Glaucoma and Dry Eye: UNI-MED SCIENCE

1. A clinical overview of dry eye 14 1.1. The dry eye 15 1.2. The wet eye 18 1.3. The inflamed eye 19 1.4. References 21 2. Investigation of dry eye 24 2.1. Introduction 24 2.2. History 24 2.3. Findings 24 2.3.1. Lid parallel conjunctival folds (LIPCOF) 24 2.3.2. Meibomian gland dysfunction 26 2.4. Diagnostic tests 27 2.4.1. Notes on diagnostic tests 27 2.4.2. Measurement of tear volume 27 2.4.2.1. Schirmer's test 27 2.4.2.2. Other tests of volume 30 2.4.3. Measurement of tear film stability 30 2.4.4. Integrity of the ocular surface 32 2.4.4.1. Fluorescein test 32 2.4.4.2. Rose Bengal test 33 2.4.5. Measurement of the osmolarity of tear fluid 34 2.5. References 35 3. Eye-associated lymphoid tissue (EALT) and its relationship to sicca syndrome 38 3.1. Overview of the dry eye 38 3.1.1. Definition and forms 38 3.1.2. Symptoms and investigations 38 3.1.3. Epidemiology 38 3.1.4. Effect of the mucosal immune system on dry eye 38 3.2. Anatomy of the ocular surface and mucosal immune system 39 3.2.1. Structure of the ocular surface and tear film 39 3.2.2. Mucosal immune system of the ocular surface 40 3.2.2.1. Components of the mucosal immune system 41 3.2.2.2. The mucosal immune system of the ocular surface forms coherent eye-associated lymphoid tissue 43 3.3. Influence of the mucosal immune system on dry eye 44 3.3.1. The normal function of EALT is protective 44 3.3.2. Deregulation of the mucosal immune system through chronic surface irritation in dry eye can lead to the loss of immune tolerance 44 3.3.3. The loss of immune tolerance leads to chronic progressive immune-modulated inflammation with destruction of the ocular surface 46 3.4. References 48 4. The importance of autoimmune processes in sicca syndrome and glaucoma 56 4.1. Introduction 56 4.2. Tear fluid and sicca syndrome 58 4.3. Natural autoimmunity 60 4.4. References 61 5. Preservatives and their relevance for the ocular surface 66 5.1. Background 66 5.2. Is the use of preservatives necessary? 66 5.3. Preservatives 67 5.3.1. Quaternary ammonium compounds 67 5.3.2. Thiomersal 67 5.3.3. Alcohols 69 5.3.4. Sorbic acid 69 5.3.5. EDTA 69 5.3.6. Polidronium chloride 69 5.3.7. Oxychloro complex 69 5.4. Problems 69 5.5. Special storage forms 69 5.6. Single-dose drop containers 70 5.7. Allergy 70 5.8. When should preservative-free artificial tears be used? 70 5.9. References 71 6. Results of the German Register for Glaucoma Patients with Dry Eye 74 6.1. Introduction 74 6.2. Prevalence of concomitant diseases 74 6.3. Gender and age differences 74 6.4. Effect of anti-glaucoma agents and duration of glaucoma disease on the prevalence of dry eye 74 6.5. Benzalkonium chloride/anti-glaucoma active substances as cofactors for dry eye in glaucoma patients 75 6.6. Ways to improve compliance in glaucoma patients 75 6.7. References 76 7. PEX glaucoma as a model of glaucoma with sicca symptoms 80 7.1. Background 80 7.2. Involvement of the conjunctiva in the PEX process 80 7.3. Tear function in PEX syndrome/glaucoma 81 7.4. Composition of tear fluid in PEX syndrome/glaucoma 82 7.5. Dry eye in PEX syndrome/glaucoma 84 7.6. References 84 8. Importance and availability of preservative-free eye drops 88 8.1. Tolerability 88 8.2. Adherence and persistence 89 8.3. Success of glaucoma filtering surgery 89 8.4. Alternatives to benzalkonium chloride 90 8.5. References 90 9. Compliance in glaucoma patients 94 9.1. Introduction 94 9.2. The different types of non-compliance 94 9.3. Current studies 95 9.4. Reasons for non-compliance 96 9.5. Possibilities for improving compliance 96 9.6. References 97 Index 100