What Is Keratoconjunctivitis Sicca?

Primary insufficient secretion of tear fluid is clinically referred to as Sjogren's syndrome. There are two broad and narrow senses. The generalized Sjogren's syndrome (SJS for short) refers to the combination of other autoimmune-related diseases (such as rheumatoid arthritis) in addition to dry mouth and eyes; SJS in the narrow sense is dryness angle. Conjunctivitis (KCS for short). In addition to the lack of primary tear secretion, dry keratoconjunctivitis can also be found in the following situations: chronic diseases such as endocrine diseases, anemia, vitamin deficiency. Acute diseases such as acute exfoliative dermatitis, Stevens-Jonhnson syndrome, ocular pemphigus. Trauma and surgery of eyelid and conjunctiva may damage most basic secretory tissue.

Basic Information

English name: keratoconjunctivitis sicca
Visiting department: Ophthalmology

Common causes: The cause is not clear and may be related to autoimmunity
Common symptoms: Dry eyes, itching and pain, foreign body or burning sensation, blurred vision, photophobia, cloudy cornea, etc.

Causes of dry keratoconjunctivitis

The cause is unknown. The disease falls into the category of connective tissue disease in internal medicine. This disease is often combined with other autoimmune diseases and the increase of immunoglobulins in the blood may be related to autoimmunity.

Clinical manifestations of dry keratoconjunctivitis

Clinical manifestations are dry eyes, itching, foreign body or burning sensation, blurred vision, photophobia, corneal opacity, erosion or ulceration, small blood vessel proliferation, perforation in severe cases, and iris choroiditis; conjunctival inflammation, bulb Conjunctival blood vessels dilate; less tears, a few lacrimal glands are enlarged, and they are prone to bacterial, fungal, and viral infections.

Examination of dry keratoconjunctivitis

1. Schirmer test

Filter paper wetting is less than 10 mm, and the tear river width is less than 0.1 mm, which indicates insufficient tear secretion.

2. Tear film rupture time (BUT for short)

Less than 10 seconds, indicating that the tear film is unstable and is a prominent marker of KCS caused by mucin deficiency in the tear fluid, suggesting that the conjunctival goblet cells are severely damaged or lost.

3. Conjunctival sac

(Especially the lower fornix) is rich in stick-like secretions, and the corneal surface is infiltrated with filaments or dots.

4.Tiger red staining, Lissamine green staining

Observe the specific staining of conjunctiva and cornea.

5. Conjunctival biopsy

Hypertrophy of the conjunctival epithelium, keratinization of the surface layer, lymphocyte infiltration between basal cells, reduction or disappearance of goblet cells, connective tissue proliferation and angiogenesis under the epithelium, with lymphocyte infiltration.

6. Salivary ductography

Inject the contrast agent into the costal or submandibular glands, take the film during the filling period, remove the catheter and give a saliva-promoting agent (such as lemon juice) to stimulate saliva secretion. Take a second film 5 minutes later. Normal people due to saliva secretion contrast agent at 2 Drained within minutes, while patients with SJS and KCS can show punctate dilatation of the surrounding ducts of salivary ducts, and in severe cases have mulberry-like shapes or form cavities.

7. Salivary gland isotope scan

The normal glands took a ^99m scan to produce a bright scintillation scan. After intravenous injection of ^99m labeled sodium perrhenate, 3, 8, 15 minutes scintillation scans recorded the salivary gland's ^99m intake. The salivary duct radiography is similar.

8. Labial Gland Biopsy

It can be seen that diffuse lymphocytic infiltration around the lobular ducts without ductal femoral epithelial hyperplasia. If a labial biopsy is suspicious, a lacrimal or salivary gland biopsy is used to further confirm the diagnosis.

9. Pathological changes of lacrimal glands

Stage 4 classification, stage 0 glands are normal; stage has mild chronic inflammatory cell infiltration, irregular arrangement of ducts, intralobular fibrosis; stage normal leaflet structure destruction, extensive lymphocyte infiltration and acinar atrophy; stage is only very Few acinar cells remain, and the glands are essentially fibrotic.

10. Hematology test

It showed mild anemia, increased eosinophil count, and accelerated erythrocyte sedimentation.

11. Immunological examination

Serum albumin decreased, globulin increased, IgA, IgM, and IgG increased, and lymphoblast transformation rate indicated that the level of cellular immunity was low.

Diagnosis of dry keratoconjunctivitis

The main diagnosis of this disease is insufficient tear secretion and dry mouth. Comprehensive clinical and laboratory findings are helpful for diagnosis.

Complications of dry keratoconjunctivitis

The disease can affect multiple systems.

Oral cavity

Less saliva when heavier, food stimulation and chewing can not increase saliva secretion, chewing and swallowing difficulties, common caries and gingivitis, teeth are powdery or small pieces broken, lips and mouth corners are dry and cracked, bad breath, half of patients repeat Swelling of the parotid gland can occur, as well as swelling of the submandibular gland.

Eye

Dry keratoconjunctivitis, dry eyes, itching, foreign body or burning sensation, blurred vision, photophobia, corneal opacity, erosion or ulceration, small blood vessel proliferation, perforation in severe cases, and iris choroiditis; Conjunctival inflammation, bulbar conjunctival blood vessels dilate; less tears, a few lacrimal glands are swollen, prone to bacterial, fungal, and viral infections, with exophthalmos as the first symptom.

3. Respiratory tract

Nasal mucosal gland invasion causes dry nasal cavity, dry throat, hoarse voice, thick sputum, bronchitis, bronchitis, pleurisy, interstitial pneumonia, and atelectasis. Patients without clinically obvious lung disease may There are restrictive ventilation disorders and decreased gas diffusion function.

4. Digestive tract

Dry throat and esophagus can make swallowing difficult, and the incidence of atrophic gastritis is as high as 70.5%. Impaired absorption of the small intestine impairs the response to gastrin and trypsin, suggesting that subclinical pancreatitis is common, and liver and spleen Swelling.

5. Urinary tract

Common is interstitial nephritis with renal tubular dysfunction, renal tubular acidosis, renal diuresis, amino aciduria, and decreased uric acid reabsorption. There are also concurrent glomerulonephritis, IgM and complement deposition in the glomerulus. .

6. Nervous system

The central nerve involvement is 25%, and the peripheral nerves are 10% to 43%. The former can be affected from the meninges to the brain parenchyma and the spinal cord in various parts. The peripheral nerves have a wide range of parts, including nerve roots, axons, myelin sheath, sensory and motor Branches can be involved; clinical manifestations are diverse, including mental disorders, convulsions, hemi-blindness, aphasia, hemiplegia, paraplegia, ataxia, etc.

7. Muscle

Presented as myalgia and muscle weakness, caused by interstitial myositis, infiltration of lymphocytes and monocytes around interstitial small blood vessels, and periodic paralysis due to renal tubular acidosis and hypotension can also occur.

8. Joint

About 10% of the cases involve joints, showing swelling and pain, and are non-invasive arthritis.

9. Skin and mucosa

Dry like ichthyosis, with nodular erythema, purpura, Raynaud's phenomenon, and skin ulcers; vaginal mucosa can also be dry and atrophic.

10. Lymph nodes

Local or systemic lymph nodes can become swollen.

Dry keratoconjunctivitis treatment

If the secretion caused by systemic diseases is insufficient, thyroxine tablets, diethylstilbestrol, testosterone, vitamin A, etc. should be given according to the cause. The general effect is good, and it relieves quickly after taking the medicine.

Add tears

Artificial tears are the main treatment method. Sodium hyaluronate or 1% methyl cellulose is usually used for eye drops, but the cornea is maintained for only half an hour. There have been many artificial tears abroad in recent years.

2. Reduce tear loss

Hydrophilic soft mirror combined with artificial teardrops has a certain effect on mild and moderate KCS, which can not be tolerated in severe patients; closed tear spots to prevent tear drainage. Currently, lacrimal plugs are used, including temporary or permanent lacrimal plugs So that the patient's extremely precious trace of tears can be preserved.

3. Application of anti-inflammatory drugs

Glucocorticoids: For patients with moderate to severe dry eyes and ocular surface inflammation, pay attention to their side effects. Cyclosporine: used in patients with moderate to severe dry eyes and patients with ocular surface inflammation. Non-steroidal anti-inflammatory drugs: for mild to moderate dry eyes, patients with ocular surface inflammation, those with hormonal complications can be preferred.

4. Personal hygiene

Those with insufficient tear secretion have reduced local defense function and are more susceptible to infection by pathogenic microorganisms than normal people. When there are more yellow secretions in the conjunctival sac, it is suggested that there is a bacterial infection (more common in staphylococcus). It should be cultured with bacteria and given sensitive antibiotics. In addition, KCS patients are allergic to penicillin and sulfa and should be vigilant.