Glaucoma and Dry Eye

1.A clinical overview of dry eye 14
1.1.The dry eye15
1.2.The wet eye18
1.3.The inflamed eye19
1.4.References21
2.Investigation of dry eye24
2.1.Introduction24
2.2.History24
2.3.Findings24
2.3.1.Lid parallel conjunctival folds (LIPCOF)24
2.3.2.Meibomian gland dysfunction26
2.4.Diagnostic tests27
2.4.1.Notes on diagnostic tests27
2.4.2.Measurement of tear volume27
2.4.2.1.Schirmer’s test27
2.4.2.2.Other tests of volume30
2.4.3.Measurement of tear film stability30
2.4.4.Integrity of the ocular surface32
2.4.4.1.Fluorescein test32
2.4.4.2.Rose Bengal test33
2.4.5.Measurement of the osmolarity of tear fluid34
2.5.References35
3.Eye-associated lymphoid tissue (EALT) and its relationship to sicca syndrome38
3.1.Overview of the dry eye38
3.1.1.Definition and forms38
3.1.2.Symptoms and investigations38
3.1.3.Epidemiology38
3.1.4.Effect of the mucosal immune system on dry eye38
3.2.Anatomy of the ocular surface and mucosal immune system39
3.2.1.Structure of the ocular surface and tear film39
3.2.2.Mucosal immune system of the ocular surface40
3.2.2.1.Components of the mucosal immune system41
3.2.2.2.The mucosal immune system of the ocular surface forms coherent eye-associated lymphoid tissue43
3.3.Influence of the mucosal immune system on dry eye44
3.3.1.The normal function of EALT is protective44
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 surface46
3.4.References48
4.The importance of autoimmune processes in sicca syndrome and glaucoma56
4.1.Introduction56
4.2.Tear fluid and sicca syndrome58
4.3.Natural autoimmunity60
4.4.References61
5.Preservatives and their relevance for the ocular surface66
5.1.Background66
5.2.Is the use of preservatives necessary?66
5.3.Preservatives67
5.3.1.Quaternary ammonium compounds67
5.3.2.Thiomersal67
5.3.3.Alcohols69
5.3.4.Sorbic acid69
5.3.5.EDTA69
5.3.6.Polidronium chloride69
5.3.7.Oxychloro complex69
5.4.Problems69
5.5.Special storage forms69
5.6.Single-dose drop containers70
5.7.Allergy70
5.8.When should preservative-free artificial tears be used?70
5.9.References71
6.Results of the German Register for Glaucoma Patients with Dry Eye74
6.1.Introduction74
6.2.Prevalence of concomitant diseases74
6.3.Gender and age differences74
6.4.Effect of anti-glaucoma agents and duration of glaucoma disease on the prevalence of dry eye74
6.5.Benzalkonium chloride/anti-glaucoma active substances as cofactors for dry eye in glaucoma patients75
6.6.Ways to improve compliance in glaucoma patients75
6.7.References76
7.PEX glaucoma as a model of glaucoma with sicca symptoms80
7.1.Background80
7.2.Involvement of the conjunctiva in the PEX process80
7.3.Tear function in PEX syndrome/glaucoma81
7.4.Composition of tear fluid in PEX syndrome/glaucoma82
7.5.Dry eye in PEX syndrome/glaucoma84
7.6.References84
8.Importance and availability of preservative-free eye drops88
8.1.Tolerability88
8.2.Adherence and persistence89
8.3.Success of glaucoma filtering surgery89
8.4.Alternatives to benzalkonium chloride90
8.5.References90
9.Compliance in glaucoma patients94
9.1.Introduction94
9.2.The different types of non-compliance94
9.3.Current studies95
9.4.Reasons for non-compliance96
9.5.Possibilities for improving compliance96
9.6.References97
Index100