Dry Eyes/Lid issues Flashcards
What are the two subcategories of dry eyes?
Aqueous deficiency or evaporative
How does Sjogren’s syndrome typically present?
Female 30-40, dry eyes, dry mouth, parotid gland enlargement
What is the difference between primary and secondary Sjogrens?
Primary: no underlying rheumatic disease
Secondary: underlying rheumatic disease eg. SLE RA or scleroderma
Which section of the tear film is affected by Sjogren’s syndrome?
Aqueous component: secreted by the lacrimal gland which is damaged by inflammation
What section of the tear film is affected by blepharitis?
Lipid layer deficiency:due to blocked meibomian glands
How does Sjogren’s syndrome appear on initial examination?
Red eye with dull corneal reflex (due to surface irregularity)
Which test is used to evaluate tear production?
Schirmer’s test
Paper under bottom eyelid
a normal result is a wetted length of >10mm in 5 minutes
What does Rose Bengal stain highlight?
Dead/devitalised (no mucus cover) cells
What does fluorescein highlight?
Epithelial cell loss
What other examinations are important to carry out in suspected Sjogren’s?
Oral examination: check for decreased saliva, oral candidiasis
Joint examination: 1/3 of patients with RA have Sjogren’s
Which blood tests should you order in suspected Sjogren’s?
RF
ANA
Anti-Ro
Anti-La
What is the most useful test for diagnosing Sjogren’s?
Minor salivary gland biopsy
How is dry eye treated?
First with artificial tear supplements
- Topical steroids, unpreserved tears/gels at night, cyclosporine A
- Tetracyclines, punctal occlusion, autologous tears
- Permanent punctal occlusion, topical vitamin A, systemic anti-inflam, moisture chamber glasses
What are some complications of Sjogren’s?
Parotid tumours
Parotid infections
Lymphoma
