Millions of Americans suffer from dry eyes, dry mouth and feel as though they are just drying up. In most cases it may be simple signs of aging, or other benign systemic changes. However, there is a systemic condition called Sjogren’s Syndrome, an autoimmune disorder, that will cause these symptoms, and frequently goes misdiagnosed escaping much needed therapy.

This disease affects approximately 3 million Americans, 90% of whom are woman, and is one of the 3 most common autoimmune disorders. The differential diagnosis is often difficult because Sjogren’s is not well taught in post graduate training programs, according to the NY Times personal health section on Oct 7, 2008. The condition attacks the secretory glands, and mimics the symptoms of other disorders.

Sjogren’s was first diagnosed in 1892 and was called Mikulicz’s Syndrome, but included many conditions within the disorder. In 1933 Henrik Sjogren renamed the disease, and was more specific regarding its signs. He classified the disorder as dry eyes and dry mouth caused by an autoimmune disease. The disease often is masked, or may appear as another disease or the sign of another disorder. Patients with fibromyalgia, multiple sclerosis, strokes, Lyme Disease, chronic fatigue syndrome, and even reflux are confused with Sjogren’s because they all have dry eyes and sometimes mouth. Unfortunately, 40% of the time blood tests are negative for the antibodies, and lead the doctor in another direction with a diagnosis.

While the diagnosis of this condition is often missed, all doctors must consider it as an option. Therapy for the dry eyes must, and always include all the remedies available. Artificial tears, lubrication at bed time, topical prescriptions as needed and careful follow up. In addition, Rheumatologists must treat the patient on a systemic level to help control the condition. It is a lifelong disease that will get worse with advancing age, and only aggressive therapy will keep the patient as comfortable as possible for the long haul.

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The danger of acquiring ectasia, or thining of the cornea, after undergoing LASIK is a constant concern for all refractive surgeons. Avoiding this very serious complication is best accomplished by better preoperative testing and weeding out those patients at significant risk. Research has concluded that the best way to evaluate these individuals is to accurately measure the elevation data from the posterior surface of the cornea.

Previously, doctors have attempted to evaluate presurgical patients simply be looking at the anterior surface of the cornea; since that is the easiest location to discover Keratoconus and corneal thinning to some degree. However, true readings must include both anterior(front) and posterior(back) surfaces for accurate thickness measurement. Pachometry (corneal thickness) measurements are the easiest and most sensitive way to get an early reading on potential disasters.

Elevation readings measure both the anterior and posterior surfaces of the cornea which are then displayed in a color map showing differences in the two surfaces using color and numerical schemes. In most, if not all Keratoconus and ectasia patients the early changes in the posterior surface are much more noticeable then the anterior surface.

Unfortunately, some of the early signs of ectasia may be mistaken as signs of contact lens warpage and not corneal pathology. Prior to undergoing any refractive procedure it is imperative to be fully evaluated and the cornea must be with out any irregularities. One must be 100% sure that there are no signs of Keratoconus or ectasia because once the procedure is performed there is no turning back.

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