Rethinking Sjögren Beyond Inflammation: Considering the Role of Nerves in Driving Disease Manifestations

Abstract

Sjögren syndrome (SS) is a chronic inflammatory autoimmune disease characterized by destruction of mucosal glands resulting in dry eye and dry mouth. Ocular presentations can be heterogenous in SS with corneal nerves abnormalities that are structural, functional, or both. Some individuals present with corneal hyposensitivity, with a phenotype of decreased tear production and epithelial disruption. Others present with corneal hypersensitivity, with a phenotype of neuropathic pain including light sensitivity and pain out of proportion to signs of tear dysfunction. A similar correlate can be found outside the eye, with dry mouth predominating in some individuals while pain conditions predominate in others. Understanding how nerve status affects SS phenotype is an important first step to improving disease management by targeting nerve abnormalities, as well as inflammation.

Corneal neuropathy in central serous chorioretinopathy

“…The importance of the ocular nervous system has been increasingly recognized in the pathogenesis of ocular surface diseases 14 such as meibomian gland dysfunction 15,16 and limbal deficiency 17 or in dry eye 18, 19 in which in vivo confocal microscopy allowed to visualize and characterize the damaged nerves 14 . In the posterior segment of the eye, no imaging method allows to analyze the choroidal nerves.…”

Inflammatory Dry Eye: Nerves, Microbiome, Onset, and New Treatments

“…Anat Galor, MD, MSPH, delivered the Harold A. Stein, MD, Lecture, which is summarized in “Rethinking Sjögren's Beyond Inflammation: Considering the role of nerves in driving disease manifestations.” by Sanchez et al Sanchez et al 2 review the role of corneal nerves in dry eye associated with SS. Patients might present with corneal hyposensitivity and decreased tear production, or they may present with corneal hypersensitivity due to neuropathic pain, or they might have a mix of these findings.…”