Dryness in aqueous tear deficiency dry eye patients tends to be worse as the day progresses due to progressive exposure. Frequent blinking exacerbates mechanical dry eye symptoms, while increasing blinking improves symptoms of aqueous tear deficiency dry eye. Diagnosis can be further made under a slit lamp upon the observation of redundant conjunctival folds. These folds can be made more apparent by staining with fluorescein dye and by applying gentle upward pressure with a finger to the eyeball through the lower lid. In pure aqueous tear deficiency dry eye patients, fluorescein stains in the interpalpebral exposure zone. In mechanical dry eye patients, fluorescein staining can be seen by pulling down the lower lid spread to the non-exposure zone. A tear-clearance test can also detect irregularities in the tear film.Diagnosis can also be made by measuring the replenishment of the tear meniscus. The test can be done as follows: Apply 5 μl of fluorescein to the base of the inferior fornix, maximally deplete the lower tear meniscus by a capillary tube or Weckcel sponge, and then monitor the recovery of the tear meniscus height with or without blinking. Patients with mechanical dry eye detectable within 3–8 seconds without blinking or within 0.5-1.5 seconds with blinking. Treatment
Mild Conjunctivochalasis can be asymptomatic and in such cases does not require treatment. Lubricating eye drops may be tried but are often ineffective.If discomfort persists after standard dry eye treatment and anti-inflammatory therapy, surgery may be undertaken to remove the conjunctival folds and restore a smooth tear film.
Cetirizine/pseudoephedrine (Zyrtec-D) is an antihistamine and decongestant formulation. It is a fixed-dose combination drug containing cetirizine hydrochloride and pseudoephedrine hydrochloride for symptoms related to seasonal allergic rhinitis. == References ==