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Keratoconjunctivitis Sicca

Disease Details

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Description: Keratoconjunctivitis sicca, also known as dry eye syndrome, is a chronic condition characterized by insufficient tear production or rapid tear evaporation, leading to inflammation and damage of the eye's surface.
Type: Keratoconjunctivitis sicca, commonly known as dry eye syndrome, is primarily an acquired condition rather than a genetically inherited one. However, there can be some genetic predispositions that increase the likelihood of developing the condition. The genetic factors are not typically transmitted in a straightforward Mendelian pattern.
Signs And Symptoms: Typical symptoms of dry eye syndrome are dryness, burning and a sandy-gritty eye irritation that gets worse as the day goes on. Symptoms may also be described as itchy, stinging or tired eyes. Other symptoms are pain, redness, a pulling sensation, and pressure behind the eye. There may be a feeling that something, such as a speck of dirt, is in the eye. The resultant damage to the eye's surface increases discomfort and sensitivity to bright light. Both eyes usually are affected.There may also be a stringy discharge from the eyes. Although it may seem contradictory, dry eye can cause the eyes to water due to irritation. One may experience excessive tearing such as if something got into the eye. These reflex tears will not necessarily make the eyes feel better since they are the watery tears that are produced in response to injury, irritation, or emotion which lack the lubricating qualities necessary to prevent dry eye.Because blinking coats the eye with tears, symptoms are worsened by activities in which the rate of blinking is reduced due to prolonged use of the eyes. These activities include prolonged reading, computer usage (computer vision syndrome), driving, or watching television. Symptoms increase in windy, dusty or smoky (including cigarette smoke) areas, in dry environments high altitudes including airplanes, on days with low humidity, and in areas where an air conditioner (especially in a car), fan, heater, or even a hair dryer is being used. Symptoms reduce during cool, rainy, or foggy weather and in humid places, such as in the shower.Most people who have dry eyes experience mild irritation with no long-term effects. However, if the condition is left untreated or becomes severe, it can produce complications that can cause eye damage, instability of the tear film, neurosensory changes, impaired vision, or (rarely) in the loss of vision.
Prognosis: Keratoconjunctivitis sicca usually is a chronic problem. Its prognosis shows considerable variance, depending upon the severity of the condition. Most people have mild-to-moderate cases, and can be treated symptomatically with lubricants. This provides an adequate relief of symptoms.When dry eyes symptoms are severe, they can interfere with quality of life. People sometimes feel their vision blurs with use, or severe irritation to the point that they have trouble keeping their eyes open or they may not be able to work or drive.
Onset: Keratoconjunctivitis sicca, commonly known as dry eye syndrome, typically has a gradual onset. It is characterized by chronic dryness and inflammation of the cornea and conjunctiva. Symptoms may develop slowly over time and can include a gritty or burning sensation, redness, and sensitivity to light. The condition can be associated with aging, autoimmune disorders, certain medications, and environmental factors.
Prevalence: Keratoconjunctivitis sicca, also known as dry eye syndrome, is a common condition, especially among older adults. The prevalence of this condition varies widely based on factors such as age, gender, and geographic location. Estimates suggest that it affects approximately 5% to 34% of the global population, with higher rates generally observed in older adults and women.
Epidemiology: Keratoconjunctivitis sicca is relatively common within the United States, especially in patients aged 40 or older. 10–20% of adults experience Keratoconjunctivitis sicca. Approximately 1 to 4 million adults (age 65–84) in the US are affected.While persons with autoimmune diseases have a high likelihood of having dry eyes, most persons with dry eyes do not have an autoimmune disease. Instances of Sjögren syndrome and keratoconjunctivitis sicca associated with it are present much more commonly in women, with a ratio of 9:1. In addition, milder forms of keratoconjunctivitis sicca also are more common in women. This is partly because hormonal changes, such as those that occur in pregnancy, menstruation, and menopause, can decrease tear production.In areas of the world where malnutrition is common, vitamin A deficiency is a common cause. This is rare in the United States.Racial predilections do not exist for this disease.
Intractability: Keratoconjunctivitis sicca, commonly known as dry eye syndrome, is generally not considered intractable. While it is a chronic condition that requires ongoing management, various treatments such as artificial tears, lifestyle modifications, anti-inflammatory medications, and sometimes surgical options can significantly alleviate symptoms and improve quality of life.
Disease Severity: Keratoconjunctivitis sicca, also known as dry eye syndrome, is a common condition characterized by insufficient tear production or excessive tear evaporation, leading to dry and irritated eyes.

**Disease Severity:**
The severity of keratoconjunctivitis sicca can vary widely among individuals. It ranges from mild discomfort and occasional dryness to severe, chronic symptoms that can significantly impair vision and quality of life.

**Key Severity Levels:**
1. **Mild:** Occasional eye dryness and irritation, with symptoms generally manageable through over-the-counter artificial tears and simple environmental adjustments.
2. **Moderate:** More frequent discomfort, with potential for episodic blurry vision and more persistent symptoms that may require prescription medications or specialized treatments.
3. **Severe:** Constant dry eye symptoms with potential damage to the ocular surface, leading to significant pain, discomfort, and visual impairment, often necessitating more advanced treatments, such as punctal plugs or surgery.

Effective management typically involves a combination of lifestyle changes, environmental modifications, and medical treatments.
Healthcare Professionals: Disease Ontology ID - DOID:12895
Pathophysiology: Having dry eyes for a while can lead to tiny abrasions on the surface of the eyes. In advanced cases, the epithelium undergoes pathologic changes, namely squamous metaplasia and loss of goblet cells. Some severe cases result in thickening of the corneal surface, corneal erosion, punctate keratopathy, epithelial defects, corneal ulceration (sterile and infected), corneal neovascularization, corneal scarring, corneal thinning, and even corneal perforation.Another contributing factor may be lacritin monomer deficiency. Lacritin monomer, active form of lacritin, is selectively decreased in aqueous deficient dry eye, Sjögren syndrome dry eye, contact lens-related dry eye and in blepharitis. The ocular surface microbiome, composed of a diverse community of microorganisms, has been implicated in the pathogenesis of dry eye syndrome, potentially influencing the ocular surface inflammation and homeostasis.
Carrier Status: Keratoconjunctivitis sicca, also known as dry eye syndrome, does not involve a carrier status as it is not a genetic disorder.
Mechanism: Keratoconjunctivitis sicca, also known as dry eye disease, involves the following mechanisms:

**Mechanism:**
- **Reduced Tear Production:** This often results from damage to the lacrimal glands due to aging, autoimmune diseases (e.g., Sjögren's syndrome), or other conditions.
- **Increased Tear Evaporation:** This may occur due to environmental factors such as wind, dry air, or screen time, and also due to dysfunction of the meibomian glands which produce the lipid layer of the tear film.
- **Imbalance in Tear Film Composition:** Tears may lack sufficient water, mucus, or lipids, leading to an unstable tear film which doesn't cover the eye adequately.

**Molecular Mechanisms:**
- **Inflammation:** Chronic inflammation of the ocular surface and lacrimal glands is a central feature. Pro-inflammatory cytokines (e.g., IL-1, IL-6, TNF-α) and matrix metalloproteinases are elevated, causing cellular damage and further tear film instability.
- **Immune Response:** Dysregulated immune responses can lead to autoimmunity against lacrimal gland cells, further reducing tear production (notably in conditions like Sjögren's syndrome).
- **Oxidative Stress:** Reactive oxygen species can damage cellular structures on the ocular surface, exacerbating inflammation and reducing the regenerative capacity of epithelial cells.
- **Neurogenic Inflammation:** Damage or dysfunction of the sensory nerves in the cornea can alter the feedback loop necessary for tear production, contributing to dry eye symptoms.
- **Epithelial Cell Apoptosis:** Increased apoptosis of corneal and conjunctival epithelial cells due to the aforementioned inflammatory cytokines and stress signals can result in a compromised ocular surface.

Together, these mechanisms disrupt the normal tear film, leading to symptoms of dryness, irritation, and potentially, more severe complications like corneal damage.
Treatment: A variety of approaches can be taken to treat dry eye syndrome. Approaches include: avoidance of exacerbating factors (things that make it worse), tear stimulation and supplementation, increasing tear retention, eyelid cleansing, and treatment of eye inflammation.Conditions such as blepharitis can often co-exist and paying particular attention to cleaning the eyelids morning and night with mild soaps and warm compresses can improve both conditions.
Compassionate Use Treatment: For keratoconjunctivitis sicca (dry eye syndrome), compassionate use, off-label, and experimental treatments may include:

1. **Cyclosporine A (Restasis):** While FDA-approved, it is also used off-label in various formulations and concentrations not commercially available.
2. **Lifitegrast (Xiidra):** Another FDA-approved treatment that may be used in special populations or under special circumstances.
3. **Autologous Serum Eye Drops:** Created from the patient’s own blood serum, these drops can provide essential growth factors and vitamins that help in severe cases.
4. **Tacrolimus:** Often used off-label similarly to cyclosporine for its immunomodulatory effects.
5. **Lifitegrast Solution:** An experimental drug in clinical trials aiming to reduce inflammation on the ocular surface.
6. **Rebamipide:** Experimental in many countries, it is used in some places for mucin deficiency-related dry eye.
7. **Omega-3 Fatty Acid Supplements:** While commonly used, these supplements are not specifically approved for treating dry eye syndrome.
8. **Soft Contact Lenses:** Special scleral lenses can be used off-label to provide moisture and protect the ocular surface.

These treatments are considered when conventional therapies are inadequate. Always consult a healthcare provider before pursuing these options.
Lifestyle Recommendations: For keratoconjunctivitis sicca, commonly known as dry eye syndrome, here are some lifestyle recommendations:

1. **Blink Frequently**: Make a conscious effort to blink more often, especially during activities that reduce blinking, like reading or using digital devices.

2. **Use Humidifiers**: Adding moisture to the air with a humidifier can help alleviate dry eye symptoms, particularly in arid or air-conditioned environments.

3. **Stay Hydrated**: Drink plenty of water throughout the day to maintain overall hydration, which can help with tear production.

4. **Wear Sunglasses**: Use wraparound sunglasses to protect your eyes from wind, dust, and sun, which can exacerbate dryness.

5. **Take Breaks from Screens**: Follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds to reduce eye strain.

6. **Adjust Your Environment**: Avoid direct exposure to air from fans, heaters, or air conditioners. Position computer screens below eye level to reduce eye surface exposure.

7. **Follow a Healthy Diet**: Include foods rich in omega-3 fatty acids, such as fish, flaxseed, and walnuts, which may improve tear quality.

8. **Avoid Smoking and Exposure to Smoke**: Smoking and secondhand smoke can worsen dry eye symptoms.

9. **Practice Good Eyelid Hygiene**: Maintain clean eyelids by gently washing them with mild soap or specific eyelid cleansers.

10. **Use Artificial Tears**: Over-the-counter lubricating eye drops can provide relief. Use them as needed throughout the day.

These lifestyle changes can help manage the symptoms of keratoconjunctivitis sicca effectively.
Medication: Inflammation occurring in response to tears film hypertonicity can be suppressed by mild topical corticosteroids or with topical immunosuppressants such as ciclosporin (Restasis, Vevye). Elevated levels of tear NGF can be decreased with 0.1% prednisolone.
Repurposable Drugs: Keratoconjunctivitis sicca, also known as dry eye syndrome, can benefit from several repurposable drugs that are not originally intended for treating this condition but can help alleviate its symptoms:

1. **Cyclosporine (Restasis)**: Originally used as an immunosuppressant for organ transplants, it also helps increase tear production in patients with dry eye disease.
2. **Lifitegrast (Xiidra)**: Initially developed for other inflammatory conditions, it can reduce inflammation and improve tear production in dry eye syndrome.
3. **Pilocarpine**: Typically used for glaucoma, it can stimulate tear production.
4. **Omega-3 fatty acid supplements**: Originally used for cardiovascular benefits, they can help reduce inflammation and improve symptoms of dry eye.
Metabolites: Keratoconjunctivitis sicca, commonly known as dry eye syndrome, can involve several metabolites in its pathology. These metabolites are often markers of inflammation and oxidative stress. Elevated levels of pro-inflammatory cytokines (e.g., IL-6, IL-1β), matrix metalloproteinases (e.g., MMP-9), and reactive oxygen species (ROS) are observed in tear fluid. Changes in lipid metabolites, such as decreased levels of meibum lipids, and alterations in osmolarity and electrolyte balance can also be significant in the disease process. Potential nanotechnology applications involve using nanoparticles to deliver therapeutic agents directly to the eye, targeting specific pathways to reduce inflammation and improve tear production.
Nutraceuticals: Keratoconjunctivitis sicca, commonly known as dry eye syndrome, is primarily managed with artificial tears, anti-inflammatory medications, and lifestyle modifications. Nutraceuticals, particularly omega-3 fatty acids, have shown potential in alleviating symptoms due to their anti-inflammatory properties. They can be found in fish oil supplements, flaxseed oil, and certain marine algae. While not universally effective for all patients, some studies suggest that regular intake of omega-3 fatty acids can improve tear quality and decrease ocular surface inflammation. Always consult with a healthcare provider before starting any new supplement regimen.
Peptides: Keratoconjunctivitis sicca, commonly known as dry eye syndrome, can involve treatments with peptides and nanoparticle-based therapies to enhance ocular surface health and tear production. Peptides like thymosin beta-4 have shown potential in promoting wound healing and anti-inflammatory effects on the eye. Nanoparticles, including liposomal delivery systems, can improve drug retention time on the ocular surface, potentially increasing the efficacy of lubricants and medications. Research in these areas is ongoing to optimize treatment strategies for this condition.