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The animated image shows how basic functional complexes maintain eye health and how their disruption leads to the development of dry eyes. At the same time, the understanding of the origin of the disease gives rise to approaches for successful therapy.
=> go directly to Disease Factors and Therapy Selection
Once an adequate diagnostic examination has been performed, the eye doctor may consider various dry eye treatment options.
For this purpose, it is useful to have a brief overview of the normal function of the ocular surface, the basic causative factors and the risk factors for the development of dry eye. This is shown in an animated figure.
The disease factors that are relevant in an individual patient determine the most promising treatment options for this respective patient.
Therapy-Options
The figure shows the relationship between the disease factors that are important for the following selection of different therapeutic approaches.
=> HERE you will find information on a appropriate steps of a staggered therapy for dry eyes according to severity.
TREATMENT / THERAPY
for Dry Eye Disease … Interactive Scheme to ´Click´
Overview of important disease factors and respective therapy options
For a better overview, it can be useful to set the screen of a smartphone to "desktop mode” (usually accessible via the 3 dots in the upper right corner of the browser) - otherwise the therapy options and their explanation are simply displayed one below the other.
The order of the disease factors and the resulting therapy options correspond to the previous summarizing illustration.
The nervous system regulates the function of the ocular surface. To do so, it perceives various stimuli from the surface of the eye.
If the stimuli become too strong and too frequent, a feeling of unpleasant irritation and pain develops. This can progress into a chronic pain syndrome in dry eye disease after a longer period of illness. The feeling pain can persist even when the objective signs of the disease itself are significantly improved. The treatment of a chronic pain syndrome is a challenge for both patient and eye doctor.
These are mainly desiccating environmental factors. They damage the tear film on the eye and thus lead to wetting disorders with subsequent tissue damage, which causes typical symptoms of dry eye disease.
The most common external risk factors can be improved by a few simple changes in life circumstances and working environment, as far as possible.
Disorders of the eyelids and disorders in the regulation of the eyelid stroke/ blink (that must be complete and sufficiently frequent) lead to damage to the eye surface and a feeling of dryness even when tears may be present in sufficient quantity and quality.
Changes in the shape and position of the eyelids are relatively easy to detect and, if necessary, can be improved by surgery.
Disturbances in the nerve regulation of the eyelid are more difficult to detect. They require more complex diagnostics and may be more difficult to treat effectively.
These are mainly desiccating environmental factors. They damage the tear film on the eye and thus lead to wetting disorders with subsequent tissue damage, which causes typical symptoms of dry eye.
The most common external risk factors can be improved by a few simple changes in life circumstances and working environment, as far as possible.
Lacrimal gland disorder
Severe aqueous tear deficiency is generally rare and typically occurs when the lacrimal gland is disturbed, usually by inflammation. This can occur e.g. due to irradiation, after bone marrow transplantation (graft-versus-host disease) or in Sjögren's Syndrome. Lacrimal gland failure often leads to severe dry eye disease and requires intensive therapy.
Milder aqueous deficiency is thought to arise due to damage of the ocular surface nerves by tissue damage in dry eye disease.
Tear film deficiency (in quantity and/or quality)
A disturbance of the thin tear film on the eye is usually the typical pathology in dry eyes. A precise diagnosis of the pathophysiology is useful. Tear supplements are the backbone of any dry eye therapy and are offered in different compositions for different types of the disorder.
Lipid deficiency due to Meibomian gland dysfunction (MGD)
Lipid deficiency due to Meibomian gland dysfunction (MGD)
Lipid deficiency is considered the most common cause of dry eye. In addition to aqueous tear substitutes, a supplementation of the oil layer is indicated. A blockage of the meibom oil glands in the eyelids requires an eyelid therapy. This can be done as a basic therapy at home or more effectively and with the help of equipment at the ophthalmologist.
Internal risk factors
They damage the tissue that produces the tears (glands) or the surface tissue to which the tears must adhere.
Chronic damage to the ocular surface
leads to a subsequent inflammation, which can intensify itself. This often requires specific anti-inflammatory therapy by the ophthalmologist to break the harmful vicious circles of self-aggravation and thus effectively improve dry eye.
Internal risk factors
They damage the tissue that produces the tears (glands) or the surface tissue to which the tears must adhere.
Disorders of the regulatory systems
Disorders of the regulatory systems (nervous, hormonal and immune systems) cause complex disorders of tissue function. This is often caused by age, gender, general illnesses or medication. The diagnosis requires a thorough medical examination and is often difficult to treat.
=> HERE is more information about steps of the staggered therapy for dry eye disease according to the grade of severity.