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Wednesday, 10 July 2013

Part 3 Immune System Gone Wild: Sjogrens National Conference 2013 Dr Bruce Jackson

Dr Bruce Jackson is an ophthalmologist at the University of Ottawa Eye Institute whose topic was  "Dry Eye-Tear Dysfunction: Are We Making Any Progress in Diagnosis and Treatment?"  He feels that ophthalmologists should take a greater role in treatment and diagnosis in patients suspected of having Sjogren's Syndrome.

We learned that the meibomian glands are a major cause of tear abnormalities and that blepharitis and rosacea are often seen in dry eye patients.
                             meibomian glands. elsevier.pt

Dr Jackson showed us the treatment protocols for dry eye as the severity increases.
To treat mild dry eye:
  1. Lid hygiene, warm compress (15 minutes)
  2. Lifestyle coaching (systemic medication management, stop smoking, alter computer use)
  3. Environmental modification(e.g.humidifiers)
  4. Allergy Control
  5. Artificial tear lubricants
All of the above daily management tools continue to help even if the severity increases. 

The next steps to take in addition, if the above are not helping enough:   
  1. Nutritional support (essential fatty acids e.g.Omega 3)
  2. Use preservative-free lubricants (drops,gels and  ointments)
  3. Topical antibiotic (short term only)
  4. Cyclosporine A drops (Restasis)
  5. Topical steroids (short term only)
  6. Systemic tetracycline
  7. Punctal plugs
  8. Moisture retaining eye wear
Most of the steps above require treatment by an eye care professional yet it's good to know the possibilities you may be presented with. Dr Jackson suggested a combination of fish oils and flaxseed oil for the Omega 3 supplementation.
                                          Moisture retaining glasses dryeyeshop.com

And finally for severe dry eye, further steps
  1. Punctal plugs /cautery
  2. Secretagogues
  3. Autologous Serum Tears
  4. Surgery (tarsorrhaphy)
  5. Scleral contact lenses
*It's not always the preservative in artificial tears that can irritate the eyes. Sometimes it's the buffer (borate vs lactate)

Inflammation influences the quality and quantity of the tears we produce.
                        dry as a desert freevintagedigistamp.blogspot

Loss of barrier function causes the tears' meniscus to decrease and dessicate.
It is possible to develop neuropathy of the eye even with normal tear function.
Fast food may be influencing an increase in dry eye disease.

DEWS (International Dry Eye Workshop) definition of Dry Eye Disease: Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.1
It is accompanied by increased osmolarity (concentration) of the tear film and inflammation of the ocular surface.
1."Definition and Classification of Dry Eye. Report of the Diagnosis and Classification Subcommittee of the Dry Eye Workshop (DEWS)." The Ocular Surface 5(2): 75-92, 2007.

Dr Jackson also discussed new treatments in the pipeline such as Rejena, Cyclokat, CF101 Oral, SAR 1118, Rebamipide  and the value of autologous serum tears (terrific treatment)

Not connected to Conference but Sjogren's Related:
Here's a lesson that I found while checking the terminology for this post: 11th Annual Dry Eye Report. Recalibrate Dry Eye Management.  It is clear and well illustrated. I liked seeing the way staining of the eye looks to our eye care professionals.


                                 clspectrum.com

Other Sjogren's posts:

Part 2 Immune System Gone Wild. Sjogren's National Conference Dr.Papas


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