Letter from my new optician to my GP for your possible interest

[MAT51]

I live in Scotland so this may be of limited relevance to members here but I think this letter explains most of the eye problems associated Sjogrens (both primary and secondary) pretty well and also demonstrates why it isn't always necessarily better to see an opthamologist in hospital than your optician/ optometrist - some optometrists are pretty tip top on Sjogrens (at least in the U.K.) - my new one certainly is!

Massage tool he mentions here is Eyepeace - eyepeace.org.uk - "massages the meibomian glands in the only effective way to treat MGD and posterior blepharitis". I find it really useful as gives even massage and my fingertips and nails are very sore so this device is much nicer and cleaner than massaging with fingertips in my case.

"(To Dr/GP)
21st February 2017
Dear Dr...(GP)
Re: Ms (me)
DoB: 1963

Ms T came to see me for the first time on 18/01/17. She has Primary Sjogrens Disease and was being treated with Lacrilube and Hyloforte. This appears to be quite stable at present but she has to use lots of the drops/gel.

At the first appointment the Sjogrens keratitis appeared to be well under control with a very low Tear Break-Up Time (TBT) and tear meniscus and very low grade Superficial Punctate Keratitis (SPK). She also has concurrent Meibomean Gland Dysfunction (MGD), which requires treatment with a heat mask and massager to be used on daily basis. I also advised her to use of Artelac Nighttime Gel as an alternative to Lacrilube while the situation is stable. Her Mycophenolate therapy is almost certainly implicated in the present stability.

She has returned to see me today for a follow-up. She is having problems with the MGD treatment as just moving house but should improve in the near future.

She has been feeling a sporadic twitch at the Right frontal temporal area, but her eyes feel better and new prescription glasses with tinted lenses have helped and she is seeing well
On slitlamp examination today she has bilateral discrete low grade ISK with moderate/ shallow depth staining; the limbus is slightly injected, but there are no vessel changes. TBT is low at 5-7 secs and there is obvious low grade free mucin; there is also some tarsal and bulbar conjunctival injection. Tear meniscus is on the low side. The lid margin has obvious MGD disease with low grade scarring and stenosis; glands are expressible but cloudy with a slightly thick discharge from about R: 65% L: 65% of glands; there is also low grade non ulcerative bilateral blepharitis with small crusts present.
She has low grade mucin and tear deficient dry eye concurrent with Sjogrens syndrome, with low grade anterior blepharitis and moderate MGD.

My advice for treatment is: Hyloforte four times a day and more if required; Lacrilube on a nightly basis; heat with an eye bag followed by massage with Blephagel on daily basis with massage; Artelac Nighttime Gel used during the day during acute attacks; Celluvisc 1% to be used while travelling. I would be very grateful if you could prescribe the Hyloforte, Celluvisc and Artelac Nighttime Gel on a repeat basis.

Many thanks for your help.
Yours sincerely,
Kind regards,
(optician)"

[Nymph]

What a wonderful letter! Don't you love it when you find a caring professional like that?!

[MAT51]

Yes - I think he's just fabulous!

[Kathy57]

Impressive!  Puts my Othomalogist to shame!

Kathy

[anita]

I think you have a great doctor!  Not all optometrists in the US are this knowledgeable.  They limit their practice to just the basics...hence why some of us see an ophthalmologist who focus their care on the more special types of problems (like Sjogren's).  Many of us also take Plaquenil, and therefore must f/u every 6 months for full evaluations and testing.  I have had optometrists actually tell me that the type of care I need is beyond their scope of practice.

This guy you have is a keeper!!

[MAT51]

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