Abstract

DO.21.03

Dry eye – medical vs. surgical therapy in severe cases

Shandurkov I., Vassileva P.
Specialized Eye Hospital “Pashev” Sofia, Bulgaria

Objective: Dry eye results from reduced tear production, excessive tear evaporation or abnormal tear composition. We compared patients’ relief and objective signs for tear quality among severe dry eye sufferers after medical or surgical treatment of this syndrome.
Methods: 165 severe dry eye sufferers were randomly selected out of 2850 consecutive patients examined for a period of 18 months. The grade of the dry eye was measured according to the Madrid triple classification of dry eye. Routine tests used for diagnosis and follow-up were: biomicroscopy, Schirmer I, TBUT, LIPCOF, OPI and vital staining with Fluorescein or Rose Bengal. 80 patients underwent lacrimal occlusion with temporary or permanent plugs. The other group of 85 patients was treated with artificial tears. Additional therapy was applied in 4 patients with Cyclosporine A ophthalmic emulsion 0,05% and in 6 patients with Bromhexine 48mg/d.
Results: We detected significant improvement of complains and local status in 76 patients (95%) after lacrimal occlusion. In 4 patients (5%) punctual plug associated complications disturbed adequate tears preservation.
Substitution with artificial tears is still a milestone in treatment of all severe dry eye cases. Subjective relief was reported from 73 patients (86%) on medical treatment. No significant change in tear tests was measured in the group with artificial tears.
Topical immunosuppression and basal tears stimulation showed promising effect. Mild improvement was reported and detected in cases treated with Cyclosporine A and Bromhexine.
Conclusions: Although pathogenetic therapy for dry eye is still not known combinations of surgical and medical therapy could give efficient long term improvement and may ensure relief for severe dry eye sufferers. Further clinical investigations are necessary to establish the efficacy of local immunosuppression and tear cells stimulation by various types of medications.

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