Treatment of dry eye in Sjögren's syndrome: General principles and initial therapy
- Alan N Baer, MD, FACP
Alan N Baer, MD, FACP
- Associate Professor of Medicine
- Director, Jerome L. Greene Sjogren’s Syndrome Center
- Johns Hopkins University School of Medicine
- Esen K Akpek, MD
Esen K Akpek, MD
- The Bendann Family Professor of Ophthalmology and Rheumatology
- Director, Ocular Surface Disease and Dry Eye Clinic
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 ocular or systemic 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 . 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 general principles and initial treatment of dry eye in patients with SS will be reviewed here. The treatment of dry eye in patients with moderate to severe involvement and other issues in SS, 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, are discussed separately. (See "Treatment of moderate to severe dry eye in Sjögren's syndrome" and "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".)
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- GENERAL PRINCIPLES
- INITIAL THERAPY AND MILD DISEASE
- Tear conservation
- - Environmental management
- Operating room and perioperative management
- - Avoidance of medications causing dryness
- - Physical barriers
- Artificial tears
- - Artificial tear composition
- - Choice of replacement fluid
- - Potential complications
- MODERATE TO SEVERE DISEASE
- RISKS OF OPHTHALMOLOGIC PROCEDURES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS