TERMINOLOGY IN OPTHALMOLOGY

PTERYGIUM a winglike structure, especially an abnormal triangular fold of membrane in the interpalpebral fissure, extending from the conjunctiva to the cornea.

SJGREN'S SYNDROME(SS) is a disorder in which the mouth and eyes become extremely dry, often associated with other autoimmune disorders. The main problem in Sjgren's syndrome is dryness. The salivary glands are often attacked and slowly destroyed, leaving the mouth extremely dry and sticky. Swallowing and talking become difficult. Normally, the saliva washes the teeth clean. Saliva cannot perform this function in Sjgren's syndrome, so the teeth develop many cavities and decay quickly. The parotid glands produce the majority of the mouth's saliva. They are located lying over the jaw bones behind the area of the cheeks and in front of the ears, and may become significantly enlarged in Sjgren's syndrome. The eyes also become extremely dry as the tear glands (called glands of lacrimation) are slowly destroyed. Eye symptoms include itching, burning, redness, increased sensitivity to light, and thick secretions gathering at the

eye corners closest to the nose. The cornea may have small irritated pits in its surface (ulcerations). Destruction of glands in other areas of the body may cause a variety of symptoms. In the nose, dryness may result in nosebleeds. In the rest of the respiratory tract, the rates of ear infection, hoarseness, bronchitis, and pneumonia may increase. Vaginal dryness can be quite uncomfortable. Rarely, the pancreas may slow production of enzymes important for digestion. The kidney may malfunction. About 33% of all patients with Sjgren's syndrome have other symptoms unrelated to gland destruction. These symptoms include fatigue, decreased energy, fevers, muscle aches and pains, and joint pain. Many patients with SS also develop a variety of skin problems that include dry patches, vasculitis, and cutaneous B-cell lymphoma. In addition to physical symptoms, patients with SS appear to be at increased risk for depression and other mood disorders. Diagnosis of Sjgren's syndrome is based on the patient having at least three consecutive months of bothersome eye and/or mouth dryness. A variety of tests can then be done to determine the quantity of tears produced, the quantity of saliva produced, and the presence or absence of antibodies that could be involved in the destruction of glands. There is no cure for Sjgren's syndrome. Instead, treatment usually attempts to reduce the discomfort and complications associated with dryness of the eyes and mouth (and other areas). Artificial tears are available, and may need to be used up to every 30 minutes. By using these types of products, the patient is more comfortable and avoids the complications associated with eyes that are overly dry. Dry mouth is treated by sipping fluids slowly but constantly throughout the day. Sugarless chewing gum can also be helpful. An artificial saliva is available for use as a mouthwash. Patients may also be given such drugs as pilocarpine (Salagen) or cevimeline (Evoxac) to increase saliva and tear secretions. Careful dental hygiene is important in order to avoid tooth decay, and it is wise for patients to decrease sugar intake. Vaginal dryness can be treated with certain gel preparations. Steroid medications may be required when other symptoms of autoimmune disorders complicate Sjgren's syndrome. However, these medications

should be avoided when possible because they may make the cornea thin and even more susceptible to injury. The prognosis for patients with primary Sjgren's syndrome is particularly good; these patients have a normal life expectancy. Although the condition is quite annoying, serious complications rarely occur. The prognosis for patients with secondary Sjgren's syndrome varies since it depends on the prognosis for the accompanying autoimmune disorder.