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Sjögren's Disease
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
The current diagnostic approach requires a multidisciplinary evaluation in most patients. The ophthalmologist seeks evidence of aqueous-deficient dry eye disease, with an assessment of the tear meniscus, tear debris, corneal filaments, ocular surface staining with vital dyes, and measurement of tear flow (generally with Schirmer test strips) and, occasionally, tear osmolarity. An oral medicine specialist or dentist measures salivary flow and examines the oral cavity for signs of salivary hypofunction, including root and incisal caries (relatively unique to salivary hypofunction) and chronic erythematous candidiasis (51). A minor salivary gland biopsy (MSGB) provides the most direct evidence for glandular involvement by SjD, with the finding of focal lymphocytic sialadenitis of sufficient severity to have one or more focal lymphocytic aggregates per 4 mm2 of glandular tissue (focus score ≥1). Finally, the rheumatologist evaluates for systemic manifestations, including serologic abnormalities, and the presence of other autoimmune diseases. Each element of the diagnostic evaluation must be interpreted in the context of the others. None has absolute specificity for the diagnosis.
Pathological Processes of the Eye Related to Chemical Exposure
Published in David W. Hobson, Dermal and Ocular Toxicology, 2020
There are many other evaluative procedures that can be used on eyes clinically such as tonometry, gonioscopy, the schirmer test for tearing, and exophthalmometry.3 Special tests may be indicated in specific instances, but the examination procedures described above for the ocular fundus, the anterior segment, and the adnexa will be sufficient to clinically evaluate most lesions produced by chemical exposures to the eye.
Chronic Fatigue Syndrome: Limbic Encephalopathy in a Dysregulated Neuroimmune Network
Published in Jay A. Goldstein, Chronic Fatigue Syndromes, 2020
CFS patients are often thirsty. The traditional regulators of thirst are osmoreceptors controlling release of vasopressin, and volume receptors which secrete atrial natriuretic peptide. CGRP (calcitonin gene-related peptide) has recently been added to the list as a promo-tor of venous capacitance. There is little evidence to suggest that these mechanisms are operative in CFS. Psychogenic polydipsia is sometimes seen. The most powerful stimulus to thirst is angiotensin II, and the receptors for this peptide in the brain may be dysregu-lated in CFS. Treatment with angiotensin-converting enzyme inhibitors is sometimes effective.80 Nitric oxide acts as an inhibitory mechanism when thirst is stimulated by water deprivation or angiotensin II in the preoptic area.81 If nitric oxide synthase is inhibited, psychogenic polydipsia could ensue. Sicca syndrome is frequently seen in the CFS patient. Sjogren antibodies are not present although enhancement of the salivary glands on MRI in CFS patients with positive antinuclear antibodies is rarely present. The Schirmer test is often positive. This deficit is probably due to dysfunctional autonomic control of tear and saliva secretion and waxes and wanes along with other symptoms. It could also be caused via descending pathways to brain stem parasympathetic nuclei.
The Effect of OTX-101 on Tear Production in Patients with Severe Tear-deficient Dry Eye Disease: A Pooled Analysis of Phase 2b/3 and Phase 3 Studies
Published in Current Eye Research, 2022
Melissa Toyos, Preeya K. Gupta, Brittany Mitchell, Paul Karpecki
Currently, there is no gold standard diagnostic test for DED.13 The Schirmer test is commonly used in ophthalmic examination and/or clinical trials to measure tear production for the diagnosis of conditions, such as KCS, that generally refer to dry eye. It is an easy and economic clinical test to perform, and an abnormal finding indicates a tear deficiency. A score of greater than 10 mm in 5 minutes is accepted as normal. As defined in our pooled analysis, the unanesthetized Schirmer’s score <5 mm after 5 minutes is highly suggestive of severely aqueous deficient dry eye. Overall, the Schirmer test score is one of the proven criteria for outcome measures in other ophthalmological studies, despite the controversies concerning its variations and repeatability.4,14
Hidradenitis Suppurativa is Associated with Symptoms of Keratoconjunctivitis Sicca
Published in Current Eye Research, 2021
Marc Schargus, Christine Anna Langhorst, Stephanie Joachim, Andreas Frings, Kristina Krause, Julia Reifenberger, Gerd Geerling, Verena Gerlinde Frings
The Schirmer test was performed over 5 minutes without anesthetic with sterile strips inserted at the border of the medial to the lateral third of the lower lid margin with the lids being closed. After completing the test, the strips were immediately frozen at −80°C for further MMP-9 and IL-17 analysis. Schirmer strips were eluted with 500 μl phosphate-buffered saline plus 1% Triton X-100 to obtain tear samples for subsequent MMP-9 and IL-17A analysis.26,27 Solid phase sandwich Human MMP-9 and IL-17A ELISA Kits (both Fischer Scientific, Schwerte, Germany) were used to determine MMP-9 or IL-17A concentrations in human tear fluid, respectively. The assays were performed according to the manufacturer’s instructions. All standard curve points as well as all samples were measured in duplicates. The measurements were performed at a wavelength of 405 nm and analyzed using a Microplate Reader (AESKU.Reader with Gen5 ELISA Software; AESKU.DIAGNOSTICS, Wendelsheim, Germany).
Tear Film Dynamics of Soft Contact Lens-Induced Dry Eye
Published in Current Eye Research, 2020
Minako Kaido, Motoko Kawashima, Reiko Ishida, Kazuo Tsubota
DE examinations including conjunctival and corneal vital staining with fluorescein, tear BUT measurement, and Schirmer test without topical anesthesia were performed after removing the SCLs. Tear stability was assessed by standard tear BUT measurement. Keratoconjunctival epithelial damage was evaluated after tear BUT measurement. Two microliters of preservative-free 1% sodium fluorescein were instilled into the conjunctival sac using a micropipette. Overall epithelial damage was scored on a scale of 0–9 points.13 The Schirmer test was administered after completion of all other examinations using a sterilized Schirmer strip (Whatman No. 41, Ayumi Pharmaceutical Corporation, Tokyo, Japan) to evaluate tear quantity. All examinations were performed between 2 p.m. and 5 p.m. Room temperature was maintained at 22–24°C during examinations, with 50–55% humidity.