Most often, dry eyes are due to Blepharitis (inflammation of the eyelid) , Sjogren syndrome, aging, eye infections, corneal ulcers or other factors. Schirmer's Test is done to check for dry eyes or even severely watering eyes. A special strip of paper is placed inside the lower eyelids for about 5 minutes. The paper strips are then checked for level of moisture to determine the eye's ability to produce tears. How far down the tears reach on the paper strips is also noticed. In some cases, anaesthetic drops are applied prior to administering this test. Another alternative to the Schirmer's Test is the Phenol Red Thread test wherein red strips of special thread are used instead of special paper strips. Remove contact lenses before this test and do not wear for a couple of hours after it.
Sjogren syndrome is an autoimmune disorder causing conditions such as xerostomia and Xerophthalmia. It was first discovered by Henrick Sjogren. The symptoms associated with this disorder are often chronic and occur due to damage or impairment of the exocrine glands caused due to the lymphocytic infiltrates and hypersensitivity reactions. The onset of Sjogren syndrome predominantly occurs in the region of salivary glands and lacrimal glands. The primary form of Sjogren syndrome is generally associated with external glandular symptoms such as dry eyes and dry mouth without any connective tissue damage. The secondary form of the Sjogren syndrome usually occurs because of preexisting autoimmune disorders.
Clinical manifestations of Sjogren syndrome
Sjogren syndrome usually occurs in the older age group; however exceptions have been reported on it affecting younger persons. The factors causing Sjogren syndrome are predominantly genetical or environmental. Neuro-endocrine impairment plays a significant role in the onset of the Sjogren syndrome. HLA-DR genotype is the predominant factor in the genetic propagation of the disease.
Sjogren syndrome is associated with a cascade of symptoms related to many organ systems and their functions. The affected regions are ocular, oral, ontological, laryngeal, vascular, neurologic and endocrine systems respectively. The effect of the Sjogren syndrome is mainly on the head and neck region and hence the sense organs are affected to a larger extent. Other clinical conditions include loss of hearing, arthralgia, myalgia and also frequent epistaxis. Sjogren syndrome if not treated, can lead to serious conditions such as lymphoma and renal failure.
Diagnosis and treatment of Sjogren syndrome
Sjogren syndrome is diagnosed by using radiological, pathological and serological analysis. Schirmer's test is used in the diagnosis of Xerophthalmia. It is used to estimate the tear secretion level of patients suffering with dry eye conditions. The decreased levels or absence of tear secretion indicates probability of Sjogren syndrome. Salivary biopsy is advised for patients suffering xerostomia. The pathological analysis of the salivary glands also reveals underlying infiltration and damage caused to the exocrine glands. Serological analysis of the Sjogren syndrome are generally associated with low WBC counts, increased erythrocyte sedimentation rates, elevated levels of protein and hyper-gammaglobulinemia of IgM. Careful clinical study of the diagnostic parameters along with symptoms is necessary to rule out false positive results.
The treatment of Sjogren syndrome is generally a slow process because it is an autoimmune disorder. Immunosuppressive drugs and salivary substitutions are some of the methods administered to manage Sjogren syndrome. Pilocarpine an FDA approved tear stimulating drug is widely used for the treatment of dry eyes.
In Xerophthalmia or dry eye syndrome, the eye doesn't produce enough tears or the tears have a chemical composition that causes them to evaporate quickly. Dry eye syndrome is common fallout of increasing age since the body produces less oil over time. The oil deficiency has a bearing on the tear film since the water layer over the eye dries faster. This condition is more pronounced in women than men. Women suffering from dry skin or menopausal symptoms may notice dry eyes too.Causes for dry eyes
A condition of dry eyes is determined by a physician who will measure the production, evaporation rate and quality of tear film. A thin strip of filter paper placed at the edge of the eye, called a Schirmer test, is one way of measuring this. An ophthalmologist can look at the film of tears on your eye using a slit lamp (bio-microscope). Treatment for dry eyes involves trying to preserve as much of the eye's natural moisture as possible. Eye drops act as artificial tears and provide temporary relief. Anti-inflammatory agents are prescribed for more severe cases of dry eyes.
While topical steroids can be used for inflammation, they can cause side effects after prolonged use. Some forms of dry eye syndrome benefit from the placement of tiny plugs in the ducts that drain tears from the eye. These special plugs trap the tears on the eye, keeping it moist. This may be done on a temporary basis with a dissolvable collagen plug or permanently with a silicone plug. For severe cases, special goggles called moisture-chamber spectacles can be worn.
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Bibliography / Reference
Collection of Pages - Last revised Date: October 18, 2019