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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Keratoconjunctivitis sicca causes various ocular symptoms, including the sensation of a foreign body, burning, tiredness, dryness, redness, blurred vision, itchiness, soreness, pain, photosensitivity and excessive secretion.
Dry Eye Syndrome/Keratoconjunctivitis Sicca/Xerophthalmia
Published in Charles Theisler, Adjuvant Medical Care, 2023
Dry eyes are a common symptom and occur in up to 30% of those older than 50 years.1 Unfortunately, the medical literature is confusing regarding terminology with the term dry eye syndrome often used interchangeably with dry eye symptoms. Dry eyes from most causes is keratoconjunctivitis sicca. Sjögren’s syndrome, systemic lupus erythematosus, and rheumatoid arthritis can cause dry eyes.2
Blepharoplasty
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Keratoconjunctivitis sicca (dry eye syndrome) is most often seen in patients who have a pre-existing tear film insufficiency. This should be specifically examined for pre-operatively and the patient counselled accordingly. This can be particularly important in patients who have undergone corneal refractive procedures (e.g. LASIK) or who wear contact lenses. The consistent continued use of frequent artificial tears is imperative in these patients who may also require additional procedures at a later date (e.g. punctal plug placement or punctal cautery). Patients who require artificial tears more frequently than three or four times per day should use a preservative free preparation.
A review of dry eye disease therapies: exploring the qualities of varenicline solution nasal spray
Published in Expert Review of Ophthalmology, 2023
Siddharth Bhargava, Ranjani Panda, Asma M Azam, John D Sheppard
The prototypical patient who is likely to most benefit from VNS nasal spray is the challenging glaucoma patient who is concurrently suffering from DED. A glaucoma patient may already be on numerous antihypertensive drops. They may have significantly decreased vision from advanced intra-ocular disease and arthritis or tremors due to advanced age. They may have neurotrophic corneas from diabetes, herpes corneal surgery, contact lenses, or involutional ectropion. As a twice-daily spray, VNS would reduce the drop burden for this patient. Their dry eye may have been intrinsic or developed secondarily from toxicity from glaucoma drops decreased blink rate, or a deficient tear-lake. As patients’ discomfort may originate from drops themselves, a nasal delivery system would mitigate compliance in settings where another drop may not be welcome. Likewise, for those who have undergone filtration surgery, whether due to nonadherence or advanced disease, protection of conjunctival health is a must. Thus, factors that ease the treatment of keratoconjunctivitis sicca would improve long-term outcomes.
Efficacy of low-dose of baricitinib in the treatment of patchy alopecia and sicca syndrome in an SLE patient
Published in Scandinavian Journal of Rheumatology, 2022
The patient was a 20-year-old Asian female who was diagnosed with SLE and secondary SS 1.5 months earlier. Her hair loss, dry eyes, and dry mouth started 4 months before her referral, without rash or Raynaud’s phenomenon. Her keratoconjunctivitis sicca was confirmed by an ophthalmologist. Serological testing showed an anti-nuclear antibody titre of 1:640 (homogeneous pattern) with positive antibodies to double-stranded DNA, Ro52, and SSA/Ro60. Rheumatoid factors and lupus anticoagulants were also observed at the onset. She had received prednisolone (PSL, 5 mg/day), hydroxychloroquine (HCQ), and iguratimod treatment for 1.5 months when she was referred to our hospital, but her hair loss and SS did not improve, and her erythrocyte sedimentation rate (ESR) increased from 40 to 51 mm/h. On examination, we noted patchy alopecia (Figure 1A, B). Since promising efficacy of treatment with baricitinib for alopecia areata (AA) has been reported, we introduced baricitinib (2 mg/day) along with combination therapy with PSL (10 mg/day) and HCQ. Surprisingly, prominent hair regrowth was observed after 1.5 months of treatment (Figure 1C, D). Her European Alliance of Associations for Rheumatology Sicca Score (2) also decreased from 6 to 2, and the ESR reduced to 26 mm/h. After 3 months, no alopecia (Figure 1E, F) or SS could be observed in this patient. The PSL dose was gradually tapered to 5 mg, with no alopecia or SS relapse. The therapeutic interventions and main clinical parameters of the patient are depicted in Figure 2. No adverse events occurred in this patient.
A Review of Ocular Graft-versus-Host Disease: Pathophysiology, Clinical Presentation and Management
Published in Ocular Immunology and Inflammation, 2021
Jimena Tatiana Carreno-Galeano, Thomas H. Dohlman, Stella Kim, Jia Yin, Reza Dana
Ocular GVHD (oGVHD) arises in 30 to 60% of patients who undergo HSCT and in 60 to 90% of patients with systemic GVHD.6,7 oGVHD is characterized by involvement of the lacrimal glands, eyelids and ocular surface, with resulting inflammation and fibrosis in these tissues. These changes produce symptoms of dry, painful eyes and signs of keratoconjunctivitis sicca (dry eye) and sometimes even cicatricial conjunctivitis. These changes have the potential to lead to severe visual impairment and a significant reduction in patient quality of life.8 The management of oGVHD can be challenging due to the persistence and severity of patient systems, and a multidisciplinary approach is critical to improving patient outcomes. Here, we present a comprehensive review of oGVHD, including disease pathophysiology, clinical presentation and current management strategies.