Kerato-Conjunctivitis Sicca

KERATO-CONJUNCTIVITIS sicca has been fairly prominent in the ophthalmic literature since Sjogren's classical series of papers (1933Sjogren's classical series of papers ( -1940)), and has been reviewed recently by Henderson (1950).A further fifty cases are reviewed below. GENERAL CONSIDERATIONSThe presumptive diagnosis was made on clinical grounds in the majority of cases, the signs and symptoms being those usually described-redness and discomfort, tenacious mucous discharge, and corneal erosions and filaments.Confirmation was obtained by the measurement of the lacrimal secretion by the filter-paper test (Schirmer, 1903) and in doubtful cases by staining with rose bengal.The relative value of these two tests is still in doubt, since neither gives a certain indication of the clinical severity of the condition.In addition, the normal values obtained by the filter-paper test are not known with.sufficient accuracy.The usual criterion, using a piece of filter paper 5 mm.broad, with 5 mm.tucked over the lower lid, is that in five minutes a normal eye will produce enough moisture to wet the paper for a distance of more than 20 mm.Less than 15 mm. is suspicious of a dry eye, and less than 10 mm. may be diagnostic.This method is not yet fully standardized; some, following Schirmer himself, place the filter paper at the outer canthus, some at the inner.The former is preferable, as there is less likelihood of a lake of lacrimal fluid at the outer than at the inner canthus, a condition which will give an initial rapid wetting of the paper and possibly a false reading, particularly if the lacrimal passages are for some reason occluded.Some observers