Tear dysfunction

Dysfunction may be caused by aging, systemic inflammatory diseases, a decrease in androgen hormones, surgery, ocular surface diseases (such as herpes zoster), systemic diseases, or medications that affect the efferent cholinergic nerves. Decreased tear secretion produces an inflammatory response on the ocular surface called keratoconjunctivitis sicca. This inflammation is now a target for new medications that treat dry eye.29,30... 

The lipids of the external tear film namely, neutral oils, phospholipids, sterol esters, various waxes, and other lipids are requisite for regulation of evaporation. These lipids are produced by the Meibomiam and other glands. The ability of the glandular structures situated in the conjunctiva and the lid propia to produce the tear film may be impaired due to exposure to pollutants and irritants or as a result of age-related dysfunction. 

Olson MC, Korb DR, Greiner JV. Increase in tear film Upid layer thickness following treatment with warm compresses in patients with meibomian gland dysfunction. Eye Contact Lens 2003 29 96-99. 

The Schirmer II test can be performed in extremely dry eyes with very low results on Schirmer I. Before removing the paper strips at the conclusion of the Schirmer I test, a cotton swab is inserted into the nose to mechanically irritate the nasal mucosa. In normal subjects this stimulates an impressive basal tear secretion. If this response is present, ocular surface disease that has interfered with the normal neurologic feedback mechanism is suspected of contributing to the dry eye state. If the response is absent, lacrimal gland dysfunction is the likely cause. 

Evaporative dysfunction is caused by a reduction in the lipid layer of the tear film. Most often, this condition is caused by MGD or blepharitis. MGD is traditionally conceptualized as a triad of meibomianitis (stagnated secretions within the meibomian glands), meibomian seborrhea (overabundance of meibomian secretions into the tear film), and seborrheic blepharitis (oily debris visible on the eyelashes and ocular adnexal surfeces). Additionally, we have become increasingly aware of the influence of male hormones, or androgens, on the health of the meibomian glands. Clinically significant androgen deficiency, which naturally occurs in women of menopausal age and men in... 

Several forms of blepharitis may cause evaporative dysfunction as well. Increased bacterial colonization of the eyelids causes breakdown of the lipids present on the surfece of the tear film into free fetty acids this in turn causes instability of the lipid layer. 

Hu, H. and Cristani, D., Reactive airways dysfunction after exposure to tear gas, Lancet, 339, 1535, 1992. 

Patients with chronic lateral ankle injuries and functional instability can have various problems that can cause confusion reaching a specific diagnosis. Although uncommon, PTD is one cause of lateral ankle dysfunction. PTD may include fissures, fraying, partial thickness tears, full thickness tears, subluxation, or complete... 

The lipid composition is kept within physiological limits by androgens [17]. The decrease of their secretion in elderly people is one of the reasons for development of dry eye syndrome. Patients with Meibomian gland dysfunction show a high tear film evaporation rate and a high tear osmolality [18, 19]. 

Green-Church KB, Butovich I, Willcox M et al (2011) The international workshop on Meibomian gland dysfunction report of the subcommittee on tear film lipids and lipid-protein interactions in health and disease. Invest Ophthalmol Vis Sci 52 1979-93... 

The beneficial effect of curcumin in preventing the acute renal failure and related oxidative stress caused by chronic administration of cyclosporine was examined in rats (Tirkey et al. 2005). Curciunin administered concurrently with for 21 days effectively attenuated cyclosporine induced nephrotoxicity through its antioxidant activity as revealed by markedly countered elevated levels of TEARS, attenuated renal dysfunction, and increased levels of antioxidant enzymes. 

Rotator cuff disease is the commonest cause of shoulder pain and dysfunction in adults. It derives from a wide range of pathologic conditions, including acute and chronic trauma, arthritis and shoulder instability (Laredo and Bard 1996). Most tears, however, occur in patients who lack a definite clinical history of trauma or systemic disease. In these cases, rota-... 

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