Causes

The most common causes are bacteria, chlamydia, and viruses. Occasional systemic associations include:

Symptoms

Subacute onset of grittiness, usually bilateral, and a mucoid or serous discharge.

Signs

These include normal visual acuity, redness which is maximal in the lower fornices (Figure 1.1) and a variable amount of discharge.

Treatment

This is usually with topical antimicrobial agents.

Prognosis

This is excellent and, even without treatment, the vast majority resolve within 7—10 days.

Causes

Most cases are idiopathic and unassociated with any systemic disease.

Symptoms

These are acute or subacute onset of mild unilateral discomfort and redness.

Signs

A localized red patch involving either the medial or the lateral aspects of the eye (Figure 1.2).

Treatment

Topical steroids may be helpful if started early.

Prognosis

This is excellent and most cases resolve within a few days but recurrences may occur.

Causes

Pure KCS This is common and is characterized by involvement of the lacrimal gland alone.

Primary Sjögren’s syndrome This is an autoimmune disease characterized by the frequent presence of rheumatoid factor, antinuclear antibodies and hypergammaglobulinaemia. Less common findings include antibodies to DNA, salivary duct tissue, smooth muscle and gastric parietal cells. Involvement of the salivary glands may cause a dry mouth (xerostomia), and the bronchial epithelium and the vagina may also be affected.

Secondary Sjögren’s syndrome This is the presence of KCS in association with a systemic disorder such as:

Symptoms

These are chronic ocular irritation and a foreign body sensation.

Signs

Slit lamp biomicroscopy shows an absent or diminished lower lid tear meniscus, mucous threads in the tear film and corneal filaments. Rose bengal is a dye which shows up mucous threads and corneal filaments more clearly (Figure 1.3), and also stains the bulbar conjunctiva in the form of two triangles with their bases at the limbus (Figure 1.4). The amount of tear secretion can also be determined by measuring the amount of moistening of a special strip of filter paper folded so that 5 mm of the strip lies within the conjunctival sac (Schirmer’s test). A value of less than 5 mm in 5 minutes is indicative of KCS and values between 5 and 10 mm are borderline.

Treatment

Frequent instillation of artificial tears (e.g. hypromellose) is effective in most patients.

Prognosis

This is excellent although treatment may have to be continued indefinitely.

Causes

The most common causes are herpes simplex, herpes zoster, bacteria and hypersensitivity to staphylococcal exotoxins. Occasional systemic associations include:

Symptoms

These are variable blurring of vision, watering, pain and photophobia.

Signs

Corneal haziness and ulceration are the two most common signs (Figure 1.5).

Treatment

Treatment is with topical antimicrobial agents and, in selected cases, steroids may also be indicated.

Prognosis

This is usually good provided treatment is started early.

Causes

The most common local cause is herpes zoster. The most frequent systemic associations include:

Symptoms and signs

For these see Chapter 4.

Treatment

Treatment is with systemic non-steroidal anti-inflammatory agents in mild cases, and steroids and/or cytotoxic agents in severe cases.

Prognosis

Many cases develop complications such as keratitis, cataract and glaucoma.

Causes

Many cases are idiopathic. Systemic associations include: