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Sjogren's Syndrome and Dry Eyes

Sjogrens Syndrome Dry Eyes What is Sjögren's syndrome?
Sjogren's syndrome (pronounced SHOW-grins) is a chronic autoimmune disease in which the patient's immune system mistakenly attacks moisture-producing glands throughout the body. The destruction of these glands results in systemic dryness including dry eyes, dry mouth, and dry skin.

It is believed that this disorder affects as many as 4,000,000 people in the United States, with 90% of sufferers being women. The average age of onset for the disease is late 40s.

Sjogren's syndrome occurs alone (referred to as Primary Sjögren's) about 50% of the time, but is also found alongside another connective tissue or autoimmune diseases (Secondary Sjögren's). The most common disorders to co-exist with Sjogren's syndrome are systemic lupus, scleroderma, rheumatoid arthritis, and polymyositis/dermatomyositis.

The disease is named for Swedish eye doctor Henrik Sjögren, who first described the condition.

Symptoms
The most common symptoms of Sjogren's syndrome are dry eyes and dry mouth, but symptoms may also include dry sinuses (and sinus infections), tooth decay, trouble chewing and swallowing, dry skin, vaginal dryness, joint and muscle pain (without swelling), and fatigue. Sjogren's can also cause dryness of internal organs, affecting the lungs, liver, pancreas, gastrointestinal tract, kidneys, blood vessels, and/or the central nervous system.

Some patients experience only minor symptoms, which can be remedied with simple medications such as eye drops. Unfortunately, some patients have more severe symptoms which greatly affect their quality of life, and may need more aggressive treatment, such as immunosuppressant drugs.

In addition, people with Sjogren's syndrome have a much higher risk of lymphoma (cancer of the lymphatic system) than the general population, and should be monitored for signs of this disease.

Diagnosis
Early diagnosis and treatment is important to prevent complications from Sjogren's syndrome, but unfortunately, the condition is often overlooked or misdiagnosed. Doctors will often treat one symptom without realizing it is part of a larger, systemic disorder. For example, an eye doctor might treat a patient's dry eye, or a dentist might treat dry mouth. The average time from onset of symptoms to diagnosis is over six years.

Once Sjoren's syndrome is suspected, tests used to confirm the diagnosis may include:

  • Schirmer's test - a special strip of paper is inserted in the corner of the eye and used to measure tear production

  • Dye staining - dye is used to stain the eye, which allows the doctor to observe the quantity and distribution of tears, as well as any tissue damage that may have resulted from dryness. This exam is often done with a slit lamp microscope.

  • Lip biopsy - examination of a tiny salivary gland from the lip

  • Tests to measure saliva production

  • Blood tests to look for specific antibodies sometimes present with Sjogren's syndrome

Treatment
There is no cure for Sjogren's syndrome. Treatment is mainly to manage symptoms and make the patient more comfortable. Since symptoms vary widely from person to person, treatment will as well. Common treatments include:

  • Artificial tears or other lubricants for dry eyes
  • Artificial saliva, sugarless gum, or hard candies
  • Lotion for dry skin
  • Saline nasal spray
  • Vaginal lubricant
  • Drinking plenty of fluids
  • Use of a humidifier
  • Good oral hygiene and special toothpaste
  • Lifestyle changes, such as avoiding alcohol and not smoking
  • Prescription medications to protect dry eyes or stimulate saliva production
  • Pain relievers and/or anti-inflammatory medications for joint and muscle pain
  • Immunosuppressant drugs (in severe cases)

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