The clinical presentation of keratoconjunctivitis sicca (more commonly known as "dry eye") stems from an excessive evaporation of tears and/or their deficiency [1] [2]. This condition is a relatively frequent disorder in general practice, particularly in the elderly population, with the most common complaints being a burning, stinging, foreign body sensation, as well as pruritus and photophobia [1] [2] [3] [4]. Keratoconjunctivitis sicca has shown to significantly affect the quality of life due to its overall effect on vision [2] [5]. Driving could be problematic, reading speed is frequently markedly reduced, while looking at the computer screen can be quite disturbing and unpleasant [2] [5]. In fact, anxiety and depression were shown to be much more frequent among patients suffering from dry eyes compared to disease-free individuals [2] [5] [6]. Aside from present complaints, keratoconjunctivitis sicca predisposes individuals to numerous complications. Scarring, ulceration, and even perforation of the cornea, bacterial keratitis (an infection with the potential to cause blindness), post-procedural complications from eye surgeries, blepharitis, meibomitis, and conjunctival pathologies have all been reported [1] [2].

• Lymphedema

  Intrinsic causes Meibomian gland disease may involve a reduced number of functioning glands, as in congenital deficiency or acquired meibomian gland dysfunction, or complete gland replacement, as in distichiasis, lymphedema-distichiasis syndrome, or metaplasia [emedicine.medscape.com]

• Camping

  IL-2 also binds to the delta opioid receptor and inhibits cAMP production and neuronal function. This loss of neuronal function diminishes normal neuronal tone, leading to sensory isolation of the lacrimal gland and eventual atrophy. [emedicine.medscape.com]

• Dry Eyes

  Dry eye disease may be subdivided into 2 main types as follows: Dry eye disease unassociated with SS (non-SS KCS) Dry eye disease can also be subdivided into pure aqueous deficiency dry eye and evaporative dry eye. [3] Eighty-six percent of patients with [emedicine.medscape.com]

• Lacrimation

  Aplasia of the lacrimal and salivary glands may present with symptoms of congenital lacrimal obstruction, and failure to make an early diagnosis will result in inappropriate lacrimal surgery and dry eye. [ncbi.nlm.nih.gov]

  Eye tear system anatomy, (Description) a. tear gland / lacrimal gland, b. superior lacrimal punctum, c. superior lacrimal canal, d. tear sac / lacrimal sac, e. inferior lacrimal punctum, f. inferior lacrimal canal, g. nasolacrimal canal. [emedicine.medscape.com]

• Blurred Vision

  Even with the most severe dry eyes, it is rare that vision is lost. However, people sometimes feel that their blurred vision or eye irritation is so severe, frequent, and prolonged that it is difficult to function normally. [merck.com]

  Q: Should I be worried about blurred vision as a result of keratoconjunctivitis sicca? A: Temporarily blurred vision can be a symptom of keratoconjunctivitis sicca. Although an inconvenience, it can usually be managed through treatment. [ada.com]

  The patients were interviewed regarding the 5 major KCS symptoms, foreign body sensation, dry eye sensation, photophobia, ocular pain, and blurred vision, with each graded from none (0) to very severe (4). [ncbi.nlm.nih.gov]

• Foreign Body Sensation

  The patients were interviewed regarding the 5 major KCS symptoms, foreign body sensation, dry eye sensation, photophobia, ocular pain, and blurred vision, with each graded from none (0) to very severe (4). [ncbi.nlm.nih.gov]

  Impaired vision, erythema, photophobia, pruritus, and sensations of stinging or as if a foreign body is present are notable signs and symptoms reported in patients with this condition. [symptoma.com]

  Clinical features: Symptoms: Foreign body sensation, itching, burning and moderate conjunctival redness Decreased vision, pain and photophobia usually occur in advanced cases Exacerbated by wind, blinking or prolonged reading. [columbiaeye.org]

  They may complain of a dry sensation or of a foreign body sensation of the eyes. The conjunctiva is hyperemic, and thick strands of mucus may cover the eye. [sideeffects.embl.de]

  Symptoms Dryness Burning Light sensitivity Foreign body sensation Ocular pain Blurred vision Visual fatigue Discomfort Risk Factors The prevalence of dry eye increases with age and is far more common in women. [quidel.com]

• Excessive Tearing

  "You may experience excessive tearing the same way you would if something got in your eye." But these tears won't necessarily make the eyes feel better. [web.archive.org]

  If high-quality tears are not produced at a steady rate, the surface of your eyes becomes irritated and your eyes will tear excessively in an attempt to lubricate them. This is why excess tearing can occur from dry eyes. [umkelloggeye.org]

  […] or gritty feeling as if something is in the eye Episodes of excess tears following very dry eye periods A stringy discharge from the eye Pain and redness of the eye Episodes of blurred vision Heavy eyelids Inability to cry when emotionally stressed Uncomfortable [eyecenter.emory.edu]

  […] of the condition has changed over time with the progress of understanding the disease process e.g. – in 1995 the National Eye Institute defined DES as “a disorder of the tear film due to tear deficiency or excessive tear evaporation which causes damage [gpnotebook.co.uk]

Because keratoconjunctivitis sicca may be a constitutive feature of a very large number of diseases, the physician should obtain a detailed patient history and conduct a thorough physical examination in order to determine the underlying etiology. The course of symptoms, their progression, as well as severity must be assessed, whereas the presence of any systemic disease (for example diabetes mellitus), history of drug use (postmenopausal estrogens, tricyclic antidepressants, diuretics, beta-blockers, antihistamines), and recent corneal surgery are some of the factors that might play a crucial role in the pathogenesis [1] [2] [7]. Sjogren's syndrome, however, is one of the most important causes of keratoconjunctivitis sicca and thus appropriate studies need to be carried out [2] [7]. After a detailed inspection of the eye (assessment of blinking rate and the lids being important components), a slit-lamp examination can solidify clinical suspicion [2]. Evaluation of eyelid margins, tear film, and meibomian glands, staining of the ocular surface (with fluorescein), and the Schirmer test are recommended studies [2]. On the other hand, appropriate laboratory studies are equally useful. Both anti-Ro (SSA) and anti-La (SSB) antibodies need to be measured to rule out Sjogren's syndrome and other autoimmune disorders as the cause [2].

• Lymphocytic Infiltrate

  All cases are characterized by progressive lymphocytic (predominantly B and CD4 lymphocytes) infiltration of the lacrimal and salivary glands that leads to disorganization of the normal gland architecture and consequent loss of function. [web.archive.org]

  They also exert potent anti-inflammatory activity through the production of transforming growth factor beta (TGF-β), suppressing lymphocytic infiltration. [emedicine.medscape.com]

• HLA-B8

  Pathophysiology A genetic predisposition in SS-associated dry eye disease exists, as is evidenced by the high prevalence of human leukocyte antigen B8 (HLA-B8) haplotype in these patients. [emedicine.medscape.com]

[…] compared to those of pre-treatment. [ncbi.nlm.nih.gov]

370.33, 710.2 DiseasesDB 12155 MeSH D007638 Keratoconjunctivitis sicca Microchapters Home Overview Pathophysiology Causes Differentiating Keratoconjunctivitis sicca from other Diseases Epidemiology and Demographics Natural History, Complications and Prognosis [wikidoc.org]

We also wished to determine the incidence of the various manifestations of Sjögren's syndrome among patients with keratoconjunctivitis sicca and to study the course and prognosis of both conditions. [jamanetwork.com]

Levels of activated CD8+ T cells could be used as a prognosis marker of inflammatory disease manifestation to follow-up AS individuals. [ncbi.nlm.nih.gov]

Expectations (prognosis) Return to top Most patients with dry eye have only discomfort, and no vision loss. With severe cases, the cornea (clear window on the front of the eye) may become damaged or infected. [web.archive.org]

Keratoconjunctivitis sicca is one of the terms denoting dry eye disease, which can be seen in a myriad of conditions of different etiologies. [symptoma.com]

Third, certain DED etiologies involve multiple mechanisms. [ajmc.com]

Material and Methods: 94 adult patients were treated for follicular conjunctivitis with symptoms of KCS with possible Chlamydia pneumoniae etiology. [eurekaselect.com]

PURPOSE: Herpesvirus infection of the lacrimal gland was investigated as an etiologic factor for keratoconjunctivitis sicca in patients who were positive for human immunodeficiency virus (HIV). [ncbi.nlm.nih.gov]

Tom Lietman, a Professor in both the Departments of Ophthalmology and Epidemiology and Biostatistics at UCSF. Dr. [grantome.com]

[…] click here Keratoconjunctivitis sicca ICD-10 H19.3, M35.0 ICD-9 370.33, 710.2 DiseasesDB 12155 MeSH D007638 Keratoconjunctivitis sicca Microchapters Home Overview Pathophysiology Causes Differentiating Keratoconjunctivitis sicca from other Diseases Epidemiology [wikidoc.org]

C lassification / type of disease: Epidemiology : it becomes more common with increasing age. Dry eyes affects about 7 in 100 people in their 50s, and about 15 in 100 people in their 70s. Women are affected more often than men. [mymedicalstudentnotes.com]

The book opens with a review of the epidemiology and the multifactorial etiologies of dry eye disease. [web.archive.org]

Links: epidemiology classification of dry eye disease risk factors for dry eye aetiology clinical features diagnosis screening and diagnostic tests for dry eyes management Ocular Surface Disease Index (OSDI) referral criteria from primary care - dry eyes [gpnotebook.co.uk]

For patient information click here Keratoconjunctivitis sicca ICD-10 H19.3, M35.0 ICD-9 370.33, 710.2 DiseasesDB 12155 MeSH D007638 Keratoconjunctivitis sicca Microchapters Home Overview Pathophysiology Causes Differentiating Keratoconjunctivitis sicca [wikidoc.org]

For KCS and other forms of dry eye, current treatments are limited, with many medications providing only symptomatic relief rather than targeting the pathophysiology of disease. [ncbi.nlm.nih.gov]

Although recent research has made progress in elucidating DED pathophysiology, currently there are no uniform diagnostic criteria. [ajmc.com]

Pathophysiology : complications can include conjunctivitis, keratitis, corneal ulceration or perforation of globe Transmission Treatment / management: Artificial tears: Eye drops and gels, and are usually good at relieving symptoms. [mymedicalstudentnotes.com]

Pathogenesis Pathophysiology Chronic eyelid inflammation leading to decreased production of aqueous tear film. [vetstream.com]

Prevention It is not possible to prevent keratoconjunctivitis sicca. It is possible to prevent complications of keratoconjunctivitis sicca, such as infections, from developing. [lahey.org]

Prevention Return to top There is no way to prevent keratoconjunctivitis sicca. Complications can be prevented by use of wetting and lubricating drops and ointments. Update Date: 11/1/2004 Updated by: Edward B. [web.archive.org]

About Prevent Blindness Ohio Prevent Blindness Ohio, founded in 1957, is Ohio’s leading volunteer nonprofit public health organization dedicated to prevent blindness and preserve sight. [preventblindness.org]

1. Javadi M-A, Feizi S. Dry Eye Syndrome. J Ophthalmic Vis Res. 2011;6(3):192-198.
2. Messmer EM. The Pathophysiology, Diagnosis, and Treatment of Dry Eye Disease. Dtsch Arztebl Int. 2015;112(5):71-82.
3. Solomon A, Dursun D, Liu Z, Xie Y, Macri A, Pflugfelder SC. Pro- and anti-inflammatory forms of interleukin-1 in the tear fluid and conjunctiva of patients with dry-eye disease. Invest Ophthalmol Vis Sci. 2001;42:2283–2292.
4. Jones DT, Monroy D, Ji Z, Atherton SS, Pflugfelder SC. Sjögren’s syndrome: cytokine and Epstein-Barr viral gene expression within the conjunctival epithelium. Invest Ophthalmol Vis Sci. 1994;35:3493–3504.
5. Miljanovic B, Dana R, Sullivan DA, Schaumberg DA. Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol. 2007;143:409–415.
6. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the beaver dam offspring study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157:799–806.
7. Whitcher JP. The treatment of dry eyes. Br J Ophthalmol. 2004;88(5):603-604.