Sjögren’s Syndrome as an Ocular Problem: Signs and Symptoms, Diagnosis, Treatment

Abstract

Sjögren's syndrome (SS) is an autoimmune disease of exocrine glands, which is characterized by dry mouth and dry eye, though ocular disturbances, such as dry eye disease, may be the first sign of the problem. In pathogenesis of SS, activated T-cells and B-cells infiltrate the lacrimal glands and autoimmune process leading to cell destruction. This process causes hyposecretion of tears and aqueous-deficient dry eye disease. Evaporative dry eye disease is connected with Meibomian gland dysfunction (MGD) and/or goblet cell loss. There are many questionnaires and tests to dry eye disease diagnosing, but there is no "gold standard." Correlation of data from symptom questionnaires and results of ocular staining score, Schirmer test I (without anesthesia), and break-up-time make it easier to diagnose. The treatment of SS includes both local (tear drops and moistures) and systemic (nonsteroidal anti-inflammatory drugs-NSAIDs, glucocorticoids, and disease-modifying antirheumatic drugs-biologics) therapies, but it is individual. We would like to present recent data on the ocular involvement and perspective of dry eye disease diagnosis and treatment in patients with SS.

Tear Film – Physiology and Disturbances in Various Diseases and Disorders

“…Aqueous layer deficiency is the most common reason of dry eye and is classified into two groups: Sjögren Syndrome dry eye and non-Sjögren Syndrome dry eye [69,70].…”

“…Sjögren's syndrome (SS) is a rheumatic autoimmune disease in which exocrine glands (salivary and lacrimal glands) are involved that results in clinical symptoms of dry mouth and dry eye. SS can be primary-pSS (without any other accompanying symptoms) or secondary-sSS (with other autoimmune diseases: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), polyarteritis nodosa, systemic sclerosis, granulomatosis with polyangiitis (GPA), primary biliary cholangitis (PBC), mixed connective tissue disease, occult thyroid eye disease) [69,71]. Some studies demonstrated coincidence of dry eye disease (DED) and SS in 46.7% cases [69,72].…”

“…In non-SS dry eye reduced tear secretion is a result of senile hyposecretion, lacrimal excision, lacrimal duct obstruction, immune lacrimal gland damage in sarcoidosis or lymphoma, sensory or motor reflex block, scarring conditions of the conjunctiva (pemphigoid, chemical burns, trachoma, chronic ocular Graftversus-Host Disease) [8,57,69,73,74]. Corneal hypoesthesia and due to it dry eye can be result of corneal refraction surgery [75], contact lens wearing [76], herpetic keratitis or as a side effect after surgical trigeminal neuralgia management [77].…”