the Systein series, they are used three to four times a day.

Systein Ultra is addressed to patients with a deficiency of water and mucin layer. These drops are distinguished by "intelligence" - their ingredients are selected in such a way that after instillation the drug, adapting to the physiological fluid of a particular patient, independently changes its consistency from liquid to gelatinous mass. This ability allows the use of Cystein ultra drops in the treatment of different stages of xerophthalmia. You can use the owners of contact lenses, digging directly on them.

The Systemic Gel initially has a gelatinous consistency and, accordingly, a prolonged action. According to the patients, it is more convenient to apply it before bedtime. It is used in more advanced stages of corneal conjunctival xerosis.

Systain Balance - drops on an oily basis, are intended for persons with malfunctioning of meibomia glands (insufficiency of lipid layer of tear film). Their action is based on sealing the damage to the lipid layer, as a result of which its integrity remains and moisturizing substances are preserved.

The last two drugs require the extraction of contact lenses before instillation. All types of drops Systein retain their properties for a long time after opening the bottle (ultra and balance - up to six months, gel - three months).

Oxyal droplets - are produced on the basis of hyaluronic acid. Composition, close to the composition of human tears. It has a moisturizing and moisture-saving effect, relieves the symptoms of irritation and inflammation, promotes the regeneration process. Electrolytes, which are part of the drug, support the natural degree of mucin production. Used in the composition of the preservative, getting on the cornea, decomposes into inert hypoallergenic components. Bury one or two drops from four to five times a day. Increase the number of applications can be after consulting a doctor. Compatible with lenses of any modifications.

Hilo-chest of drawers (Hilo-chest of forte) drops are produced on the basis of hyaluronic acid. The properties and structure of the drops are similar to human tears, in particular, to the mucinous layer of the tear film. It has a moisturizing and moisture-saving effect, relieves the symptoms of irritation and inflammation, promotes the regeneration process. It is used for any, even severe, degrees of dry eyes. It is recommended to instill one drop three times a day. Compatible with lenses of any modifications.

Innoca drops (blue) - a phytopreparation based on extracts of medicinal plants. Eliminates fatigue, irritation, flushing, has a vasoconstrictive effect, restores the eyes a comfortable state. Before instillation it is necessary to remove contact lenses. To drip two or three drops in the corners of the eyes, allow to absorb about five minutes and you can put on the lens. Apply as needed. After opening the bottle with drops, you can use a fortnight.

A natural tear is an absolute analog of human tears, both in rheological and in chemical properties. It removes itching, aching hyperemia, moisturizes the cornea, replenishes the deficiency of tear film. Bury one or two drops as necessary. Contact lenses must be removed before instillation. The open vial is stored for no more than a month.

Vitamin and vitamin-mineral complexes can be useful for treating dry eyes. Women with menopausal syndrome surely experience their deficiency. After consultation with the attending physician, you can choose the appropriate complex for yourself. It must necessarily include retinol (vitamin A), the deficit of which is manifested by such a symptom as a decrease in adaptation to darkness. Vitamin C is needed to strengthen the vessels of the eye, B vitamins are necessary for the normalization of metabolic processes in the nervous tissue of the eye, among other things, these vitamins are characterized by high antioxidant activity. It is desirable that the complex included vitamin E, taurine, zinc, selenium, copper and chromium.

Alternative treatment

To eliminate the symptoms of corneal conjunctival xerosis, you can use alternative medicine, the simplest of which is lotion from tea brewing, known from childhood to almost everyone. Moistened Wheat soaked in hard boiled tea is put on the eyes and held for a quarter of an hour or slightly more. You can use a tea bag for this. Doing this procedure, it's good to lie down, relax and remember something pleasant. If you do so in the morning and in the evening, you can probably avoid the problems of a "dry eye".

It is possible to alternate tea lotions with lotions from the chamomile, especially since there are packaged chamomile tea on sale. First, apply ordinary tea for about ten minutes, then - chamomile.

Infusion of chamomile is brewed as follows: three tablespoons of flowers pour a glass of boiling water. Let it brew and cool, drain and make lotions. You can use only chamomile infusion.

Therapy with ordinary clean water, according to observations, works no worse than infused with medicinal herbs. Moreover, this method is completely safe, since herbal treatment can cause an allergic reaction. Replenishing the same deficiency of moisture with pure water will not exactly cause side effects.

Alternative medicine suggests flushing your eyes with morning dew - in a week's time all problems will disappear. However, it is hardly reasonable to follow this advice in gassy cities, but somewhere in the country, in the recreation area, away from the highways, perhaps you can try.

Honey lotions: dissolve a teaspoon of honey in three table water and make lotions two or three times. Every time you need to prepare a fresh composition.

As a therapy from the "dry eye" syndrome, simple gymnastics is suitable, which can be done more often, for example, simply blink frequently or rotate the eyes clockwise, then against it. Move, without turning the head, eyeballs from side to side, holding them briefly in the extreme position. You can alternate these exercises.

Homeopathy

Okulochel - homeopathic drops, relieving pain and inflammation, active towards infectious agents. Normalize the trophic processes in the eyes and muscle tone. The active ingredients are extracts of medicinal plants in homeopathic dilution. It can be used as a means to normalize the state of the eyes at high loads, causing tearing disorders and symptoms of irritation. The recommended dosage is two drops three times a day. An open capsule should not be stored for more than a day.

DreamTeam MagicEye ™ - energy-information homeopathic drops, are produced in Russia. The active ingredient is sterile water, which carries a "matrix of health" at the cellular level (information of healthy eyes). This medicine is the future, stimulating the recovery and normalization of intracellular and intercellular processes. All this is done by water, using the information spectrum of healthy eye cells recorded on it. Stuck in the eye, she finds the pathology and restores the normal state with the help of the "matrix of health".

Classical homeopathy offers drugs:

• relieving eye fatigue when reading, working behind a computer monitor, other visual loads - Fagopyrum (Fagopirum), Heracleum sphondylium (Heracleum spondylium);
• with a feeling of dryness, rezi, fog in the eyes - Senega (Senaga);
• one of the best drugs that eliminate excessive lacrimation, photophobia, lack of clarity of vision - Conium (Conium).

Operative treatment

Surgical intervention for the overlap of the tear fluid that flows out of the eye is used in extreme cases if the drug therapy does not give positive results or the need for instillation occurs too often. In this case, plugging the tear out with silicone occludors is done - creating a mechanical barrier for the tear to cover its insufficiency. Before making a permanent overlap of lacrimal ducts, they are temporarily blocked with absorbable collagen tampons. The expediency of the operation is confirmed by the reduction of the symptoms of "dry eyes", in this case the ways of tear removal are blocked by constant occludors.

In the treatment of complications of corneal-conjunctival xerosis-xerorrhagic ulcer, corneal perforation, and others, surgical treatment is also often used.

Prevention

Women during the menopause lead the group at risk of xerophthalmia. To prevent the disease you need to use simple rules:

• use enough liquid, better than clean water;
• observe a diet containing vitamins A, B, C, E, trace elements;
• protect the eyes from direct sunlight (wear quality sunglasses, hats with wide margins, visors);
• humidify the air in the premises, especially with electrical appliances, try to avoid dusty and smoky rooms;
• owners of contact lenses, office workers who spend a lot of time at the computer to apply for preventive purposes moisturizing drops for the eyes;
• do in the work of technological breaks, gymnastic exercises for the eyes.

Feeling that there are symptoms of dry eyes, without delay, consult a doctor. Timely diagnosis and therapy of xerophthalmia significantly improves the condition, reduces the likelihood of complications, which can lead to serious consequences for vision and surgical interventions.

Forecast

Most patients who go through menopause to an ophthalmologist with complaints of dry eyes have a mild or moderate degree of disease. Their treatment consists in replacing the lack of tear fluid and stabilizing the tear film, with which the remedies are successfully coping. Almost always, the forecast regarding the patient's preservation of visual functions is quite favorable.

[7], [8]