Dry eye syndrome (Keratoconjunctivitis sicca, wetting disorder of the cornea)

PD Dr. med. Karl-Georg Schmidt


With "dry eye" syndrome, a distinction is made between the "moist dry eye", i.e., the evaporative form (evaporative dry eye) and the form caused by aqueous tear-deficiency (hypovolaemic, aqueous tear-deficient dry eye).

 

In the case of the evaporative form, there is usually damage to certain glands in the area of the eyelid that produce certain components (lipids) for the stabilization of the tear film (Meibomian glands). As a result, the lipid layer of the tear film is altered in such a way that the aqueous portion of the tear fluid evaporates more. With both forms of dry eye there is functional impairment of the tear film, which can lead to increasing chronic inflammation of the eyes.

If the lack of tear secretion or changes in the composition of the lacrimal fluid are not treated, the inflammatory processes intensify and can lead to various medical conditions, damage to tissue and hence to a considerable restriction in quality of life.


Typical symptoms

  • Blurred vision
  • Dazzle
  • Feeling of pressure
  • Burning sensation
  • Reddening
  • Foreign body sensation
  • Pain
  • Eyelid swelling
  • Tired eyes


Typical causes 

  • Contact lenses
  • Screen activity ("office eye syndrome“)
  • Reduced air humidity
  • Allergies
  • Diseases (e.g. rheumatism, rosacea)
  • Hormonal change  (menopause)
  • Drugs (e.g. hormonal contraception – "the Pill", betablockers, antihistamines)


Tests

  • Examination of the eye surface and eyelid edges with the biomicroscope
  • Measurement of tear breakup time (TBUT)
  • Fluorescein test (test for damage to the eye surface)
  • Schirmer’s test (measuring tear secretion in eyes)


Treatment

If you are suffering from the sensation of a foreign body in the eyes, or burning, reddened, dry or extremely watery eyes, you should consult an ophthalmologist. 

It is nowadays assumed that the two main categories of dry eye, namely the evaporative form and the form caused by aqueous tear-deficiency, will develop into a combined form through interactions that occur over time, and may increase the severity of dry eye .
Your subjective feeling is crucial for the therapy, and our goal is always to achieve extensive freedom from symptoms as far as possible.

In our daily practice, a combination therapy consisting of preservative-free tear substitutes, gels, possibly additional ointments and sprays as well as possibly omega 3 fatty acids has proven to be very effective, the surface of the eye is increasingly moistened, and the quality of the tear film increases.

This combination therapy offers the safety necessary for treating both aspects (evaporation and aqueous tear deficiency) adequately. The actual weighting of the products within the therapy is geared to your individual symptoms.

We adapt the respective combination therapy together with you to your specific needs. With that in mind, if your products are also suitable for contact lens wear , the tear substitute should be both phosphate and preservative-free .

Extensive treatments such as blockage of the lacrimal drainage system (e.g. through the insertion of punctal plugs) or local suppression of underlying inflammatory processes (cyclosporin A) are rarely necessary.


What you can do yourself? 

  • Avoid draughts
  • Do not direct fans (e.g. in the car) towards your eyes
  • Avoid smoke-filled rooms
  • Use humidifiers
  • Use non-irritant cosmetic products, and possibly, regularly cleanse the eyelid edge
  • Wear so-called sicca glasses, e.g. for skiing and cycling


Literature

  • Definition und Klassifikation des Trockenen Auges: Bericht des Unterausschusses für Definition und Klassifikation des International Dry Eye WorkShop 2007; 5: 75-92
  • Brewitt H, Rüfer F. Das trockene Auge. Klin Monatsbl Augenheilkd 2004; 221: R51-R70
  • Auw-Hädrich C, Reinhard T. Chronische Blepharitis. Ophthalmologe 2007; 104: 817-828
  • Dausch D, Lee S, Dausch S, Kim JC, Schwert G, Michelson W. Vergleichende Studie zur Therapie des Trockenen Auges bedingt durch Lipidphasenstörungen mit lipidhaltigen Tränenpräparaten. Klin Monatsbl Augenheilkd 2006; 223: 974-983
  • Maus M, Hanneken L. Trockenes Auge nach LASIK – erfolgreiches Management für Therapieerfolg und Patientenzufriedenheit. Ophthalmo-Chirurgie 2007; 19(Suppl. 3): 1-4
  • Lohmann CP, Lindenschmid A, Maier M, Specht H. New topical medication to prevent dry eye. Cataract & Refractive Surgery Today, January/February 2008, (Insert): 1-8
  • Lange W, Ladwig KJ, Reich W. Benetzungsstörungen nach Kataraktoperationen. Z. prakt. Augenheilkd. 29 (Suppl. 3): 1 – 8 (2008)
  • Künzel P. Die Behandlung des kontaktlinsenbedingten Trockenen Auges. Kontaktlinse 2008; 41 (10): 4-10
  • Khaireddin R, Schmidt KG. Vergleichende Untersuchung zur Therapie des evaporativen trockenen Auges. Klin Monatsbl Augenheilkd. 2009 Sep 15.
  • Lakomy U, Ruob C, Hersberger K, Beutler M. Gesucht – das beste Tränenersatzmittel. Schweizer Apothekerzeitung, 13/2006: 509-515

Squint (strabismus)

What is a squint?
A squint (strabismus) refers to a permanent or recurring malposition of one or both eyes. Both eyes look in different directions.

Strabismus can occur in all directions, or can also be combined: internal misalignment (esotropia), external misalignment (exotropia) and vertical misalignment (hypertropia).

Strabismus is not just a beauty problem, but can lead to severe vision impairment without treatment. A squint leads to your child using only one of their two eyes actively to see. As a result, visual acuity in the squinting eye cannot develop and produces a visual weakness. The technical term for this is amblyopia. If amblyopia in childhood is not recognised and treated in time, it will last for a lifetime. Amblyopia prevents proper binocular vision (three-dimensional vision), the danger of an accident increases and there is a narrowing of the choice of profession.

Maturation of visual acuity and coordination of the eyes develop enormously in the first months of life, but are still more susceptible to disorders up to the age of about 8 years and complete maturation only occurs with the completion of puberty.

For a more successful treatment of childhood visual impairment, early detection is particularly important! The sooner the visual impairment is discovered and treated, the better the chances of achieving a full visual acuity and permanent damage can be treated more successfully (possible as early as the sixth month of life).

Hence, the specialist communities of ophthalmologists and orthoptists advise having screening in the first, third to fourth and sixth years of life, even if there are no abnormalities.


Forms of strabismus
A manifest, i.e. permanently present and frequently congenital squint or squint emerging in the first months of life does not allow any or only a small amount of coordination of the eyes.

In addition to the obvious squint, there is still the hidden (latent) squint that can also occur in all directions, but usually allows good binocular coordination. Around 80% of all people have this latent squint and it usually causes no symptoms. If the latent squint affects binocular coordination too much, symptoms may develop which can and should be examined and treated by an ophthalmologist and orthoptist.

A particular form and especially important form of strabismus is so-called microstrabismus. In this case, the squint angle is so small that it cannot be seen with the naked eye. Hence, any visual impairment from this squint form is usually only discovered late.


The following observations suggest a deviation from the normal development of the eye and should be investigated without fail:


  • Squint from the 6th month of life (a squint NEVER disappears in time)
  • Nystagmus
  • Tilting of the head
  • Missing the mark
  • Clumsiness (stumbling, bumping into things)
  • “Reading down the nose”
  • Reluctance to read
  • Reading disorders
  • Frequent blinking, winking, squinting
  • Concentration problems
  • Double vision
  • Headache
  • Stinging eyes
  • Often reddened eyes 
  • Watery eyes
  • Blurred vision


Does my baby squint? 

In the first few weeks of life up to the third month of life, squinting in infants is often observed, since the eye movements are not yet sufficiently coordinated. Conspicuous squinting after the third month of life should be investigated by an ophthalmologist and orthoptist. 

Often it is "pseudostrabism". Because of the still childlike wide and flat bridge of the nose, the impression of a squint is produced with only a slight glance to the side. Here too, an ophthalmological examination can exclude actual squinting.


Treatment for a squint

Firstly, a detailed examination by an ophthalmologist and orthoptist is carried out to determine the type, size and cause of the squint or visual impairment. Objective determination of the refractive power of the eye (farsightedness, myopia or astigmatism) by means of harmless eye drops is indispensable for this examination. Depending on the findings of this examination, glasses may be prescribed.


My child has been prescribed a pair of glasses

How to choose children's eyewear.

Most important is a comfortable but firm fit. These include sports eyewear side pieces, a soft silicon nose bridge and plastic glasses.

Manufacturing such spectacles places high demands on the optician trade. Be well-advised. Let your child choose his own glasses. We have particularly experienced opticians available at Augenzentrum Höfe.


Promote a positive attitude to glasses!

Will your child accept the glasses?

In most cases, children accept their new glasses quite well after an initial phase of accustomisation. However, getting accustomed to a new pair of glasses can take up to four to six weeks. 


Occlusion treatment

An already existing visual impairment (amblyopia) requires occlusion treatment, which can take several years. The non-squinting, better-seeing eye is usually provided with an eye patch or covering over the glasses.

Successful treatment is essentially dependent on good and trusting cooperation between patient, parents, ophthalmologist, orthoptist and optician! There is an experienced and coordinated team available at Augenzentrum Höfe for you and your child.

 Amblyopia

Amblyopia denotes visual impairment in one eye (rare in both eyes), which arises due to under-development of the visual system in early childhood. Amblyopia is usually combined with defective vision (long or short-sightedness, or corneal curvature (astigmatism)).

Defective vision can be compensated for with optical correction (glasses or contact lenses). In the case of amblyopia, the visual impairment remains even with optimally adjusted glasses or the corresponding contact lenses.

If, therefore, only defective vision exists (without amblyopia), the visual defect can be corrected with the appropriate glasses and / or contact lenses.

The main symptom of amblyopia is a reduction in visual acuity on one or both sides. In addition to the worsening of central acuity, so-called “separation difficulties” occur, which can lead to considerable problems in reading. In addition, spatial vision impairment may occur.


The most common risk factors for amblyopia are:

  • Squint
  • Differing defective vision
  • Famililal frequency 
  • Eyelid anomalies
  • Opacity of the lens and / or cornea as well as
  • Premature birth

Amblyopia usually develops in the early childhood development phase (between birth and 3rd + 4th year of life). The earlier amblyopia occurs, the more extreme it can be. 

Certain forms of amblyopia can also occur later in childhood (late amblyopia). From the age of 13, the risk of amblyopia tends towards zero.

Subsequently acquired visual loss (e.g., toxic changes in the optic nerve through alcohol or smoking) is not amblyopia, since the underlying cause here is optic nerve damage. 

Orthoptists make a diagnosis of amblyopia with the following tests:

  • Sight test
  • Squint test
  • Stereo test
  • Tests for defective vision

Examination of the anterior and posterior segments of the eye with respect to lens opacity and / or retinal disease by our ophthalmologists completes the medical clarification. Typical signs indicating possible amblyopia during examination of small children are:

  • intense defensive movements when the healthy eye is kept closed
  • frequent rubbing of the eye or squinting of the diseased eye

The earlier amblyopia is detected, the better the prognosis for successful treatment. Basically, functional visual impairments, which develop during the first years of life and are not discovered and treated early, generally can no longer be cured with the onset of puberty. For this reason, a routine check-up is recommended during special consultations.


The aim of treatment is to restore normal visual acuity. The first step in the treatment (in the event of additional defective vision) is correction of the existing refractive errors with a pair of glasses and / or contact lenses. If there is still a difference in vision, a diagnosis of amblyopia is confirmed. The next step in the treatment consists of stimulating the diseased eye to see with auxiliary measures. In this respect, depending on the severity of amblyopia, an eye patch (foil) is worn on the healthy eye for a few hours a day. During this so-called occlusion (wearing of an eye patch) the diseased eye is forced to see. Hence, the visual acuity can gradually develop and become normal visual acuity. The duration of treatment of this kind depends on the severity of the amblyopia, the organic causes and last but not least, the cooperation of the child and its parents. 


However, it is not uncommon for a promising therapy to take up to the age of 12 or 13 years.