Definition

Keratoconjunctivitis is a condition in which the membranes on the surface of the eye known as the conjunctiva become red and inflamed. The most common form of this condition is keratoconjunctivitis sicca. This occurs when the surface of the eye becomes dry due to a lack of quality tears.

Causes

There are 2 main reasons that keratoconjunctivitis sicca occurs:

• The eye no longer makes enough tears to keep the surface moist and the eye dries out.
• The eye does make enough tears, but they evaporate too quickly. The tears produced are of poor quality and are unable to coat the surface of the eye.

Risk Factors

Keratoconjunctivitis sicca is more common in females. Other factors that may increase your chance of keratoconjunctivitis sicca:

• Increased age—The normal production of tears decreases as we age, so it is common for older and elderly people to have some degree of dryness in their eyes.
• Some chronic conditions, such as rheumatoid arthritis,systemic lupus erythematosus, and Sjogren’s syndrome
• Certain medications, such as:
  • Diuretics
  • Beta-blockers
  • Antihistamines
• Laser vision correction surgery, such as LASIK
• Though rare in the US and most developed countries, a deficiency in vitamin A may contribute to the development of keratoconjunctivitis sicca and other serious eye problems.

Symptoms

The main symptom of keratoconjunctivitis sicca is discomfort in the eye. This soreness can range from mild to severe. Some other symptoms of keratoconjunctivitis sicca include:

• The sensation of a

  burning, itching, or

  foreign body in the eye

• Sensitivity to light
• Redness or irritation of conjunctiva
• Discomfort with contact lenses

Most cases of keratoconjunctivitis sicca cause only discomfort. However, in severe cases, the dryness in the eye can lead to damage to the cornea. If this occurs, it is possible that vision may be permanently lost.

Diagnosis

Most of the time, the diagnosis of keratoconjunctivitis sicca is made by an eye specialist. An ophthalmologist is a physician who specializes in diseases and disorders of the eye.

The cause of the discomfort can be determined using specialized equipment to view the surface of the eye.

These special tests may include:

• Slit lamp visualization—The ophthalmologist may use a special light called a slit lamp or biomicroscope to look at the film of tears on the eye surface to determine if there are enough tears to keep the eye moist.
• Dye—The ophthalmologist may use a special dye to evaluate the health of the eye’s front surface.
• Schirmer’s test for dry eye—This test involves placing a small paper wick near the eyelid to measure the amount of tears that are made by the eye.

Treatment

Treatment for keratoconjunctivitis sicca is often simple and effective. This involves keeping the eye moist and preserving the tears that are made naturally. Treatment methods used include:

• Lubricating eye drops—Lubricating eye drops, which are also known as artificial tears, mimic the eyes natural tears. These eye drops are available over-the-counter. They provide relief from the discomfort caused by keratoconjunctivitis sicca and help maintain the natural moistness of the eye.
• Lubricating ointments—Lubricating ointments are similar to artificial tears, except they have a much thicker consistency and last longer than eye drops. They are used to provide moisture for more severe cases of keratoconjunctivitis sicca. However, because of the thick texture, the drops may cause vision to be blurry. For this reason, they are usually used at night, before bedtime.
• Punctal plugs—In some cases, it may be helpful to place a tiny plug called a punctal plug in the tear drainage ducts on the eyelids. These devices help the tears that are produced naturally to remain on the surface of the eye longer. The ophthalmologist can insert the plug in the office. It is a quick and painless procedure. Often, your doctor will try placing temporary plugs to make sure they work well for you before placing permanent ones. However, even permanent ones can be removed if necessary. Your doctor may also choose to permanently close your tear drainage hole with a laser or cautery.
• Prescription eye drops—Cyclosporine eye drops are occasionally used to help your eye make more tears. It usually takes several weeks to months to notice an improvement.
• Oral nutritional supplements—Some studies support supplementation of omega-3 fatty acids and other nutrients to help people with dry eyes.

Prevention

It is not possible to prevent keratoconjunctivitis sicca. It is possible to prevent complications of keratoconjunctivitis sicca, such as infections, from developing. To help reduce the chance that the condition will worsen:

• Try to avoid very dry environments—Furnaces and air conditioning can dry the air, which can evaporate tears too quickly. You may want to use a humidifier, which is a machine that puts moisture back into the air to prevent dry eyes.
• Dusty and smoky areas can worsen symptoms—If possible, limit time spent in these areas.
• Avoid prolonged visual tasks—Staring at a computer screen, driving, watching television, and reading may worsen symptoms.
• Promptly use artificial tears—This is important to prevent the eye surface from drying out.

Most cases of keratoconjunctivitis sicca are not serious, and while uncomfortable and irritating, pose no real danger to the eye. However, it is still important to receive evaluation and diagnosis to prevent any of the more dangerous consequences of this condition.

Eye Smart—American Academpy of Ophthalmology http://www.eyesmart.org

Health Canada http://www.hc-sc.gc.ca

Foulks GN. The evolving treatment of dry eye. Ophthal Clin N Am. 2003;16:23-35.