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]

• Dry Eyes

  Keratoconjunctivitis sicca (dry eye) is dryness of the conjunctiva and cornea. Dry eyes may be due to inadequate tear production (aqueous tear deficient dry eyes). [web.archive.org]

  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

  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]

  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]

  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]

  Keratoconjunctivitis Sicca Symptoms Dry eye symptoms associated with KCS include a pulling sensation, pressure behind the eyes, irritation and or ocular burning sensations, stinging, photophobia, itching, blurred vision, or a constant feeling that something [flei.com]

• 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]

  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 of dry eyes include irritation, burning, itching, a pulling sensation, pressure behind the eye, and grittiness or a feeling as if something is in the eye (foreign body sensation). [merck.com]

  Typical symptoms include intermittent itching; burning; a gritty, pulling, or foreign body sensation; and photosensitivity. [msdmanuals.com]

• Excessive Tearing

  tearing (secondary to reflex secretion) Documenting the history of exacerbating or alleviating factors and a systemic past medical history is important, including history of connective tissue disease, thyroid disease, and rheumatoid arthritis. [web.archive.org]

  This is why excess tearing can occur from dry eyes. Risk Factors Tear production normally decreases as we age. [umkelloggeye.org]

  Some other symptoms of keratoconjunctivitis sicca include: The sensation of a burning, itching, or foreign body in the eye Sensitivity to light Redness or irritation of conjunctiva Excess tearing (poor quality tears) Discomfort with contact lenses Most [winchesterhospital.org]

• Prostatic Disease

  Patients on antiandrogenic therapy for prostate disease also have increased viscosity of meibum, decreased tear breakup time (TBUT), and increased tear film debris, all of which indicate a deficient or abnormal tear film. [emedicine.medscape.com]

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].

• Liver Biopsy

  In patients with KCS a higher staging score was noted in liver biopsy compared to those without KCS (4.50 /- 1.65 vs 3.06 /- 1.88, p 0.005). CONCLUSION: Greek patients with chronic HCV infection have a high prevalence of KCS (36.6%). [ncbi.nlm.nih.gov]

• 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]

• HLA-DR4

  There was no significant association of HLA-DR4, Pi phenotype and KCS with bronchial reactivity. We conclude that there is no overall significant association of HLA-DR4, Pi phenotype and KCS with airflow obstruction and bronchial reactivity in RA. [ncbi.nlm.nih.gov]

[…] 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]

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]

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]

THURSDAY, 14 JUNE 2018 Rheumatoid arthritis – prognosis, predictors and outcome THU0127 The severity of keratoconjunctivitis sicca in rheumatoid arthritis correlates with the medical outcome study 36-item short form health survey (SF-36) score but not [ard.bmj.com]

This similarity suggests an etiological association between the sclerosing peritonitis of this case and that caused by practolol. [ncbi.nlm.nih.gov]

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

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]

Dry Eye or Keratoconjunctivitis sicca syndrome (KCS or dry eye) is a problem of major epidemiologic importance. [uveitis.org]

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

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]

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]

Pathophysiology The tear film is constituted by 3 layers, as follows: (1) a lipid layer (0.11 µm thick), produced by the Meibomian glands; (2) an aqueous layer (7.0 µm thick), produced by the main and accessory lacrimal glands of Krause and Wolfring; [web.archive.org]

Anticipation of this problem can prevent it, but lack of recognition may result in permanent central scarring from ulceration, which responds slowly to treatment. [ncbi.nlm.nih.gov]

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

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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.
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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.