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Keratoconjunctivitis Sicca (KCS)

  1. KCS
    It is dry eye primarily resulting from aqueous tear deficiency
  2. Types of KCS
    1. Pure KCS: Only lacrimal glands are involved
    2. Sjögren’s syndrome: KCS with RA with Xerostomia, with hypergammaglobulinemia, and ANA  Also termed as Primary. Sjögren’s syndrome
    3. When associated with connective tissue disorder, it is termed as Secondary Sjögren’s Syndrome
  3. Causes:
    1. Destruction of lacrimal gland due to tumor, inflammation.
    2. Meibomian gland dysfunction.
    3. Congenital/Surgical absence of lacrimal glands.
    4. Blockage of excretory ducts.
    5. Destruction of goblet cells in conjunctival scarring conditions.
    6. Neurological lesions-Familial dysautonomia (Riley-Day Syndrome).
  4. Clinical Features
    1. Irritation, FB sensation, burning, stingy mucus discharge
    2. Severe pain due to filamentary keratitis
      1. On Examination
        1. Tear film:
          1. Marginal tear meniscus is concave, small and less than 1 mm.
          2. Increase of mucus strands and debris in tear film.
      2. Corneal abnormalities:
        1. Punctate epitheliopathy.         
        2. Filamentary keratitis.        
        3. Mucous plaques.
  1. ​Investigations
    1. Tear film break-up time
      1. Normal   15 - 34 Sees
      2. Abnormal   < 10 sees.
    2. Rose Bengal Staining: It has affinity for dead cells and mucus.
      In KCS, typical picture is-Two triangles with base towards limbus.
    3. Schirmer’s test:
      1. Normal> 15 mm
      2. BorderlineBetween 5 mm and 10 mm
      3. Abnormal -<5 mm
    4. Lactoferrin level in tears
    5. Tear osmolality measurements.
  2. Treatment :
    1. Tear substitutes
      1. Cellulose derivatives       
      2. Polyvinyl alcohol         
      3. Muco mimetics.
    2. Mucolytic agents: 5% Acetylcysteine drops
    3. Reduction of tear drainage: Punctal occlusion
      1. Temporary                 
      2. Permanent




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