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H. Watanabe, T. Soma, S. Koh, K. Nishida, N. Maeda, Y. Tano; Difference of the epithelial recovery of the conjunctiva between Sjogren and non–Sjogren dry eye by punctal plug . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3895.
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Purpose: The damage of the conjunctival epithelium as well as the corneal epithelium by dry eye is restored by plug treatment in regardless of Sjogren and non–Sjogren dry eye. However, we noticed that the recovery of the conjunctival epithelium varies depending on Sjogren and non– Sjogren dry eye. To evaluate the difference of the recovery, we examined epithelial damage of the conjunctival epithelium caused by dry eye in Sjogren and non–sjogren dry eye Methods: Twelve eyes of 12 patients with Sjogren dry eye and fourteen eyes of 14 patients with non– Sjogren dry eye were examined by slit lamp examination and scored before and one month after treatment of punctual occlusion for both upper and lower puncta by punctal plug. The damage of the epithelium was examined by fluorescein staining in the corneal and conjunctival epithelium. Results: Schirmer I test significantly increased in either Sjogren or non–Sjogren dry eye patients (Wilcoxon test; P<0.001) however, there is no significant difference of the value on Schirmer test between Sjogren syndrome and non–Sjogren dry eye after treatment. The FL score of the corneal epithelium and the conjunctival epithelium showed significantly decreased in Sjogren and non–Sjogren dry eye (Wilcoxon Test, P<0.001). Concerning the corneal epithelium, there is no significantly difference on the damage of the corneal epithelium between Sjogren and non–Sjogren dry eye before and after treatment (Mann–Whitney Rank Sum Test; P=0.837 before treatment and P=0.519 after treatment). In point of the conjunctival epithelium, the damage of the conjunctival epithelium before treatment showed no statistically difference between Sjogren and non–sjogren dry eye (Mann–Whitney Rank Sum Test; p=0.567) , however, there existed a significantly difference on FL score after treatment between Sjogren and non– Sjogren dry eye(Mann–Whitney Rank Sum Test; p<0.001). Conclusions: In accordance with the increase of the tear volume, the damage of the corneal epithelium is restored in Sjogren and non–Sjogren dry eye. The damage of the conjunctival epithelium is also well restored in non– Sjogren dry eye. However, the damage of the conjunctival epithelium in Sjogren syndrome is not so much improved by punctal plug compared with that in non– Sjogren dry eye. This suggests that the damage of the conjunctival epithelium in Sjogren syndrome is also caused by other reasons than tear abnormality.
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