Dry Eye Syndrome and Sjogren's Syndrome Quiz

Non-Cicatricial Ocular Surface Disorders

• This presentation focuses on non-scarring eye conditions.
• Sjögren's syndrome, a systemic autoimmune disorder, is a key focus.

Sjögren's Syndrome

• Characterized by aqueous deficiency dry eye (ADDE)
• Lacrimal gland inflammation caused by T-cells
• A reduction in tear production is a primary symptom
• Two major classifications: Primary Sjögren's and Secondary Sjögren's syndrome

Aqueous-deficient Dry Eye (ADDE)

• Symptoms: Blurred vision, fluctuating vision, grittiness/foreign body sensation, burning, itching, pain, photophobia, mucus/sticky discharge.
• Signs of ADDE: Bulbar conjunctival injection, decreased tear meniscus, debris/mucus in tear film, punctate epithelial erosions, filaments, irregular astigmatism.

Primary Sjögren's Syndrome

• Increased risk of lymphoma development.
• Dry eyes (xerostomia)
• May also include vaginal dryness (in females).
• Often accompanied by symptoms like fatigue, fibromyalgia, polyarthralgia, and depression/anxiety.

Secondary Sjögren's Syndrome

• Associated with other conditions:
• Rheumatoid arthritis (RA)
• Systemic lupus erythematosus (SLE)
• Progressive systemic sclerosis (scleroderma)
• Polymyositis & dermatomyositis
• Mixed connective tissue disease

Sjögren's Investigation: Biopsy

• Salivary gland biopsy (lower lip region) is crucial in diagnosis
• Shows lymphocytic infiltration.

Sjögren's Investigation: Labs

• Diagnostic tests include antibodies to Ro/SS-A, La/SS-B, rheumatoid factor, antinuclear antibody, Erythrocyte Sedimentation rate (ESR), and C-reactive protein (CRP).

Ocular Surface Staining

• Bulbar conjunctival staining (especially temporal side)
• Patchy staining patterns are often non-specific for Sjögren's, whereas negative or specific patterning are considered more indicative of the condition
• This is often indicative of keratoconjunctivitis sicca.

Keratoconjunctivitis Sicca vs. Dry Eye

• Keratoconjunctivitis Sicca: Dry eye due to a problem with the lacrimal gland secretions.
• Dry Eye: May be caused by reduced tear production or increased tear evaporation, abnormalities in tear film constituents.

Clinical Assessment

• Assessing patient symptoms and history, such as discomfort during activities like reading, working on a computer, or watching TV, as important in diagnosis.
• Evaluating environmental factors potentially exacerbating eye conditions, such as low humidity or wind exposure.

Ocular Surface Disease Index (OSDI)

• Diagnostic tool for evaluation of dryness symptoms.
• Used to assess severity of eye dryness symptoms
• Applicable for significant cases of dry eye/cicatricial conjunctivitis.

Schirmer's Test

• Used to measure tear production.
• Two versions exist, one with and one without topical anesthesia.
• Normal values indicate adequate tear production, whilst abnormal values suggest decreased tear production.

Tear Film Osmolarity

• Measures the salt concentration of tears, determining differences between the eyes when conditions such as dryness might be present.
• Elevated values suggest dry eye conditions.

Ocular Treatment

• Methods for treating ocular symptoms of Sjogren's Syndrome, including topical medications and other interventions.

Punctal Plugs

• Used to block tear drainage from the eye.
• Different types exist, varying in duration (short, medium, long-term) and materials (e.g., collagen, hydrogel, silicone).
• Important to note the placement locations within the eye and their overall durability, with careful attention to factors such as biocompatibility.

Environmental Modifications

• Simple but effective ways to prevent dry eye symptoms, including use of: hydration, humidifiers, moisture chamber goggles, sleep goggles and conscious blinking when using digital devices.

Sjögren's Syndrome Management

• Management usually requires a multidisciplinary team: Rheumatologist, Ophthalmologist or Optometrist, and Dentist
• Includes oral cholinergic agonists, such as pilocarpine (5-7mg p.o. BID-QID) and cevimeline (15-30mg p.o. TID), for improving salivary and tear production.

Filamentary Keratitis

• Characterized by mucus threads, often painful
• Treatment approaches include jeweler's removal, topical medications like PFAT's (every hour), Erythromycin ointments every night, and Acetylcysteine (Mucomyst) (4 times daily). Antibiotic use, like Moxifloxacin, may also play a role, depending on the diagnosis/bacteria related to the condition.

Perforation Assessment

• The Seidel Test may be performed to evaluate for leakage from the anterior chamber of the eye.
• A positive test indicates a perforation of the cornea and/or the sclera.

Desmetocele

• An eye condition that is characterized by a visible disruption of the eye's cornea, resulting from a specific form of corneal perforation.

Thygeson Superficial Punctate Keratitis

• Presents with specific eye symptoms like tearing, foreign body sensation, photophobia, and the appearance of raised and punctate epithelial lesions, also occasionally, mild conjunctival hyperemia or redness.
• Treatment recommendations often include frequent application (four times a day) of topical medications such as flouride containing medications.