Dry Eye Disease After Epidemic Keratoconjunctivitis As A Mask Of Sjogren's Syndrome.

We aim to describe a diagnostic pathway of dry eye disease after epidemic keratoconjunctivitis as a mask of Sjogren's syndrome.

Dry eye disease is among the most frequently established diagnoses in ophthalmology. Dry eye syndrome have a multifactorial etiology , may occur as a secondary symptom to post-inflammatory conditions. Sjogren's syndrome is one of the most common autoimmune disorder of adults, affecting about 4% of the general population. It has been reported that about 10% of patients with significant dry eye have underlying Sjogren's syndrome.

Department of Ophthalmology, University Clinical Centre of Medical University of Silesia in Katowice

Based on the retrospective medical record review, the diagnostic pathway and interdisciplinary approach to treatment of the DED in Sjogron's syndrome.

A 38-year-old female patient referred to our center with symptoms of dry eye in the left eye after EKC, which had been treated for 6 months. On the first visit BCVA of left eye 0.4, BCVA of right eye 1.0. No general diseases were detected. Slit lamp examination revealed MGD in both eyes, redness and keratopathies: punctate epithelial loss, scar after ulcer, subepithelial hazes in the left eye. Result of TBUT and Schirmer’s test was low (<5 mm) in the left eye. The antiviral treatment was discontinued. Check up was done after 1 month treatment (topical corticosteroids, artificial tears). 

The symptoms dry eye reduced, but deacrease BCVA of left eye and filamentous keratitis in both eyes. Due to of lack of improvement, she was referred to the Rheumatology Clinic, in which Sjogren's syndrome was diagnosed, general medications were started (hydroxychloroquine,  oral steroids).The targeted treatment was introduced (Ikervis -ciclosporin 0.1% eye drops, 10% acetylcysteine eye drops, preservative-free artificial tears). After treatment the improvement in the condition of the e cornea was observed, along with improvement of BCVA, stabilization of the tear film on the ocular surface. After 3 months of observation the achieved BCVA  0,9 in left eye ,the Schirmer's test was 10 mm, the patient’s subjective complains have decreased.

Autoimmune disorder should be considered in the differential diagnosis of DED.The diagnosis and treatment of DED is problematic, but treated multidisciplinary produces better results.