Keratoconjunctivitis Sicca (KCS), commonly known as dry eye syndrome, is a condition characterized by insufficient tear production or poor tear quality. This leads to ocular discomfort, inflammation, and potential damage to the corneal surface. It affects millions worldwide and is more prevalent in older adults and women.
Causes of Keratoconjunctivitis Sicca
1. Tear Film Dysfunction
The tear film consists of three layers:
- Lipid Layer: Prevents tear evaporation
- Aqueous Layer: Provides hydration
- Mucin Layer: Helps tears adhere to the ocular surface
Any imbalance in these layers leads to tear instability and dry eyes.
2. Meibomian Gland Dysfunction (MGD)
Blocked or dysfunctional meibomian glands reduce oil secretion, leading to rapid tear evaporation.
3. Autoimmune Disorders
Diseases such as Sjögren’s syndrome, rheumatoid arthritis, and lupus can impair tear gland function.
4. Environmental and Lifestyle Factors
- Prolonged screen time reduces blink rate.
- Exposure to smoke, wind, or dry climates accelerates tear evaporation.
- Contact lens use disrupts tear film stability.
5. Medications and Hormonal Changes
Certain drugs, including antihistamines, beta-blockers, and antidepressants, may contribute to dry eye symptoms. Hormonal fluctuations, particularly in postmenopausal women, also increase susceptibility.
Symptoms of Dry Eye Syndrome
- Persistent dryness and irritation
- Redness and inflammation
- A gritty or burning sensation
- Blurred vision
- Sensitivity to light (photophobia)
- Watery eyes (paradoxical reflex tearing)
Diagnosis of Keratoconjunctivitis Sicca
1. Schirmer’s Test
Measures tear production using filter paper strips placed under the lower eyelid.
2. Tear Break-Up Time (TBUT)
Assesses tear film stability by measuring evaporation time.
3. Fluorescein and Lissamine Green Staining
Highlights areas of corneal damage caused by inadequate lubrication.
4. Meibography
Imaging test to evaluate meibomian gland structure and function.
Treatment Options for Keratoconjunctivitis Sicca
1. Artificial Tears and Lubricating Eye Drops
Preservative-free artificial tears help relieve dryness and irritation.
2. Prescription Medications
- Cyclosporine (Restasis): Reduces inflammation and increases tear production.
- Lifitegrast (Xiidra): Targets inflammation in dry eye disease.
- Corticosteroid Drops: Used for severe inflammation.
3. Punctal Plugs
Small silicone or collagen plugs inserted into the tear ducts to retain moisture and improve tear film.
4. Meibomian Gland Treatment
- Lid hygiene: Regular warm compresses and eyelid massages.
- LipiFlow® Thermal Pulsation: Clears blocked glands using heat and massage.
5. Lifestyle Modifications
- Increase omega-3 fatty acids intake (fish oil, flaxseeds).
- Reduce screen time and follow the 20-20-20 rule (look 20 feet away for 20 seconds every 20 minutes).
- Use humidifiers to maintain moisture levels indoors.
Prevention of Dry Eye Syndrome
- Stay hydrated and maintain a balanced diet.
- Avoid smoky or dry environments.
- Wear protective eyewear in windy conditions.
- Blink frequently during prolonged screen use.
Keratoconjunctivitis Sicca is a prevalent condition that significantly impacts ocular comfort and vision quality. Early diagnosis and appropriate treatment—ranging from artificial tears to advanced therapies like punctal plugs and LipiFlow®—can help manage symptoms effectively. By adopting preventive measures and lifestyle modifications, individuals can reduce the risk of chronic dry eye and maintain optimal eye health.
