OBJECTIVE: To determine the prevalence of sicca symptoms, dry eye, and secondary Sjögren's syndrome and to evaluate the severity of dry eye in patients with mixed connective tissue disease. METHODS: In total, 44 consecutive patients with mixed connective tissue disease (Kasukawa's criteria) and 41 healthy controls underwent Schirmer's test, a tear film breakup time test, and ocular surface staining to investigate dry eye. In addition, the dry eye severity was graded. Ocular and oral symptoms were assessed using a structured questionnaire. Salivary gland scintigraphy was performed in all patients. Classification of secondary Sjögren's syndrome was assessed according to the American-European Consensus Group criteria. RESULTS: The patients and controls had comparable ages (44.7±12.4 vs. 47.2±12.2 years) and frequencies of female gender (93 vs. 95%) and Caucasian ethnicity (71.4 vs. 85%). Ocular symptoms (47.7 vs. 24.4%) and oral symptoms (52.3 vs. 9.7%) were significantly more frequent in patients than in controls. Fourteen (31.8%) patients fulfilled Sjögren's syndrome criteria, seven of whom (50%) did not have this diagnosis prior to study inclusion. A further comparison of patients with mixed connective tissue disease with or without Sjögren's syndrome revealed that the former presented significantly lower frequencies of polyarthritis and cutaneous involvement than did the patients without Sjögren's syndrome. Moderate to severe dry eye was found in 13 of 14 patients with mixed connective tissue disease and Sjögren's syndrome (92.8%). CONCLUSIONS: Sjögren's syndrome, particularly with moderate to severe dry eye, is frequent in patients with mixed connective tissue disease. These findings alert the physician regarding the importance of the appropriate diagnosis of this syndrome in such patients.

RESUMO Foi realizado um estudo retrospectivo de 400 casos de ferimento perfurante ocular admitidos na Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de janeiro de 1991 a dezembro de 1992. Houve maior incidência de ferimento perfurante no sexo masculino (79,5%) e o grupo etário de 21 a 30 anos foi o mais exposto ao trauma. Os acidentes de trânsito representaram 30,8 %, seguidos pelos acidentes domésticos (27,8 %), ocupacionais (22,8%), lazer e esporte (10,2 %) e violência (8,5%). O atendimento inicial ocorreu no primeiro dia para 82,6 % dos casos e após o terceiro dia para 8,2% dos pacientes. Os ferimentos perfurantes oculares constituíram causa importante de incapacidade visual funcional: apenas 61 de 283 olhos alcançaram acuidade visual de 20/40 ou melhor. Medidas preventivas necessitam ser tomadas para reduzir a incidência de perfurações oculares.

SUMMARY A retrospective study of 400 ocular perforating injuries from the ocular emergency centre of the University of São Paulo Medical School that ocurred from January, 1991 to December, 1992 was realized. 79.5 % of the injured were males and the group between 21 and 30 years of age was mainly affected. Traffic accidents (30.8%), domestic accidents (27.8 %o) and those related to work activities (22.8 %o) were the main causes. First care was carried out during the first day for 82.6% of the patients and after the third day for 8.2%. The perforating eye injuries were considered an important cause of visual deficit because only 61 out of 283 eyes obtained a visual acuity of 20/40 or better. Safety precautions should be effective in order to reduce frequence and morbidity of these perforating ocular injuries.

RESUMO Descrevemos 2 casos de carcinoma metastático para o segmento anterior ocular. Apesar da raridade desta patologia é importante suspeitar de tal diagnóstico ao avaliar tumorações em segmento anterior e proceder a investigação clínica adequada. Nos 2 casos descritos, a hipótese diagnóstica de metástase foi feita pelo exame oftalmológico. Os pacientes não apresentavam queixa sistêmica e não tinham o diagnóstico do tumor primário. Em um dos casos, o diagnóstico foi confirmado pela biópsia aspirativa, sugerindo ser um instrumento valioso no diagnóstico desta patologia.

SUMMARY We report 2 cases of metastatic carcinoma to the anterior segment of the eye. Although this patology is very rare, it is important to suspect of it when evaluating anterior segment ocular tumors, in order to demand a complete clinical investigation. In these 2 cases, the diagnosis was suspected by the ophthalmological examination. Neither patients did have clinical symptoms and both had no diagnosis of the primary tumor. In one of the cases the aspirative biopsy confirmed the diagnosis of metastatic carcinoma beeing a valuble tool for the diagnosis of this pathology.