Dry Eyes

• Adisturbance of thetear filmcharacterizesdry eyesyndrome，，，，a very common and usuallybenigncondition。这种异常可能会导致indisruption of theocularsurface, causing a variety of symptoms and signs and interference withquality of life。
• 为了使眼睛保持舒适和视力最佳，正常，薄film眼泪覆盖眼睛。三个主要层组成tear电影。
• 这innermost layer is the thinnest. It is a layer of mucin (ormucus). The cells in the结膜（（这clearskinthat lines the眼睛) produce a very thin layer of mucus. The mucus helps the overlying watery layer to spread evenly over the eye.
• 这middle (or aqueous) layer is the largest and the thickest. This layer is essentially a very dilute saltwater solution. Thelacrimal腺s under the upper lids and the配饰tear glands produce this watery layer. The function of this layer is to keep the eye moist and comfortable, as well as to help冲洗消除可能会进入眼睛的任何灰尘，碎屑或异物。水层的缺陷是干眼综合征的最常见原因，也称为干眼症或角膜结膜炎sicca（（KCS).
• 最多superficiallayer is a very thin layer oflipids（（脂肪or oils). The meibomian glands and the glands of Zeis (oil glands in the eyelids) produce these lipids. The main function of thislipidlayer is to help decrease evaporation of the watery layer beneath.

Dry eye syndrome (DES) -- also called dry eye, dry eye疾病，，，，or角膜结膜炎SICCA（KCS） - 催泪膜的常见状况，影响很大一部分人口，尤其是40岁以上的人群。干眼综合征可以影响any种族and is more common in women than in men. Another term used for dry eye isocularsurface disease.

More than 3 million American women over the age of 50 have moderate to severe dry eyes, while more than 1.5 million American men over the age of 50 are similarly afflicted. Millions of others have mild dry eyes. In the majority of these people, thishealthcondition is benign and easily treated with人造眼泪。

Many wearers of隐形眼镜experience dry eyes at some point with many discontinuing or limitinglens穿。干眼症是经过折射的患者的重要发现外科手术， 尤其LASIK。

在addition to affecting ocular health, the discomfort and irritation of dry eyes can cause deterioration of general well-being, emotional health, and social functioning. Studies have demonstrated that people with dry eye syndrome are three times more likely than those without dry eyes to have difficulty with reading, computer work, watching TV, and driving. Direct costs of dry eyes, such as frequentphysician访问，诊断测试和费用medicationand surgery影响our health care resources. In addition, there are immeasurable indirect costs related to decreased productivity and efficiency and lost work time.

干眼症综合征是正常撕裂膜的常见疾病，它是由于泪液产生，过度泪液蒸发和通常在泪液层中通常发现的粘液或脂质产生的异常而导致的。水（水）撕裂性缺乏是由于水性撕裂的产生不佳或水撕裂层过度蒸发引起的。泪腺产生的眼泪不良可能是年龄，荷尔蒙变化或各种的结果自身免疫疾病s, such asprimary干燥's syndrome,rheumatoid arthritis，，，，orsystemic lupus erythematosus。蒸发的水泪层通常是由于上覆的不足而导致的lipidlayer.

Some medications, such as抗组胺药，，，，抗抑郁药，，，，beta-blockers, and口服避孕药可能会减少泪水产生。

如果闪烁减少或眼睑无法闭合，则由于撕裂蒸发而使眼睛变干。在阅读，看电视或执行需要关闭的任务时attentionwith the eyes, a person may not blink as often. This decreased blinking allows excessive evaporation of the tears. Certain health conditions, such asstrokeorBell'spalsy，使闭上眼睛很难。结果，眼睛可能会因蒸发而变干。

Abnormal生产粘蛋白结膜may occur. This can result from chemical (alkali)burnsto the eye or because of different autoimmune diseases, such asStevens-Johnson syndromeand cicatricial pemphigoid. This abnormal production leads to poor spreading of the tears over the surface of the eye. The surface of the eye can dry out and even become damaged despite the presence of sufficient watery tears.

脂质层不足是meibomian glanddysfunction，，，，rosacea，，，，or following oralisotretinoinmedication. Meibomian glands are the oil glands in the eyelids that produce the lipid layer. If these oil glands become blocked or if the oil is too thick, there may not be enough oil to cover the watery tear layer to prevent its evaporation.

在addition, if aninfection沿着眼睑或睫毛存在（称为睑缘炎) the细菌可能会分解油，因此可能没有足够的油。这可能会导致眼泪和干眼的蒸发。

Dry eye syndrome is more common with increasing age,女性性和亚洲种族。绝经可以增加干眼综合症的风险。矛盾的是，postmenopausal女性hormone replacement therapy， 尤其雌激素salone, have a higherprevalenceof dry eyes thanpostmenopausal不接受激素的女性。

职业和环境因素增加风险包括低湿度，高空间temperature，风暴露，污染和空气质量差，smoking，，，，and decreased blink rates due to sustained computer use or reading.

与眼睛干燥有关的疾病包括vitamin A deficiency（（historically known as寒武地),痤疮酒渣鼻，自身免疫/结缔组织疾病，，，，hepatitis Cinfection,HIVinfection, Sjögren's syndrome,sarcoidosis，，，，diabetes mellitus，，，，and雄激素or雌激素deficiency.

Wearing contact lenses increases the risk of dry eye syndrome. Refractive surgery, especiallyLASIK，，，，frequently causes dry eyes.

Adietlow inomega-3 fatty acidsor adietwith a relatively high amount of omega-6fatty acidsrelative toomega-3 fatty acidscan also increase the risk of dry eye syndrome.

Various types of medications, includingsystemicchemotherapy，，，，利尿剂，，，，抗抑郁药，，，，抗组胺药and beta-adrenergic blockers, may cause dry eyes as a side effect of the medication.

不规则结膜表面如puneaculae或pterygia所见，会导致眼睛症状干燥。眨眼机制或机械盖异常的异常也会产生DES症状。

Aperson with dry eye syndrome may experience dry, gritty/scratchy, or filmy feeling, burning oritching，，，，redness of the eyes（（conjunctivitis),blurred vision，，，，foreign body感觉，，，，and lightsensitivity。

Dry eye symptoms seem to worsen in dry or windy climates and with higher temperatures and lower humidity. Symptoms may also be worse with prolonged use of the eyes (for example, while reading and watching TV) and toward the end of the day.

有时symptom干眼症综合症实际上可能是间歇性的过度撕裂。用干眼睛，当眼睛略微干燥和刺激时，它可能会引发reflex一次生产大量的眼泪撕裂，以尝试再次变得潮湿和舒适。不幸的是，任何一次眼睛只能处理这么多眼泪。这restpour over the eyelids and down the cheeks. A short time later, the eyes will become slightly dry and irritated again and the wholeprocessmayrepeat本身。

在眼睛检查中，眼睛carespecialist (ophthalmologist) will most likely be able to diagnose dry eye syndrome just by听力这patient's complaints abouthisor her eyes. A health care professional can confirm thediagnosisof dry eyes by observing signs of dry eyes. As part of the eye examination, adoctormay

• examine the front of the eyes is examined using a specialmicroscope，，，，called a slit lamp;
• inspect the amount and thickness of the tear film;
• assess the stability of the tear film by checking the tear breakup time;
• inspect the eyelids for signs ofinflammation;
• 检查盖子及其开口的Meibomian腺体；
• assess the conjunctiva to determine if it is too dry or inflamed; and
• 检查corneato see if it has dried out or become damaged. If both thecorneaand conjunctiva are involved, the condition is known as keratoconjunctivitis.

An ophthalmologist may use different dyes during a patient's eye examination. An eye care specialist will place the dyes into the tears in the form of a drop. Fluorescein is a yellow dye that stains the cornea where上皮（（surface) cells have been worn away because of the lack of an adequate protective tear film. Rose Bengal is a red dye that stains the cornea and the conjunctiva where the cells are dead or dying as well as where健康细胞受催泪膜不充分保护。Lissamine Green是一种绿色染料，可以帮助区分角膜和结膜的正常表面细胞和异常。

Schirmer测试测量眼睛产生的眼泪量。眼科医生将一条细的滤纸末端放在下部的末端眼睛lid。After a minute, the doctor removes the filter paper, and the amount of wetting is measured. Less wetting of the filter paper is more indicative of dry eye syndrome.

这osmolarity（（盐content) of the tears may be measured. This is a new test that aids in the diagnosis of dry eye syndrome, in which tear osmolarity is increased over normal levels.

关于眼泪的另一个新测试可以检测到MMP-9的存在（基质金属蛋白酶9），A物质which, when present in the tears, is a reliablemarker对于早期的眼表疾病和干眼症而存在。该测试可能有助于鉴定眼表炎症患者自身免疫疾病并可能有助于提出决定反对-inflammatory treatment in these patients. If autoimmune diseases or Sjögren's syndrome are suspected as a cause of a patient's dry eye syndrome,血可以执行测试。这些血液检查检查是否存在可能与干眼综合征有关的不同自身抗体。

很少有医生可以表演biopsyof the salivary glands. Certain disease processes, such as Sjögren's syndrome, affect both the salivary glands, which producesalivain your嘴，以及产生眼泪的泪腺。

虽然不cure干眼症综合症存在，许多药物可用。治疗取决于病情的严重程度；有些人可能只需要一个加湿器or occasional eye drops while others may require surgery to help decrease dry eyes.

Over-the-counterlubricating eye drops, commonly referred to as artificial tears, may help relieve dry eyes. Some examples of these products include20/20泪水，celluvisc，舒适的眼泪，干眼，鼠，刷新，振荡，舒缓，theratears，Systane和Tears Naturale。其中大多数都在防腐剂包装中可用，这减少了防腐剂的刺激可能性。应该避免撕裂替代品，其中包含血管收缩器，例如naphazoline，，，，tetrahydrozoline,苯肾上腺素和羟甲唑啉。医生还可以开药，以帮助患有干眼综合症的患者。

Amajorportion of the ophthalmologist's decision aboutprescriptiontreatment of DES is based on determining whether the problem is primarily evaporative or aqueous-deficient, or a combination of both. There is a great deal of overlap between evaporative and aqueous-deficient dry eye.

Certain prescription medications may help with dry eye syndrome. An eye care professional may prescribe eye lubricants, such asLacrisert，，，，an artificial tear insert. The insert is similar to a contact lens, and the patient will need to insert the eyelubricantone to two times per day. Cellulose is contained in the insert and acts to stabilize and thicken the film of tears over the eyes and to prolong the time the tear film works.Corneal abrasion如果未正确插入人造撕裂插入物，可能会发生。

Certain prescription medications may help with dry eye syndrome.环孢菌素A0.5% (Restasis）有助于减少眼表面的任何炎症。这种炎症降低了眼睛保持健康泪膜的能力。每天使用两次，环孢菌素为0.5％，可以帮助人们自行产生更多，更健康的眼泪。LifiteGrast 5％（Xiidra）是另一种批准的处方眼滴，可减少泪腺中的炎症。皮质类固醇滴（Lotemax，，，，Alrex，，，，FML，，，，Vexol）单独或与环孢菌素或Lifitegrast结合使用，请减少眼睛干眼症的体征和症状。虽然FDAhas not yet approved this group of drops for the medical treatment of dry eye syndrome, many ophthalmologists use them. Corticosteroid drops, if used in excess, may have someside effects，，，，but new formulations with fewer side effects have become available. Like all medications, patients should only use these under a doctor's supervision and according to her or his instructions. Nonsteroidal anti-inflammatory drops (伏尔塔伦，，，，Acular，，，，Nevanac，，，，andXibrom）同样减少与干眼综合征有关的炎症。

People with睑缘炎or meibomian腺dysfunction need antibiotics. The patient will use抗生素ophthalmic滴剂或药膏，例如erythromycin，，，，azithromycinandbacitracin，除其他外，大约七到10天，以减少分解泪膜脂质层的细菌数量。在ointment形式，这些也会在一夜之间润滑眼睛。口服抗生素，特别是阿奇霉素和doxycycline或其他tetracycline，，，，not only help to decrease the number of bacteria, but also help to make the oil more fluid so it flows out of the oil glands more easily. This is often used if a person hasrosacea。有很多人rosacea在眼睑中，患有干眼综合征，在其余的面部没有酒渣鼻的典型变化。

其他医生处方药可能包括通过化合物制备的滴剂药店例如自体血清或激素滴。

为了减轻干眼综合症的症状，在家某些自我护理技巧可能会有所帮助。加湿器将更多的水分放入空中。随着空气中更多的水分，泪水蒸发得更慢，使眼睛更舒适。冬季和空气中的两个炉子调理在夏天，空气中的湿度降低了。过度的空气运动会使眼睛变干。避免通过减少空气移动过多速度of ceiling fans and/or oscillating fans. Large amounts of dust or other particulate matter in the air may worsen the symptoms of dry eye. In those situations, an air filter may be helpful.

温暖的压缩和眼睛lidscrubs/massage提供婴儿洗发水的帮助，提供更厚，更稳定的脂质层。如果一个人患有Meibomian腺功能障碍，酒渣鼻或睑缘炎，这一点尤其有用。热量（小心，温暖的压缩不应该太热；compressshould be comfortable if placed on yourwrist）将油腺中的油加热，使其更容易流动；轻度的按摩作用有助于将油从腺体中取出。清洁作用减少了分解油的细菌数量。

人造泪水，润滑眼和凝胶（在柜台上可用）有助于为眼睛的表面提供更多的水分和润滑。个人通常每天大约四次使用润滑眼润滑剂，但可以根据需要的频率使用。医生为那些希望每天使用眼泪多六次以上的人推荐无防腐剂解决方案。没有一个最适合每个人的非处方倒流。每个人都会确定哪种滴剂可以最大程度地缓解症状。有些滴的时间可能比其他滴剂更长。

润滑眼软膏比眼滴和凝胶厚得多。因为软膏太厚，所以它们的持续时间比眼滴和凝胶更长。但是，由于它们的厚度，如果人们在白天使用它们，软膏可能会模糊视力。因此，人们通常使用软膏在一夜之间润滑眼睛睡觉。

如果在阅读或看电视时主要是干燥的，那么经常休息一下，让眼睛休息并再次变得湿润和舒适是有帮助的。每五到10分钟闭上眼睛10秒钟将增加舒适感，眨眼都会更频繁地闪烁。

Taking a鱼油(或其他高质量的aci的ω- 3脂肪酸的来源ds) supplement every day can often be helpful in alleviating symptoms of dry eye.

慢性dry eye syndrome is a persistent condition of dry eyes that may wax and wane over an extended period of time. Removing environmental influences or reducing contact lens wear does not provide relief.

Differentminorsurgical procedures may help decrease dry eye syndrome. Near the inner corner of each eyelid are tiny openings, called punctae, that are the beginning of the normal tear drainage system. From there, tears normally flow through鼻泪管进入nose。点状阻塞helps by decreasing the normal drainage of the tears from the ocular surface and down the tear drainage system, into the back of the nose, and down the喉。This occlusion is usually done by a very simple office procedure and only takes a few minutes. An eye care professional can place different punctal plugs or lacrimal canalicular plugs at or just inside these openings to block the normal drainage of tears down the tear drainage system. Just like a stopper placed in the流走水槽的waterfrom flowing down the drain, these plugs keep the tears from flowing down the tear drainage system. Therefore, the eyes stay more moist and comfortable, even if one has fewer tears. Ophthalmologists can remove these plugs very easily, if necessary. Sometimes, in severe cases of dry eye syndrome, eye care professionals permanently close these openings, usually by cautery (burning) orlaser。This accomplishes the same thing as the plugs, but it is very difficult, if not impossible, to reverse.

如果一个人出于任何原因难以闭上眼睛，例如贝尔的麻痹，那么由于蒸发撕裂，眼睛可能会变干。Lateraltarsorrhaphy is a procedure during which the lateral (outside) one-third of the eyelids are sewn together to decrease the ability of the eye to open widely and to help the eyes close more easily. Ifstrokeornervedamage keeps the eyelids from closing properly, a doctor mayimplanta small gold weight into the upper eyelid to help it close.

Sometimes, people睡觉with their eyes slightly open. If a person sleeps this way, he or she might want to tape the eyes shut at night.

Moisture chambers are塑料shields (similar to swim goggles) that help keep the eyes from drying out by decreasing the evaporation of tears off the eye. A person may use the moisture chambers just at night if he or she sleeps with his or her eyes slightly open, or they may be used all day, if necessary.

Most people with dry eye syndrome have nothing to worry about aside from an annoying inconvenience. Although the symptoms might makeactivities of daily living（（for example, reading, watching TV, driving) miserable, no long-term vision loss is to be expected.

For those with more severe dry eye syndrome, significant drying of the surface of the eye can lead to an increased risk of serious infections. Ultimately, scarring, thinning, and even perforation of the cornea may occur. As a result, vision, or even the eye itself, may be permanently damaged or function lost.

Although dry eye syndrome can be verysymptomatic，这很少是视觉丧失的原因。大多数情况是良性的，很容易用人工眼泪处理。尽管可以发生角膜溃疡，但它们极为罕见。

Avoiding environmental causes of dry eye can be helpful in预防。如果在阅读或看电视时主要是干燥的，那么经常休息一下，让眼睛休息并再次变得湿润和舒适是有帮助的。每五到10分钟闭上眼睛10秒钟将增加舒适感，眨眼都会更频繁地闪烁。

Taking a鱼油(或其他高质量的aci的ω- 3脂肪酸的来源ds) supplement every day can often be helpful in alleviating symptoms of dry eye.