Slow-release artificial tear inserts in the treatment of dry eyes resulting from the oculomucocutaneous syndrome

Relationship of Symptomatology with Closed Chamber Infrared Thermometry and Humidity in Dry Eyes

Purpose

To evaluate the relationship of symptoms of dry eye with closed chamber infrared thermometry and humidity measurements.

Methods

The authors studied 54 patients (108 eyes) with dry eye disorders of different grades of clinical severity (mean age 35.75±14.37 years), 31 cases (62 eyes) with normal eyes (mean age 33.68±14.42 years), and 10 cases (20 eyes) with epidemic conjunctivitis (mean age 33.68±14.42 years). The symptoms and the clinical tests (Schirmer-1 test, fluorescein tear break up time, Lissamine green stain; closed chamber infrared thermometry and humidity) were used to establish the diagnosis of dry eyes. The closed chamber humidity difference was used to classify the groups of dry eye.

Results

The authors noted no temperature difference from closed to open eye position in dry eyes as compared to 0.10±0.00 °C difference in normal eyes and epidemic conjunctivitis. Four groups of cases were identified by difference in values of humidity: Group 1 = <0.9 relative humidity (RH)% to 1 RH%; Group 2 = >1 RH% to 1.5 RH%; Group 3 = >1.5 RH% to 2 RH %; and Group 4 = >2 RH%. The symptomatology was measured in the eyes using Oxford scale (0–4) and correlated with the humidity groups. The grading of symptoms with the humidity showed a statistically significant relationship (p<0.0001) in each group. The severity of the symptoms showed an increase in frequency and severity from Group 1 to Group 4, which was statistically significant (p<0.0001). The mean sum total of global symptomatology score was statistically significant (p<0.0001): 3.43±0.31 in Group 1, 4.65±0.42 in Group 2, 8.56±0.78 in Group 3, and 13.35±1.21 in Group 4. However, total symptomatology score in epidemic conjunctivitis did not show a statistically significant value (p=0.20).

Conclusions

The closed chamber humidity and thermometry measurements showed statistical correlation in all four groups of dry eyes to total mean symptomatology score (p<0.001) and showed an increase in value with increasing severity of symptoms. However, all individual symptoms fail to show any conclusive relationship.

Management of conjunctival cicatrizing diseases and severe ocular surface dysfunction

Physical or chemical injuries, infections, immunologic oculocutaneous disorders, drugs, and various systemic disorders may cause scarring of the conjunctiva and disturbances of the ocular surface. Trichiasis, lid margin malposition, and dry eye may result in persistent ocular irritation. The cornea may be primarily or secondarily involved. If severe, disturbances of the ocular surface may lead to significant visual impairment. Thorough evaluation of patients and of the underlying disease process is required for optimal management. Treatment may be challenging and should be comprehensive, combining medical measures and surgical correction of structural changes. Suppression of exogenous irritants, treatment of dry eye, antiinflammatory therapy, and immunosuppressants are paramount to control the underlying disease and allow optimal surgical results. Surgical correction of trichiasis and lid margin malposition, conjunctival grafting, mucous membrane transplantation, limbal stem cell transplantation, amniotic membrane transplantation, and penetrating keratoplasty help reestablish a physiologic ocular surface. Severe cases may require keratoprosthetics for visual rehabilitation. Corneal ulceration or perforation requires prompt attention to maintain ocular integrity. Special measures should be considered for patients who require cataract or glaucoma surgery.

Slow-release artificial tear inserts in the treatment of dry eyes in patients with rheumatoid arthritis

Twenty-two patients with rheumatoid arthritis and moderate to severe bilateral keratoconjunctivitis sicca were treated with artificial tears and a soluble slow-release artificial tear insert in a crossover trial. While using the inserts all but two patients reported an improvement in their symptoms. All the patients showed an improvement in the degree of conjunctival and corneal staining while using the inserts (p = 0.0001 and 0.00001 respectively). Nineteen patients (86%) found the inserts an acceptable form of therapy and 14 (64%) preferred them to other treatment regimens. Placement of the insert was not a problem despite all the patients having rheumatoid changes in their hands resulting in varying degrees of deformity. Two patients experienced initial difficulties with placement, but these were quickly resolved.