Keratoconjunctivitis sicca is the summary term for dry eyes, without consideration of possible causes. The term dry eye syndrome is also used synonymously. Symptoms affect the cornea and conjunctiva, a mucosa-like tissue that connects the eyeball to the eyelids. If left untreated, dry eye can lead to secondary damage.
What is keratoconjunctivitis sicca?
Keratoconjunctivitis sicca is the technical term for dry eye syndrome, without considering the various causes for the syndrome to occur. The name keratoconjunctivitis sicca already indicates that the cornea and conjunctiva are affected. The conjunctiva is formed by a mucosa-like tissue that connects the eyeball to the eyelids. Proper, regular moistening of the cornea ensures – literally – smooth movement of the eyeball, clear optics without streaks and distortions, and supply and disposal of the cornea. Except when the eyes are closed, the tear fluid supplies the cornea with oxygen and some nutrients and provides protection against bacterial inflammation. In addition, the lacrimal fluid ensures that dead corneal cells or small foreign bodies are flushed out. If left untreated, dry eyes lead to further problems and diseases. In principle, the syndrome can be caused by insufficient production of tear fluid or by a change in the composition of tear fluid.
Causes
There are many different causes that can lead to keratoconjunctivitis sicca and require different treatments in terms of root cause control. Temporarily, dry eyes can be caused by unusual environmental conditions, such as the combination of strong winds in extremely dry air or air conditioning with built-in air drying, because the tear film dries out very quickly. Certain diseases can cause impaired production of serous tear fluid, resulting in the symptoms of dry eyes. The production of the tear fluid depends, among other things, on the hormone and vitamin balance. A deficiency of testosterone in men at an older age or a deficiency of vitamin A can contribute to dry eyes. However, the most common cause is a qualitative change in the tear fluid. Impairment of the accessory meibomian glands in the eyelids, which normally secrete a fatty substance that coats the tear film in the form of a thin outer lipid layer and protects it from rapid dehydration, is often observed. Pathologically reduced production of the meibomian glands leads to very rapid evaporation of the tear film because of the lack of a lipid layer. Direct diseases and inflammation of the lacrimal glands or obstruction of the outlets and accessory glands can also result in insufficient production or altered composition of the tear fluid.
Symptoms, complaints, and signs
The most common symptoms and complaints caused by keratoconjunctivitis sicca are a feeling of dryness, burning of the eyes, and often a feeling that there are foreign bodies on the cornea – a similar sensation to conjunctivitis. The external signs are reddened and tired eyes, and hypersensitivity to bright light and drafts usually sets in. In some cases, watery eyes occur, which may sound contradictory at first. The inner layer of the tear film, which is only 18 micrometers thick, consists of a thin layer of mucus, which ensures that the tear film adheres to the eyeball. If the function of the accessory lacrimal glands that secrete the mucus film is disturbed, the tear film cannot adhere sufficiently to the eyeball. The tear fluid leaks out of the eye, and the symptoms of a watery eye appear, even though the cornea is suffering from dryness.
Diagnosis and course of the disease
For a diagnosis of keratoconjunctivitis sicca, the first measure that is important is the medical history, the initial interview with the patient. If there is an initial suspicion, the ophthalmologist can examine the amount and composition of the tear fluid after inspecting the ocular surface using a slit lamp.With the so-called Schirmer test, the tear fluid produced within 5 minutes can be recorded and determined with a special paper strip. The composition of the tear film is measured indirectly using the tear break-up time. This is the time interval between a blink and a tear film breakup. Further examinations can concern hormone status, rheumatoid factors and still further parameters. As long as there is no serious damage to the cornea and conjunctiva, dry eye syndrome resolves as soon as the cause is removed. If left untreated, keratoconjunctivitis sicca can lead to serious corneal damage and disease.
Complications
As a result of keratoconjunctivitis sicca, those affected suffer primarily from very dry eyes. This can have a negative impact on the quality of life of the affected person. If there is no treatment and the symptoms are permanent, irreversible consequential damage is possible. In most cases, there is also a burning sensation in the eyes. The patient’s eyes are reddened and tired. Furthermore, keratoconjunctivitis sicca can also lead to conjunctivitis, which must be treated by a doctor in any case. Likewise, there is a strong sensitivity to light. The daily life of the affected person is made more difficult by these complaints and, if necessary, ordinary work or activities can no longer be carried out without further ado. The treatment of keratoconjunctivitis sicca is usually causal and depends on the underlying disease. No particular complications occur and the course of the disease is usually positive. Life expectancy is also not reduced or limited by keratoconjunctivitis sicca. Eye drops or other therapies can be used to relieve the symptoms of this disease.
When should you see a doctor?
If the affected person suffers from a persistent feeling of dryness around the eyes, a visit to the doctor is advisable. Burning and itchy eyes indicate existing irregularities that should be examined by a doctor. In case of a foreign body sensation in the eyes or disturbances of the usual vision, a doctor should be consulted. Control examinations are necessary, which will lead to clarification of the cause. If there is a feeling of hypersensitivity to normal light or bright daylight, a doctor should be consulted. Sensitivity of the eyes indicates a disorder that should be clarified and treated. Reddened, easily tired or watery eyes should also be examined by a physician. If the existing symptoms cause itching or open wounds, the affected person needs sterile wound care. Otherwise, pathogens may enter the organism and contribute to the development of further diseases. In case of headache, inner restlessness, reduced well-being or limitations in performing everyday tasks, consultation with a doctor is advisable. If, in addition to the physical complaints, there are also abnormalities in behavior, mood swings or a depressive demeanor, a doctor should be asked for help. Because of the impairment, there is an increased vulnerability to the development of a mental illness.
Treatment and therapy
The goal of dry eye treatment, in addition to symptom control, is primarily to eliminate the cause. If the cause is insufficient production of tear fluid, a wide variety of eye drops can be used as tear substitutes to relieve symptoms. If it is a hyperevaporative form of dryness, i.e., the problem of too high an evaporation rate, lipid-containing eye drops may help. However, at the same time, an attempt should be made to reactivate the function of the meibomian glands so that the protection of the tear film by a natural lipid layer is restored. More extensive treatment options also exist that aim to eliminate the causative factors.
Outlook and prognosis
A prognosis for keratoconjunctivitis sicca is not possible until the cause of the symptoms has been determined. Dryness of the eyes may be formed for a variety of reasons. In the case of inflammation, drug treatments are often used. These usually lead to relief of the existing complaints within a few days or weeks.In most cases, the administration of the medication results in freedom from symptoms after a short period of time. Consequential disorders are not to be expected in these patients. In the course of life, however, a renewed inflammation can occur at any time with a likewise favorable prognosis. If a chronic underlying disease is present, the likelihood of cure worsens. Some patients face lifelong symptoms. They receive long-term therapy in which the dryness of the eye is treated. Regular control examinations are necessary, so that in case of abnormalities or unfortunate changes a quick reaction can be made. If the function of the meibomian glands is permanently damaged, the affected person is also given an unfavorable prognosis. Again, ongoing therapy is used so that symptoms can be regulated. In some patients, there is no prospect of a cure. Nevertheless, a significant improvement in symptoms can be achieved through the treatment method. If prescribed medications are discontinued, an immediate relapse of the irregularities can be expected in this case.
Prevention
Direct prevention to avoid keratoconjunctivitis sicca is almost impossible because of the large number of possible causes. However, life circumstances that favor dry eye syndrome can be avoided. Above all, it is indicated to react to first signs such as burning eyes and foreign body sensation in the eye in order to relieve the symptoms immediately. If symptoms persist, an ophthalmologist should be consulted immediately, as it cannot be ruled out that serious diseases are hiding behind dry eye syndrome.
Follow-up care
In most cases, the possibilities of aftercare for keratoconjunctivitis sicca are very limited. In this case, those affected are primarily dependent on an early diagnosis of the disease so that further complications and discomfort can be prevented. The earlier a doctor is contacted, the better the further course of the disease usually is. Self-cure is usually not possible with keratoconjunctivitis sicca. Most patients are dependent on taking various medications for this disease. In any case, the patient should pay attention to a regular intake and also to the correct dosage in order to permanently alleviate the symptoms. If there are any uncertainties or questions, a doctor should always be consulted first so that no further complications can arise. In everyday life, help and support from one’s own family also has a positive effect on the course of keratoconjunctivitis sicca and can also prevent or alleviate depression or other psychological upsets. In some cases, there is a reduced life expectancy of the affected person due to the disease.
Here’s what you can do yourself
To support quality of life and successful treatment of keratoconjunctivitis sicca, patients work closely with their treating physician and follow instructions for taking medications and other treatment approaches. In therapy, it is essential to identify the underlying causes of the disease and eliminate or reduce them. As a result, the symptoms usually subside and the quality of life of those affected improves. The patients take the prescribed preparations as prescribed by the doctor, which are a replacement of the tear fluid and relieve the dryness of the eye. In addition, patients try to locate those factors in their everyday life that contribute to the existence of keratoconjunctivitis sicca. Depending on the activities and occupation, these may be different reasons in individual cases, but identifying and reducing them is often an essential step in the genesis. Patients reduce the amount of time they spend in front of screens such as the computer or television. Higher humidity levels also often reduce dry eye symptoms. However, some patients also suffer from certain allergies that promote eye dryness and need to be diagnosed.
