Lacrimal Gland Tear Film And Dry Eye Syndromes 3

During the past several decades, a significant international research effort has been directed towards understanding the composition and regulation of the preocular tear film. This effort has been motivated by the recognition that the tear film plays a critical role in maintaining corneal and conjunctival integrity, protecting against microbial challenge and preserving visual acuity. In addition, research has been stimulated by the knowledge that alteration or deficiency of the tear film, which occurs in numerous individuals throughout the world, may lead to desiccation of the ocular surface, ulceration and perforation of the cornea, an increased incidence of infectious disease, and potentionally pronounced visual disability and blindness.

During the past several decades, a significant international research effort has been directed towards understanding the composition and regulation of the preocular tear film. This effort has been motivated by the recognition that the tear film plays a critical role in maintaining corneal and conjunctival integrity, protecting against microbial challenge and preserving visual acuity. In addition, research has been stimulated by the knowledge that alteration or deficiency of the tear film, which occurs in numerous individuals throughout the world, may lead to desiccation of the ocular surface, ulceration and perforation of the cornea, an increased incidence of infectious disease, and potentionally pronounced visual disability and blindness.

During the past decade a significant international research effort has been directed towards understanding the composition and regulation of the preocular tear film. This effort has been motivated by the recognition that the tear film plays an essential role in maintaining corneal and conjunctival integrity, protecting against microbial challenge and preserving visual acuity. In addition, research has been stimulated by the knowledge that alteration or deficiency of the tear film, which occurs in countless individuals throughout the world, may lead to desiccation of the ocular surface, ulceration and perforation of the cornea, an increased incidence of infectious disease, and potentially, pronounced visual disability and blindness. 7 To promote further progress in this field of vision research, the International Conference on the Lacrimal Gland, Tear Film and Dry Eye Syndromes: Basic Science and Clinical Relevance was held in the Southampton Princess Resort in Bermuda from November 14 to 17, 1992. This meeting was designed to assess critically the current knowledge and 'state of the art' research on the structure and function of lacrimal tissue and tears in both health and disease. The goal of this conference was to provide an international exchange of information that would be of value to basic scientists involved in eye research, to physicians in the ophthalmological community, and to pharmaceutical companies with an interest in the treatment of lacrimal gland, tear film or ocular surface disorders (e. g. Sjogren's syndrome).

During the past two decades, a significant international research effort has been di rected toward understanding the composition and regulation of the preocular tear film. This effort has been motivated by the recognition that the tear film plays an essential role in maintaining corneal and conjunctival integrity, protecting against microbial challenge, and preserving visual acuity. In addition, research has been stimulated by the knowledge that alteration or deficiency of the tear film, which occurs in countless individuals throughout the world, may lead to desiccation of the ocular surface, ulceration and perfo ration of the cornea, an increased incidence of infectious disease, and, potentially, pro nounced visual disability and blindness. To promote further progress in this field of vision research, the Second International Conference on the Lacrimal Gland, Tear Film and Dry Eye Syndromes: Basic Science and Clinical Relevance was held at the Southampton Princess Resort in Bermuda November 16-19, 1996. This conference was organized and directed by David A. Sullivan, Ph. D. , codirected by Darlene A. Dartt, Ph. D. , and Michele A. Meneray, Ph. D. , and sponsored by the Schepens Eye Research Institute (Boston, MA), an affiliate of Harvard Medical School. The meeting was designed to assess critically the current knowledge and "state of the art" research on the structure and function of lacrimal tissue, tears, and the ocular sur face in both health and disease.

There has been considerable increase in the knowledge concern ing tear secretion, the ocular surface, and pathophysiologic con ditions leading to the dry eye. Much of this new knowledge is not widely appreciated. Although there have been proceedings of symposia published, there is no currently available book of suf ficient scope, yet reasonable length, which ties together aspects of this newly acquired knowledge. This textbook is designed to give the ophthalmic practitioner a comprehensive, yet concise, guide line concerning the diagnosis and treatment of the dry eye. We have been able to bring together leading researchers to accom plish the same. We wish to express our special thanks to the company Dr. Mann Pharma of Berlin without whose generous sponsorship we could not have completed our task. The sponsor ship, in bringing together the authors in planning, preparation, and realization of this text, is gratefully acknowledged. Washington/Ulm, March 1992 M. A. Lemp R. Marquardt Contents Introduction 1 Chapter 1 History of the Dry Eye J. Murube . . . . . 3 1 lntroduction 3 2 The Concept of the Dry Eye 5 3 The History of the Causes of the Dry Eye 6 4 The History of the Diagnosis of the Dry Eye 11 5 The History of the Treatment of the Dry Eye 15 6 The Social Response to the Dry Eye 19 References . . . . . . . . . . . . . . . . 19 Chapter 2 Functional Morphology of the Conjunctiva J. W. Rohen and E. Lütjen-Drecoll. With 20 Figures and 3 Tables . . . . . . . . . 35 1 Conjunctiva . . . . . . . .

A number of structures contribute to tear production and maintenance, including the tear system, the lids and the orbit. The ocular surface itself is also a part of the system, including the cornea and conjunctiva. This makes for a very complex situation that can easily lead to changes in tear film and the ocular surface that are called "dry eye." Here a team of experts carefully examine how and when surgery is indicated, addressing normal tear film, normal anatomy (including immunological interactions), classification and diagnosis, anti-inflammatory and immnunosup-pressive concepts, correction and drainage techniques, surgery of the conjunctiva and cornea, keratoprosthesis surgery, botulism toxin injections, mucous membrane grafting, and salivary gland transplantation along with other treatments. The collection closed with a set of scientific studies. The color and monochrome clinical photographs and line illustrations are especially well-chosen and informative.