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Treatment of dry eye in Sjögren's syndrome

Alan N Baer, MD, FACP
Esen K Akpek, MD
Section Editor
Robert Fox, MD, PhD
Deputy Editor
Paul L Romain, MD


Sjögren’s syndrome (SS) is a chronic multisystem inflammatory disorder characterized by diminished lacrimal and salivary gland function. This results in the “sicca complex,” a combination of dry eye (xerophthalmia) and dry mouth (xerostomia). A variety of other disease manifestations may also be present, including systemic signs and extraglandular features. The term “keratoconjunctivitis sicca” was coined by Henrik Sjögren in 1933 to describe the ocular surface disease resulting from severe aqueous tear deficiency in a series of 19 patients [1]. This term has been largely supplanted in the medical literature by “dry eye.”

SS occurs in a primary form not associated with other diseases and in a secondary form associated with other autoimmune rheumatic conditions, including rheumatoid arthritis and systemic lupus erythematosus.

The treatment of dry eye in patients with SS will be reviewed here. Other issues in SS are discussed separately, including the clinical manifestations and diagnosis of SS, the treatment of dry mouth and other non-ocular sicca symptoms in patients with SS, and the treatment of extraglandular manifestations of SS. (See "Clinical manifestations of Sjögren's syndrome: Exocrine gland disease" and "Clinical manifestations of Sjögren's syndrome: Extraglandular disease" and "Diagnosis and classification of Sjögren's syndrome" and "Treatment of dry mouth and other non-ocular sicca symptoms in Sjögren's syndrome" and "Treatment of systemic and extraglandular manifestations of Sjögren’s syndrome".)

Dry eye unrelated to SS and an overview of dry eye, including the clinical manifestations, diagnosis, and management of dry eye unrelated to SS, are also presented separately. (See "Dry eyes" and "Diagnosis and classification of Sjögren's syndrome", section on 'Dry eye and mouth in older adults' and "Diagnosis and classification of Sjögren's syndrome".)


Patients with Sjögren’s syndrome (SS) benefit from multidisciplinary care. An eyecare professional should diagnose and manage the dry eye of SS patients for a number of reasons. Several tests for diagnosing and monitoring dry eye, including ocular surface staining and the tear break-up time, require a slit lamp and therefore an ophthalmological examination (see "Diagnosis and classification of Sjögren's syndrome", section on 'Tests for dry eye'). Measuring the tear film osmolarity can be performed by non-ophthalmologists as point-of-care testing and has been reported useful to assess presence of dry eye [2]. Nevertheless, conflicting reports also exist [3]. Symptoms of ocular irritation may arise from multiple causes, not only aqueous tear deficiency, and these can be differentiated by an eye care professional. Over 80 percent of patients with SS have a meibomian gland dysfunction as well, and this requires recognition and specific treatment [4,5]. Finally, patients with SS and severe dry eye disease are at risk of vision-threatening ocular complications, sometimes with minimal antecedent symptoms and regular monitoring by an eye care professional is therefore warranted [6].


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Literature review current through: Jan 2017. | This topic last updated: Mon Oct 05 00:00:00 GMT+00:00 2015.
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