Lacrimal Disorders Disease

BASICS

DESCRIPTION

Lacrimal disorders refer to diseases and abnormalities of tear production and tear film. The most common lacrimal disorder is "dry eye." Lacrimal duct disorders, seen in the pediatric age group, often result in "overflow" tearing.

System(s) affected: Skin/Exocrine
Genetics: None
Incidence/Prevalence in USA: Very common and more often seen in arid climates of the desert Southwest
Predominant age: Dry eye symptoms increase with age. Most common in the elderly.
Predominant sex: Female > Male

SIGNS AND SYMPTOMS

Gritty sensation to the eyes
Visual blurring
Redness
Excessive tearing and mucus production
Inadequate tears on the ocular surface

CAUSES

Poor tear production and/or rapid evaporation of the tears

RISK FACTORS

Individuals who live in arid regions, are on diuretics or have a history of collagen vascular diseases such as rheumatoid arthritis, Sjögren's syndrome, Bell's palsy, eyelid abnormalities and thyroid disease, are most at risk.

DIAGNOSIS

LABORATORY

Tear production can be measured using a Schirmer's filter strip after instillation of topical anesthetic. Wetting of less than 10 mm of the slip after 5 minutes is indicative of insufficient tear production.

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

In Sjögren's syndrome infiltration of the lacrimal gland with inflammatory cells may be evident

SPECIAL TESTS

N/A

IMAGING

None

DIAGNOSTIC PROCEDURES

Staining of the ocular surface with fluorescein will show areas of abnormal uptake and patches of drying. Rose bengal will be taken up by dead or dying epithelial cells and may be a more sensitive test.

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Those with systemic illnesses predisposed to dry eye should be informed and instructed in the appropriate use of artificial tear supplements
Cool mist vaporizer and home humidification is helpful

SURGICAL MEASURES

N/A

ACTIVITY

No restrictions

DIET

No special diet

PATIENT EDUCATION

All individuals with systemic illnesses predisposed to dry eye, menopausal women, and those residing in arid climates or over the age of 60 should be instructed in the use of artificial tear supplements to combat dry eye symptoms

FOLLOW UP

PREVENTION/AVOIDANCE

Prevent exposure to eye irritants from pollution, cigarette smoke, and sun exposure
Ensure adequate vitamin A intake in the diet or as a supplement

POSSIBLE COMPLICATIONS

Severe dry eye can lead to corneal break-down, secondary invasion by bacteria and eye infections

EXPECTED COURSE AND PROGNOSIS

Lacrimal disorders can be adequately managed with artificial tear supplements. Blocked tear ducts can be managed with probing and punctal dilation and/or dacryocystorhinostomy procedures in more severe cases.

MISCELLANEOUS

ASSOCIATED CONDITIONS

Sjögren's syndrome and age-related factors more commonly seen in the elderly population

AGE-RELATED FACTORS

Pediatric: May find lacrimal duct blockage in infants
Geriatric: Most common in this age group
Others: N/A

PREGNANCY

Dry eyes can frequently be associated with pregnancy in an otherwise healthy individual. Vitamin A intake should not exceed 6000 IU a day.

OTHER NOTES

Symptoms of dry eye are most often overlooked by practitioners when considering conjunctivitis (pink eye) and allergic disorders

ABBREVIATIONS

N/A

Clinical Investigations

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