Chronic Dry Eye Disease Pathophysiology
Laura Periman, MD
Laura Periman, MD
Originally Published on Ophthalmology Management
Part III: Ocular Surface Disease as seen through lessons learned on the Montana Ranch.
Part IV: Pathophysiology of Ocular Surface Disease as seen through lessons learned on the Montana ranch.
Rocky mountain ecosystems can be fragile or robust and are at the mercy of wild swings in climate. So it is on the 160 acres of land my great grandparents homesteaded in the early 1900s, five miles outside of modern day Drummond, Montana (a “blink” of a cowtown—if you blink, you’ll miss it) along I-90. The hand-built homestead stands to this day (photo). Still, a healthy system can endure harsh conditions and return to balance as long as there is care, time and resources to recover. So it is with a healthy Ocular Surface.
Chronic Self-Perpetuation and Damage
Now the heat from the grass fire dries out the moisture that’s left from the shrubs and trees, creating more tinder for the fire (TLR activation). With progressive loss of immunoregulatory goblet cells, the fire picks up intensity and involves more area (more triggered dendritic cells). If left unattended, this vicious circle keeps going on unchecked and pretty soon you have a full-fledged forest fire. In the case of autoimmune disease, you’re fighting a forest fire with high winds fanning the flames. The best time to control the damage has past, and the work is much harder now. But, if you dig in with all you’ve got, maybe the homestead can be spared and even restored.
The entire TFOS DEWS II report is available to all for free at www.TearFilm.org.
Laura M. Periman, MD is Director of Dry Eye Services and Clinical Research at Evergreen Eye Center in Seattle, WA. Relevant to this series, she discloses relationships with Allergan, Bio-Tissue, Eyedetec, Lumenis, Science Based Health, Sun Pharmaceuticals, TearLab, Topcon and Visant.