Hormonal changes are a main cause of dry eye syndrome, causing changes in tear production.

Diseases associated with decrease corneal sensation.

A wide variety of common medications can cause dry eye by reducing tear secretions like diuretics for high blood pressure, beta- blockers for cardiac diseases, antihistamines for allergy, sleeping pills, anti - anti-anxiety medications, pain relievers .

Exposure to dry, windy climate as well as smoke and air conditioning which can speed tear evaporation can also be the cause of dry eye.

People who have Sjogren’s syndrome usually have dry eye. Systemic diseases like lupus, rheumatoid arthritis, thyroid disease,npeople with post refractive or lasik surgery can also experience dry eye, long term contact lens wear and people who are sensitive to certain climates such as windy, dry air, cigarette smoke and air conditioning.

Symptoms
1-Foreign body sensation(sandy or gritty feeling).
2- Transient blurring of vision.
3- Excessive stringy mucus.
4- Burning sensation.
5- Photophobia
6- Intolerance to smoke and winds.
7-Discomfort when wearing contact lenses.

Signs
1-Pre-corneal tear film –Increase amounts of mucus strands and debris in the upper and lower tear menisci.
2- Marginal Tear Strip- Marginal tear strip is reduced,and it contains mucus and debris.
3-Conjunctiva- Hyperaemia of the conjunctiva, appearance of foldas on temporal side ,specially on abduction , papillary conjunctivitis.

Dry eye condition is diagnosed with the help of

1. Schirmer’s test
A 5mm wide and 35mmlong,special fiter paper is placed in the lower fornix at the junction of the middle and outer third of the eye lid ,after folding it 5mm.After 5minutes ,the amount of wetting from the fold is measured. Normal value ranges from 11-25 mm, Borderline 5-10mm and impaired secretion less than 5mm . Schirmer’s test 1 measures basic secretion and schirmer’s test 2 measures reflex secretion.

2. Tear film break up time (TBUT)
A drop of fluoroscein is instilled, and the patient is asked to blink 2-3 times to distribute the dye .The patient is then asked not to blink while the cornea is studied by a cobalt blue filter with the slit lamp. The BUT is the break up time in seconds,between the last blink and the appearance of dry (black )spots.Anormal BUT is more than 10 seconds (15 to 35 seconds), and BUT value less than 10 seconds is abnormal.

3. Vital dye staining
(Fluoroscein 2% and Rose Bengal 1% staining patterns.

Treatment depends upon the cause of optic nerve disorders. Vision is required for communication, access to information, and mobility. The maximum distance at which faces can be seen, and facial expressions seen and learned from, needs to be determined and conveyed to parents and carers. The language framework required to compensate for reduced vision should be established. The size and contrast, and the proximity of toys and printed information required for maximum speed of access to the information need to be determined. The provision of low-vision aids at an early stage warrants consideration. The visual limitations to all aspects of mobility need to be understood and compensated for

Tarsorrhaphy, to prevent exposure keratitis.

Lid taping.

Punctal occlusion .

Ans-The results may vary from patient to patient .Ophthalmologists must actively encourage these patients to continue to persue their normal activities.

Keratitis(ulceration of the cornea), blepharitis, conjunctivitis etc.

The answer to this depends on the severity and strength of eye disease. Firstly consultation is required with an ophthalmologists and relevant follow ups visits as per his advise.

The expense depends upon the grades of treatment.