eMedicine Specialties > Ophthalmology > Cornea

Keratoconjunctivitis, Sicca: Differential Diagnoses & Workup

Author: Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Contributor Information and Disclosures

Updated: Apr 21, 2006

Differential Diagnoses

Chlamydia
Familial Dysautonomia
Conjunctivitis, Allergic
Herpes Simplex
Conjunctivitis, Bacterial
Herpes Zoster
Conjunctivitis, Giant Papillary
Ichthyosis
Conjunctivitis, Viral
Keratitis, Herpes Simplex
Contact Lens Complications
Keratitis, Interstitial
Corneal Abrasion
Keratoconjunctivitis, Atopic
Corneal Erosion, Recurrent
Keratopathy, Neurotrophic
Corneal Foreign Body
Keratopathy, Pseudophakic Bullous
Corneal Mucous Plaques
Ocular Rosacea
Dermatitis, Atopic
Psoriasis
Dermatitis, Contact
Scleritis
Dry Eye Syndrome
Dystrophy, Map-dot-fingerprint
Episcleritis

Other Problems to Be Considered

Filamentary keratitis

Workup

Laboratory Studies

  • Keratitis sicca generally is diagnosed on slit lamp examination. Lab testing occasionally can be helpful.
  • Tear protein analysis: This test allows the measurement of the lysozyme content of tears. Lysozyme accounts for approximately 20-40% of total tear protein content. The main disadvantages of this test include its lack of specificity in cases of the following:
    • Meibomitis
    • Herpes simplex keratitis
    • Bacterial conjunctivitis
  • Lactoferrin analysis: This test is commercially available through colorimetric solid phase and enzyme-linked immunosorbent assay (ELISA) technique. It offers good correlation with other tests.
  • Impression cytology: In advanced cases of keratitis sicca, the epithelium undergoes pathologic changes, resulting in squamous metaplasia and loss of goblet cells.
    • When the mucin layer of the tear is decreased (such as that associated with xerophthalmia or ocular cicatricial pemphigoid), squamous metaplasia and the following cytological characteristics occur:
      • Loss of goblet cells
      • Enlargement and increase of cytoplasmic/nuclear ratio of superficial epithelial cells
      • Keratinization
    • This method is highly sensitive; its main difficulty is the need for proper staining and expert microscopic evaluation of samples.

Histologic Findings

Pathologic examination of the lacrimal gland reveals age-related changes, including lobular and diffuse fibrosis and atrophy, as well as periductal fibrosis. An underlying autoimmune mechanism (represented by round cell infiltration) may be present. No circulating autoantibodies are present in patients who do not have Sjögren syndrome with keratitis sicca.

More on Keratoconjunctivitis, Sicca

Overview: Keratoconjunctivitis, Sicca
Differential Diagnoses & Workup: Keratoconjunctivitis, Sicca
Treatment & Medication: Keratoconjunctivitis, Sicca
Follow-up: Keratoconjunctivitis, Sicca
References
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References

  1. Barber LD, Pflugfelder SC, Tauber J. Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years. Ophthalmology. Oct 2005;112(10):1790-4. [Medline].

  2. Fox RI, Chan R, Michelson JB. Beneficial effect of artificial tears made with autologous serum in patients with keratoconjunctivitis sicca. Arthritis Rheum. Apr 1984;27(4):459-61. [Medline].

  3. Fujita M, Igarashi T, Kurai T. Correlation between dry eye and rheumatoid arthritis activity. Am J Ophthalmol. Nov 2005;140(5):808-13. [Medline].

  4. Lamberts DW, Foster CS, Perry HD. Schirmer test after topical anesthesia and the tear meniscus height in normal eyes. Arch Ophthalmol. Jun 1979;97(6):1082-5. [Medline].

  5. Lee HK, Ryu IH, Seo KY. Topical 0.1% prednisolone lowers nerve growth factor expression in keratoconjunctivitis sicca patients. Ophthalmology. Feb 2006;113(2):198-205. [Medline].

  6. Mathers WD. Ocular evaporation in meibomian gland dysfunction and dry eye. Ophthalmology. Mar 1993;100(3):347-51. [Medline].

  7. Murillo-Lopez F, Pflugfelder SC, eds. Cornea and External Disease: Clinical Diagnosis and Management, Vol II. 1997;663-686.

  8. Nelson JD. Diagnosis of keratoconjunctivitis sicca. Int Ophthalmol Clin. Winter 1994;34(1):37-56. [Medline].

  9. Pflugfelder SC, et al. Correlation of goblet cell density and mucosal epithelial mucin (MEM) expression in patients with ocular irritation. Invest Ophthalmol Vis Sci. 1995;36:S399.

  10. Pflugfelder SC, Roussel TJ, Culbertson WW. Primary Sjogren''s syndrome after infectious mononucleosis. JAMA. Feb 27 1987;257(8):1049-50. [Medline].

  11. Stonecipher K, Perry HD, Gross RH. The impact of topical cyclosporine A emulsion 0.05% on the outcomes of patients with keratoconjunctivitis sicca. Curr Med Res Opin. Jul 2005;21(7):1057-63. [Medline].

  12. Tsubota K, Toda I, Yagi Y. Three different types of dry eye syndrome. Cornea. May 1994;13(3):202-9. [Medline].

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Further Reading

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Keywords

dry eye syndrome, sicca syndrome, keratitis sicca, KCS, xerophthalmia

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Contributor Information and Disclosures

Author

Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Stephen D Plager, MD, FACS, Chief, Department of Ophthalmology, Dominican Hospital; Assistant Clinical Professor, Department of Ophthalmology, Stanford University Hospital
Stephen D Plager, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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