Sjogren's Thygeson's Filamentary Seidel PDF

more (non-cicatricial) Ocular Surface Disorders Alex Hynes OD FAAO Sjogren’s Syndrome  Sjogren’s syndrome Aqueous deficiency dry eye (ADDE) T cell mediated inflammation of lacrimal gland ↓’d tear production 2 major classes Symptoms Worse later i...

more (non-cicatricial) Ocular Surface Disorders Alex Hynes OD FAAO Sjogren’s Syndrome  Sjogren’s syndrome Aqueous deficiency dry eye (ADDE) T cell mediated inflammation of lacrimal gland ↓’d tear production 2 major classes Symptoms Worse later in day Symptoms of ADDE Blurred vision Fluctuating Grittiness/FB sensation, burning, itching Pain (esp. filamentary keratitis) Photophobia Mucus/sticky discharge Signs of ADDE Bulbar conj injection ↓’d tear meniscus Debris/mucus in tear film Punctate epithelial erosions Filaments Irregular astigmatism Primary Sjogren’s Syndrome Primary Sjogren ↑’d risk for lymphoma development (+) dry __________ (xerostomia) (+) dry eye +/- vaginal dryness (females) Can also have fatigue Fibromyalgia (pain) Polyarthralgia Depression/anxiety Risk of developing non Hodgkin lymphoma Mucosal associated lymphoid tissue Sjogren investigation: biopsy Salivary gland biopsy Lower lip (minor salivary glands) Lymphocytic infiltration Secondary Sjogren’s syndrome Pt also has 1 of following: Rheumatoid arthritis (RA) Systemic lupus erythematosus (SLE) Progressive systemic sclerosis (scleroderma) Polymyositis & dermatomyositis Mixed connective tissue disease Sjogren investigation: labs Antibodies to Ro/SS-A Antibodies to La/SS-B Rheumatoid factor Antinuclear antibody (ANA) Erythrocyte Sedimentation rate (ESR) C-reactive protein (CRP)  Ocular Surface staining Bulbar conj staining (esp. temporal) Patchy pattern K staining= non- pathognomonic for Sjogren’s syndrome Typically indicative of keratoconjunctivitis (k.) sicca Keratoconjunctivitis (K) sicca vs Dry eye K sicca= dry eyes 2/2 qualitative and quantitative abnormality of lacrimal gland secretions Or _________________________________________ Dry eye can be 2/2 ↓’d tear production ↑’d tear evaporation abnormality in specific constituents of tear film Clinical Assessment Sjogren’s Syndrome Ocular Surface Disease Index (OSDI) *note: perform OSDI on all significant dry eye &/or cicatricial conjunctivitis presentations, not just  Schirmer’S teSt i Filter paper strip inserted for 5 min 2 versions: 1=Without topical anesthesia: basal vs reflexive tear production Normal > 10 mm Abnormal < 5 mm 2= With topical anesthesia: basal vs reflexive tear production Normal > 5 mm *note: perform Schirmer’s or equivalent test on all significant dry eye presentations  Tear film osmolarity > 300 mOsm/L > 8 mOsm/L difference bt/w eyes milliosmoles = mOsm *multiple devices on market [Ocular] Treatment Sjogren’s Syndrome Sjogren’s ocular tx PFAT’s Autologous Serum or Octaplas Platelet rich plasma (PRP) Topical steroid Topical cyclosporine Restasis (0.05%) BID Cequa (0.09%) BID Erythromycin 5mg/g ung Or Vitamin A containing ointment punctal plugs?? Medically necessary CL Intranasal Tear Neurostimulator?? E.g. tyrvaya [*+ any necessary MGD/evaporative dry eye tx] Sutureless Amniotic membrane Punctal plugs Punctal vs (intra)canicular location Dissolvable vs semi-permanent  Environmental Modification Hydration Humidifier Moisture chamber goggles Sleep goggles Conscious blinking when using digital devices Sjogren’s syndrome management Multidisciplinary team Rheumatologist Ophthalmologist/optometrist Dentist Oral cholinergic agonists pilocarpine 5-7 mg p.o. BID-QID cevimeline 15-30 mg p.o. TID Filamentary Keratitis  Filamentary Keratitis Mucus threads Painful Tx: jeweler’s removal PF AT’s q1h erythromycin ung qhs Acetylcysteine (Mucomyst) 10% gtts Q.I.D. BCL E.g. moxifloxacin coverage Perforation Assesment  Seidel Test (+)= leakage from AC thru cornea → aqueous leakage dilutes NaFl → dark blue/black stream (aqueous) +/- bright green diluted fluorescein (as fluorescein becomes diluted it turns bright green under blue light) Fig. 2-7 American Academy of Ophthalmology 2024-2025 BCSC, Section 08: External Disease and Cornea eBook Seidel Test https://www.aao.org/education/ba sic-skills/positive-seidel-test https://www.youtube.com/watch? v=wNBlaTatsN0 https://www.youtube.com/watch? app=desktop&v=2R0xm2JOXFo Desmetocele Thygeson superficial punctate keratitis  Thygeson superficial punctate keratitis Tearing, FB sensation, photophobia Raised punctate epithelial lesions Negative staining Mild bulbar conj hyperemia possible Recurrent episodes FML 0.1% Q.I.D. Thygeson’s SPK Small, round gray-white granular opacities