Punctal plugs versus artificial tears for treating primary Sjögren’s syndrome with keratoconjunctivitis SICCA: a comparative observation of their effects on visual function
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KERATOCONJUNCTIVITIS SICCA
Artificial tears
Sjögren syndrome
Keratoconjunctivitis
Sicca syndrome
Interest in keratoconjunctivitis sicca, which is an inflammation of the cornea and conjunctiva associated with dryness, was limited primarily to ophthalmologists until 1933 when Sjögren1reported finding stomorhinopharyngolaryngitis sicca, enlargement of the salivary glands, and arthritis in patients with keratoconjunctivitis sicca. The association of these conditions with keratoconjunctivitis sicca since then has been designated as Sjögren's syndrome. This study was undertaken to investigate the relationship of other clinical conditions to keratoconjunctivitis sicca and Sjögren's syndrome and to determine the occurrence of various protein and hematologic abnormalities in both conditions. We also wished to determine the incidence of the various manifestations of Sjögren's syndrome among patients with keratoconjunctivitis sicca and to study the course and prognosis of both conditions.
Materials and Methods
The records of 248 patients with keratoconjunctivitis sicca observed at the Mayo Clinic from 1950 through 1956 were reviewed. Each patient was examined by an ophthalmologist, and keratoconjunctivitisKERATOCONJUNCTIVITIS SICCA
Keratoconjunctivitis
Sicca syndrome
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KERATOCONJUNCTIVITIS SICCA
Sjögren syndrome
Keratoconjunctivitis
Sicca syndrome
Connective Tissue Disorder
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1Toronto, Canada; 2Indiana University, School of Optometry, Bloomington, IN; Sjogren's Syndrome Research Group, Toronto Western Hospital; DREI Group,
KERATOCONJUNCTIVITIS SICCA
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Sjögren syndrome
Schirmer test
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Keratoconjunctivitis sicca is a disorder with the deficiency of aqueous component of the tear film. Dry eyes, associated with ocular irritation and photophobia, may lead to corneal and conjunctival changes, including superficial puntate keratitis and filamentary keratitis. We have utilized Artelac (0.3% hydroxypropylmethylcellulose) in the therapy of 30 patients suffering from dry eye. Subjective symptoms and objective signs were used to evaluate the efficacy of Artelac eye drops for the treatment of dry eye. Subjective symptoms improved on 29/30 patients (96.6%), and objective signs improved on 25/30 patients (83.3%). In statistical analysis, symptoms and signs significantly improved after medication with Artelac. Side effects were not observed on these 30 patients during the period of application of Artelac. Artelac is an effective artificial tear substitute to treat keratoconjunctivitis sicca.
KERATOCONJUNCTIVITIS SICCA
Artificial tears
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Keratoconjunctivitis
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The effect of sustained-release artificial tear inserts on symptoms and signs of reduced tear production in keratoconjunctivitis sicca (KCS) was evaluated in an open clinical trial including 30 patients. A significant relief of sicca symptoms and a decrease in keratoconjunctival staining were seen in 10 patients fulfilling the study, whereas no significant effect on Schirmer test and tear break-up-time could be detected, neither in patients with pure KCS nor with KCS as a manifestation of Sjögren's syndrome. Twenty patients (67%) withdrew due to adverse effects, which were reported in total 80% of the patients. Absence of measurable tear secretion predicted treatment failure. Due to the frequent side effects, the artificial tear inserts cannot be recommended as a first line treatment in KCS patients.
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Schirmer test
Sicca syndrome
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The paper is devoted to an analysis of the clinical manifestations of keratoconjunctivitis sicca in Sjogren's syndrome in combination with SLE, sclerodermia systematica, rheumatoid arthritis, and in Sjogren's disease. Some characteristic signs of a course of keratoconjunctivitis sicca in Sjogren's disease and syndrome were defined.
KERATOCONJUNCTIVITIS SICCA
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Case Reports1 June 1960SJÖGREN'S SYNDROME IN ASSOCIATION WITH SCLERODERMAMARTIN A. SHEARN, M.D.MARTIN A. SHEARN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-52-6-1352 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe symptom complex known as the sicca syndrome, or Sjögren's syndrome, has been observed frequently in conjunction with rheumatoid arthritis. A relationship between this syndrome and the other diseases that affect primarily connective tissues has been suggested but rarely documented. The purpose of the present paper is to report the association of the sicca syndrome with scleroderma in two patients, and to review the literature relating this syndrome to collagen diseases.In a series of contributions beginning in 1933, expanding previous observations, Sjögren1helped to establish a symptom complex that has become known as the sicca syndrome, or Sjögren's syndrome....Bibliography1. Sjögren H: Zur Kenntnis der Keratoconjunctivitis sicca, Acta ophth. (Suppl. 2) 11: 1, 1933. Google Scholar2. Forster HW: Rose bengal test in diagnosis of deficient tear formation, Arch. Ophth. 45: 419, 1951. CrossrefMedlineGoogle Scholar3. Sjögren H: Keratoconjunctivitis sicca and the sicca syndrome, some actual problems, Tr. Ophth. Soc. Australia 11: 27, 1951. Google Scholar4. Holm S: Keratoconjunctivitis sicca and the sicca syndrome, Acta ophth. (Suppl. 33) 27: 1, 1949. Google Scholar5. Houwer AW: Keratitis filamentosa and chronic arthritis, Tr. Ophth. Soc. U. Kingdom 47: 88, 1927. Google Scholar6. Fischer E: Ueber Fädchenkeratitis, Graefes Arch. Ophth. 35 (pt. 3): 201, 1889. CrossrefGoogle Scholar7. Sjögren H: Zur Kenntnis der Keratoconjunctivitis sicca II, Allgemeine Symptomatologie und Ätiologie, Acta ophth. 13: 1, 1935. CrossrefGoogle Scholar8. Stenstam T: On the occurrence of keratoconjunctivitis sicca in cases of rheumatoid arthritis, Acta med. scandinav. 127: 130, 1947. CrossrefGoogle Scholar9. Henderson JW: Keratoconjunctivitis sicca. A review with a survey of 121 additional cases, Am. J. Ophth. 33: 197, 1950. CrossrefMedlineGoogle Scholar10. ThompsonEadie MS: Kerato-conjunctivitis sicca and rheumatoid arthritis, Ann. Rheumat. Dis. 15: 21, 1956. CrossrefMedlineGoogle Scholar11. LackingtonCharlinGormaz MCVCBA: Kerato-conjunctivitis sicca y artritis reumatoidea, Rev. méd. de Chile 79: 233, 1951. MedlineGoogle Scholar12. LeinwandDuryeeRichter IAWMN: Scleroderma: 150 cases of scleroderma, in Rheumatic diseases, American Rheumatism Association, 1952, W. B. Saunders Co., Philadelphia, p. 265. Google Scholar13. BeigelmanGoldnerBayles PMFTB: Progressive systemic sclerosis (scleroderma), New England J. Med. 249: 45, 1953. CrossrefMedlineGoogle Scholar14. Leriche R: Traitement chirurgical du syndrome de Sjögren (oeil sec et bouche sèche), résultat au bout de vingt-huit mais d'une double section du nerf vertébral; nature de la maladie, Presse méd. 55: 77, 1947. Google Scholar15. RamageKinnear JHWF: Kerato-conjunctivitis and the collagen diseases, Brit. J. Ophth. 40: 416, 1956. CrossrefMedlineGoogle Scholar16. Sheldon JH: Sjögren's syndrome associated with pigmentation and scleroderma of the legs, Proc. Roy. Soc. Med. 32: 255, 1938. CrossrefGoogle Scholar17. Weber FP: Discussion of case report, ibid. Google Scholar18. HarringtonDewar ABHA: A case of Sjögren's disease with scleroderma, Brit. M. J. 1: 1302, 1951. CrossrefMedlineGoogle Scholar19. CardelGurling BSKJ: Observations on the pathology of Sjögren's syndrome, J. Path. and Bact. 68: 137, 1954. CrossrefMedlineGoogle Scholar20. McLeanRobinson KHS: Sjögren's syndrome, Canad. M. A. J. 71: 597, 1954. MedlineGoogle Scholar21. Heaton JM: Sjögren's syndrome and systemic lupus erythematosus, Brit. M. J. 1: 466, 1959. CrossrefMedlineGoogle Scholar22. Morgan WS: The probable systemic nature of Mikulicz's disease and its relation to Sjögren's syndrome, New England J. Med. 251: 5, 1954. CrossrefMedlineGoogle Scholar23. CaugheyRichardson JEW: Acrosclerosis; with a report of a case treated with cortisone, New Zealand M. J. 51: 227, 1952. MedlineGoogle Scholar24. Kaposi M: Neue Beiträge zur Kenntnis des Lupus erythematosus, Arch. Dermat. u. Syph. 4: 36, 1872. CrossrefGoogle Scholar25. ShearnPirofsky MAB: Disseminated lupus erythematosus: analysis of 34 cases, Arch. Int. Med. 90: 790, 1952. CrossrefGoogle Scholar26. Shearn MA: Unpublished cases. Google Scholar27. HarveySchulmanTumultyConleySchoenrich AMLEPACLEH: Systemic lupus erythematosus: review of the literature and clinical analysis of 138 cases, Medicine 33: 291, 1954. CrossrefMedlineGoogle Scholar28. MorganCastleman WSB: Clinicopathologic study of Mikulicz's disease, Am. J. Path. 29: 471, 1953. MedlineGoogle Scholar29. SeifertGeiler GG: Salivary glands and rheumatic disease, German M. Month. 3: 87, 1958. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Oakland, California*Received for publication December 17, 1958.From the Department of Medicine, Permanente Medical Group, Kaiser Foundation Hospital, Oakland, California.Requests for reprints should be addressed to Martin A. Shearn, M.D., Director of Medical Education, Kaiser Foundation Hospital, 280 West MacArthur Boulevard, Oakland 11, California. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Second Definition of Sjögren's Syndrome as an Autoimmune DisorderThe First Definition of Sjögren's SyndromeSjögren's Syndrome in Systemic Sclerosis: A Clinical Study of 26 PatientsSjögren’s Syndrome and Systemic Sclerosis (Scleroderma)Sjogren's syndrome in an adolescentScleroderma in childhood: Report of 5 casesSjögren's syndrome in progressive systemic sclerosis (scleroderma)Uncommon Connective Tissue Disorders in ChildhoodSerum Hyperviscosity in Sjögren's Syndrome Interaction Between Serum IgG and IgG Rheumatoid FactorDONATO ALARCÓN-SEGOVIA, M.D., F.A.C.P., EUGENIA FISHBEIN, JOHN L. ABRUZZO, M.D., F.A.C.P., RALPH HEIMER, Ph.D.Features of Sjögren's Syndrome in Primary Biliary CirrhosisDONATO ALARCÓN-SEGOVIA, M.D., F.A.C.P., EFRAIN DÍAZ-JOUANEN, M.D., EUGENIA FISHBEINZUR KENNTNIS DER KERATOCONJUNCTIVITIS SICCA VIIIDifferential Diagnosis in Mikulicz's Syndrome, Mikulicz's Disease, and Similar Disease EntitiesThe Coexistence of Sjögren's Syndrome and Systemic Lupus ErythematosusALFRED D. STEINBERG, M.D., NORMAN TALAL, M.D.Die Stellung des Sjögren-Syndroms im allergisch-hyperergischen FormenkreisOesophageal Abnormalities in Sjögren's SyndromeNephrogenic diabetes insipidus and other defects of renal tubular function in Sjögren's syndromeAntinuclear and Precipitating Auto-antibodies in Sjogren's SyndromeSjögren's syndromeRheumatism and Arthritis Review of American and English Literature of Recent Years (Fifteenth Rheumatism Review)CHARLEY J. SMYTH, M.D., F.A.C.P., FELIX E. DEMARTINI, M.D., F.A.C.P., EPHRAIM P. ENGLEMAN, M.D., F.A.C.P., EDWARD C. FRANKLIN, M.D., DONALD F. HILL, M.D., F.A.C.P., JOSEPH LEE HOLLANDER, M.D., F.A.C.P., HOWARD L. HOLLEY, M.D., F.A.C.P., JOHN G. MAYNE, M.D., F.A.C.P., WILLIAM M. MIKKELSEN, M.D., F.A.C.P., MAX M. MONTGOMERY, M.D., F.A.C.P., CARL M. PEARSON, M.D., F.A.C.P., CHARLES L. SHORT, M.D., F.A.C.P., HUGH A. SMYTHE, M.D., F.R.C.P. (C), OTTO STEINBROCKER, M.D.Sjögren's syndrome and its relation to connective tissue diseasesA review of recent observations and current theories on the etiology and pathogenesis of progressive systemic sclerosis (diffuse scleroderma)A Clinical Study of Sjögren's SyndromeNEAL A. VANSELOW, M.D., VERNON N. DODSON, M.D., DAVID C. ANGELL, M.D., IVAN F. DUFF, M.D., F.A.C.P.Familial Occurrence of Collagen Diseases: I. Progressive Systemic Sclerosis and Systemic Lupus Erythematosus 1 June 1960Volume 52, Issue 6Page: 1352-1362KeywordsArthritisCollagen diseasesConnective tissue diseasesCorneaHospital medicineMucous membranesRheumatoid arthritisSclerodermaVagina ePublished: 1 December 2008 Issue Published: 1 June 1960 PDF downloadLoading ...
KERATOCONJUNCTIVITIS SICCA
Sicca syndrome
Sjögren syndrome
Scleroderma (fungus)
Keratoconjunctivitis
Systemic scleroderma
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the relationship of other clinical conditions to keratoconjunctivitis sicca and Sj\l=o\gren's syndrome and to determine the occurrence of various protein and hematologic ab- normalities in both conditions. We also wished to determine the incidence of the various manifestations of Sj\l=o\gren'ssyn- drome among patients with keratocon- junctivitis sicca and to study the course and prognosis of both conditions. ) typical symptoms such as stinging, burning, and foreign-body sensation, (2) dryness of the conjunc¬ tiva as indicated by Schirmer's test,2 and (3) corneal and conjunctival staining with Bengal rose or fluorescein typical of keratoconjunctivitis sicca. Sjogren's syndrome was diagnosed when patients had keratoconjunctivitis sicca plus one or more additional features of the syndrome. In considering arthritis we included only joint diseases, such as rheumatoid arthritis, which may be regarded as systemic disorders. The incidence of associated clinical conditions, protein changes, and hematologie abnormalities in cases of Sjogren's syndrome was compared with that in cases of keratoconjunctivitis sicca without other evidence of Sjogren's syn¬ drome. Specimens of bone marrow were examined in 22 cases of Sjogren's syndrome and differential counts of 500 cells were performed. Follow-up letters were sent to the 248 patients in the current study and to 121 additional patients with kerato¬ conjunctivitis sicca who were the subjects of an earlier study.3
KERATOCONJUNCTIVITIS SICCA
Sicca syndrome
Keratoconjunctivitis
Xerophthalmia
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Rose bengal
KERATOCONJUNCTIVITIS SICCA
Keratoconjunctivitis
Sjögren syndrome
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