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Questions and Answers
What is a characteristic symptom of aqueous deficiency dry eye (ADDE)?
What is a characteristic symptom of aqueous deficiency dry eye (ADDE)?
Which of the following signs is typical in a patient with aqueous deficiency dry eye (ADDE)?
Which of the following signs is typical in a patient with aqueous deficiency dry eye (ADDE)?
In primary Sjogren's syndrome, which condition is associated with an increased risk of lymphoma development?
In primary Sjogren's syndrome, which condition is associated with an increased risk of lymphoma development?
What laboratory test is primarily used to detect antibodies in patients suspected of having Sjogren's syndrome?
What laboratory test is primarily used to detect antibodies in patients suspected of having Sjogren's syndrome?
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Which of the following conditions can co-occur with secondary Sjogren’s syndrome?
Which of the following conditions can co-occur with secondary Sjogren’s syndrome?
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Which of the following tear production tests assesses both basal and reflexive tear production without topical anesthesia?
Which of the following tear production tests assesses both basal and reflexive tear production without topical anesthesia?
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What is a characteristic osmolarity measurement that indicates dry eye syndrome?
What is a characteristic osmolarity measurement that indicates dry eye syndrome?
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Which treatment option for Sjogren's syndrome ocular symptoms specifically involves autologous serum?
Which treatment option for Sjogren's syndrome ocular symptoms specifically involves autologous serum?
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What common misconception about dry eye syndrome is represented by the term 'keratoconjunctivitis sicca'?
What common misconception about dry eye syndrome is represented by the term 'keratoconjunctivitis sicca'?
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Which of the following environmental modifications is NOT recommended for managing dry eye symptoms?
Which of the following environmental modifications is NOT recommended for managing dry eye symptoms?
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Study Notes
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.
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Description
Test your knowledge on aqueous deficiency dry eye (ADDE) and Sjogren's syndrome with this quiz. Explore characteristic symptoms, diagnostic tests, and treatment options related to these conditions. This quiz is designed for medical students and healthcare professionals.
