Dry Eyes in Rheumatic Disease

Abstract

Dry eyes are a frequent feature of routine ophthalmic clinical practice, but also form one of the commonest ocular manifestations of rheumatological disease. The spectrum of dry eye disease ranges from mild tear film instability through to severe dry eye which can threaten the integrity of the ocular surface and even lead to ocular perforation. This article discusses the disease pathophysiology and clinical manifestations of dry eye disease and also explores methods of diagnosis and assessment of dry eye. Current and emerging treatment modalities are also discussed, including the different types of ocular lubricants, the role of topical cyclosporine in the management of associated ocular inflammation, and mechanical measures such as plugging of the lacrimal punctum. Keywords: Dry eye, tear film, Sjogren syndrome, autoimmune diseases, Rheumatic Disease, ocular perforation, ocular lubricants,, topical cyclosporine, ocular inflammation, lacrimal punctum, rheumatoid arthritis, sclero-derma, polymyositis, lymphoma, amyloidosis, haemochro-matosis, sarcoidosis, systemic lupus erythematosus, ophthalmologists, optometrists, Schirmer test, corneal neovascularisation, symblepharon, cicatrisation, conjunctival epithelium, autonomic nerves, Goblet, cornea, mucin, meibomian glands, fatty acid, phospholipids, sphingomyelin, ceramides, cerebrosides, lyso-zyme, lactoferrin, growth factor-alpha, pons, trigeminal nerve, pterygopalatine ganglion, hyperosmolarity, MAP kinases, NFB, IL-1a, IL-1, TNF-a, MMP-9, lacrimal exhaustion, immunohomeostasis, autoantigens, fodrin, anti-M3 antibody, autoantibodies, cirrhosis, connective tissue disease, Congenital, dysautonomia, graft versus host disease, hema multiforme, LASIK refractive eye surgery, diabetes melli-tus, Rose Bengal dye, Auxiliary tests, Fluorescein, Lissamine green, The Schirmer Test, tear meniscometry, tear osmolarity, xerostomia, salivary gland biopsy, non-Hodgkin's B cell lymphomas, hyper-gammaglobulinaemia, non-inflammatory rheumatic disorder, allogeneic bone marrow trans-plantation, haematopoietic stem cell, histocompati-bility antigens, polyarteritis nodosa, Wegener's granulomatosis, human T-lymphotropic virus type 1, human immunodeficiency, lymphadenopathy, hepatitis C, fibronectin, neurotrophic growth, vitamin A, Benzalkonium chloriade, sodium perborate, collagen, diquafosol, Cevilimine, loteprednol, fluorometholone, azathioprine, methotrexate, lefluno-mide, hydroxychloroqine, mycophenolic acid, anti-B cell therapy, rituximab, meibomian gland, acne rosacea