As I mentioned in my previous post, the three basic legs of therapy for Sjogren's syndrome are: a) topical therapy of dry mucosal surfaces; b) prevention and treatment of extraglandular manifestations; and c) approaches to fibromyalgia in the patient with sicca symptoms. In the coming weeks, I invite you to review and critique my approach to each of these topics. Also, please add your suggestions so that we can all arrive at more efficient ways to educate our patients and ourselves.
This week I would like to share our basic approach at Scripps Memorial in the treatment of dry eyes, including the choice of artificial tears, ointments, and gels. To put this problem in perspective, a fairly recent study found that patients equated their dry effects on their “quality of life” at the level of moderate angina and the impact on their quality of work (especially those using computers) at the 40% impairment level.
As a rheumatologist, I do not attempt to replace the ophthalmologist. In fact, I want to emphasize that treatment of dry eyes requires a partnership between patients, ophthalmologists, rheumatologists and other health care professions. I appreciate the help in preparing this post from Dr. Paul Michelson, our former Head of Ophthalmology, who has now limited his practice to teaching, consulting, and providing eye care to underserved areas of the US and other parts of the world. We have also prepared 4 tables that list several available artificial tears with preservatives; artificial tears without preservatives; the basic components of artificial tears to help in evaluating generic brands; and suggestions for the initiation of of therapy with artificial tearsl, gels, or ointments. These tables are available on my site, and readers are invited to download them and offer suggestions for improving them.
http://boards.medscape.com/forums?128@759.o6aWaNZdeZ7@.29f22933!comment=1bump Thanks again LynnI can't believe I missed this! I have been walking about with what feels like the Sahara in my eyes! The Restasis does seem to now be helping, but only about 50% I'd say. I had to cancel my appt. for eye plugs because of all the cardiac testing.