Keratitis Sicca Treatment & Management
- Author: Mark Ventocilla, OD, FAAO; Chief Editor: Hampton Roy Sr, MD more...
Approach Considerations
Early detection and aggressive treatment of keratitis sicca may help avoid corneal ulcers and scarring. The frequency of follow-up care depends on the severity of the signs and symptoms.
Although, supplemental lubrication is the mainstay of treatment for mild and moderate aqueous deficient keratitis sicca, the treatment of any concominant lid disease needs to be addressed. Moreover, the use of topical cyclosporine A has been shown to increase the production of aqueous, as well as increase goblet cell density. Other forms of treatment include the use of silicone plugs that block the puncta (the hole that drains the tears on the lid).
Insert temporary punctal occlusion with collagen (dissolvable) or silicone (permanent) plugs, and, if they are effective, perform electric cauterization of the puncti.
The use of oral omega 3s has beneficial anti-inflammatory properties that aid in the production of tears.
Environment-related issues that may exacerbate the dry eye should be discussed and alternatives may be needed.
Treatment of very severe keratitis sicca or keratitis sicca associated with a connective-tissue disorder, including Sjögren syndrome, should be coordinated with an internist or a rheumatologist.
If mucous strands or filaments are present, remove with forceps and administer 10% acetylcysteine 4 times a day. The surgical treatment of keratitis sicca is reserved for very severe cases in which ulceration or impending perforation of the sterile corneal ulcer occurs.
Supplemental Lubrication
Lubricating supplements are the most common medications used to treat keratoconjunctivitis sicca. If these agents are to be used more frequently than every 3 hours, preservative-free formulations are the treatment of choice. If a patient has Sjögren syndrome, the use of systemic immunosuppressants should be considered.
Prescribe artificial tears, preferably preservative-free artificial tears, and a lubricating ointment. Mild keratitis sicca cases can be treated with drops 4 times a day. More severe cases require more aggressive treatment, such as drops 10-12 times a day. Thick artificial tear drops or gels can also be used in more severe cases, although these agents tend to blur the vision. Tear ointments can be used during the day, but they are generally reserved to bedtime use because of the poor vision after placement.
Patch with lubrication at night.
Place an artificial tear insert (eg, Lacrisert) into the inferior cul-de-sac every morning.
Surgical Management
Surgical care includes the following:
- Sealing of the perforation or descemetocele with corneal cyanoacrylate tissue adhesive
- Corneal or corneoscleral patching for an impending or frank perforation
- Lateral tarsorrhaphy - Temporary tarsorrhaphy (50%) is indicated in patients with keratitis sicca secondary to exposure keratitis after facial nerve paralysis and after trigeminal nerve lesions that give rise to keratitis sicca secondary to loss of corneal sensation.
- Conjunctival flap
- Surgical occlusion of the lacrimal drainage system[4]
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Fujita M, Igarashi T, Kurai T, Sakane M, Yoshino S, Takahashi H. Correlation between dry eye and rheumatoid arthritis activity. Am J Ophthalmol. Nov 2005;140(5):808-13. [Medline].
Geerling G, Tost FH. Surgical occlusion of the lacrimal drainage system. Dev Ophthalmol. 2008;41:213-29. [Medline].
Barber LD, Pflugfelder SC, Tauber J, Foulks GN. Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years. Ophthalmology. Oct 2005;112(10):1790-4. [Medline].
Stonecipher K, Perry HD, Gross RH, Kerney DL. The impact of topical cyclosporine A emulsion 0.05% on the outcomes of patients with keratoconjunctivitis sicca. Curr Med Res Opin. Jul 2005;21(7):1057-63. [Medline].
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