Management of the dry eye in Sjogren's syndrome.

Abstract

In this paper we report the efficacy of carefully controlled standard forms of treatment in the keratoconjunctivitis (KCS) of Sj0gren's syndrome (SS). Since it is accepted that SS is a chronic benign inflammatory disease characterized by remissions and exacerbations, the results of this study have been withheld until several years have elapsed. For this reason also we make no attempt to comment on forms of treatment such as hydrophilic contact lenses (Gasset and Kaufman, 1971;Krejci, 1972) or motorized fluid delivery from reservoir glasses (Dohlman, I97I) which as yet we have not utilized in a large series of patients.Since there is at present nothing that will eradicate KCS in Sj0gren's syndrome, our aim has been to produce reliefofsymptoms, reduction in signs, and thus a reduced incidence of irreversible ocular damage over a long period of time.Patients studied 98 patients suffering from KCS were supervised for no less than 5 years. All were suffering from definite rheumatoid arthritis according to the American Rheumatism Association criteria (Ropes, Bennett, Cobb, Jacox, and Jessar, 1959). There were 88 females and ten males. The mean age was 58-4 yrs (range 32 to 74).Seventy of the patients were cases diagnosed for the first time by one of us (J.W.); the remaining 28 were referred by ophthalmic colleagues from various parts of the West of Scotland. A diagnosis ofKCS was made when a forced Schirmer tear test using standardized tear strips (Halberg and Berens, Contactisol, Lindenhurst, U.S.A.) with Io per cent. ammonia inhalation for 5 min. showed less than i 5 mm. of wetting, and i per cent. rose Bengal dye caused at least minimal staining of the interpalpebral conjunctivae (Williamson, Cant, Mason, Greig, and Boyle, I967). Methods of assessmentProgress was determined by change in symptoms and slit-lamp signs, using Tables I and II as guides. The factors shown in these Tables were compiled in a parallel study on the diagnosis of KCS which has been published elsewhere (Williamson, Whaley, Dick, and Anderson, 197ia).

Effect of Acetylcysteine on Experimental Corneal Wounds in Dogs

“…They reported that the healing of normal superficial epithelial ulcers is not affected by acetylcysteine. The nontoxicity and some improving effects of acetylcysteine in the present study are slightly similar to those of Absolon and Brown [4], Brown and Weller [7], Berman [11], Williamson et al [9], Frauenfelder et al [12], Marsh and Cooper [13], Burns et al [24], Sugar and Waltman [16] and Petroutsos et al [15].…”

“…Williamson et al [9] reported that 20 of the 98 patients (suffering from Sjögren's syndrome and keratoconjunctivitis sicca) who had not responded to tear substitute therapy or nasolacrimal canalicular obliteration were treated with a 5% acetylcysteine solution, pH 8.4 for 1 year. 30% of the cases in this group improved in both symptoms and signs.…”

Effects of N-acetylcysteine on matrix metalloproteinase-9 secretion and cell migration of human corneal epithelial cells

“…Our maximum dose of 20 mM NAC is equivalent to a 0.33% solution, which is much lower than the solutions used clinically. Although, in clinical studies, topical applications of 5 and 20% NAC have been shown to be effective in the treatment of Sjogren syndrome 22 and long-standing corneal epithelial defects, 23 respectively, without toxic effects, the reports on animal experimental studies are contradictory. In all, 3% NAC has been shown to reduce the healing time in dog and rabbit corneas 12,13 whereas 10 and 20% concentrations had no effect in dogs.…”

Evaluation of the Effect ofN-Acetylcysteine on Protein Deposition on Contact Lenses in Patients with the Boston Keratoprosthesis Type I

“…The safety profile of this medication is consistent with previously reported studies using NAC topically on the ocular surface. [30][31][32] Current contact lens cleaning solutions available have been shown to remove daily accumulation of lysozyme, lactoferrin, and lipocalin. 20 Full-time contact lens wear has the disadvantage of protein buildup due to the deviation from preferred daily contact lens removal and cleaning protocols.…”

“…To date, there have been numerous studies touting the efficacy of topical or oral N-acetylcysteine (NAC) for decreasing ocular mucous plaques/buildup on the corneal surface in such diseases as keratoconjunctivitis sicca, meibomian gland dysfunction, and Sjogren's syndrome. [30][31][32][33][34] However, NAC is more commonly utilized for reducing pulmonary mucous plugging and as a treatment for acetaminophen overdose. [35][36][37][38] NAC functions as an antioxidant 39 and this study addresses the potential effect on the ocular surface.…”