News and Events

DRY EYES – WHY YOU

SHOULD BE

CONCERNED!

By: Dr. Phillip Haiman, OD

A 47 year-old female presented for a routine eye exam with complaints of red eyes that constantly tear and burn.  She also feels like something is in her eye and that her vision is not as clear as before.  The vision varies with blinking.  She has noticed this condition over the past several years.  Her medical history is significant for rheumatoid arthritis.  She is not taking medications or vitamins on a routine basis.  She only wears reading glasses and her last eye exam was 4 years ago.

EXAMINATION

Examination revealed 20/20 vision in both eyes without the need for distance correction. She has a small prescription for near tasks. The process of determining her prescription was difficult and required constant reminding of her to blink – this is because a poor tear film causes blurred vision. Blinking stimulates tear secretion. Evaluation of her tear film revealed a significant decrease in tear production.  Other tests performed confirmed she had a dry eye state caused by a decrease in tear production.  Upon further questioning she revealed that her mouth was always dry and carried a bottle of water with her at all times.  The rest of the exam was normal.  I diagnosed her with Sjogren’s syndrome.

DISCUSSION

Sjogren’s Syndrome is an autoimmune disease that involves diffuse secretory gland dysfunction throughout the body.  There are 2 types.  Primary, when there is just dry eye and dry mouth and secondary, which occurs in association with a host of autoimmune diseases such as arthritis.  Sjogren’s syndrome usually occurs in women with the initial age of onset between 40 and 60.  The age of onset correlates well with the high incidence of other autoimmune syndromes in women in this age group.  Approximately 25% of patients have rheumatoid arthritis and 90% usually have dry eyes. Of significant importance is a 44 times greater incidence of life threatening malignant lymphoma. The diagnosis of Sjogren’s syndrome is made when a patient meets 2 or more of the following criteria: 1. Drying mucous membranes (oral, ocular, and nasopharyngeal), 2. Enlarged parotid (major salivary gland) or other salivary glands, or 3. An autoimmune disease (such as rheumatoid arthritis) that involves connective tissue (tissue between joints.)  There are multiple concerns that must be addressed.  There is an increase of ocular infection due to the lack of ocular lubrication, dental cavities and loss of taste due to the lack of saliva and frequent nose bleeds due to the lack of nasal lubrication. 75% of patients with dry eyes develop an infection of the eye’s surface or eyelids – with the most severe cases causing blindness.

TREATMENT/FOLLOW-UP 

The clinical course can follow one of 2 patterns, either slowly progressive, or rapidly progressive.  The more rapid the course the more severe the symptoms and clinical presentation.  Treatment is aimed to reduce symptoms, as there is no cure. Patients need to be co-managed by their primary care doctor (or rheumatologist), eye doctor and dentist.  After this patient was diagnosed she was referred for a comprehensive blood evaluation to assure no other systemic diseases are present.  Her dentist prescribed Salagen, which promotes saliva function. I am treating her with Cyclosporin-A (suppresses the cells that destroy the lacrimal gland) and Optive (a non-preserved artificial tear.)  I have her scheduled every 2-3 weeks until her symptoms abate or are tolerable.  Once we achieve this, I will see her every 3 months to assure her ocular (eye) surface remains healthy. This patient was thoroughly educated about the chronic and progressive nature of this disease and the importance of compliance with treatment to HELP avoid some of the serious problems that can occur.  The progressive nature of glandular destruction causes Sjogren’s syndrome to be one of the most frustrating diseases for both patient and healthcare provider.

Additional information can be found on the Sjogren’s syndrome Foundation website www.sjogren.org.

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