When the eye becomes "dry" and threatens the sight - a campaign for diagnosis and treatment

(by Nicola Simonetti) “Dry eye”, a disorder that affects, in Italy, 9 out of 10 women in menopause and 25% of those over 50 years old. For the World Health Organization, it is "one of the most ignored and underestimated disorders of modern society".

Launched, in recent days, the free screening campaign promoted by the Italian Dry Eye Center in Milan (Piazza della Repubblica 21, directed by Dr. Lucio Buratto, world-renowned ophthalmologist), the first structure completely dedicated to the treatment of this disease, in collaboration with the Eye Clinic of the Insubria University of Varese.

Free visits are booked through the website www.centroitalianoocchiosecco.it

During the Campaign (Dry Eye Prevention and Care Month - 8 May-14 June), university and hospital eye centers of excellence throughout the territory will be available for a free visit and a series of diagnostic tests. Specialized techniques allow to detect anomalies in the exam lacrimal system and eventually to make a diagnosis of pathology. Screening will be performed only in the Centers participating in the initiative.

The Campaign aims to raise awareness about the problem of dry eye and stimulate it to be examined by its treating ophthalmologists after screening.

The visits are aimed at all those who suspect a dry eye and want an in-depth visit.

Visits can be made at the following facilities:

Milan - CIOS Italian Center for Dry Eye - Piazza della Repubblica 21
Varese - Macchi Foundation Circle Hospital - Insubria University Eye Clinic - Viale Borri, 57
Ancona - University Hospital - United Hospitals Ancona Umberto I - GM Lancisi-G. Salesi, Via Conca 71
Bari - University Eye Clinic Bari Polyclinic - Piazza Giulio Cesare 11
Catania - Garibaldi Hospital - Ophthalmology Nesima - Via Palermo 636

Lecce - Vito Fazzi Hospital of Lecce - Piazzetta Muratore
Milan - Neovision Eye Clinics Corso Vercelli 40 - Via Procaccini 1 - Viale Restelli 1

Naples - San Giovanni Bosco Hospital - Cornea and Ocular Surface Pathology Center - OU of Ophthalmology - PO San Giovanni Bosco - ASL Napoli 1 Center Via FM Briganti 255 Naples - Mediterranean Clinic - Via Orazio 2
Padua - San Paolo Eye Center, Sant'Antonio Hospital, AULSS 6 Euganea Via Jacopo Facciolati 71

Pisa - Cisanello Hospital - Via Paradisa 2
Sassari - San Pietro Clinics - Viale San Pietro 43

Turin - AO Ordine Mauriziano Umberto I - Largo Turati 62

Visits can only be booked on the website www.centroitalianoocchiosecco.it

If you use contact lenses, remove at least 24 hours before.

Do not wear make-up on the day of the visit.

Bring with you any recent laboratory tests, the list of drugs currently in use and the therapies already practiced.

The prof. Claudio Azzolini - Director of the Ophthalmology Clinic of the University of Insubria - Varese, Doctor Lucio Buratto - Scientific Director of the Ambrosiano Ofta Lucio Burattolmico Center (CAMO) - Milan and Doctor Giuseppe Di Meglio (CIOS) - Milan.

The "tear film" is the layer of liquid that bathes the front structures of the eye, that is, it is the interface between the eye and the environment. The light reaches the eye as it passes through tears; the presence of a good layer of tears is essential to allow the eye to have a good view.

Various causes can lead to situations of:

Hypolacrymia caused by a reduced production of tears which, in turn, are divided into hypolacrymia from Sjogren's Syndrome and hypolacrymia from other factors (pathologies of the lacrimal gland, obstruction of tear ducts, loss of tears reflected by herpes, diabetes, contact lenses ).
Dyscracy caused by increased evaporation of the tear film not compensated for by increased secretion (altered eyelid closure, blepharitis, systemic diseases, menopause, drugs).

Social costs Such a widespread and expanding pathology such as dry eye syndrome also worries about the social and health costs that the population has to bear. The annual cost, quantified by an international study of 2006, was found to be greater in England (1100 dollars per patient) than in Spain (800), Italy (600), Germany (500), Sweden (400), France (300) , probably due to the different cost of the drugs used.

Numerous physiological and pathological conditions create alterations of the tear film and often the whole apparatus of protection of the eye is the victim of pathologies or general situations of our body.

The eyeball inside the bony cavity of the orbit is surrounded by a thin film, called the tear film, which has a very complex composition rich in numerous nutritional and protective substances. Lacking that liquid the eye could not move, obey the commands of the brain and turn to the right and to the left, up and down: without that "lubricant" our sense of sight would remain paralyzed or moving with difficulty to prevent a full vision.

The eyelids, two small "shutters", whose function is to oppose a first defensive barrier to our eyes: they rise and fall (wink) and approaching each other, close and defend the eye. Not only that: with this movement (about 15000 winks a day) they continually reciprocate the tear film which is produced by numerous glands.

Whenever a blink occurs, the eyelids gently brush the conjunctiva and cornea, evenly distributing the tear film.

The tear, or rather the tear film, is made up of three layers:

lipid, secreted by the eyelid sebaceous glands, has the function of delaying the evaporation of the aqueous layer of the tear and lubricating the eyelids;
watery, used to moisten and lubricate the eyeball;
mucinous or mucoid, it contributes to lubrication but also has a protective function, both antibacterial and mechanical.

THE DISORDERS:

Disorders reported by a patient with dry eye syndrome are the most disparate and sometimes even seem contradictory.

In the initial stages the most common symptoms are:

Burning and persistent itching linked to the variation of the osmolarity of the tear film.
Irregular tearing, above all triggered by atmospheric or environmental agents: wind, smog, smoke, variation in humidity or temperature.
Need to wash and constantly rub your eyes.
Difficulty in spontaneously opening the eyes in the morning: during the night the secretion of the watery part of the tears is very reduced or even absent which leads to the adhesion of the ocular surface to the palpebral conjunctiva due to the thick and dehydrated mucus.
Presence of mucous secretion and filaments.

When the syndrome gets worse these symptoms occur:

Foreign body sensation linked to the reduced thickness of the tear film.
Sensation of dry eye.
Photophobia (light sensitivity) resulting from the irregularity of the tear film.
Even nighttime pain related to corneal changes.
Vision disorders related to irregular astigmatism that is created on the altered corneal surface.

Why. Incorrect lifestyles and foodstuffs, states of stress, metabolic and hormonal dysfunctions, increase in the average age of the population, increase in average environmental temperatures, areas of high pollution, fumes and toxic substances dispersed in the air, are some of the most frequent causes of dehydration states; situations that very often also affect the organ of sight which, due to its delicate position of "window on the outside world" is more affected than other organs of changes in the external environment that put a strain on its defense system, for the most part represented by that layer of tears that constantly day and night separate the ocular surface from the outside.

Drought, heat waves, pollution. Atmospheric pollution is the alteration of the natural conditions of the air, due to exhaust emissions from motor vehicles, boilers, power plants, factories, and incineration plants.

Smog. Important gaseous contaminants are: carbon monoxide emitted mainly by the exhausts of vehicles with hydrocarbon engines whose highest concentrations are found near the roads; benzopyrene and benzene, suspected carcinogens; ozone, sulfur dioxide and nitric oxide which cause acute inflammation of the respiratory mucous membranes and the eye. According to a study published in the British Journal, 42% of children living in cities with a high level of fine particles suffer from redness and itching of the eyes, blinking, pain in the eyes, tearing and discharge abnormalities due to pollution. Several analytical studies carried out in the United States show how the rate of pollution in large cities significantly affects the onset of dry eye syndrome. Screenings performed by NASA, the National Veterans Administration and the National Climatic Data Center, in the cities of New York and Chicago have reported a 4 times greater proportion of patients suffering from dry eyes than in areas with less air pollution.

Cold and wind. But also cold and wind, according to many scientific studies, are factors responsible for the risk of dry eye: cold has heavy repercussions on the oily substance that makes up the outer layer of the tear film, making it too thick and rigid and therefore unable to spread on the surface of the eye.

Excessive heat and sun. Even with exposure to the sun you can suffer from dry eye more easily; an increase in the evaporation of the tear film nullifies its function which is to protect the epithelia of the ocular surface and the internal structures of the eye through a filtering action on ultraviolet and infrared radiations. It is advisable to wear sunglasses to reduce sun exposure; if you take a bath in the sea it is better to wear a mask or goggles.

Lifestyles. The dry eye is a condition that is increasingly common today and linked not only to environmental conditions, but also to some lifestyles. The increasingly widespread use of video terminals and air-conditioning or air heating devices leads to a reduction in the humidity of the environment in which one lives: all this also has an effect on the surface of the eye and on its integrity.

Old age. As the age advances, all organism has transformations; so also the composition of tears varies. In fact, the eyes often produce tears with a lower lipid content that are necessary to prevent their watery parts from evaporating too quickly. Over the years, the dehydrating forms determine the frameworks of real chronic inflammations of the ocular surface: a disorder that seemed at first trivial becomes a real pathology of the ocular surface.

Menopause. Some hormones help stimulate the production of tears. This is why changes in hormone levels can reduce the natural production of tears. This is why dry eye syndrome prefers female sex especially after 35 - 40 years of age: pregnant or menopausal women are the most numerous group of patients suffering from dry eye.

An increasing frequency caused by the significant anticipation of the menstrual cycle, up to affect about 60% of women. The discomfort resulting from dry eye tends to become more frequent over the years. Contact lens intolerance is one of the first symptoms of reduced tear secretion in postmenopausal women. In the first 7-8 years after menopause, the disorder is controllable but after this period, the involution of the lacrimal glands becomes irreversible. For this reason it is important to make a timely diagnosis and, above all, to start in time the appropriate tear replacement therapies based on hyaluronic acid, or other artificial tears, or by taking orally supplements containing estradiol.

Autoimmune diseases There are many autoimmune syndromes, including hypothyroidism and hyperthyroidism, rheumatoid arthritis, lupus, multiple sclerosis that have negative effects on the cells and glands responsible for producing the tear film. Sjogren's syndrome can also cause severe inflammation of the tear glands, dramatically reducing the production of the aqueous layer of the tear film.

drugs. Many drugs cause dry eye as a side effect, for example: Antidepressants, Antihistamines (especially those over the counter that can be bought without a prescription), Nasal decongestants, Anxiolytic sedatives, Oral contraceptives, Beta-blockers, Diuretics.

Contact lenses. Contact lenses are positioned on the cornea and float on the tear film absorbing a large amount of it and tend to adhere to the cornea, to limit its oxygenation and to cause ocular damage that can even be of a certain severity. The use but above all the abuse of contact lenses, whether they are rigid or soft, in gas-permeable or non-gas-permeable material, contributes to the determination of dry eye. This occurs above all when “disposable” contact lenses are not used and therefore for the correct and necessary hygiene lens solutions rich in disinfectants and preservatives are used.

Videoterminals. A frequent cause of the dry eye syndrome consists in the continuous use of video terminals: in this case the poor humidification of the working environment, made even more precarious by the cooling micro-fans of the computers themselves and of the other equipment connected to them, the prolonged sense of commitment and attention, the state of postural stress connected, in the long run cause a marked slowing of eyelid blinking. Normally the eyelids are opened / closed 20volte per minute. If, on the other hand, you are engaging in an activity that requires concentration, such as reading, studying, writing, driving, using your personal computer, tablet, smartphone, watching your favorite TV program, you tend to blink with a lower frequency, up to a beat per minute: the tears evaporate so quickly, they are not replaced and the dry eye syndrome is created.

Other causes. In other cases, dry eye may be secondary or associated with other skin or ocular conditions, for example rosacea, congenital or acquired corneal dystrophies or degenerations, bacterial, allergic or viral conjunctivitis, herpes zoster, diet low in trace elements and vitamins (especially vitamin A deficiency) blepharitis, eyelid surgery (blepharoplasty) or the use of botulinum toxin for cosmetic purposes in plastic surgery.

Those suffering from dry eye syndrome, in addition to taking therapeutic products that replace the delicate deficient lacrimal function, should follow some general guidelines to change habits and lifestyles.

Avoid direct exposure to air conditioning systems, windy places, heavily ventilated areas. Avoid too dry and poor humidification environments.
Reduce or eliminate cigarette smoking.
Avoid the use of irritating creams or other annoying products in the eye area.
Suspend or limit the use of corneal contact lenses.
Use sunglasses when exposed to strong UVA or UVB rays or in windy or dusty environments.
Use warm compresses in the periocular area (water and mallow, bicarbonate or boric water). Enhance nutrition with B3, B6, B12, Omega 3 / Omega vitamins.
Increase your water and fluid intake in general

HOW TO DISCOVER IF THE EYE IS DRY

To find out if a person suffers from dry eye, science now has sophisticated and very functional diagnostic equipment available. We explain the function of the most important.

Digitized biomicroscopy with slit lamp, one of the fundamental exams. Equipped with a very bright and efficient optical system and with the help of a suitable magnification system, it allows the study of the anterior ocular surface and the tear film in the most natural conditions possible without temperature-induced alterations.

The Meibografia that allows the study of the meibomian glands that have the function of producing the oily part of the tear. This lipid component is the most important of the tear film. If these glands do not work well we will have a dry eye with marked tear evaporation.

Interferometry of the tear film: allows to evaluate and study the lipid layer of the tear film and its formation and distribution.

The Schirmer test, performed to determine the amount of tears that bathe the eye.