Method of treating blepharoconjunctival form of dry eye syndrome

FIELD: medicine.

SUBSTANCE: eyelid care is performed daily twice a day for one month in the form of a 1-2-minute Blepharowipe stupe. That is followed by a 1-2-minute eyelid self-massage with Blepharogel 1 or Blepharogel 2. Systane Balance artificial tear drops are instilled into a conjunctival cavity every 4 hours 3 times a day. The instillations are alternated with eye blinking exercises for 15 seconds 3 times a day. The therapeutic course is repeated one month later.

EFFECT: recovered functional state of the lipid layer of the tear film with an increase in the protective function of tears and relevant reduction of the clinical manifestations of the degenerative and inflammatory processes in the eyelids, conjunctiva and cornea due to an interaction of the procedures of the method each of which enhances the effect of the following one.

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The invention relates to ophthalmology and is intended for treatment of blepharoconjunctivitis forms of dry eye syndrome that develops as a result of inflammatory processes, infectious and non-infectious origin, eyelids and conjunctiva, as well as the negative impact of environmental factors on ocular surface.

Inflammation of the eyelids and conjunctiva entail a violation of the functional state marojevic glands and the lacrimal film, therefore, to develop blepharoconjunctivitis forms of dry eye syndrome. Thus, therapeutic and preventive procedures aimed at restoring functional status marojevic glands and the lacrimal film, as well as reducing the impact of environmental factors, will prevent further development blepharoconjunctivitis forms of dry eye syndrome.

The latest knowledge and technology have significantly changed views on the etiology and pathogenesis in the pathological process associated with changing lesoproduktsii. So, until recently it was believed that the main reason for the development of dry eye syndrome is a systemic disease that violate the products of aqueous component of the tear film. Now we know that what used to be called a syndrome of "dry eye" is actually p is ecstasy a nosological group. This group is polymorphic, and its frequency of occurrence, especially in outpatient practice, high and ranges from 25 to 37%. Among the diverse clinical manifestations of diseases of the eyeball, of course, there is such symptom is dryness of the eyes. However, the syndrome of "dry eye" as nosological form is not the only symptom is a complex pathology, and not just a deficit of water component tears. It should be noted that most authors note that the most frequent reason for reducing the stability of the tear film and changes in its functional state is dysfunction marojevic glands, which occurs in more than 90% of patients with dry eye syndrome.

Meibomian glands are the main source of lipids for tear film person. The secret marojevic glands consists of a complex mixture of various polar and nonpolar lipids, containing cholesterol and wax esters, diesters, triacylglyceride, free cholesterol, free fatty acids and phospholipids. The secret is distributed on the tear film and slows down the evaporation of the water component, retains the transparency of the optical surface and forms a barrier that protects the eyes from microorganisms and organic contaminants such as dust and pollen.

Rapidly developing area, including complex hygienic the ski therapeutic and preventive procedures normalizes the stability of the tear film, which include research oftalmologica, allowing to minimize the negative impact of environmental factors on the organ of vision in conditions of high visual load, as a basis for developing practical recommendations. To date, however, was not considered complex carrying out the above methods of prevention and treatment of pathological processes of the ocular surface, manifested in the form blepharoconjunctivitis forms of dry eye syndrome.

There is a method of treatment of dry eye syndrome using eye drops on the basis of a phospholipid in which physiological solution of sodium salts contained sialic (karamanova) acid, L-carnosine and sulfated glycosaminoglycans. As sulfated glycosaminoglycans used sodium salt of keratomalacia, and the sodium salt of chondroitin sulfate, at a certain ratio of components, which reduces evaporation of the tear film, as well as the prevention of pathological changes in the epithelial cells of the conjunctiva and cornea, which may follow damage to the corneal stroma. This method involves symptomatic therapy, the appointment slutslittle the th therapy does not resolve the main etiological factor, leading to the development of degenerative processes of the ocular surface (patent RU 2302231, 2006).

The known method of complex treatment of dysfunction marojevic glands at UCG. To do this in one session consistently massages century, then treated roots of eyelashes with 0.5% solution of metronidazole, causing the skin age prenatal and provide exposure to an alternating magnetic field of strength 10 MT and a frequency of 17 Hz. While the sessions are conducted daily for 8-14 days. The method provides effective treatment due to the recovery of functional status marojevic glands and restore and stabilize the lipid layer of the tear film. However, the method requires special additional equipment, in addition to the normal slit lamp, as well as the need for these manipulations by an ophthalmologist, not an individual, which increases the complexity of the method (patent RU 2314102, 2006).

There is a method of treatment of dysfunction marojevic glands in SHBG with massage marojevic glands for emptying the contents marojevic glands. However, this method is technically difficult to use and, as the previous one, involves the participation of a doctor and can not be done by an individual in the home application for the invention EN 92009808/14, 1992).

The closest analogue of the invention I have is the way the same destination, containing a scheme of comprehensive treatment, including hygiene century. To do this, first on the ciliary eyelids cause beforelogin for 15-20 minutes. Then wash it with water and put on the ciliary edge of the century 2 drops of leverages-2. Then RUB it in and leave for 5 minutes. Then wash off with water and again put it there by 1 drop of 12 hours. Then the procedure was repeated. Conduct its daily treatment 2-3 months. In case of Demodex all repeat the treatment, the course of treatment is 2 weeks. The method provides effective treatment by cleansing the hair follicles century mite, normalization of marojevic glands with simultaneous recovery of the composition of the tear film. However, the proposed method does not generate a sufficient amount of lipid to stabilize the tear film on the entire period of wakefulness due to the large amount of time between treatments, also this method is too complex to use and takes too much time (patent RU 2312640, 2007).

The objective of the invention is to develop a new comprehensive medical and hygienic treatment blepharoconjunctivitis forms of dry eye syndrome.

The technical result of the invention is the recovery of the functional state of the lipid layer of the tear film with the enhancement of protective functions with the drive and the corresponding reduction of the clinical manifestations of degenerative and inflammatory processes in centuries, conjunctiva and the cornea.

The technical result is achieved due to complex medical and hygienic effects on the lipid layer of the tear film using hygienic procedures, including wraps and massages century, therapeutic factor and gymnastics for eyes.

The proposed method is technically simple to perform, takes a little time and allows patients immediately after these manipulations to feel symptomatic relief at the expense of complex restoration of the lipid layer of the tear film with complex health care procedures, including hygiene century: warm compresses with Blepharospasm and eyelids massage with Leveragein 1 or Leveragein 2; the use of tear replacement drug Sistan Balance, which includes the anionic lipids-stabilizing ophthalmic emulsion containing SE-guar gum, which replaces the lipid layer of the tear film, which allows you to restore the stability and functional status, as well as to reduce exposure to harmful environmental factors on the ocular surface, to arrest the development of degenerative processes of cellular structures of the cornea and conjunctiva and exercises for the eyes as blink for 15 seconds, 3 times a day.

Our proposed method involves a course g is hygienic treatment-and-prophylactic procedures, including: within one month of daily twice daily implementation of hygiene century in the form of a warm compress with Blepharoceridae within 1-2 minutes of self-massage of the eyelids with Leveragein 1 or Leveragein 2 within 1-2 minutes; the instillation in the conjunctival cavity through every 4 hours 3 times a day classements Sistan Balance, and in the intervals between installations carrying out exercises for the eyes as blink for 15 seconds, 3 times a day.

The method of treatment blepharoconjunctivitis forms of dry eye syndrome due to the complex restoration of the lipid layer of the tear film allows you to simultaneously reduce the negative impact of environmental factors on ocular surface, to improve the nutrition of the cornea and increase the protective properties of the tear film.

So, hygiene century aimed at restoring function marojevic glands, softening its lipid secretion under the influence of temperature - warm compresses with Blepharoceridae that facilitates evacuation at a later stage - eyelids massage with Leveragein. Self-massage has a complex effect - promotes emptying marojevic glands, consequently, restores the lipid component of the tear film, cleanse the eyelid skin, improves blood circulation, which in turn reduces the level of inflammatory and allergic re is the capabilities and provides in the case of Bevarages 2 protivonematodoznae action.

Instillation of classements Sistan Balance allow you to compensate for the lipid layer of the tear film dysfunction marojevic glands due to the action of the main chemical substances in their composition, - SE-guar, anionic phospholipid in combination with vaseline oils, emulsifiers and softening substance.

Increasing the number of blinks contribute to the emptying marojevic glands, therefore, the restoration of the protective lipid layer of the tear film, the purification of the conjunctival cavity outflow of the liquid, maintaining the temperature of the ocular surface, the reduction of which leads to disruption of the functional state of the lipid layer of the tear film and the uniform distribution of the tear film on the ocular surface.

The above sequence of steps is due to the fact that provides compensation of the lipid layer of the tear film during the day. The proposed method starts with a morning hygiene century, in which the lipid component of the tear film comes in tear fluid through the softening of lipids secreted meibomiae glands under the influence of the warm compresses with Blepharospasm and subsequent eyelids massage with Leveragein 1 or Leveragein 2, which facilitates the evacuation of melted lipids and stimulates their production. After a morning hygiene century is via every 4 hours in the conjunctival cavity installed the drug Sistan Balance, proteziruemyh the lipid layer of the tear film, with the aim of maintaining it in the proper amount, and in the intervals between installations conduct exercises for the eyes as blink for 15 seconds, 3 times a day for additional stimulation of production of lipids and their uniform distribution on the ocular surface. Before going to sleep nightly hygiene century, providing protection of the conjunctiva and cornea. Thus, the proposed method provides a comprehensive and phased restoration of the lipid layer of the tear film during the day, which prevents the development of corneal conjunctival xerosis. Just the way applied in the group, which included 34 patients. In the comparison group consisted of 29 patients with the same diagnosis who were treated in the treatment century alcoholic solution of calendula or ointment Demalon. The effectiveness of therapy in the group where treatment was conducted by our proposed method was significantly higher than in the comparison group and were manifested in the form of elimination of the complaint and the relief of clinical symptoms of blepharitis and DMG (absence of hyperemia and thickening of the eyelids, under pressure from the mouths of the ducts marojevic glands secret transparent conjunctiva pale pink). In the comparison group noted the preservation of the complaints about "dry" and the feeling of a foreign body in the eyes, saving the ISU is remii conjunctiva and others, therefore, recommended the continuation of the treatment approach, against which the above mentioned signs blepharoconjunctivitis forms of dry eye syndrome were stopped.

Higher efficiency, manifested in the form of improved objective clinical indicators (Schirmer test, test for Norn, biomicroscopic picture is the absence of signs of inflammation of the eyelids, the opening of the ducts marojevic glands, facilitating the evacuation of the secret marojevic glands) and subjective indicators (complaints), identified patients who were prescribed a comprehensive regime that includes hygiene century, installation ophthalmic emulsion, Sistan Balance, protesilaus the lipid layer of the tear film, as well as exercises for the eyes with frequent mode blinking.

The method is as follows.

Start by doing warm compresses, for which Blepharocalyx, sealed, heated in a glass of hot water, then put on closed eyelids for 1-2 minutes, followed by a self-massage of the eyelids with Leveragein 1 or Leveragein 2. For this Blafasel 1 or Leveraging 2 the patient puts on the fingertips and soft circular motion parallel to the edges and in the direction of advanced close to the Ostia massages the glands of the eyelids, including the ciliary margin, 1-2 minutes.

The choice of the type of Leverages depends on skin type. When the IRNA skin, diagnosed with demodicosis and expressed signs of inflammation use Blafasel 2, as the preparations of sulphur better remove excess fat, improve metabolism, eliminate inflammation and strengthen protivonematodoznae action hygienic procedures. The procedure is performed daily for 1-2 minutes, 2 times a day, morning and evening for one month, with the resumption of symptoms are repeated course with an interval of 1 month.

Day, every 4 hours after the morning hygiene century, 3 times a day, carry out the installation in the conjunctival cavity tear replacement drug Sistan Balance.

Another component of comprehensive treatment is gymnastics for the eyes in the form of blink - within 15 seconds, 3 times a day, in between installations classements.

Clinical examples

Example No. 1. Patient N., 54 years.

Complaints of recurrent discomfort in both eyes, the feeling of "dryness", itching of the eyelids, worse in the evening.

Anamnesis vitae: career-related work on the computer.

OD VIS=0,8-0,9 Sph+1,0D=1,0

OS VIS=0,8-0,9 Sph+0,75D=1,0

At survey: OU - relaxed, eyelids slightly thickened, hypermonogenic, mouth duct marojevic glands clogged, when pressed discharge whitish, moves with difficulty, conjunctiva pale pink, cornea etc is transparent, front camera is of medium depth, moisture transparent, structural iris, pupil round shape in the center, pigment hem partially leached, lens transparent. The fundus of the eye: without features.

The Schirmer test - OD - 10 mm; OS - 9 mm Sample burrowing OD - 7 mm; OS - 8 mm;

Diagnosis: OU - Hypermetropia weak. Blepharoconjunctivitis form of dry eye syndrome.

Treatment: within one month of daily twice a day was carried out by the hygiene century in the form of a warm compress with Blepharoceridae within 1-2 minutes and eyelids massage with Leveragein 1 within 1-2 minutes. Every 4 hours 3 times a day in the conjunctival cavity was installed lessentiel Sistan Balance, and in the intervals between installations carried out exercises for the eyes as blink for 15 seconds, 3 times a day. The course is 1 month.

Visual inspection of month: at the time of inspection, complaints of discomfort does not show. Examination: the mouth marojevic glands open, when pressed on the area of the projection marojevic glands secret is separated easily, transparent. Performance test Schirmer improved by 2 mm, the samples Norn for 4 seconds, indicating that the recovery of functional status marojevic glands, the lipid layer of the tear film, therefore, about the effectiveness of therapy.

Example No. 2. Patient T., aged 57.

Complaints the periodic sense of "dryness" in both eyes, eyes on the street when Sunny and windy weather. Anamnesis vitae: Without features. VIS: OD=1,0;OS=1,0.

At survey: OU - calm, thickened eyelids, mouth duct marojevic glands clogged, when pressed detachable transparent, thick, separated with difficulty, conjunctiva slightly hyperemic, the cornea is a transparent, dry spots, disappearing after blinking, the front camera is of medium depth, moisture transparent, structural iris, pupil round shape in the center, the lens - initial opacity in the posterior layers. The fundus of the eye: without features.

The Schirmer test - OD - 12 mm; OS - 15 mm Sample burrowing OD - 5 sec; OS - 4 sec;

Diagnosis: OU - Dysfunction marojevic glands. Blepharoconjunctivitis form of dry eye syndrome. Treatment: Install Sistan Balance 3 times a day for 2 weeks.

Control examination after 2 weeks: At the time of inspection, said improvement. Complaints about tearing absent, saved complaints about the feeling of "dryness" in the eyes while working on the computer and watching TV.

Treatment: continued instillation of drug Sistan Balance, added warm compresses with Blepharoceridae, followed by self-massage of the eyelids with Leveragein 2 in the morning and evening; exercises for the eyes with frequent mode blink in between installation preparation Sistan Balance. The course is 1 month.

Visual inspection of h is rez month: at the time of inspection, complaints of discomfort not notes. Examination: the mouth marojevic glands open, when pressed on the area of the projection marojevic glands secret is separated easily, transparent. Performance test Schirmer improved by 3 mm, the samples Norn for 2 seconds, therefore, therapy was effective.

Example No. 3. Patient A., 49.

Complaints about the periodic feeling of dryness and foreign body in the eyes, aggravated by a high visual load. Anamnesis vitae: Professionalnaya harm - bus driver. VIS: OD=0.9 to 1.0; OS=1,0;

At survey: OU - relaxed, eyelids hypermonogenic, mouth duct marojevic clogged glands on the inner surface of the eyelids telangiectasia, conjunctiva slightly hyperemic, the cornea is transparent in the Central zone, the front camera is of medium depth, moisture transparent, structural iris, pupil round shape in the center, the lens - initial opacity in the posterior layers. The fundus of the eye: without features.

The Schirmer test - OD - 17 mm; OS - 16 mm Sample burrowing OD - 4 sec; OS - 6 sec;

Diagnosis: OU - Blepharitis with dysfunction mebelieve glands. Blepharoconjunctivitis form of dry eye syndrome.

Treatment: within one month of daily twice a day was carried out by the hygiene century in the form of a warm compress with Blepharoceridae within 1-2 minutes and eyelids massage with Leveragein 1 in techenie1 2 minutes. Every 4 hours 3 times a day in the conjunctival cavity was installed lessentiel Sistan Balance, and in the intervals between installations carried out exercises for the eyes as blink for 15 seconds, 3 times a day. The course is 1 month.

Visual inspection of month: at the time of inspection, the patient noted significant improvement, complaints of discomfort does not show. Examination: the eyelids are normal thick, mouth marojevic glands open, when pressed on the area of the projection marojevic glands secret is separated easily, transparent. Performance standard Norn: OD - 9 s; OS - 10 sec.

1 month after the treatment, the patient is again asked for advice about the resumption of complaints at periodic feeling of dryness and foreign body in the eyes, aggravated by a high visual load. Recommended re-rate, against which the patient is again noted improvement. Therefore, due to the chronic course of the disease, it is recommended to conduct refresher courses offer therapy every month with an interval of one month.

Thus, the proposed integrated method of treatment blepharoconjunctivitis forms of dry eye syndrome provides restoration of the functional state of the lipid layer of the tear is Lenka with the enhancement of protective functions tears and a corresponding reduction of the clinical manifestations of degenerative and inflammatory processes in centuries, conjunctiva and the cornea, easy to use.

1. The method of treatment blepharoconjunctivitis forms of dry eye syndrome, characterized in that within one month of daily twice daily conduct hygiene century in the form of a warm compress with Blepharoceridae within 1-2 minutes and eyelids massage with Leveragein 1 or Leveragein 2 within 1-2 minutes, every 4 hours 3 timesa day in the conjunctival cavity instilliruut lessentiel Sistan Balance, and in the intervals between instillation conduct exercises for the eyes as blink for 15 seconds, 3 times a day.

2. The method according to claim 1, characterized in that the course of treatment, repeat with an interval of 1 month.