DRY EYE

Dry eye is the term given for a group of clinical conditions, characterized by burning sensation, gritty feeling, photophobia and intermittent blurring of vision, ocular discomfort and subsequent diminution of visual acuity.
The reason for selecting this subject is the increasing number of patients suffering with these complaints it the current era

Causes

• Tear production decreases as the age advances. In decreases especially during menopause and old age.
• Staring at computer or Tv for a long time
• Air conditioning/ dry heating system etc
• Systemic diseases such as rheumatoid arthritis
• Pollution/ allergic reactions/ exposure to smoke etc
• Side effects of certain medicines such as antihistamines, anti depressant, anti hypertensives, anti Parkinson disease, oral contraceptive pills etc

Tear film is a fluid that covers the cornea and conjunctiva. The primary role of tear film is to establish refractive surface, to ensure the well being of corneal and conjunctive epithelium. These layered tear films has an intrinsic relationship with the superficial epithelial layers of cornea and conjunctiva. The innermost layer of tear film is composed of a mucus layer, over laying which there is an aqueous layer and outermost layer is lipid. The tear film has an estimated thickness of 4-6 mm

Lipid layer
The bulk of lipid content of tear is produced by mibomian gland that opens on to the lid margins. The tear lipids control the overflow of tear fluid and plays a crucial role in the control of evaporation.

Aqueous layer
This is produced by larchrymal glands main and accessory glands. This layer accounts for around 98% of the total thickness of tear film. The aqueous layer is a complex fluid composed of water and solutes including dissolved mucus, electrolytes and proteins. A high number of different proteins includes immunoglobulins, albumin, lysozyme, lactoferrin. These are involved in defending the ocular surface against invading pathogens. Another function attributed to this lubrication.

Mucous layer
It is the innermost layer. It is composed of mucus in gel form. This is secreted by the goblet cells of conjunctiva. By the act of blinking, the debris get down to mucous and collapses to form mucus strands.

Symptoms of dry eye
Foreign body sensation, burning sensation, general ocular discomfort (dry, sore, gritty feeling), photophobia, intermittent blurring, eye tire easily, inability to cry under emotional stress etc.
Incidences according to age
2% below 10 years
10% under 60 years
20% between 60-8-
25% over 80
Contact lens wearers have dry eye symptom incidence more than 60%

Classification

• Tear deficient dry eye
  This is due to the deficiency of aqueous phase in tear film
• Tear sufficient dry eye
  An alternation is lipid composition is seen, hence will not have control over the evaporation of tear
• Mucus deficiency
  Either decreases in quantity of quality of mucus may lead to impaired surface wetting, decreased lipid trapping. It is marked with decreased tear stability.
• Lid surface abnormalities
  When normal lid movement is compromised, the area of cornea and conjunctivas are not adequately served. This leads to non-wetting of cornea leading to dry eye. The stability of tear film is very much needed for the health of eyes.

Test for assesssing tear volume
Stripof thin filter paper, which is hooked over lower eye, lids – on contact with the ocular surface the paper absorbs tears. The length of paper wetted over a set of five minutes is an indication of tear volume.

Treatment
It is a fundamental theory of Ayurveda that treatment is to attain doshasatmyata. Nethrarogas make no exception in this regard. Here also the treatment aims to eliminate the nidanas, to achieve doshasatmyata, to repair dhathuvaikalya and to strengthen the arogya. This demands the correct assessment of dosha, the exact perception. In dry eyes, it is already stated that almost all the nidanas vitiate vathapitta. To be precise rooksha, seetha, khara, sookshma, chala properties of vatha are increased above normal.
But in case of pitta dosha there will be increase of ushna, teeksha gunas. Increased vatha naturally causes kaphakshaya which will lead to disruption of function. At the same time, there occurs qualitative decrease in sneha and dravabhavas.
Here the intension is primarily to normalize the doshas of both kaya, and shiras and then to focus on to the pathology of the nethra. Internal and external medications are necessary for the treatment. Jeevaneeya ghritham, vidaryadi ghritham, thriphala ghritham etc are the internal medication which can be chosen according to dosha predominance

External Thailam - Medicine

1. Swedam - Haridra
2. Nethradhara - Darvee + Vara kwatham
3. Aschothanam - Jeevanathyadi ghritham
4. Anjanam - Chandandi
5. Nasyam - Anuthailam
6. Tharpanam - Jeevanathyadi ghritham
7. Sirodhara - Triphaladi

This is the general outlook. But the medicines varies according to the condition of the patient. It depends upon the desa, kala, vaya etc