[Therapy of dry eye disorders].

Abstract

The treatment of dry eyes with artificial tears often fails. We differentiated the disturbances of the three layers of the tear film in 90 such patients. This showed that only 11.1% had aqueous deficiency, while 42.3% had combined disturbances of different layers of the tear film, and 76.7% had lipid deficiencies.
We now studied the efficacy of a therapeutic approach, which intended to stabilize each individual deficiency of the three layers of the tear film (follow-up > or = 6 months). The medical history, visual acuity, slit lamp examination, rose bengal stains and fluorescein stains, Schirmer test, break-up time (BUT), dye tests, impression cytology, and lid transillumination were analyzed.
Therapy was beneficial in all patients (n = 90) with regard to the symptoms and the objective parameters. Artificial tears applied strictly were without preservatives. Patients with toxic conjunctivitis induced by high dosages of eye drops were often stabilized through withdrawing the medication. The frequency of applying artificial tears was significantly tapered by punctum plugs and -coagulation. Tarsorrhapies were helpful in the most severe cases. Topical retinoids significantly reduced the symptoms and increased the goblet cell density. Treating chronic blepharitis was very sufficient, when initiated by topical steroids and Tetracycline, and systemical Doxycycline.
Differentiating the disturbances of the three tear film layers in "sicca syndrome", and stabilizing each component is more effective than artificial tears alone.