1. Ocular Surface Diseases
The Fourth Affiliated Hospital of CMU
Eye Centre

2. Overview

3. Roles and Characteristics of the eyelids
Eye protection
Regular blink: protection and stability of the tear film
Rich of glands
Adequate blood supply
No venous valve

4. Conception Corneal epithelium Conjunctival epithelium Tear film
Clinical ocular surface consist of
conjunctiva
cornea
eyelids
lacrimal gland
lacrimal passages

5. Tear and the Tear Film Function : 1.Cleaning 2.Wetting ocular surface
3.Bacteriostasis
4.Supporting the cornea
(oxygen supply)

6. Origin of Epithelium Stem cells, SC
Corneal epithelium derived from the Limbal stem cells.
Conjunctival epithelium derived from forniceal and palpebral regions.

7. Ocular Surface Disease ★

8. Conception
The ocular surface is a complex biological continuum responsible for the maintenance of corneal clarity, elaboration of a stable tear film for clear vision, as well as protection of the eye against microbial and mechanical insults.
Comprising a variety of disorders on cornea, eyelid, conjunctiva, lacrimal apparatus and tear film.

9. Classification Corneal, conjunctival lesion Tear film disorders
Squamous epithelization type
Limbal stem cell deficiency type
Tear film disorders
Aqueous tear deficiency
Lipid tear deficiency
Mucoprotein deficiency
Kinetic disorders of lacrimal fluid

10. Treatment Reconstruction Epithelium, limbal stem cells
Lacrimal secretion, tear film
Innervation (nerve restore)
Structure and function of eyelid
Surgical operation
To re-establish conjunctiva, cornea, tear film and eyelid.

11. Dry Eye
Healthy tear film
Dry eye

12. Conception
Dry eye (known by doctors as keratoconjunctivitis sicca) is a chronic lack of sufficient lubrication and moisture in the eye.
Its consequences range from subtle but constant irritation to ocular inflammation of the anterior (front) tissues of the eye.

13. Tear Secretion Lacrimal gland
Producing the watery part of the tear film called the aqueous.
Meibomian glands
Producing lipids which keep the tear film from evaporating.
Goblet cells of the conjunctiva
Producing mucin which allows the wetting of the ocular surface as well as stabilizes the tear film.

14. Etiological factor & Classification
Aqueous tear deficiency
Lipid tear deficiency
Mucoprotein deficiency
Kinetic disorders of lacrimal fluid

15. Clinical Manifestation
Dry eye symptoms
asthenopia
irritation, grittiness
dryness
burning
ophthalmalgia
light sensitivity
pink-eye
Do you regularly experience one or several symptoms above?
Some diseases and conditions (like rheumatoid arthritis, lupus and Sjögren’s Syndrome) also cause chronic Dry Eye in many patients.
On the other hand, activities like reading, Wearing contact lenses or working at the computer may cause Dry Eye.

16. Diagnostic Tests for Dry Eye
Dry Eye questionnaire
Lacrimal river width
Schirmer test – uses paper strips under eyelid to measure the wetness that collects over a specific period of time.
Break-up time of tear film (BUT)
Staining – uses special dyes to highlight areas of possible damage to the eye surface.
Tear ferning test
Lactoferrin contents
Tear penetration pressure test
Corneal tonographic map
Impression cytology

17. Diagnosing Schirmer test, BUT, Staining Foundation Symptom
Instability of tear film
Damage on epithelium
Tear penetration pressure increasing

19. Treatment According to the clinical category
For tear deficiency: Maintain moisture in the eyes; reducing the evaporation; increasing the secretion; controlling inflammation & immunoreaction.
For over-evaporation: Therapy the Meibomian gland dysfunction; controlling inflammation; cleaning eyelid; decreasing the evaporation; lipid replacement.
According to the eye conditions
For intermittent symptoms: Artificial tears add volume to the tear film as long as they remain in contact with the surface of the eye.
For midrange dry eye: Artificial tears and punctal occlusion.
For Severe dry eye: Appending cyclosporin, surgery.

20. Summary Eliminating the etiological factors Tears replacement therapy
Maintain moisture in the eyes
Increasing the tear secretion
Immune inhibition therapy
Re-establish the tear film
Other supporting treatment

21. Meibomian Gland Dysfunction

22. Etiological Factor Failure of the glands to produce or secrete lipids.
Wax ester declining and cholesterol increasing make the symptoms worse .
Lack of tears and tear penetration pressure increasing.
Lupus, brandy nose etc.

23. Clinical Manifestation
Common in aged people and who lived in cold region.
No specific symptoms.
Lid-margin mostly thickening; abnormal secretion
while pressurizing.
Disorder in Meibomian
gland, eyelid, conjunctiva.
Figure: Notching of the lid caused by loss of meibomian glands.

24. Diagnosing
Absence of Meibomian gland.
The gland orifices are often compromised due to stenosis or closure.
A declining quality and quantity of lipid secretion.
Anyone of the physical signs can make the diagnosis of Meibomian gland dysfunction if the patient has clinical symptoms.
Figure: No visible meibomian gland orifices: Eversion of the lower lids in both eyes showed atresic meibomian glands.

25. Treatment Clearing Hot fomentation on eyelids for 5~10mins.
Massaging the eyelids.
Swabbing the lid-margin with mild cleaning solution.

26. Treatment Antibiotics oral administration. Local Medication
Antibiotic eye drops
Glucocorticoid eye drops (short term)
Artificial tears

27. The End

28. Lacrimal river width

29. Schirmer Test
Normal ：≥10mm/5min

30. Tear break-up time, BUT

31. Staining
Using special dyes to highlight areas of possible damage to the eye surface. 0分 1分 2分 3分