Treatment of dry eyes
Last reviewed: 23.04.2024
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The main goal of treating dry eyes is to reduce discomfort and to ensure the optical integrity of the surface of the cornea, as well as to prevent damage to its structures. Several methods of treatment can be used simultaneously.
Preserving the produced tears
- Decrease in room temperature to reduce the evaporation of tear film.
- Air humidifiers in the room can be used, but this often does not work, because the apparatus is not capable of increasing the relative humidity of the air. With the help of special protective glasses you can "honestly increase the humidity.
- Partial lateral tarsorphia reduces the area of the inter-palpebral space, which can be useful.
Alternates to tears
Drops
- Gipromedoza (isopio plain, isopto alkaline, tears naturale).
- Polyvinyl alcohol (hypolears, Hquifilm tears, snotears).
- Sodium hyaluronate
- Sodium chloride (normasoh sieripod blue).
- Having seen (oculotei).
NB! The main drawback of drops - a short duration of action and the development of sensitivity to the preservative (for example, benzalkonium chloride, thiomer-fat). This can be avoided by using medicines without a preservative (eg minims).
Gels (viscotears, helium replacements of tears) consist of carbomerines. They have a definite advantage over drops, since they require less instillation.
Ointments that contain petroleum jelly and mineral substances (lacrilube, lubritcars) can be used before bedtime.
[Mycolytic factors
Acetylcysteine 5% - drops (ilube) can be used to treat patients with filamentous keratitis and infiltrates. Drops are applied 4 times a day, but they can cause irritation after instillation. "In addition, acetylcysteine has an unpleasant odor and a short shelf life (2 weeks).
Reduction of teardrop
Occlusion of a lacrimal point allows to preserve natural tears and prolong the effect of artificial tears. This is important in the treatment of patients with severe dry eyes, especially in connection with the toxic effect of preservatives.
Temporary occlusion of the lacrimal point is reached when collagen plugs are placed in the tear ducts. The main goal of temporary occlusion is confirmation that ample lacrimation will not occur after permanent occlusion. Initially, close all 4 tear points and examine the patient after one week. When lacrimation appears, the upper plugs are removed again, and one week later they examine the patient again. In the absence of complaints and symptoms of the patient, the plugs are removed, the lower tubules are closed. Temporal occlusion can be performed with an argon laser.
Temporary prolonged occlusion (for several months) can be achieved with silicone plugs. Possible problems are nodding of plugs, formation of granulomas, which can cause inflammation.
Constant occlusion is performed by patients with pronounced dry eyes and repeated Schirmer test scores of 2 mm or less. This occlusion is not used for patients with lacrimation after temporary occlusion of only the lower lacrimal point. Constant occlusion is best not to be performed by young patients, since their tear production volume is not constant. This occlusion is performed with a significant expansion of the lacrimal point, burning the mucosa of the proximal edge of the tubule for 1 second. After successful occlusion of the lacrimal point, it is necessary to observe the signs of recanalization. It is important to prevent any complications of an inflammatory nature, such as chronic blepharitis and infection in the occlusion area.
Other options for treating dry eyes
Locally, 0.05% cyclosporin is used, 0.1% is a safe, well tolerated and effective drug that reduces the inflammatory effects of tear tissue at the cellular level.
Systemic administration of cholinergic drugs like pilocarpine (salagan) is quite effective in treating dry eyes. In 40% of patients with dry eyes, a positive effect is observed.