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DRY EYE SYNDROME IN KERATOCONUS PATIENTS
World KeratoconusCongress
Guilherme Ferrara
Introduction
Changes on the ocular surface• High keratometric values• Scratching & Atopy• Contact lens• Corneal sensation / Innervation
Changes in tears Inflammation
Dry eye syndrome & Keratoconus
Introduction
Changes on the ocular surface• High keratometric values• Scratching & Atopy• Contact lens• Corneal sensation / Innervation
Changes in tears Inflammation
Dry eye syndrome & Keratoconus
Break up Time
0 seconds 1 second 2 seconds 3 seconds
6 seconds4 seconds 5 seconds 16 seconds
Must be higher than blink frequency.
Introduction
Changes on the ocular surface• High keratometric values• Scratching & Atopy• Contact lens• Corneal sensation / Innervation
Changes in tears Inflammation
Dry eye syndrome & Keratoconus
Introduction
Changes on the ocular surface• High keratometric values• Scratching & Atopy• Contact lens• Corneal sensation / Inervation
Changes in tears Inflamation
Dry eye syndrome & Keratoconus
Blepharitis and Contact LensEvaporative Dry Eye
Dry eye syndrome & Keratoconus
Introduction
Changes on the ocular surface• High keratometric values• Scratching & Atopy• Contact lens• Corneal sensation / Inervation
Changes in tears Inflamation
Dry eye syndrome & Keratoconus
Cornea and Conjunctiva staining
Dry eye syndrome & Keratoconus
303 mOsm/l 368 mOsm /l368 mOsm /l
tratamiento
Lipid component: Osmolarity
368 mOsm /l
303 mOsm /l
Hiperosmolarity
Dry eye syndrome & Keratoconus
Lachrymal Functional Unit
Innervation
AferenteEferente ParasimpáticoEferente Simpático
Dry eye syndrome & Keratoconus
Schaumberg DA et al. Development and Validation of a Short Global Dry Eye Symptom IndexThe Ocular Surface 2007;5:50-57
1. Frecuencia de los síntomas: Por favor, ponga una X en la línea para indicar lo frecuente que normalmente siente sus ojos secos y / o irritados
Raramente _______________________________________Siempre
2. Gravedad de los síntomas: Por favor, ponga una X en la línea para indicar la gravedad que normalmente siente sus ojos secos y / o irritados
Muy leve_______________________________________Muy Grave
PsicometríaEscala Visual Analógica
SANDE: Symptom Assessment iN Dry Eye
Dry eye syndrome & Keratoconus
Dry eye syndrome & Keratoconus
Schaumberg DA et al. Development and Validation of a Short Global Dry Eye Symptom IndexThe Ocular Surface 2007;5:50-57
PsicometríaEscala Visual Analógica
1. Frecuencia de los síntomas: Por favor, ponga una X en la línea para indicar lo frecuente que normalmente siente sus ojos secos y / o irritados comparado con su visita de hace dos meses
Raramente _______________________________________Siempre
Ultima visita
2. Gravedad de los síntomas: Por favor, ponga una X en la línea para indicar la gravedad que normalmente siente sus ojos secos y / o irritados comparado con su visita de hace dos meses
Muy leve_______________________________________Muy Grave
Ultima Visita
Treatment
Avoid risk factors
Scratch
Contact lens Hygiene
Preventive treatment
Education of the patient
Avoid tear evaporation
Anti-inflammatory if evidence of inflammation
Dry eye syndrome & Keratoconus
Multidisciplinary approach. Multiple and Protracted
Treatment
Intra corneal ring segments
Improvement of keratometry
Reduction of dry eye symptoms
Reduction of scratch
Reduction of use of the contact lens
Dry eye syndrome & Keratoconus
Conclusions
• Keratoconus patients are more susceptible to develop a dry eye syndrome
• BUT & mucus thin layer healthy are good markers of a normal function of the epithelium of the ocular surface.
• Treatment Protocol of DES in Keratoconus patients.
Dry eye syndrome & Keratoconus
Thank you
