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Oral pilocarpine for the treatment of ocular symptoms in patients with Sjögren’s syndrome: a randomised 12 week controlled study
  1. N Tsifetaki1,
  2. G Kitsos2,
  3. C A Paschides2,
  4. Y Alamanos3,
  5. V Eftaxias2,
  6. P V Voulgari1,
  7. K Psilas2,
  8. A A Drosos1
  1. 1Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
  2. 2Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece
  3. 3Department of Hygiene and Epidemiology, Medical School, University of Ioannina, Ioannina, Greece
  1. Correspondence to:
    Professor A A Drosos
    Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina Greece; adrososcc.uoi.gr

Abstract

Objective: To evaluate the efficacy and side effects of oral pilocarpine for the treatment of ocular symptoms in patients with primary Sjögren’s syndrome (SS).

Methods: A 12 week, single centre, randomised controlled study was performed. Twenty nine patients were randomly assigned to receive oral pilocarpine (5 mg twice a day), 28 only artificial tears, and 28 inferior puncta occlusion. Patients receiving oral pilocarpine and those with inferior puncta occlusion also received artificial tears. Patients were evaluated at baseline and throughout the study for their subjective global assessment of dry eyes and for their objective assessment of dry eyes (Schirmer’s-I test, rose bengal test, and imprint test).

Results: Patients taking oral pilocarpine had significant improvement in subjective global assessment of dry eyes, as was evaluated by improvement of >55 mm on a visual analogue scale (VAS) for responses to the eye questionnaire, compared with patients treated with artificial tears (p<0.001) and those with inferior puncta occlusion (p<0.05). Furthermore, patients receiving oral pilocarpine also showed greater objective improvement, as measured by the rose bengal test (p<0.05), while Schirmer’s-I test showed no differences between the treated groups. Commonly reported adverse events were headache, increased sweating, nausea, and vomiting in the pilocarpine group, while one patient in the inferior puncta occlusion group had blepharitis and was withdrawn from the study.

Conclusion: 10 mg of pilocarpine daily given to patients with SS for 12 weeks had a beneficial effect on subjective eye symptoms, as evaluated by improvement >55 mm on a VAS. Additionally, an improvement of rose bengal staining was noted, but an increase in tear production, as measured by the Schirmer-I test, was not substantiated.

  • Sjögren’s syndrome
  • pilocarpine
  • dry eyes
  • rose bengal
  • imprint test
  • KCS, keratoconjunctivitis sicca
  • SS, Sjögren’s syndrome
  • VAS, visual analogue scale
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