Treatment of Lacrimal System Dysfunction Figure 4: Classification of Lacrimal System Dysfunction Tear Deficiency
Lacrimal Excretory Hyperactivity (Doane)
Chronic Increase in Parasympathetic Tone
Localized Dry Eye
Pterygium Pinguecula Corneal Ulcer
Chronic Nervous System Imbalance (Neuroimmune Dysregulation)
Decreased tear production
Sjogren Syndrome
Non-Sjogren Tear deficiency
Lacrimal disease
Lacrimal Reflex obstruction Oil deficient Increased Vagal Tone
Cardiac Arrhythmias Heartburn and GERD
Reflex Tears
Anterior Chamber Reaction
Watering Epiphora
Light Sensitivity Iritis andPhotophobia Pepts. on IOLs Graft rejection Glaucoma Cataracts
Thick Tenacious Mucus
Chronic Over-activation of the Inflammatory Response
Nasal Congestion
Inflammatory Component of Vascular Disease Inflammatory Component of Neoplastic Disease
Eustachian Tube Dysfunction Otitis Media Mastoiditis Meningitis
Sinus Dysfunction Sinusitis Frontal Headache Trigeminal Neuralgia
Post-nasal Drip
Laryngitis and Hoarseness Chronic Cough Chronic Bronchitis Asthma
Pneumonia Includes National Eye Institute (NEI)/Industry Workshop 1995 dry eye classification—with modifications (additions) linked by dark lines. IOL = intraocular lenses; GERD = gastroesophageal reflux disease.`
curative treatments. This will make it possible to eliminate LSD as the basic mechanism in the pathogenesis of dry eye disease and numerous other diseases. With the addition of LEH to the NEI classification of DED, it is further proposed that this title be changed to ‘Classification of Lacrimal System Dysfunction’.
Summary and Conclusions
LSD is the basic mechanism in the pathogenesis of common diseases, some of them devastating diseases occurring both in childhood and later life, including keratoconjunctivitis sicca, corneal ulceration or erosion, recurrent herpes simplex keratitis, unexplained decreased visual acuity, with the rule astigmatism, rhinitis and rinorrhea, sinusitis or sinus congestion, frontal headaches, otitis media, hayfever, post-nasal drip, hoarseness, chronic cough, chronic bronchitis, asthma and pneumonia. Patients undergoing treatment for LSD may also report improvement in heartburn, gastroesophageal reflux disease, bladder control, cardiac arrhythmias, pulmonary fibrosis, emphysema, and chronic obstructive pulmonary disease.
1. Herrick JB, Clinical features of sudden obstruction of the coronary arteries, J Am Med Assoc, 1912;59:2015–9.
2. Herrick, Robert S. 1984. Laser Punctal Occlusion. U.S. Patent 4,461, 295, filed October 21, 1983, and issued July 24, 1984."
3. Herrick RS, Berger IB, Rorabaugh R II, Herrick RS II, Benefits of occlusion therapy as measured by a pulse oximeter in pulmonary fibrosis, Poster presented at Pan American Academy of Ophthalmology, Cancun, Mexico, May, 2005.
4. Hamano T, Lacrimal duct occlusion for the treatment of dry eye, Seminars Ophthalmol, 2005;20:71–4.
5. Tost NF, Geerling G, Plugs for occlusion of the lacrimal drainage system, Developments in Ophthalmology, 2008;41:193–212.
6. Yen M, Pflugfelder S, Feuer W, The effect of punctal occlusion on
Any truly effective treatment for ocular dryness and irritation requires the prevention or elimination of LSD, which—according to Hamano4
–is easily
tested for and corrected through functional testing, LOT, and surgical procedures to reduce tear film evaporation. Use of these procedures are vital to achieve effective treatment for many diseases; their use may reduce or eliminate the use of potentially harmful systemic medications, while delaying or preventing potentially serious secondary diseases.
Hippocrates stated: ‘There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.’ To fully understand and prevent LSD, definitive studies must be conducted which produce irrefutable, objective, measurable evidence to establish lacrimology—the study of the lacrimal system and its effects on the body—as an urgently needed and exciting new surgical specialty in evidence-based medicine. Furthermore, Behrens and colleagues explain that: ‘By establishing these definitions and classification of DED, we believe clinicians will be better able to determine the level of DED, as well as the best treatment course for their patients.’14
n
tear production, tear clearance, and ocular surface sensation in normal subjects, Am J Ophthalmol, 2001;131:314–32.
7. Kojima K, Yokoi N, Nakamura Y, et al., Outcome of punctal plug occlusion therapy for severe dry eye syndrome [Article in Japanese], Nippon Ganka Gakkai Zasshi, 2002;106:360–4.
8. Laragh Gollogly (Ed), World Health Statistics 2009, Geneva, Switzerland: World Health Organization, 2009.
9. Herrick R, Lacrimal system dysfunction and resultant neuroImmune dysregulation, Available at:
http://www.lacrimedics.com/docs/dad/LSD%20and%20NID%20No v%202006.doc (accessed December 21 2010).
10. Herrick R, Herrick R II, Consider the cause when treating late- onset epiphora following occlusion therapy, Ophthalmology Times,
2005;30.
11. Lemp M, Report of the National Eye Institute/Industry Workshop on Clinical Trials in Dry Eyes, CLAO J, 1995;21:214–88.
12. Lemp M, Foulks G, The definition and classification of dry eye disease: Guidelines from the 2007 International Dry Eye Workshop, 2008, Available at:
http://www.tearfilm.org/pdfs /OM%20-%20Definition%20&%20Classification.pdf (accessed December 21 2010).
13. Doane MG, Blinking and the mechanics of the lacrimal drainage system, Ophthalmology, 1981;88:844–51.
14. Behrens A, Doyle J, Stern L, et al., Dysfunctional tear syndrome: a Delphi approach to treatment recommendations Cornea, 2006;25:900–7.
Thickening of Basement Membranes
Fuch’s Corneal Dystrophy Glaucoma Cataracts
Macular Degeneration Prostatic Hypertrophy Vascular Disease Neoplastic Disease Pulmonary Fibrosis Emphysema
Chronic obstructive pulmonary disease Contact Lens Lid related
Surface change
Evaporative
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