• Keratoconjunctivitis Sicca

    (Keratitis Sicca; Dry Eye Syndrome)

    Definition

    Keratoconjunctivitis is a condition in which the conjunctiva (the membranes on the surface of the eye) become red and inflamed. The most common form of this condition is keratoconjunctivitis sicca. This occurs when the surface of the eye becomes dry due to a lack of quality tears. This dryness in the eye causes mild irritation in some patients, but severe discomfort and even visual problems in others.
    The pain from keratoconjunctivitis sicca can be eased with medical treatment, so it is important to contact your eye doctor if you think you might have this condition.
    Inflamed Conjunctiva
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    Causes

    There are two main reasons that keratoconjunctivitis sicca occurs. The first is that the eye no longer makes enough tears to keep the surface moist, and the front surface of the eye dries out. Alternatively, the eye does make enough tears, but they evaporate too quickly. In this case, the tears produced are of poor quality, not adequately coating the surface of the eye.

    Risk Factors

    Almost anyone can experience this condition; in fact, most of the time, people with keratoconjunctivitis sicca are otherwise healthy. However, the following factors may increase your chance of developing keratoconjunctivitis sicca.
    • Increasing age—The normal production of tears decreases as we age, so it is common for older and elderly patients to have some degree of dryness in their eyes.
    • Some chronic conditions, like rheumatoid arthritis and Sjogren’s syndrome
    • Certain medications which can cause excessive dryness, such as:
      • Diuretics
      • Beta-blockers
      • Antihistamines
    • Though very rare in the US and most developed countries, a deficiency in vitamin A may contribute to the development of keratoconjunctivitis sicca (and other serious eye problems).
    • Laser vision correction surgery, such as LASIK
    • Women have an increased risk of developing dry eyes.

    Symptoms

    The main symptom of keratoconjunctivitis sicca is discomfort in the eye. This soreness can range from mild to severe. Some other symptoms of keratoconjunctivitis sicca include:
    • The sensation of a foreign body in the eye
    • Sensitivity to light (also called photophobia)
    • Scratchiness in the eye
    • Discomfort with contact lenses
    Most cases of keratoconjunctivitis sicca cause only discomfort. However, in severe cases, the dryness in the eye can lead to damage to the cornea. If this occurs, it is possible that vision may be permanently lost.

    Diagnosis

    Most of the time, the diagnosis of keratoconjunctivitis sicca is made by an eye specialist. An ophthalmologist is a physician who specializes in diseases and disorders of the eye. He or she can quickly determine the cause of the discomfort by using specialized equipment to view the surface of the eye.
    These special tests may include:
    • Slit lamp visualization—The ophthalmologist may use a special light called a slit lamp (or biomicroscope) to look at the film of tears on the eye surface. The doctor can tell if there are not enough tears to keep the eye moist.
    • Dye—The ophthalmologist may use a special dye (called fluorescein, rose Bengal, or lissamine green) to evaluate the health of the eye’s front surface.
    • Schirmer’s test for dry eye—This test involves placing a small paper wick near the eyelid to measure the amount of tears that are made by the eye.

    Treatment

    Treatment for keratoconjunctivitis sicca is often simple and very effective. This involves keeping the eye moist and preserving the tears that are made naturally. Treatment methods used for this goal include:
    • Lubricating eye drops—Lubricating eye drops, which are also known as artificial tears, mimic the eyes natural tears. These eye drops are available over-the-counter. They provide relief from the discomfort caused by keratoconjunctivitis sicca and help maintain the natural moistness of the eye.
    • Lubricating ointments—Lubricating ointments are similar to artificial tears, except they have a much thicker consistency and last longer than eye drops. They are used to provide moisture for more severe cases of keratoconjunctivitis sicca; however, because of the thick texture, the drops may cause vision to be blurry after administration. For this reason, they are usually used at night, before bedtime.
    • Punctal plugs—In some cases, it may be helpful to place a tiny plug in the tear drainage ducts on the eyelids. These devices are called punctual plugs, and they help the tears that are produced naturally to remain on the surface of the eye longer. The ophthalmologist can insert the plug in his or her office, a quick and painless procedure. Oftentimes your doctor will try placing temporary plugs to make sure they work well for you before placing permanent ones. However, even permanent ones can be removed if necessary. Your doctor may also choose to permanently close your tear drainage hole with a laser or cautery.
    • Prescription eye drops—Restasis (cyclosporine) eye drops are occasionally used to help your eye make more tears. This is a prescription medication that must be taken twice per day, every day. It usually takes several weeks to months to notice an improvement.
    • Oral nutritional supplements—Some studies support supplementation of omega-3 fatty acids and other nutrients to help patients with dry eyes.

    Prevention

    It is not possible to prevent keratoconjunctivitis sicca; however, it is possible to prevent complications of keratoconjunctivitis sicca—such as infections—from developing. To help reduce your chance that the condition will worsen, take the following steps:
    • Try to avoid excessively dry environments—Furnaces and air conditioning can dry the air, which can evaporate tears too quickly. You may want to use a humidifier, which is a machine that puts moisture back into the air to prevent dry eyes.
    • Dusty and smoky areas can aggravate symptoms—If possible, limit time spent in these areas.
    • Avoid prolonged visual tasks—Staring at a computer screen, driving, watching television, and reading may worsen symptoms.
    • Promptly use artificial tears—This is important to prevent the eye surface from drying out.
    Most cases of keratoconjunctivitis sicca are not serious, and while uncomfortable and irritating, pose no real danger to the eye. However, it is still important to receive evaluation and diagnosis to prevent any of the more dangerous consequences of this condition. As always, a prompt discussion with your doctor is the best prevention of long-term consequences.

    RESOURCES

    The American Academy of Ophthalmology http://www.aao.org

    The American Optometric Association http://www.aoa.org

    CANADIAN RESOURCES

    Canadian Association of Optometrists http://www.opto.ca/

    Canadian Ophthalmological Society http://www.eyesite.ca

    References

    Foulks GN. The evolving treatment of dry eye. Ophthal Clin N Am. 2003;16:23-35.

    Keratoconjunctivitis sicca. The Merck Manual. 2005. Merck website. Available at: http://www.merck.com.mrkshared/mmanual.section8.chapter96/96e.jsp . Accessed August 25, 2005.

    Ophthalmic disorders not associated with systemic disease. In: Goldman L, ed. Cecil Textbook of Medicine. 22nd ed. WB Saunders Company; 2004.

    Red eye. In: Rakel RE, ed. Textbook of Family Practice. 6th ed. WB Saunders Company; 2002.

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