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a. Continue with topical cyclosporine 0.05%
Yes. Topical cyclosporine has been shown to increase tear production, which can improve signs and symptoms in patients with moderate-to-severe dry eye. 1 What else may help improve the patient’s condition? Please select again.
- Sall K, Stevenson OD, Mundorf TK, et al. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. Ophthalmology. 2000;107(4):631-9.
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b. Discontinue use of oral pilocarpine
I did not instruct the patient to stop using oral pilocarpine. Acting on salivary glands to stimulate saliva production, oral pilocarpine is approved for treatment of dry mouth in Sjögren’s syndrome. Pilocarpine can also stimulate tear secretion, albeit to a less degree than saliva secretion. 1 Please select again.
- Vivino FB, Al-Hashimi I, Khan Z, et al. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group. Arch Intern Med. 1999;159(2):174-81.
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c. Discontinue use of loratadine
Yes. Ocular dryness can occur with use of common oral antihistamines. 1 Discontinuing use of oral loratadine eliminates one potential contributor to ocular dryness. What else may help improve the patient’s condition? Please select again.
- Ousler GW, Wilcox KA, Gupta G, et al. An evaluation of the ocular drying effects of systemic antihistamines: loratadine and cetirizine hydrochloride. Ann Allergy Asthma Immunol. 2004;93:460-4.
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d. Both a and c
Yes. Inflammation is a key element of the pathogenesis of Sjögren’s syndrome dry eye and a fundamental mechanism underlying dry eye symptoms and associated ocular surface damage. 1 Topical cyclosporine has been shown to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca. 2 On the other hand, oral antihistamines such as loratadine have drying effects on the eye 3; use of such medications should be minimized or avoided altogether in patients with severe dry eye.
- Stevenson W, Chauhan SK, Dana R. Dry eye disease: an immune-mediated ocular surface disorder. Arch Ophthalmol. 2012;130(1):90-100.
- Sall K, Stevenson OD, Mundorf TK, et al. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. Ophthalmology. 2000;107(4):631-9.
- Ousler GW, Wilcox KA, Gupta G, et al. An evaluation of the ocular drying effects of systemic antihistamines: loratadine and cetirizine hydrochloride. Ann Allergy Asthma Immunol. 2004;93:460-4.
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