Tear dynamics and dry eye

被引:267
作者
Tsubota, K
机构
[1] Tokyo Dent Coll, Dept Ophthalmol, Chiba 2728513, Japan
[2] Keio Univ, Sch Med, Dept Ophthalmol, Tokyo, Japan
关键词
D O I
10.1016/S1350-9462(98)00004-4
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Tears undergo four processes. production by the lacrimal gland, distribution by blinking, evaporation from the ocular surface and drainage through the nasolacrimal duct. Abnormalities in any of these steps can cause dry eye. There are two kinds of tear production, basic and reflex, which can be distinguished From each other by the Schirmer test with nasal stimulation. Reflex tearing is important because it supplies such essential components as EGF and vitamin Al whose deficiency may cause squamous metaplasia. There is no reflex tearing in Sjogren's syndrome because of destruction of the lacrimal gland. In cases of diminished or absent reflex tearing, topical autologous serum is the treatment of choice. Even when there is adequate tear production. insufficient distribution, such as occurs with the decreased blinking associated with the use of video display terminals (VDT), may cause dry eye. Any process or activity that suppresses blinking interferes with tear distribution. Tear evaporation increases under certain conditions and in some diseases. When the exposed ocular surface area is increased, such as in VDT work, tear evaporation increases. Meibomian gland dysfunction (MGD) also causes increased tear evaporation by altering the quality of the oily layer in tears. Tear evaporation can be suppressed by using a warm compresser or a humidifier, narrowing the palpebral fissure, or wearing protective eyeglasses. The tear clearance rate is measured by fluorescein dye dilution in the conjunctiva. When the tear clearance is low, inflammatory cytokines or preservatives accumulate in the conjunctival sac, resulting in ocular surface diseases. Frequent use of artificial tears without preservative is the key treatment. A differential diagnosis of the abnormalities of tear dynamics can give us a proper understanding of the pathogenesis of dry eye. With this knowledge, we can formulate an efficient therapeutic approach. (C) 1998 Elsevier Science Ltd. Ail rights reserved.
引用
收藏
页码:565 / 596
页数:32
相关论文
共 89 条
[1]  
BLOUNT WP, 1928, Q J EXP PHYSL, V18, P111, DOI DOI 10.1113/EXPPHYSIOL.1927.SP000426
[2]   CHRONIC BLEPHARITIS AND DRY EYES [J].
BOWMAN, RW ;
DOUGHERTY, JM ;
MCCULLEY, JP .
INTERNATIONAL OPHTHALMOLOGY CLINICS, 1987, 27 (01) :27-35
[3]   CLINICAL FEATURES OF SUPERIOR LIMBIC KERATOCONJUNCTIVITIS IN AUSTRALIA - A PROBABLE ASSOCIATION WITH THYROTOXICOSIS [J].
CHER, I .
ARCHIVES OF OPHTHALMOLOGY, 1969, 82 (05) :580-&
[4]   SCHIRMER TEST - A CLOSER LOOK [J].
CLINCH, TE ;
BENEDETTO, DA ;
FELBERG, NT ;
LAIBSON, PR .
ARCHIVES OF OPHTHALMOLOGY, 1983, 101 (09) :1383-1386
[6]  
DOUGHERTY JM, 1991, INVEST OPHTH VIS SCI, V32, P2970
[7]   SJOGRENS-SYNDROME AND KERATOCONJUNCTIVITIS SICCA [J].
FARRIS, RL ;
STUCHELL, RN ;
NISENGARD, R .
CORNEA, 1991, 10 (03) :207-209
[8]  
FOSTER CS, 1983, CORNEA, P315
[9]   BENEFICIAL EFFECT OF ARTIFICIAL TEARS MADE WITH AUTOLOGOUS SERUM IN PATIENTS WITH KERATOCONJUNCTIVITIS SICCA [J].
FOX, RI ;
CHAN, R ;
MICHELSON, JB ;
BELMONT, JB ;
MICHELSON, PE .
ARTHRITIS AND RHEUMATISM, 1984, 27 (04) :459-461
[10]   SJOGRENS-SYNDROME - PROPOSED CRITERIA FOR CLASSIFICATION [J].
FOX, RI ;
ROBINSON, CA ;
CURD, JG ;
KOZIN, F ;
HOWELL, FV .
ARTHRITIS AND RHEUMATISM, 1986, 29 (05) :577-585