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    Bjerrum K.B.: Keratoconjunctivitis sicca and primary Sjoegren’s syndrome in a Danish population aged 30 – 60 years. Acta Ophthalmol Scand 75:281–286 (1997)

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    Schein O.D., Munoz B., Tielsch J.M. et al.: Prevalence of dry eye among the elderly. Am J Ophthalmol 124:723–728 (1997)

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    Moss S.E., Klein R., Klein B.E.: Prevalence and risk factors for dry eye syndrome. Arch Ophthalmol. 118:1264 –1268 (2000)

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    Holly F.J., Lemp M.A.: Tear physiology and dry eyes. Surv Ophthalmol 22:69–87 (1977)

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    Dilly P.N.: Structure and function of the tear film. Adv Exp Med Biol 350:239–247 (1994)

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    Craig J.P., Tomlinson A.: Importance of the lipid layer in human tear film stability and evaporation. Optom Vis Sci 74:8 –13 (1997)

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    Norn M.S.: The conjunctival fluid. Its height, volume, density of cells, and flow. Acta Ophthalmol 44:212–222 (1966)

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    Gilbard J.P., Farris R.L., Santamaria J.: Osmolarity of tear microvolumes in keratoconjunctivitis sicca. Arch Ophthalmol 96:677– 681 (1978)

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    Dilly P.N.: Structure and function of the tear film. Adv Exp Med Biol 350:239–247 (1994)

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    Kaura R., Tiffany J.M.: The role of mucous glycoproteins. In: The Preocular Tear Film in Health, Disease and Contact Lens Wear. Lubbock, Dry Eye Institute, 728–732 (1986)

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    Korb D.R.: The tear film- its role today and in the future. In: The Tear Film, structure, function and cli- nical examination. Butterworth-Heinemann, 181–182 (2002)

SUGGESTED READING

  • -

    Korb D.R., Craig J., Doughty M. et al.: The Tear Film, structure, function and clinical examination.

Butterworth-Heinemann, 2002.

  • -

    Kanski J.J.: Clinical Ophthalmology. Fifth edition, Oxford, Butterworth-Heinemann (2003) Chapter 3.

FLOWCHARTS

FLOWCHART I PHYSICAL EXAMINATION

PHYSICAL EXAMINATION (naked eye) Observe conjunctival hyperaemia and discharge

If minimal to moderate

If pronounced and with recent onset

If swollen more than hyperaemic

Dry Eye

Bacterial or viral infection

Allergy

30

DRY EYE

FLOWCHART I DIAGNOSTIC DECISION TREE

  • Duration of symptoms: are they chronic?

  • Symptoms predominantly bilateral?

  • Feeling of dryness in the mouth, presence of rheumatic disease?

  • Redness not usually pronounced, intermittent?

  • Age of patient: patient older than 50?

  • Symptoms worsening in winter (central heating, cold air) or in hot, dry climate?

Symptoms worsening when working on a computer, reading, or watching TV? S y m p t o m s w o r s e n i n g w h e n d r i v i n g ( v e n t i l a t i o n , a i r c o n d i t i o n i n g ) ?

  • Symptoms worsening during PMS (for premenopausal women)?

  • Discomfort while wearing contact lenses?

Questions to differentiate hyposecretory from hyperevaporative dry eye:

  • Symptoms worse in the morning/evening?

morning

evening

IF YES, ALSO

Tearing in the morning, especially in winter (cold air)?

Gritty sensation in the eyes, burning, feeling of dryness?

Consider diagnosis of Sjoegren’s syndrome

Hypervaporative dry eye (lipid layer deficiency)

Hyposecretory dry eye (aqueous layer deficiency)

IF MOST OR ALL OF THE ABOVE IS YES, CONSIDER DIAGNOSIS OF DRY EYE

ALSO REFER TO IMMUNOLOGIST AND/OR RHEUMATOLOGIST

YES to all or most of the above, with recent worsening of symptoms, more pronounced secretion, redness, and more pronounced unilaterality?

YES to all or most of the above, with recent worsening of symptoms, bilateral, with more pronounced itching?

Consider bacterial or Chlamydial superinfection.

Consider superimposed allergy.

DRY EYE

31

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