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Eliminating exacerbating factors if present should be considered in all patients with ocular surface disease. Ocular surface irritants have a negative effect on the recovery of the ocular surface. Unnecessary topical medications should be discontinued or systemic alternatives sought.go here
- Cornea and External Eye Disease (Essentials in Ophthalmology) by REINHARD
If drops are needed, preservative-free formulations should be used where possible, especially if more than six drops are required daily. It may also be advisable to avoid using make-up and cosmetics on the eyelids and around the eye. Removal of exacerbating factors is particularly important in certain ocular surface diseases, such as allergic eye disease and Stevens-Johnson Syndrome.
Blepharitis is common and should be controlled to reduce its effects on tear film quality and the ocular surface.
Warm compresses and lid massage mechanically unblocks meibomian glands in posterior lid margin disease. One- to three-month courses of tetracycline class agents, such as doxycycline mg once a day, are often helpful in controlling blepharitis in adults. In children, or in adults where doxycycline is not tolerated, macrolides, such as erythromycin mg twice a day, can be used. They are thought to improve meibomian gland dysfunction by altering their metabolism and secretion. Newer therapies, such as topical azithromycin 1.
Diseases of the eyelid and its adnexae e.
Where appropriate, eyelid surgery should be considered. An overlying physiological tear fluid is essential for a healthy ocular surface. Lubricants not only serve as tear substitutes, they also help to dilute ocular surface irritants and reduce the shearing forces of the eyelids on the corneal epithelium. Many ocular lubricants are available. Some examples include hyaluronate, carmellose, hypromellose, polyvinyl alcohol, and paraffin. Lubricants with lipids or osmoprotectants e. Excess mucous can be treated with N-acetylcysteine drops. Preservative-free lubricants are preferable for treating patients with ocular surface disease.
Excessive use of drops with preservatives that are not diluted by normal tear flow can cause intolerance or ocular surface toxicity and impede ocular surface healing. In aqueous-deficient dry eyes, punctal occlusion can prevent tear drainage and prolong the effects of tear substitutes.
Punctal occlusion may exacerbate symptoms of blepharitis, so this must be treated beforehand. Permanent occlusion can be achieved by using punctal cautery. Parasympathomimetics such as oral pilocarpine can also be useful if tolerated. In more severe disease, autologous serum is beneficial, but this is expensive and not always readily available. Therapeutic contact lenses TCL can be useful in severe dry eye diseases and persistent epithelial defects.
Proposed mechanisms of action include modification of lid-tear-ocular surface interactions, retention of fibrin matrix on the surface of an injured cornea, and retention of tears under rigid lenses. In aqueous tear deficiency, hydrogel TCL should be avoided as the risk of infection is high.
In very dry eyes, soft or silicone hydrogel TCL do not work well as they tighten up and reduce oxygen transmission. Rigid gas-permeable scierai TCL cover the cornea and most of the conjunctiva. This can prevent excessive tear evaporation and protects the ocular surface from abnormal lids. An inflammatory component is seen in almost every form of ocular surface condition. Some clinical features of ocular surface inflammation include pain, conjunctival injection redness , dilatation of conjunctival blood vessels, limbitis, conjunctival swelling chemosis , redness and swelling of the eyelids Figure 3.
Ocular surface inflammation is treatable. Product details Format Hardback pages Dimensions x x 16mm Illustrations note 14 Tables, black and white; Illustrations, color; Illustrations, black and white; XX, p. People who viewed this also viewed. Minimally Invasive Ophthalmic Surgery I. Cornea, 2-Volume Set Edward J. Contact Lens Complications Nathan Efron. Ocular Pathology Myron Yanoff.
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