DRY EYE SYNDROMe is one of the most common causes that bring patients to EYE clinics. It has different etiologies; however, the clinical manifestation and treatment modalities are nearly the same. Different medical and surgical approaches have been carried out to preserve the vision and relieve discomfort. Management of DRY EYE SYNDROMe involves a close partnership between the physician and the patient in which proper application of therapeutic, measures and previous experimentations are all important ingredients.      

Purpose: DRY EYE SYNDROMe is a multifactorial disorder of the tear film and ocular surface that results in EYE discomfort, visual disturbance, and often ocular surface damage. Studies suggest that the prevalence of clinically diagnosed DRY EYE SYNDROMe (DES) is 0.4%. to 0.5%, which is highest among women and the elderly. The burden of DES can be substantial, affecting visual function, daily activities, social and physical functioning, work place productivity and quality of life. This article discusses the normal anatomy and physiology of the lacrimal functional unit and tear film; pathophysiology of DES; DES etiology;classifications and risk factors; and DES diagnosis and management.

Our understanding of keratoconjunctivitis sicca (KCS), also known as DRY EYE SYNDROMe, has been changed over recent years. Until lately, the condition was thought to be merely due to aqueous tear insufficiency. Today, it is understood that KCS is a multifactorial disorder due to inflammation of the ocular surface and lacrimal gland, neurotrophic deficiency and meibomian gland dysfunction. This change in paradigm has led to the development of new and more effective medications.

Purpose: To compare tear secretion values following LASIK (laser in situ keratomileusis) and photorefractive keratectomy (PRK).Methods: Patients referred to Aban EYE Clinic (Isfahan, Iran) for refractive surgery were randomly assigned to LASIK or PRK. Exclusion criteria were contraindications for refractive surgery, usage of topical ocular drugs, DRY EYE and reoperation. Schirmer test was performed pre- and 1, 3 and 6 months postoperatively.Results: The study included 176 EYEs of88 patients (30 male and 58 female) with mean age of 24.7±3.5 (range 19-34) years. Each group included 44 patients without any statistically significant difference regarding age, sex, mean spherical equivalent and corneal thickness. Mean values of Schirmer test were 13.5±5.3 mm in the PRK group and 14.5±7.1mm in the LASIK group (P=0.08) preoperatively which reached 11.7±4.2, 12±4.1 and 12.7±5 mm in the PRK group and 13.5±3.6, 14.3±5 and 14.2±5.1mm in the LASIK group at 1,3 and 6 months postoperatively, respectively (P=0.07, P=0.09 and P=0.17, respectively). There were 4 cases (4.5%) of DRY EYE 6 months postoperatively in the LASIK group vs nill in the PRK group (P= 0.04).Conclusion: Tear secretion decreases following both PRK and LASIK, however it seems to be more severe after LASIK.

Purpose: To report a case of Duane's retraction SYNDROMe with DRY EYE.Patient and findings: An 18-year-old girl presented with chief complaint of limited abduction in her right EYE. Best corrected visual acuity was OD: 8/10 and OS: 9/10. Ocular motility examination revealed severe abduction limitation (-4), mild adduction limitation (-1), and moderate upshot and mild down shoot in the right EYE on adduction. The patient stated absence of lacrimation during crying in the right EYE. Schirmer and basic tear secretion tests revealed DRY EYE. Conclusion: The same teratogenic factor that induced Duane's SYNDROMe could cause impaired lacrimal gland secretion and DRY EYE symptoms.

Purpose: To evaluate the association between subjective DRY EYE symptoms and the results of the clinical examinations. Methods: The study was a clinical-based survey involving 215 first-year students selected consecutively during a regular ocular health examination at the University of Cape Coast Optometry Clinic. The data collection process spanned for a period of four months. Out of the 215 students, 212 returned their completed questionnaires and were subsequently included in the study. DRY EYE tests including meibomian gland assessment, tear break up time, fluorescein staining, Schirmer test, and blink rate assessment, were performed on each subject after completion of the Ocular Surface Disease Index (OSDI) questionnaire. ShapiroeWilk test was used to determine the normality of the clinical tests, and Spearman's correlations co-efficient was used to determine the correlations between the clinical test results and DRY EYE symptoms. Results: Statistically significant associations were found between OSDI scores and blink rate (rs ¼ 0. 140; P < 0. 042), and associations between OSDI scores and contrast sensitivity scores (rs ¼ 0. 263; P < 0001). However, the results of corneal staining (rs ¼  0. 006; P < 0. 926), Schirmer test (rs ¼  0. 033; P ¼ 0. 628), tear break up time (rs ¼  0. 121; P < 0. 078), meibomian gland expressibility (rs ¼ 0. 093; P < 0. 180), and meibomian gland quality (rs ¼ 0. 080; P < 0. 244) showed no significant association with OSDI. The correlation coefficients range from  0. 006 to 0. 263 showed low to moderate correlation between DRY EYE symptoms and the results of clinical test. Conclusion: Associations between DRY EYE symptoms and clinical examinations are low and inconsistent, which may have implications for the diagnoses and treatment of DRY EYE disease.

Purpose: To evaluate the effect of corneal flap hinge position on DRY EYE after Laser in Situ Keratomileusis (LASIK). Setting: Aban EYE Clinic, Isfahan, Iran.Methods: In a prospective double masked randomized controlled clinical trial, 212 consecutive EYEs of 106 myopic patients underwent LASIK; in each patient one EYE was randomly assigned for superior hinge and the other EYE for nasal hinge. Patients were examined preoperatively, 1 week, 1 month, 3 months and 6 months after surgery for: visual acuity, fluorescein tear film break up time, and Schirmer's baseline tear secretion test; Subjective evaluation of DRY EYE symptoms accomplished through Ocular Surface Disease Index (OSDI®) questionnaire at 1 month, 3 month, and 6 month postoperative visits.Results: Tear-film break up time was not significantly different with nasal or superior hinge flap techniques at pre-op, 1 week, 1 month, 3 month and 6 month post operative visits. No significant difference between two groups was found for amount of Schirmer's baseline tear secretion test at pre and post-op visits (P>0.05 for all comparisons between two groups, β: 0.2). Subjective evaluation of symptoms also showed no significant difference in 1 month, 3 month and 6 month postoperative visits. Conclusion: Our results show that nasal and superior hinge flap making methods do not affect signs and symptoms of DRY EYE after LASIK. We recommend that selecting hinge position should be done with the surgeons' preference and ease.