One of the most frequent causes of eye discomfort at present, (such as tearing, ocular hyperemia, irritative conjunctivitis … etc) is the evaporative dry eye by use of computer screens. Also due to associated autoimmune pathologies (such as Rheumatoid Arthritis), other local causes such as meibomian gland dysfunction, (in which there is a poor quality of the tear film), and after cosmetic surgical procedures such as Blepharoplasty, or for alteration of the eyelid position due to age (ectropion or entropion), or trauma. All this implies the typical symptom of dry eye, in which the eyes itch, cry and have a gritty sensation.
When the dryness is mild, a simple lubrication with artificial tears can improve it. There are multiple types of drops on the market, more or less viscous, in which Hyaluronic acid is the main component, and most of them without preservatives to avoid toxicity in the ocular surface due to its use.
Artificial tears are usually sufficient treatment for most patients, leaving the most liquid for use during the day, and those vehiculized in paraffin for night use for more severe dry eyes.
For patients with chronic blepharitis, there are tears with a fatty component in their specific composition for these cases.
The correct choice of artificial tear, as well as not being exposed to environments heated by heating or chimneys, air conditioning in summer or smoking environments are really useful measures to avoid it. It can be beneficial to use humidifiers in the room we are in, also remember to blink when we use the computer or do other close visual activities such as sewing or making crafts.
When ocular lubrication is not enough, the patient may suffer corneal lesions due to exposure or poor epithelialization, increasing discomfort and severity of symptoms. For them, we currently have other therapeutic measures such as:
1.-Unperforated tear plugs, to prevent the reduced amount of tear generated by the tear gland from disappearing through the inferior tear hole.
2.-Soft corticosteroids without preservatives, which contribute, applied several times a day for two or three weeks, to improve the associated inflammatory component to most chronic dry eyes.
3.-Ciclosporina collyrium as a more advanced measure to improve the inflammatory component especially when it is associated with disorders of the immune system.
4.-Patients with keratitis or corneal epithelial lesions resistant to the usual measures, very good results are obtained using eye drops generated from our own blood. For this, the blood extraction unit must be coordinated with the Hematology unit and the Hospital Pharmacy unit. Then it must be processed, centrifuged and treated the patient’s blood elements and extract the plasma or platelet growth factors, which improve the repetition of surface lesions.
These are the eye drops of autologous serum and platelet-enriched plasma. From the cells of our own body the healing of damaged eye areas is favored.
5.-If despite these measures the corneal defect persists, it is possible to apply eye drops for the regeneration and enhancement of healing such as Cacicol, before assessing the possibility of surgery.
6.- And finally, «Prokera», the first lyophilized sclera that can be implanted in consultation without the need for surgery, to protect the damaged corneas and at risk of ocular perforation, regenerate and cure has recently come to market.
7.-If finally it is not enough with all these measures mentioned above, we have an amniotic membrane transplant, on the damaged area, providing regenerative and protective nutrients.
8.- In summary, total or partial corneal transplants can be performed, especially for patients who have residual corneal or Leukopha ciacute residues, and that cause decreased vision, or for patients who have sectoral corneal thinning that are at risk of ocular perforation (the number of techniques in this subspecialty has been greatly expanded in recent years). In conclusion, the dry eye can be a simple or extremely complex pathology, with the need for a large therapeutic warehouse. The advantage is that in recent years there has been a great advance in technological research in this specialty. And today, ophthalmologists can apply treatments that were not available only a few years ago.
Dra.Gloria Carretero león. Ophthalmic and Eyelid Surgery Marbella
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