Dry Eye Syndrome Đánh giá ban đầu

Clinical Presentation

• Blurry vision which may clear temporarily with blinking
• Burning sensation
• Contact lens intolerance
• Diurnal fluctuation
• Eye fatigue
• Foreign body sensation
• Increased blinking frequency
• Eye irritation
• Foreign body sensation
• Increased blinking frequency
• Eye irritation
• Mild itching
• Mucous discharge
• Photophobia
• Redness
• Stinging
• Tearing

Dry Eye Syndrome_Initial Assesment

Tiền sử bệnh

It is important to inquire about the following, which may predispose or contribute to DES: 

• Duration of symptoms
• Use of medications (eg artificial tears, eyewash, ophthalmic or oral antihistamines, glaucoma medications, ophthalmic vasoconstrictors, diuretics, hormones, antidepressants, cardiac antiarrhythmic drugs, Isotretinoin, beta-adrenergic antagonists, chemotherapeutic drugs, or any drug with anticholinergic effects)
  • Use of eye drops >4-6 times a day may contribute to DES
  • o   Use of eye drops >4-6 times a day may contribute to DES A study has found that angiotensin-converting enzyme (ACE) inhibitors are associated with lower risk for DES
• Ocular history including contact lens wear and care, allergic conjunctivitis, ocular surface disease (eg herpes simplex or varicella-zoster virus infection, Steven-Johnson syndrome, aniridia, ocular mucous membrane pemphigoid)
• Systemic history such as smoking or exposure to second-hand smoke, dermatological diseases, frequency of facial washing, atopy, menopause, systemic inflammatory diseases (eg Sjögren syndrome, graft versus host disease, rheumatoid arthritis [RA], systemic lupus erythematosus [SLE]), trauma, chronic viral infections (eg hepatitis C, HIV), radiation of the orbit, or neurological disorders (eg Parkinson’s disease, Bell’s palsy, trigeminal neuralgia)
• Ocular surgical history (eg ketatoplasty, cataract surgery, keratorefractive surgery) or nonocular surgery (eg bone marrow transplant, head and neck surgery, trigeminal neuralgia surgery). It can be noted that refractive surgery disrupts corneal innervation and may contribute to aqueous deficiency
• Occupations like those that require sustained visual attention (eg working at a microscope or computer) or those performed with upward or horizontal gaze (eg computer use). It may result in a decreased blink rate and increased evaporation of tears. The Uupgaze widens the palpebral aperture that exposes the ocular surface more to evaporation
• Nutritional factors such as low intake of vitamin A or omega-3 fatty acid, or diet with high ratio of omega-6 to omega-3 fatty acids may predispose to DES

Khám thực thể

In assessing patients with DES, measurement of visual acuity, external examination of the eyes, and slit-lamp biomicroscopy should be done to record the severity of decreased aqueous tear production and/or increased evaporative loss, and identify possible causes of eye irritation.

Slit-lamp biomicroscopy is done to examine the tear film, eyelashes, anterior and posterior eyelid margins, puncta, conjunctiva, and cornea.

Inspect the skin for possible signs of scleroderma or rosacea. The eyelids are inspected for abnormal secretions, entropion orectropion, incomplete closure, infrequent blink, eye lid lag or retraction, proptosis. Also, the adnexa are inspected for enlargement of lacrimal gland. Inspect the hands for possible signs of rheumatoid arthritis, Raynaud phenomenon and splinter hemorrhages underneath the nails.

Lastly, neurologic examination should be done to assess the function of cranial nerves V (trigeminal) and VII (facial).

Screening

Some of the questionnaires that can be used include: 

• Ocular Surface Disease Index (OSDI)
• McMonnies Dry Eye Questionnaire
• Canadian Dry Eye Epidemiology Study (CANDEES) Questionnaire
• Dry Eye Epidemiology Projects (DEEP) Questionnaire
• Women’s Health Study Questionnaire
• NEI-Visual Function Questionnaire (NEI-VFQ)
• Dry Eye Questionnaire (DEQ)
• Contact Lens Dry Eye Questionnaire (CLDEQ)
• Dry Eye Disease Impact Questionnaire (DEDIQ)
• Ocular Comfort Index (OCI)

These questionnaires can be used to evaluate the effects of treatments or to grade the severity of the disease, screen individuals for clinical research, or to study the natural history of the disease for epidemiological research. These questionnaires usually contain clinician-based or other diagnosis of dry eye, frequency or intensity of symptoms, effect of symptoms, etc.