Talk:Keratoconjunctivitis sicca

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Contents 1 Article improvement drive 2 Restasis 3 Citation duplication 4 Androgen Research

[edit] Article improvement drive

Contact lens is currently nominated to be improved on Wikipedia:Article Improvement Drive. Please support the article with your vote. --Fenice 10:51, 16 January 2006 (UTC)

[edit] Restasis

Tell me, does that bit about "Restasis" sound too advirtisementy? (it was added 11 March 2006 by 67.87.254.63)

I don't know if that bit should be deleted but for the claim, it should certainly be backed by sources.—The preceding unsigned comment was added by Seunghun (talk)

A bit, but it's true. I added a source.-AED 05:47, 10 April 2006 (UTC)

[edit] Citation duplication

I think once per paragraph is enough. If you have different sources in the paragraph put them all at the end of the paragraph.--Chrisdab 03:20, 6 January 2007 (UTC)

The number of citations in this article is absolutely ridiculous. There's no need for a citations after every word. 84.90.41.37 22:03, 15 January 2007 (UTC)

That might have been fine had this been a non-medical article, but because this is a medical article, it is very important that there be available a source for every statement. Paragraphs and even individual sentences often comprise of info obtained from multiple sources, and it would otherwise be difficult to determine the source for any particular statement or item. The goal is to maximize trust in the content.

Also see [1]. It states:

Medical articles should be relatively dense with inline citations. It is too easy for a later editor to change the body text and then nobody is sure which statements are backed up by which sources. Unlike many established scientific disciplines, medicine attracts controversy and opponents on even the most basic and commonly held facts.

I actually think this should ideally be the case for every Wikipedia article, although it'd probably be too tedious. --Amit 04:52, 6 January 2007 (UTC)

I think at least do it at the end if the sentence. It seems a little overboard and it does make it hard to read. I mean medical journals don't have this many citations in their sentences. I'm a little tired so it may be hard to get my point across but multiple citations for the same source, at least in the same sentence, aren't useful if the link points just to the source article and not the actual text that is cited. thanks --Chrisdab 10:26, 6 January 2007 (UTC)

I understand your point that it would probably make for a cleaner and more readable article if the citations are not between two words in a sentence. However, even several individual sentences comprise of info obtained from multiple sources. At present, it is possible to know which item in the sentence is obtained from which source, but otherwise this will not be possible. It is also easy to find the actual text in the ref using the find feature in one's browser. --Amit 22:21, 15 January 2007 (UTC)

For some it wouldnt be a problem to reduce the citations. the 2nd paragraph in Symptons for example has the same citation after every sentence while the citation could just be at the end of the paragraph. it would be a good idea to review the article and make citation changes so it isnt so cluddered. 24.241.227.184 23:46, 19 January 2007 (UTC)

Again, that may not be a very good idea, because sentences can be added or modified later on by others, and if this happens in the paragraph under discussion, it'll then later be unclear as to which sentences came from where. In my opinion, what this article and WP in general really need is a better way of citing info, so users reading the article don't have to always be bothered with them. --Amit 02:00, 20 January 2007 (UTC)

[edit] Androgen Research

I don't have time to work on this now, especially with Wikipedia's rules about citations. But maybe someone else would like to get all the citations to back up the following. David Sullivan at Harvard Medical School's Eye Institute has done some work over the last several years that shows that androgen therapy helps with dry eye. Allergan currently has some androgen eye drops in clinical trials. I heard Sullivan speak at a scientific meeting (where my job was to write up the proceedings, write, not just transcribe) and his ideas were good. Basically, dry eye is more common in older women than men. He thinks it is because as women go through menopause, testosterone levels drop (little known fact), which leads to dry eye. Androgens control the viscosity of the oils in the skin oil glands and similar ones that protect the cornea as well. Men's testosterone levels generally being higher to begin with, it's less of a problem for them--oil stays thin,not too thick to stream over the eye and prevent fluid from evaporating. I'm happy to provide my write up of the meeting proceedings, which were published in 2002 and constitute a respectable secondary source (though not, ironically, if I write the material here myself). Here's the title "Proceedings of the 3rd annual conference on Sex and Gene Expression" I'll check my watchlist to see if anyone asks for it. Also, there was a recent article in the LA Times in which Sullivan's work was mentioned. Eperotao 17:01, 17 March 2007 (UTC)

Actually, as this is comparatively short, I'm just going to post it here. This IS copyrighted by the Society for Women's Health Research, but I'm hoping I'm not violating any laws by allowing people interested in dry eye to read it, since the organization's mission is to help people with health problems. Please do not plagiarize this for the entry. This is a summary of a talk given by Harvard eye researcher David Sullivan in 2002. He was given an opportunity to read and correct this, so it can be considered accurate.

"Sex, Sex Steroids, and Dry Eye Syndrome

David A. Sullivan, PhD

Since the late 1800s, physicians have wondered why woman are more prone to eye diseases than men. Research now suggests that sex steroid hormones play a central role in the normal function of the eye, and low androgen levels contribute to dry eye syndrome.

The tear film that covers and protects the eye consists of three layers—an underlying foundation of mucin; a middle aqueous component, secreted by the lacrimal glands; and an overlying lipid layer, secreted by the meibomian glands (i.e. types of sebaceous glands). The lipid layer prevents evaporation of the aqueous layer. Dry eye syndrome, which involves the disruption of these layers can lead to severe and painful damage to the cornea and even blindness.

Dry eye syndrome afflicts more than 10 million people in the United States, most of them women. It can result from insufficient fluids or from insufficient lipids. A variety of diseases cause dry eye. For example, Sjögren's syndrome, which afflicts more than a million people in the U.S. (90 percent women), is an autoimmune attack on the lacrimal glands that limits their ability to secrete tears. Dysfunction of the meibomian glands appears to play a role in more than 60 percent of dry eye cases, including Sjögren's syndrome. Because such dysfunction often begins at menopause, the associated change in hormone balance is a likely cause of dry eye.

Declines in estrogen and progesterone at menopause are, of course, well known, but androgen levels also drop steeply. This decline in androgens may promote the development of dry eye, given that these hormones typically contribute to normal function of both the lacrimal and meibomian glands.

A variety of situations associated with androgen deficiency—including aging, Sjögren's syndrome, complete androgen insensitivity syndrome (CAIS), and hormone replacement therapy - predispose people to dry eye syndrome. Women with Sjögren's syndrome are androgen-deficient, and men on anti-androgen therapy show marked changes in the meibomian gland lipid profile, tear film instability, and a consequent increase in dry eye symptoms.

Androgen treatment (both topical and systemic) appears to enhance production and secretion of meibomian lipids, improve the lipid profile, prolong tear film breakup, and alleviate symptoms of dry eye in both women and men. In both humans and dry eye mouse models, androgen treatment also decreases inflammation and/or increases tear secretion by the lacrimal glands. Androgen treatment is a promising therapy for dry eye that is currently being tested in Phase II clinical trials.

In contrast, estrogen hormone replacement therapy (HRT) seems to have just the opposite effect. Postmenopausal women on HRT have a significantly higher incidence of severe dry eye syndrome than controls, effects that might be countered with normal levels of androgens.

Estrogens are known to exert anti-androgen actions on sebaceous glands. Indeed, for many years, HRT was used clinically to reduce sebaceous gland secretions. HRT use is also associated with a change in the lipid profile of meibomian gland secretions in postmenopausal women.

A central factor in meibomian gland function may be the balance between estrogen and testosterone. Several years before menopause, women experience a rapid decline in androgens, which continues through menopause along with declines in estrogen and progesterone. HRT use replaces estrogen but not testosterone. As a result, the estrogen's effect on the meibomian gland likely dominates, and may suppress the activity of the meibomian gland.

Estrogens may also promote inflammation and dysfunction in the lacrimal gland. However, various studies offer sharply conflicting results on this point. In some, estrogen treatment has seemed to induce lacrimal gland regression and dry eye syndrome; in others, estrogen treatment shows no effect; while in still others, estrogen seems to suppress inflammation. Such conflicting results may arise from differences in experimental design, hormone dosage, or animal model used." Eperotao 17:17, 17 March 2007 (UTC)