Are you providing the highest level of care for your dry eye patients? Testing with all the latest methods, osmolarity, MMP-9, TearScience’s LipiView, to name a few? Treating will a full armamentarium, specialized artificial tears, hot compresses, cyclosporine, steroids, punctual plugs, and more?
Are you providing the highest level of care for your dry eye patients? Testing with all the latest methods, osmolarity, MMP-9, TearScience’s LipiView, to name a few? Treating will a full armamentarium, specialized artificial tears, hot compresses, cyclosporine, steroids, punctual plugs, and more? Perhaps you are, but there is more that you can do for these patients, and that is to try to determine why they have dry eye disease to begin with.
One such “why” may very well be SjÃ¶gren’s syndrome. A 2009 study showed that 26 percent of dry eye patients have an autoimmune disease, and 11 percent were found to have SjÃ¶gren’s syndrome.1
SjÃ¶gren’s syndrome is a chronic autoimmune disease in which the body’s white blood cells destroy the exocrine glands, specifically the salivary and lacrimal glands that produce saliva and tears, respectively.2
Symptoms include dry eye, dry mouth, and can also include joint pain and fatigue. One study showed that 10 percent of SjÃ¶gren’s patients develop lymphoma.3
Next: Diagnosing SjÃ¶gren’s
Diagnosis is usually made in part by autoantibodies Ro and La. The problem with this is that they often show up late in the disease state, when much of the glandular damage has been done, and many SjÃ¶gren’s patients test negative for the autoantibodies.4
The SjÃ¶ test by Nicox takes advantage of novel autoantibodies, salivary gland protein 1 (SP-1), carbonic anhydrase 6 (CA6) and parotid secretory protein (PSP).5
In my practice, we are running more and more of the tests, and we are getting a pretty high hit rate. In a broad sense, think of your recalcitrant dry eye patients-the patients who are in your chair many times throughout the year. In addition, consider patients who are positive for MMP-9, have moderate corneal and conjunctiva staining, or also have dry mouth complaints, joint pain, and fatigue. You can order the test at a local lab, and your Nicox rep can help with the lab orders.
I send the patients to a lab and schedule a follow-up for about three weeks later to review results. If your patient tests positive, you will need to send her to a rheumatologist to confirm the diagnosis. It is also a good idea to get her dentist in the loop because the damage to the salivary glands can lead to dental problems.
Add the SjÃ¶ test to your dry eye clinic. This will provide a higher level of care for you patients and enhance your perception as a primary care provider. Good for your patients, good for your practice.
Editor’s note: Dr. Schachter has no financial relationship with Nicox.
1. Akpek EK, Klimava A, Thorne JE, et al. Evaluation of patients with dry eye for presence of underlying SjÃ¶gren Syndrome. Cornea. 2009 Jun;28(5):493-7.
2. Borchers AT, Naguwa SM, Keen CL, et al. Immunopathogenesis of SjÃ¶gren's syndrome. Clin Rev Allergy Immunol. 2003 Aug;25(1):89-104.
3. Lazarus MN, Robinson D, Mak V, et al. Incidence of cancer in a cohort of patients with primary SjÃ¶gren's syndrome. Rheumatology (Oxford). 2006 Aug;45(8):1012-5.
4. Liew M, Zhang M, Kim E, et al. Prevalence and predictors of SjÃ¶gren’s syndrome in a prospective cohort of patients with aqueous-deficient dry eye. Br J Ophthalmol. 2012 Dec;96(12):1498-503.
5. Shen L, Suresh L, Lindemann M, et al. Novel autoantibodies in SjÃ¶gren’s syndrome. Clin Immunol. 2012 Dec;145(3):251-5.