Disordines de Superficie Ocular Non-Cicatricial

Non-Cicatricial Ocular Surface Disorders

• This presentation covers non-scarring eye surface issues, specifically Sjogren's Syndrome.

Sjogren's Syndrome

• Aqueous Deficiency Dry Eye (ADDE): Characterized by insufficient tear production.
• T cell-mediated inflammation: Immune cells trigger inflammation in the tear-producing glands.
• Decreased tear production: Reduced tear generation.
• Two Major Classes: Primary and secondary Sjögren's syndrome.
• Symptoms: Dry eye, worsening later in the day.

Symptoms of ADDE

• Blurred Vision: Fluctuating vision.
• Grittiness/Foreign Body Sensation: Burning and itching sensations.
• Pain (especially filamentary keratitis): Significant pain.
• Photophobia: Sensitivity to light.
• Mucus/Sticky Discharge: Viscous secretions.

Signs of ADDE

• Bulbar Conjunctival Injection: Inflammation of the white part of the eye.
• Decreased Tear Meniscus: Reduced tear layer.
• Debris/Mucus in Tear Film: Presence of foreign matter in the tears.
• Punctate Epithelial Erosions: Small breaks in the protective surface layer.
• Filaments: Thread-like structures in the eye.
• Irregular Astigmatism: Uneven eye shape.

Primary Sjogren's Syndrome

• Increased Risk of Lymphoma: Higher chance of developing lymphoma.
• Dry Mouth (Xerostomia): Mouth dryness.
• Dry Eye: Insufficient tear production.
• Vaginal Dryness (sometimes): Additional symptom in females.
• Associated Conditions: Fibromyalgia, Polyarthralgia, Depression, and Anxiety.

Sjogren Investigation: Biopsy

• Salivary Gland Biopsy: Tissue sample from salivary glands to examine.
• Lower Lip Biopsy: (minor salivary glands) for inspection.
• Lymphocytic Infiltration: Presence of immune cells within tissue.

Secondary Sjogren's Syndrome

• Association with Other Conditions: Often associated with Rheumatoid arthritis, Systemic Lupus Erythematosus (SLE), Progressive Systemic Sclerosis, Polymyositis & Dermatomyositis and Mixed Connective Tissue Disease.

Sjogren Investigation: Labs

• Antibodies: Presence of antibodies, such as anti-Ro/SS-A, anti-La/SS-B, and Rheumatoid Factor.
• Anatomic Nuclear Antibody (ANA): Blood test for autoantibodies.
• Erythrocyte Sedimentation Rate (ESR): Lab test indicating inflammation.
• C-Reactive Protein (CRP): Marker of inflammation.

Ocular Surface Staining

• Bulbar Conjunctival Staining (especially temporal): Dye to reveal spots on the eye suggestive of damage on the eye surface.
• Patchy Pattern K Staining: Non-specific for Sjogren's Syndrome.
• Keratoconjunctivitis Sicca (K. Sicca): Dry eye condition.

Keratoconjunctivitis (K) Sicca vs Dry Eye

• Keratoconjunctivitis Sicca (K. Sicca): Irregular eye staining pattern, from insufficient or unusual tear formation or quality.
• Dry Eye: Overall deficiency in tear production or tear quality.
• Decreased Tear Production: Lower quantity of tears, which is a part of keratoconjunctivitis sicca.
• Increased Tear Evaporation: Tear loss potentially due to increased evaporation rate.
• Tear Film abnormalities: Potentially due to abnormal composition of tears.

Clinical Assessment

• Procedure to evaluate eye health.

Ocular Surface Disease Index (OSDI)

• Diagnostic tools to quantify symptoms associated with dry eyes.
• Scoring system to evaluate the severity of symptoms.

Schirmer's Test

• Measures tear production, with or without anesthetic.
• Normal Results: Tear production exceeding a certain measurement (mm).
• Abnormal Results: Tear production below this measurement.

Tear Film Osmolarity

• Measures the salt concentration of the tear film.
• Normal Tear (Healthy): Low salt concentration.
• Hyperosmolarity (Dry Eye): High salt concentration, suggesting abnormally high tear concentrations, which dries the eye.

Ocular Treatment

• PFAT's (Platelet-Rich Fibrin-Autologous Tissue):
• Autologous Serum or Octaplas:
• Platelet-Rich Plasma (PRP):
• Topical Steroids:
• Topical Cyclosporine: Eye drops or ointments.
• Restasis: (eye drops)
• Cequa: (eye drops)
• Erythromycin:
• Vitamin A:
• Ointments: For topical application.
• Punctal Plugs: (Medical Procedure) Block tear drainage in the eyes.

Punctal Plugs

• Intra/Canicular Location: Placement of the plug in a specific eye area.
• Dissolvable vs Semi-Permanent: Different durations of plug effects.

Environmental Modification

• Hydration: Drink enough water.
• Humidifiers: Increase moisture and humidity in your surroundings.
• Moisture Chamber Goggles: Protects eyes from air and environmental conditions.
• Sleep Goggles: Prevent eye dryness during sleep.
• Conscious Blinking: Use blinking strategically when using digital devices.

Sjogren's Syndrome Management

• Multidisciplinary Team: Collaboration of specialists (Rheumatologist, Ophthalmologist, and Dentist)
• Oral Cholinergic Agonists: Drugs to stimulate saliva and tear production.
• Pilocarpine: Drug to stimulate saliva and tear production (oral)
• Cevimeline: Drug to stimulate saliva and tear production (oral).

Filamentary Keratitis

• Symptoms: Thread-like mucus strands in the eye, significant eye pain.
• Treatment: Removal of mucus, anti-inflammatory eye drops (possibly containing corticosteroids) and eye drops containing anti-inflammatories or other medications.

Perforation Assessment

• Seidel Test: Used to check for fluid leakage from the anterior chamber of the eye.

Desmetocele

• Description: A specific eye condition related to a problem in the protective layer of the eye.

Thygeson Superficial Punctate Keratitis

• Symptoms: Itching, tearing, foreign body sensation in the eye, slight eye pain or discomfort, and visual discomfort associated with irritation.
• Characteristics: Raised lesions on the surface of the eye, negative surface staining.
• Treatment: Medicated eye drops.

Este quiz explora los disordines ocular non-cicatricial, con un foco special al Sindrome de Sjogren. Examina los sintomas e signos asociados con la insufficiencia de produccion de lagrimas e inflammation. Testa tu conocimiento sobre estas condiciones oculars e sus implicaciones.