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Introduction: With growing prevalence, reduced quality of life, significant socioeconomic burden and a definite impact in cataract and laser vision correction surgeries, dry eye disease (DED) is currently a hot topic in ophthalmology. In recent years, several guidelines have been carried out to standardize the diagnosis and improve treatment approach. We intend to characterize current practices in Portugal, identify opportunities for improvement and delineate strategies to address them. Material and Methods: Cross-sectional online survey designed to assess the diagnostic approach and treatment of DED and made available to ophthalmologists across the country. The survey included 5 questions on ophthalmological profile of participants, 4 questions on DED diagnosis and 3 questions on DED treatment. Statistical analysis was made using SPSS version 26. Results and Discussion: One hundred twenty two ophthalmologists answered the survey (about 10% of practitioners in Portugal). A percentage of 48% observe between 20-40 patients with DED per month. A total of 67% always examine ocular surface of laser vision correction candi- dates, whereas only 30% always do it for cataract surgery patients. The most frequently identified DED symptom is foreign body sensation. The most commonly used diagnostic methods are fluo- rescein staining and tear break up time. Regarding treatment modalities, almost 50% of participants never used lacrimal plugs and very few recommended contact lenses or autologous serum. Mild DED treatment is considered to be very effective by 80% of ophthalmologists, while in severe DED by only 0.01%. 36% believe available treatment options are ineffective in severe DED. Conclusion: DED represents a high volume of patients seen in ophthalmology clinics. Our results mimic others in Europe and the United States. Overall, diagnosis and treatment practice patterns are in agreement with the current recommendations. However, there is still room for improvement. All patient prior surgery should be examined for DED, symptoms should be considered more as part of diagnosis and follow-up, and some easily available treatment options should be considered more often. Our findings also highlight the concern with treatment in severe DED, in which more effective therapies are needed., Introdução: A doença do olho seco apresenta uma prevalência crescente e impacto socioeconómico significativo, resultando em diminuição de qualidade de vida e com repercussões demonstradas em cirurgia de catarata e refrativa a laser. Nos últimos anos, várias guidelines foram realizadas para padronizar a abordagem diagnóstica e terapêutica. Pretendemos com este estudo caracterizar as práticas atuais em Portugal e identificar oportunidades de melhoria. Material e Métodos: Estudo transversal com recurso a questionário online, elabora- do para avaliar a abordagem diagnóstica e tratamento do olho seco por oftalmologistas do setor público e privado em Portugal. O questionário incluía 5 perguntas sobre o perfil dos participantes, 4 perguntas sobre o diagnóstico e 3 sobre o tratamento da doença do olho seco. A análise estatísti- ca foi realizada com recurso a versão 26 do SPSS. Resultados e Discussão: Um total de 122 oftalmologistas responderam ao questionário. Dos inquiridos, 48% observa entre 20 e 40 doentes com olho seco por mês. Avaliam sempre a superfície ocular em candidatos a cirurgia refrativa a laser 67%, enquanto apenas 30% realizam essa avaliação na cirurgia de catarata. O sintoma de olho seco mais frequentemente identificado é a sensação de corpo estranho. Os métodos diagnósticos complementares mais utilizados são a coloração com fluoresceína e o TBUT. Quase 50% nunca utilizou plugs lacrimais e um menor número utilizou lentes de contato e soro autólogo. A maioria dos oftalmologistas (80%) considera a terapêutica para olho seco ligeiro muito eficaz. Por outro lado, apenas 0,01% considera a terapêu- tica muito eficaz no olho seco grave e 36% afirma que a mesma é ineficaz. Conclusão: O olho seco afeta um grande número de doentes observados em consulta de oftalmologia. Os nossos resultados são semelhantes a outros estudos na Europa e Estado Unidos e, em geral, estão de acordo com as recomendações atuais. No entanto, ainda há a necessidade de melhorar. Todos os pacientes antes da cirurgia devem ser avaliados para olho seco e algumas opções de tratamento devem ser consideradas mais frequentemente (por exemplo, plugs lacrimais).Destaca-se também a dificuldade no tratamento de doença grave, sugerindo que terapias mais eficazes são necessárias.

Intrudução: O diagnóstico de Síndrome de Sjögren’s Primário (SSp) é, por vezes, desafiador, atendendo à variabilidade da sintomatologia e do cumprimento dos critérios diagnósticos. Este estudo tem como objectivo a avaliação do menisco do lacrimal (ML) e plexo do nervoso sub-basal da córnea (PNSB) na SSp. Materais e Métodos: Estudo transversal de 50 doentes com SSp e 20 controlos saudáveis. Foram realizados o teste de Schirmer I, BUT e coloração corneana com fluoresceína como avaliação convencional de síndrome de olho seco. O ML foi analisado quanto à altura e área, através da tomografia de coerência óptica de segmento anterior (OCT-SA); e o PNSB da córnea foi avaliado por Microscopia Confocal in vivo (MCIV), com estudo da densidade, comprimento e tortuosidade nervosa. A análise estatísticas foi conduzida IBM-SPSS Statistics 25.0. Resultados: A altura do ML revelou-se significativamente menor nos doentes com SSp comparativamente ao grupo controle. O PNSB da córnea revelou uma densidade e comprimento significativamente menores e tortuosidade significativamente maior nos doente com SSp comparativamente ao grupo controle (p, Introduction: The diagnosis of Primary Sjögren's Syndrome (pSS) is sometimes challenging, taking into account the clinical heterogeneity and the variability of diagnostic criteria fulfillment. This study aims to evaluate the tear meniscus (TM) and corneal sub-basal nerve plexus (SBNP) in a population with pSS. Material and Methods: Cross-sectional study of 50 patients with pSS and 20 healthy controls. Conventional dry-eye disease evaluation was performed, using Schirmer test I without anaesthesia, tear break-up time and corneal fluorescein staining. TM height and area were analyzed using anterior segment optical coherence tomography (AS-OCT) and corneal SBNP was evaluated using in vivo Confocal Microscopy (IVCM), with study of nerve density, length and tortuosity. Differences in pSS ophthalmic features were analyzed according to phenotype profile. Data analysis was conducted by IBM-SPSS Statistics 25.0. Results: TM height was significantly lower in pSS in contrast to the controls (p < 0.001). Corneal SBNP density and length were significantly lower and tortuosity significantly higher in pSS patients comparing to controls (p < 0.001, p = 0.004 and p = 0.001, respectively). Conclusion: AS-OCT and IVCM may be useful in the evaluation of lachrymal unit dysfunction in pSS, complementing the conventional methods used in the evaluation of dry-eye disease.

Introduction: The diagnosis of Primary Sjögren's Syndrome (pSS) is sometimes challenging, taking into account the clinical heterogeneity and the variability of diagnostic criteria fulfillment. This study aims to evaluate the tear meniscus (TM) and corneal sub-basal nerve plexus (SBNP) in a population with pSS. Material and Methods: Cross-sectional study of 50 patients with pSS and 20 healthy controls. Conventional dry-eye disease evaluation was performed, using Schirmer test I without anaesthesia, tear break-up time and corneal fluorescein staining. TM height and area were analyzed using anterior segment optical coherence tomography (AS-OCT) and corneal SBNP was evaluated using in vivo Confocal Microscopy (IVCM), with study of nerve density, length and tortuosity. Differences in pSS ophthalmic features were analyzed according to phenotype profile. Data analysis was conducted by IBM-SPSS Statistics 25.0. Results: TM height was significantly lower in pSS in contrast to the controls (p < 0.001). Corneal SBNP density and length were significantly lower and tortuosity significantly higher in pSS patients comparing to controls (p < 0.001, p = 0.004 and p = 0.001, respectively). Conclusion: AS-OCT and IVCM may be useful in the evaluation of lachrymal unit dysfunction in pSS, complementing the conventional methods used in the evaluation of dry-eye disease., Revista Sociedade Portuguesa de Oftalmologia, Vol. 43 N.º 4 (2019)