THERAPY IN TEAR FILM DEFICIENCIES

Background The treatment of dry eyes with artificial tears often fails . We differentiated the disturbancies of the three layers of the tear film in 90 such patients. This showed that only 11.1% had aqueous defi ciency, while 42.3% had combined disturbancies of different layers of the tear film, and 76.7% had lipid deficiencies. Patients and Methods We now studied the efficacy of a therapeutic approach, which intended to stabilize each individual deficiency of the three layers of the tea r film (follow-up greater than or equal to 6 months). The medical hist ory, visual acuity, slit lamp examination, rose bengal stains and fluo rescein stains, Schirmer test, break-up time (BUT), dye tests, impress ion cytology, and lid transillumination were analyzed. Results Therapy was beneficial in all patients (n=90) with regard to the symptoms and the objective parameters. Artificial tears applied strictly were with out preservatives. Patients with toxic conjunctivitis induced by high dosages of eye drops were often stabilized through withdrawing the med ication. The frequency of applying artificial tears was significantly tapered by punctum plugs and -coagulation. Tarsorrhapies were helpful in the most severe cases. Topical retinoids significantly reduced the symptoms and increased the goblet cell density. Treating chronic bleph aritis was very sufficient, when initiated by topical steroids and Tet racyclin, and systemical Doxycyclin. Conclusions Differentiating the d isturbancies of the three tear film layers in ''sicca syndrom'', and s tabilizing each component is more effective than artificial tears alon e.