Diagnosis Of Keratoconjunctivitis Sicca Research Articles

Keratoconjunctivitis sicca in dogs

This article discusses keratoconjunctivitis sicca (KCS), factors that may contribute towards KCS and how we might treat/manage it. KCS is often characterised by uncomfortable eyes accompanied with mucopurulent discharge and a general dry appearance to the cornea. Often these patients present to the veterinary practice with secondary complications such as corneal ulcers and infections. In this instance it may be difficult to get a diagnosis of KCS, however this article will discuss some pre-disposing factors, and this information along with patient history may help towards deciding treatment options. KCS can be difficult to manage if the patient is not cooperative and so this article will touch on cyclosporin implants which can be a median-term alternative to administering eye drops. Cyclosporin implants are commonly used in veterinary equine practice, however they can be similarly used for small animal patients and can provide much relief for pets and owners!

Immune-mediated keratoconjunctivitis sicca in dogs: current perspectives on management.

Keratoconjunctivitis sicca (KCS) is a frequent canine ophthalmic disease, resulting from the deficiency of one or more elements in the precorneal tear film. There are different known causes of KCS in dogs, including congenital, metabolic, infectious, drug induced, neurogenic, radiation, iatrogenic, idiopathic, and immune mediated, though the last one is the most prevalent form in dogs. Initially, clinical signs of KCS include blepharospasm caused by ocular pain, mucoid to mucopurulent ocular discharge, and conjunctival hyperemia; secondary bacterial infection may also occur, with chronicity, corneal epithelial hyperplasia, pigmentation, neovascularization, and corneal ulceration. The diagnosis of KCS is based on the presence of consistent clinical signs and measurement of decreased aqueous tear production using the Schirmer tear test. Therapy is based on administering the following topical drugs: ocular lubricant, mucolytics, antibiotics, corticosteroids, pilocarpine, and immunomodulators. These last drugs (eg, cyclosporine, pimecrolimus, and tacrolimus) have immunosuppressive activity and stimulate tear production. Furthermore, the nerve growth factor is a new subject matter of the research. Although these therapies are advantageous, stimulation of natural tear production seems to provide the highest recovery in clinical signs and prevention of vision loss. The goal of the following article is to describe the recent developments about KCS in dogs emphasizing the use of new therapies.

Keratoconjunctivitis sicca of human T cell lymphotropic virus type 1 (HTLV-1) infected individuals is associated with high levels of HTLV-1 proviral load

Background A high HTLV-1 proviral load is found in HTLV-1-associated diseases, mainly HAM/TSP. However, the association between proviral load and keratoconjunctivitis sicca (KCS) has not been well established. Aim To verify the association between KCS and HTLV-1 proviral load. Study design 104 HTLV-1 infected patients (51 asymptomatic and 52 with HAM/TSP) from the HTLV reference center in Salvador, Brazil were followed from June 2008 to May 2010. Evaluation of tear secretion was performed by BUT (break-up time), Rose Bengal and Schirmer I tests. The diagnosis of KCS was based upon the presence of symptoms and when at least two of three tests were positive. HTLV-1 proviral load was determined using real-time PCR. Results The prevalence of KCS was 44.2%. KCS was more frequent among HAM/TSP patients ( p = 0.022). Patients with KCS had higher proviral load (mean 134,672 ± 150,393 copies/10 6 PBMC) than patients without the disease (mean 66,880 ± 109,525 copies/10 6 PBMC) ( p = 0.001). HTLV-1 proviral load > 100,000 copies/10 6 PBMC increased significantly the risk of developing KCS (OR = 4.05 and 95% CI = 1.40–11.76). After age > 45 years and HAM/TSP status were excluded in stepway reward analysis, the variables PVL > 100,000 (OR = 4.77 and 95% CI = 1.83–12.44) still remained statistically significant. Conclusion HTLV-1 proviral loads are higher in patients with KCS and may represent a relevant biological marker of disease.

Breed predisposition to congenital alacrima in dogs

To evaluate the clinical characteristics and breed predisposition of congenital alacrima in dogs. Animals studied Dogs with congenital keratoconjunctivitis sicca. A search of the medical records of the University of Tennessee Veterinary Teaching Hospital from 1974-2005 and the University of California-Davis Veterinary Teaching Hospital from 1986-2006 for dogs under 1 year of age with a diagnosis of keratoconjunctivitis sicca (KCS) was performed. These cases were further reviewed for dogs with a Schirmer's tear test I of <or= 5 mm/min before 6 months of age, with no known causes for KCS, which did not respond to appropriate KCS therapy; these cases were considered to have congenital alacrima. These breeds were compared to all other breeds using the Fisher's exact test with correction for multiple comparisons. Congenital alacrima was identified in 19 dogs representing 11 breeds and mixed breeds. Yorkshire Terriers and Bedlington Terriers were statistically overrepresented compared to reference populations (P < 0.01 and P = 0.04, respectively). Yorkshire terriers are significantly at risk for congenital alacrima compared to other breeds. The significance of the increase in congenital alacrima in Bedlington Terriers in this study may not be clinically relevant and may be due to the small total number of dogs of this breed that presented to the both hospitals. Based on the poor response to therapy in humans with congenital alacrima, it may be prudent to offer guarded prognoses for KCS in juvenile Yorkshire terriers.

Qualitative and quantitative tear film abnormalities in dogs

Tear film disorders in dogs can be classified into quantitative or qualitative abnormalities, or both, and are commonly observed in daily clinical practice. Inadequate production of one or more tear film components can lead to variable degrees of ocular disorders, called keratoconjunctivitis sicca. Keratoconjunctivitis sicca in dogs has several causes, but in most cases the disease is idiopathic, with T lymphocytes playing a role. In veterinary medicine, the diagnosis is made based on the results of the Schirmer tear test. In this article, we review aspects related to the etiopathogenesis and diagnosis of keratoconjunctivitis sicca in dogs and discuss new therapeutic modalities for this disease.

Tear Film Osmolarity: Determination of a Referent for Dry Eye Diagnosis

To determine new referents, or cutoff levels for tear film hyperosmolarity in the diagnosis of keratoconjunctivitis sicca (KCS) and to assess their effectiveness in independent patient groups. A meta-analysis was performed on published data for tear osmolarity in samples of normal eyes and various subtypes of dry eye, and pooled estimates of the mean and standard deviations for normal and (all) dry eye subjects were determined. Diagnostic referents were derived from the intercept between the distributions of osmolarity in the two samples and from receiver operator characteristic (ROC) curves. This referent was tested for effectiveness of diagnosis in independent groups with normal and dry eyes. An osmolarity referent of 315.6 mOsmol/L was derived from the intercept of the distribution curves, and 316 mOsmol/L from the ROC curve. When applied to independent groups of normal and dry eye subjects a value of 316 mOsmol/L was found to yield sensitivity of 59%, specificity of 94%, and an overall predictive accuracy of 89% for the diagnosis of dry eye syndrome. Tear hyperosmolarity, defined by a referent of 316 mOsmol/L, was superior in overall accuracy to any other single test for dry eye diagnosis (Lactoplate, Schirmer test, and Rose Bengal staining), even when the other test measures were applied to a diagnosis within the sample groups from which they were derived. For overall accuracy in the diagnosis of dry eye, the osmolarity test was found to be comparable with the results of combined (in parallel or series) tests.

Effect of age, gender, weight, and time of day on tear production in normal dogs

To investigate the effects of age, weight, gender, and of time of day on tear production in normal dogs. studied One hundred ophthalmoscopically and systemically unremarkable dogs. Schirmer tear tests (STT) were performed every 2 h during the day on one randomly chosen eye of each of 100 dogs. There was a statistically significant effect of time of day and age on the STT measurement. The mean STT decreased by 0.4 mm for every 1 year that age increased (P=0.007). Mean STT values taken at 10:00 am were 0.7 mm lower than values taken at 4:00 pm (P=0.04). Tear production decreases with age in the normal dog. In this population of dogs the largest difference was between the 10:00 am and the 4:00 pm STT measurements, but this still only amounted to 0.7 mm. This value is unlikely to be of clinical significance in the diagnosis of keratoconjunctivitis sicca (KCS).

Assessment of keratoconjunctivitis sicca in patients with fibromyalgia: results of a prospective study.

Patients with fibromyalgia (FM) often describe the presence of dry eyes and other ocular symptoms. It has been claimed that a subgroup of patients with FM might have features suggestive of primary Sjögren syndrome. In others, such a relationship could not be found. The purpose of the present study was to investigate the association and prevalence of keratoconjunctivitis sicca (KCS) in patients with FM. Among 285 patients with FM, 40 patients reporting sicca symptoms were screened with Schirmer's I test, break-up time and Rose-Bengal score. KCS was diagnosed when two of the selected three tests gave pathological results. A detailed ophthalmological examination was also performed. In 15 patients the diagnosis of KCS could be confirmed. Eighteen of 40 patients had been taking low-dose antidepressants and 7 of them had objective signs of KCS. Eight of 40 patients had signs of chronic blepharitis and 4 of them had KCS. Fourteen patients showed unremarkable test results. Chronic blepharitis and the use of tricyclic antidepressants may play a role in developing KCS. It seems that the rate of KCS does not increase in patients with FM and they probably have objective ocular findings comparable with the normal population.

Sjögren's syndrome

The review describes the historical development and nomenclature of Sjögren's syndrome--primary and secondary. The strengths and weaknesses as well as similarities and dissimilarities for establishing the diagnosis of keratoconjunctivitis sicca and xerostomia used among the five most commonly classification criteria sets are focused upon in text and table. Validation of the different sets of criteria are performed. Primary and secondary disease activity markers and outcome measures as well as future research plans for improving diagnosis are dealt with.

Rapid Assay of Lactoferrin in Keratoconjunctivitis Sicca

We compared measurement of lactoferrin concentration by the LactoCard solid phase ELISA assay with the LactoPlate radial immunodiffusion assay in tears of normal patients and those with keratoconjunctivitis sicca. The LactoCard, a new lactoferrin assay, allows rapid determination of tear lactoferrin concentration in 10-15 min, a notable improvement over the 3 days required of the LactoPlate. There was no statistically significant difference between the accuracy of the two assays in normal patients nor in those patients with a diagnosis of keratoconjunctivitis sicca. Both assays showed a significant decrease in tear lactoferrin concentration in patients with severe keratoconjunctivitis sicca when compared to normal patients. The LactoCard is a rapid and reliable means of measuring tear lactoferrin concentration in a clinical setting.

Association of patterns of labial salivary gland inflammation with keratoconjunctivitis sicca. Analysis of 618 patients with suspected Sjögren's syndrome.

To determine the association between patterns of inflammation in labial salivary glands (LSG) and the ocular component of Sjögren's syndrome (SS). We classified LSG biopsy specimens from 618 patients with suspected SS as showing focal lymphocytic sialadenitis (FLS), other chronic sialadenitis (CS), or other diagnoses. We then determined the association of the other component of primary SS, keratoconjunctivitis sicca (KCS), with FLS, CS, parotid flow rate, and xerostomia. FLS, rather than CS, was associated with a diagnosis of KCS (chi 2 = 191, P < 0.0001). The severity of KCS correlated directly with the severity of FLS (r = 0.52, P < 0.0001), but not of CS, and correlated inversely with parotid flow rate in those patients who had FLS (r = -0.29), but not in those who had CS (r = -0.03). Xerostomia was marginally associated with KCS (chi 2 = 5, P = 0.02). The stronger KCS association found in patients whose LSG biopsies show FLS makes FLS the best criterion presently available for diagnosing the salivary component of SS. CS is a common feature of labial salivary glands but is neither associated with SS nor an end stage of primary SS. Histopathologic examination of salivary tissue is currently essential for diagnosing primary SS as well as secondary SS in which KCS is lacking, especially cases to be included in studies of SS.

Schirmer test. I. A review.

Since its introduction by Schirmer in 1903, the Schirmer test has been widely used for the assessment of the adequacy of tear production. Although the faults of the Schirmer test have been well documented, it is nevertheless still being used to assess tear production, especially in the diagnosis of keratoconjunctivitis sicca (KCS) and for screening potential contact lens wearers. We summarize the findings and conclusions of some of the previous studies.

Cross-Validatory Selection of Binary Variables in Differential Diagnosis

SUMMARY The statistical method of cross-validatory choice is used to construct a basis for prediction of a binary dependent variable from binary independent variables. The implementation of the method involves a score function, a cut-off value and a loss function. It proceeds by unrestricted sequential splitting, followed by a cross-validatory selection of the cut-off value which is then applied to the result of the splitting. The method is evaluated on three well-known data-bases for the diagnosis of kerato conjunctivitis sicca, rheumatoid arthritis and the treatment of jaundice. Generalizations of the technique are outlined.

A Statistical Aid to the Diagnosis of Keratoconjunctivitis Sicca

A computer-assisted statistical method of logistic discrimination is described for the diagnosis of keratoconjunctivitis sicca. Ten symptoms and seven signs of keratoconjunetivitis sicca in 40 patients with keratoconjunctivitis sicca and 37 patients with no clinically obvious ocular pathology who acted as controls formed the basis of the computer diagnosis. As a test, the statistical method was applied to 34 further patients, 17 of whom had keratoconjunctivitis sicca. Of the latter, two patients were incorrectly diagnosed and five were given queried diagnosis. The remaining 27 patients were diagnosed correctly. Study of the inter-observer error in eliciting the symptoms and signs of keratoconjunctivitis sicca by an ophthalmologist and two physicians indicated a high degree of concordance in eliciting symptoms, but a low concordance in eliciting signs. When calculation of diagnosis was based on analysis of the 10 symptoms only, in the 34 patients, 17 of whom had keratoconjunctivitis sicca, the results were better than when analysis was based on the 10 symptoms and seven signs. Four patients with no keratoconjunctivitis sicca were allocated a query diagnosis: none of the patients were allocated incorrect diagnoses. The method is suitable for use by physicians in screening patients with rheumatoid arthritis for keratoconjunctivitis sicca, and has the attraction that once the scoring system has been established it is possible to calculate the diagnostic score for a patient using simple arithmetic or a desk calculator.

BENGAL ROSE AS AN AID IN THE DIAGNOSIS OF “KERATO‐CONJUNCTIVITIS SICCA”; (SJÖGREN'S SYNDROME)

BENGAL ROSE AS AN AID IN THE DIAGNOSIS OF “KERATO‐CONJUNCTIVITIS SICCA”; (SJÖGREN'S SYNDROME)