This document summarizes Sjogren's syndrome, an autoimmune disease affecting the salivary and lacrimal glands. It causes dryness of the eyes and mouth. The hallmark is infiltration of T4 lymphocytes into the exocrine glands, triggering B lymphocytes to form autoantibodies. Clinical features include dry eyes and mouth, occurring most often in women ages 40-60. Diagnosis involves labial gland biopsy showing lymphocyte infiltration and reduced tear and saliva production on tests. Treatment focuses on lubricating the eyes and mouth, and stimulating saliva production with drugs like pilocarpine.
5. CLINICAL FEATURES
AGE:4th –6th decade
SEX:F>M [10:1]
CLINICAL PRESENTATION
LACRIMAL GLANDS SIGNS & SYMTOMS Dryness of
eyes,feeling of dirt or foreign body are common
symptoms
Conjuctivitis & corneal ulcers may be seen
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6. C.F.-SALIVARY GLANDS
XEROSTOMIA - Common symptom
Enlargement salivary glands-unilateral/bilateral
Candidiasis may be seen
Increased incidence of dental caries
Dryness of pharynx,larynx may lead to pneumonia
Vaginal candidiasis in 5% cases
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12. DIAGNOSTIC TESTS
SCHIRMER’STEST
Place the filter paper in the lower conjuctival sac
Normal pts will wet 15mm of filter paper in 5minutes
Pt’s with SS will wet less than 5mm
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14. 14
BUT TEST:
Test carried with slit lamp
Note the interval between the complete blink and
dry spot on the cornea
ROSE BENGAL TEST
TO detect damaged and denuded area on the cornea
If two tests are positive then patient is diagnosed
as kerarato conjuctivitis sicca
15. INVESTIGATIONS–SALIVARY GLAND
Salivary flow rate:
Carried out by placing special
fabricated cup”Lashley” cup
Over the orifice of the stensen
duct [parotid]
Saliva can be collected
stimulated or
unstimulated[lemon juice]
Normal range:5ml/min
Pt’s with sjogrens
syndrome;<5ml/5min
Minor gland biopsy
1.5 –2cm incision made on
lower labial mucosa
5 gland lobules are
removed and lymphocytes
focus score made
Scores are graded;0-4 SS-
2-4 grades
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21. SCINTIGRAPHY
Radioactive isotopes 99mTC by IV route and salivary gland is
imaged scintilation camera.
10 milicuries of radioactive isotope
99mTC pertechnetate is injected througH IV.
Gland is then imaged by Gamma scintilation camera.
Photographs are taken for every 2min. For first 10 min and later
every 10 min for 1hr.
SS patient show reduced uptake and slow execration of Isotope.
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27. Ptyalism
Hypersalivation (also
called ptyalism[1] and
sialorrhea[2]) is excessive
production of saliva. It has
also been defined as
increased amount of
saliva in the mouth, which
may also be caused by
decreased clearance of
saliva.[3
.
Hypersalivation can
contribute to drooling
if there is an inability to
keep the mouth closed
or in difficulty in
swallowing the excess
saliva.