Hello and welcome to Case of the Day. I’m Dr. Croley and today we’re gonna discuss an interesting case that came in the office. A lady came in the office today complaining of severe irritation and redness of her eye. It turns out that she had very dry eyes. It actually dries to the point that actually the cell walls on the surface of her eye had actually decomposed and when we put a dye in her eye, we can put different kinds of dye that stain those cell walls that are broken down and she had several areas on her eyes especially the cornea, where the cells have actually died and not survived due to the dryness of her eye.
After taking her history, she was also complaining of her mouth of being very dry as well, and also had a history of rheumatoid arthritis. So when we put those three things together, that is called Sjögren’s Syndrome. Sjögren’s Syndrome was first described by a doctor in Sweden, and he noticed that a lot of the ladies who are coming in to his office were complaining of dry eyes, and dry mouth and they were having arthritis problems, and he was the first to describe this triad of Sjögren’s Syndrome.
So what is Sjögren’s Syndrome? It is an autoimmune disease in which the glands of the mouth and the eyes become inflamed and stop producing their fluid. And so being an autoimmune disease, it’s a lot of times very difficult to diagnose that because there are other types of autoimmune diseases, that’s the reason why there is an association with rheumatoid arthritis, which is also an autoimmune disease. Other things such as lupus scleroderma, those diseases are the same type of thing, so it’s very difficult sometimes to figure out in the beginning whether someone has Sjögren’s Syndrome or some other type of autoimmune disease.
There are blood tests that we can do that can help diagnose Sjögren’s Syndrome. That is ANA or antinuclear antibody test, which is typically in most cases of Sjögren’s is elevated. But this is not specific, so it doesn’t tell you if it’s Sjögren’s. It just tells you there is inflammation in the body. Same thing with rheumatoid factor and same thing which is a sed rate.
Sed rate is measuring how much inflammation is in someone’s body, it is a non-specific test so it just tells you that there is a problem going on but not what that is. If there is really a concern trying to diagnose Sjögren’s syndrome, so the final thing to do is to actually take a biopsy inside the lower lip of one of the glands, and see if there are inflammatory cells inside that gland and therefore that way we can diagnose specifically, that this person has Sjögren’s syndrome.
As far as the eyes go, these people tend to get, in a lot of cases, severe dry eyes, to the point that sometimes, the cornea or the clear part of the eye, actually becomes scarred, and actually can blur the vision or cause the loss of vision permanently. That’s not very often, but it can happen. But Sjögren’s syndrome dry eye patients are very difficult to treat, so they take a lot of care, a lot of time and effort to try to get them comfortable. One thing that does seem to help, in my hands at least, is been putting these people on Restasis, which is an eye drop for dry eyes.
It seems that the anti-inflammatory effects of the Restasis that helps with the dry eyes also helps with dry eyes associated with Sjögren’s, at least in my experience. There are other things that we can do, we can plug up the tear ducts to try to keep the tears up on the surface of the eye instead of draining away into the nose. Then of course there’s a variety of different kinds of tear drops that are available.
Sjögren’s can also cause other problems in other parts of your body. So, I’ve had one severe case that actually had the central nervous system, that is brain effects, inflammatory process in their brain from Sjögren’s syndrome. So it can affect the different parts of the body, the kidneys, intestines, and those kinds of things. You can get very dry skin as well with Sjögren’s syndrome. Sjögren’s syndrome can be a very severe problem in some people. This lady, we’re gonna start on a regimen of Restasis and tears and see how she does.
If you have any questions about what we discussed here at Case of the Day, you can contact us through the website, we’d be happy to answer questions that you have, and try to make this an informative maybe sometimes fun time together. Maybe in the future we will start discussing different glasses, frames, and what to do about choosing the right type of lens. So, we got all kinds of things coming in the future.
May God bless each and every one of you with great vision and healthy eyes.