Keratoconjunctivitis sicca

Dysfunction may be caused by aging, systemic inflammatory diseases, a decrease in androgen hormones, surgery, ocular surface diseases (such as herpes zoster), systemic diseases, or medications that affect the efferent cholinergic nerves. Decreased tear secretion produces an inflammatory response on the ocular surface called keratoconjunctivitis sicca. This inflammation is now a target for new medications that treat dry eye.29,30... 

Keratoconjunctivitis sicca Dryness of conjunctiva and cornea a component of Sjogren s syndrome. 

The carbomer polymeric gel base itself has been used successfully to treat moderate to severe cases of dry eye (keratoconjunctivitis sicca) [282]. The dry eye syndrome is usually characterized by deficiency of tear production and, therefore, requires frequent instillation of aqueous artificial tear eyedrops to keep the corneal epithelium moist. The gel base applied in a small amount provides a prolonged lubrication to the external ocular tissues, and some patients have reduced the frequency of dosing to control their symptoms to three times a day or fewer. 

A more recent report shows clear sulfonamide-induced idiosyncratic responses in dogs (mostly Dobermans) that encompasses fever, arthropathy, blood dyscrasias (neutropenia, thrombocytopenia, or hemolytic anemia) hepatotoxicity, skin eruptions, uveitis, and keratoconjunctivitis sicca [65], These symptoms became apparent as soon... 

A number of ocular surface disorders collectively termed as Dry Eye Syndromes have also been associated with the conjunctiva. For example, a deficiency and/or imbalance in compositions of the tear film is often found on the ocular surface during keratoconjunctivitis sicca. Since the conjunctiva plays a direct role in the maintenance of the tear fluid stability via secretion of mucin [1] by its resident goblet cells [4] and basal fluid secretion driven by electro-osmotic gradients across the tissue [3], the conjunctiva is a well deserved, but not intensively studied, target of interest in research efforts aimed against combating Dry Eye Syndromes. 

Cyclosporine is used to prevent organ rejection after tissue transplantation. It is also used for rheumatoid arthritis, psoriasis and dry eyes (keratoconjunctivitis sicca). For... 

Patients with severe keratoconjunctivitis sicca are at definite risk of this complication, and the addition of phosphate-containing eye-drops tilted the precariously balanced situation toward precipitation of calcium in the cornea and bandage contact lens. Acetate-containing rather than phosphate-containing glucocorticoid eye drops may be a safer alternative in patients with such predisposing factors. 

Galatoire, O., Baudouin, C., Pisella, P. J., and Brignole, F. (2003), Flow cytometry in impression cytology during keratoconjunctivitis sicca Effects of topical cyclosporin A on HLA DR expression,/. Francois d Ophtalmol., 26, 337-343. 

Topical LE 0.5% (Lotemax) four times a day may benefit patients with keratoconjunctivitis sicca that has at least a moderate inflammatory component. Currently, however, the use of topical steroids for dry eye treatment is strictly off label. ... 

Cyclosporine A (CsA, Restasis 0.05%) was approved in 2002 by the FDA as an ocular therapeutic for patients with keratoconjunctivitis sicca (dry eye). Until 2002 the therapy of choice for the treatment of dry eye was artificial tears and punctal plugs and the occasional use of pulse doses of topical steroids.Artificial tears and pimctal plugs brought some temporary relief to patients, but the underlying cause of dry eye, inflammation, was not affected. Steroids carried the threat of a multitude of side effects. With as many as 7.1 million people in the United States alone encountering dry eye symptoms, the development of a therapy that eliminates the inflammatory events associated with the disease has been a significant benefit. 

Stonecipher K, Perry HD, Gross RH, et al.The impact of topical cyclosporine A emulsion 0.05% on the outcomes of patients with keratoconjunctivitis sicca. Curr Med Res Opin 2005 21 1057-1063. 

Eox RI, Chan R, Michelson JB, et al. Beneficial effect of artificial tears made with autologous serum in patients with keratoconjunctivitis sicca.Arthritis Rheum 1984 27 459-461. 

GUbard J. Tear film osmolarity in keratoconjunctivitis sicca. CLAOJ 1985 11 243-250. 

GUbard JP, Kenyon KR.Tear dUuents in the treatment of keratoconjunctivitis sicca. Ophthalmology 1985 92 646-650. 

Nelson JD, Friedlainder M, Yeatts RF et al. Oral pilocarpine for symptomatic reUef of keratoconjunctivitis sicca in patients with Sjogren s syndrome. In Sulhvan DA, Dartt DA, Meneray MA, eds. Lacrimal gland, tear film, and dry eye syndromes 2 basic science and clinical relevance. New York Plenum Press, 1998 979-983. 

Prause JU. Treatment of keratoconjunctivitis sicca with Lacrisert. Scand J Rheum 1986 6l(suppl) S26l-S263. 

Figure l6-9 Rose bengal staining in patient with keratoconjunctivitis sicca (arrows). Note the typical triangular shape and location in the area of eyelid gap of the cornea and conjunctiva. (Courtesy Mark Williams, O.D.)... 

Associated conditions may include papillary conjunctivitis keratoconjunctivitis sicca (KGS), present in as many as 50% of patients superficial punctate keratitis (SPK), affecting predominantly the inferior quadrant of the cornea ... 

Darsun D, Ertan A, Bhezikei B, et al. Ocular surface changes in keratoconjunctivitis sicca with shicone punctum plug occlusion. Curr Eye Res 2003 26 263-269. 

The primary vision-threatening manifestations of sarcoidosis are uveitis, glaucoma, and optic nerve involvement dry eye (keratoconjunctivitis sicca) is common but of lower risk. Anterior segment findings (including conjunctival granulomas, iris nodules, iridocyclitis, and keratoconjunctivitis sicca) occur in up to 70% of patients. In contrast, posterior uveitis occurs in up to 30% of patients. If only vasculitis, periphlebitis, or retinal neovascularization is considered, the frequency ranges from 4% to 17% of cases. Optic nerve involvement presents in up to 7% of patients. 

Ciclosporin eye-drops have been used after keratoplasty, in high-risk cases, to prevent graft rejection and to treat severe vernal conjunctivitis, keratoconjunctivitis sicca, and various immune-related comeal disorders. Despite its severe adverse effects after systemic use, topical ciclosporin can generally be used without serious adverse reactions (44,45). 

The efficacy, safety, tolerability, and optimal dose of ciclosporin eye-drops have been studied in a randomized, double-masked, vehicle-controlled multicenter trial in 162 patients with keratoconjunctivitis sicca with or without Sjogren s disease and refractory to conventional treatment (48). Ciclosporin ophthalmic emulsion 0.05, 0.1, 0.2, or 0.4%, or the vehicle alone was instilled twice daily into both eyes for 12 weeks, followed by a 4-week observation period. There was no clear dose-response relation ciclosporin 0.1% emulsion produced the most consistent improvement in objective and subjective endpoints and ciclosporin 0.05% gave the most consistent improvement in sjmptoms. The vehicle also performed well, perhaps because of its long residence time on the ocular surface. There were no significant adverse effects, no microbial overgrowth, and no residence time of the vehicle emulsion on the ocular surface. AH treatments were well tolerated and the highest ciclosporin blood concentration detected was 0.16 ng/ml. 

Patients with severe keratoconjunctivitis sicca are at definite risk of this complication, and the addition of phosphate-containing eye-drops tilted the precariously... 

There have been two reports of Sjogren s sjmdrome (keratoconjunctivitis sicca, xerostomia, swelling of the parotids) in suspected association with penicillamine (372,373). In one study, reference was made to a patient with a Henoch-Schonlein-like syndrome as a suspected adverse reaction to penicillamine, but no details were given (374). 

Allergic reactions to tiabendazole can cause keratoconjunctivitis sicca as part of Sjogren s syndrome (5). Tinnitus has been attributed to tiabendazole (6). 

Topical tretinoin has also been used as an ophthalmic ointment 0.01% in the treatment of squamous metaplasia associated with dry eyes. In 161 patients with either keratoconjunctivitis sicca or conjunctival cicatricial diseases (Stevens-Johnson syndrome, inactive pemphigoid, radiation-induced dry eye, drug-induced pseudopemphigoid, and toxic epidermal necrolysis) there were no beneficial effects in the former, but significant reversal of conjunctival kerati-nization in the temporal bulbar site in the latter (1). Adverse effects were hmited to blepharoconjunctivitis and resolved on withdrawal. 

Dry eye (keratoconjunctivitis sicca) is a chronic condition characterised by dryness of the surface of the eye. It is caused by either a deficiency of conjunctival mucus, due to the absence or significant impairment of the mucin producing goblet cells of the conjunctiva, or tear deficiency, the latter often associated with rheumatoid arthritis. 

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