Wills Eye Institute 5-Minute Ophthalmology Consult Dellen Robert Eyck Fintelmann Note: Large images and tables

on this page may necessitate printing in landscape mode.

Description Small, saucer-like excavation at the corneal margin Most often form an ellipse; 2 1.5 mm parallel to the limbus Associated with adjacent elevation of paralimbal tissue

Epidemiology

Incidence 9% after trabeculectomy [1][C] Up to 19% after muscle surgery [2][C]

Risk Factors Any process causing elevation of the perilimbal tissue

Pathophysiology Localized dehydration of the cornea secondary to a localized break in the precorneal oily tear film layer

Etiology Elevation of paralimbal tissue leads to a change in the tear film probably by affecting lid function

Commonly Associated Conditions Episcleritis Pinguecula Pterygium Subconjunctival injection Glaucoma surgery with creation of a filtering bleb Subconjunctival hemorrhage Limbal malignancy Paralytic lagophthalmus

Wills Eye Institute 5-Minute Ophthalmology Consult Dry Eye Syndrome Melvin I. Roat Note: Large images and tables on this page may necessitate printing in landscape mode.

Description Multifactorial disease characterized by an abnormal tear film that is inadequate to support the health of the ocular surface o o Types Aqueous tear-deficient Evaporative

o o o

Exposure Isolated ocular disease Primary aqueous tear production deficient Secondary aqueous tear production deficient (e.g., surgery, radiation)

o Lacrimal ducts not transporting tears (e.g., chemical injury, mucous membrane pemphigoid, Stevens-Johnson syndrome) o o o Seborrheic blepharitis Meibomian gland dysfunction Primary lagophthalmos

o Secondary abnormal lid closure (e.g., chemosis, conjunctivochalasis, ectropion, post blepharoplasty) o o Eyelid or cheek scar (burn, chemical, thermal, radiation, trauma, surgical) Loss of corneal sensation (e.g., herpes simplex virus, varicella zoster virus) Associated ocular manifestation of a systemic disease Synonym(s). Dry Eyes, Keratoconjunctivitis Sicca, Keratitis Sicca

Epidemiology

Incidence 22% over 10 years

Prevalence 17% of females, 12% of males 8% in subjects <60 years, 19% >80 years

Risk Factors

Age, female Ocular surgery (cataract, corneal transplant, LASIK) Diabetes, contact lens use

Pathophysiology Desiccation of the ocular surface leads to squamous metaplasia with loss of goblet cells, enlargement and increased cytoplasmic/nuclear ratio of superficial epithelial cells, keratinization and secondary inflammation.

Etiology Aqueous tear-deficient

o insufficient volume of tears to keep conjunctiva and cornea moist, relative to the volume of tears lost by evaporation and via puncta Evaporative

o insufficient duration of coating by tears to keep conjunctiva and cornea moist, relative to the speed that tears are lost by evaporation and via the puncta o Exposure insufficient area of the conjunctiva and cornea coated by tears

Commonly Associated Conditions o Aqueous tear-deficient Gland not producing tears Sjgren's syndrome Drugs, (e.g., beta blockers, antihistamine) HIV Graftversushost disease Sarcoidosis

Familial dysautonomia Xerophthalmia o Ducts not transporting tears Mucous membrane pemphigoid Stevens-Johnson syndrome o Insufficient hormonal stimulation Menopause BCP Pregnancy Androgen deficient? o Insufficient neural stimulation Stroke Neurotrophic keratitis Radiation Surgery o o o o o Evaporative Androgen deficient Drugs, for example, Accutane Ectodermal dysplasia Meibomian gland dysfunction associated with acne rosacea Exposure Neurologic Unconscious Parkinson's disease (slow blink rate or incomplete) Seventh nerve palsy; Bell's palsy, acoustic neuroma, surgical, traumatic, congenital (Goldenhar syndrome), CVA

Loss of corneal sensation Radiation Fifth cranial nerve palsy; CVA, Trauma, surgery, tumor

Muscular Botulinum toxin

Endocrine Thyroid (i.e., Grave's disease)