Sjögren’s Syndrome

Sjögren’s Syndrome is a chronic (long-term) autoimmune condition that can affect multiple organs in the body, but most specifically manifests as inflammation of the lacrimal and salivary glands. This, in turn, causes symptoms of dry eyes and dry mouth.¹ Sjögren’s Syndrome is usually associated with other autoimmune disorders, like Systemic Lupus Erythematosus (SLE) or Rheumatoid Arthritis (RA).2 Sicca Syndrome or Keratoconjunctivitis Sicca is an ocular manifestation of Sjögren’s Syndrome, causing signs and symptoms of dry eyes. Sjögren’s Syndrome is more common in women versus men and is usually diagnosed in one’s mid-fifties.¹  

Signs and symptoms of Sjögren’s Syndrome include the following, but can vary significantly between patients²: 

• Red eyes 
• Blurry vision 
• Foreign body sensation (FBS, feeling like there’s something stuck in one’s eye) 
• Photophobia (light sensitivity) 
• Burning eyes 

• Xerostomia (dry mouth) 
• Oral and dental infection¹  
• Fatigue 
• Consistent cough 
• Dry skin and rashes 

• Vaginal dryness 
• Swollen salivary glands²

Sjögren’s Syndrome is an autoimmune condition, meaning the immune system attacks its own cells. There is no known specific cause for Sjögren’s Syndrome. 

Risk factors: 

• Increased age 
• Sex (much more common in females vs. males) 
• Other autoimmune disease²

Eye examination: with an eye care provider; if Keratoconjunctivitis Sicca symptoms are present for more than 3 months, a diagnosis of Sjögren’s Syndrome should be considered.¹

Schirmer test: small piece of paper placed inside the eyelid to determine tear production quantity.¹

Fluorescein staining/tear break up time (TBUT): Fluorescein dye is placed on the surface of the eye to determine how quickly the tears are breaking up/evaporating. 

Lissamine green stain: Stain that targets devitalized cells while ensuring to leave healthy cells alone.³ 

Sjo® test: in-office blood test (finger-prick) that recognizes auto-antibody markers and other early biomarkers of Sjögren’s Syndrome.⁴ 

Biopsy of salivary and lacrimal glands: very small portion of gland removed to be assessed for the presence of inflammatory cells; gold standard for diagnosis.^2,4 

Serological tests: blood tests to determine levels of auto-antibody markers and rheumatoid factors.¹

Parotid sialography or salivary gland scintigraphy: salivary gland imaging tests to determine how the salivary glands are functioning.¹, ² 

Treatment for Sjögren’s Syndrome is aimed at managing signs and symptoms.²  

Dry eye 

• Artificial tears: lubricating eye drops to supplement the tear film. 
• Cyclosporine A (Restasis®) or lifitegrast (Xiidra®): immunosuppressive eye drop to reduce inflammation.² 
• Punctal plugs: plugs are inserted into the punctum (tear duct) of our eyelids blocking tears from draining off the front of our eyes.¹ 
• Scleral contact lens: large contact lens that protects the cornea and provides optimal lubrication to the surface of the eye.¹, ⁵ 

Dry mouth 

• Pilocarpine (Salagen®) or cevimeline (Evoxac®): oral medications to increase production of saliva and reduce dry mouth symptoms.²  
• Adequate dental care¹ 

Fatigue 

• Aerobic exercise 
• Good sleep schedule¹

Associated arthritis 

• Non-steroidal anti-inflammatory drugs (NSAIDs): oral medication to reduce inflammation. 
• Hydroxychloroquine (Plaquenil®) or methotrexate (Trexall®): immunosuppressive oral medications to reduce inflammation.² 

Due to the many manifestations of Sjögren’s Syndrome, it’s important to maintain recommended appointments with specialists, as Sjögren’s Syndrome can affect multiple bodily systems.¹ It’s also important to avoid triggers that may worsen the signs and symptoms of Sjögren’s Syndrome, most specifically avoiding or eliminating smoking, caffeine and alcohol intake, and dry environments. Taking note of all signs and symptoms, including when and where they occur to report to your specialists is also important in management of the manifestations of Sjögren’s Syndrome.²

1. Stefanski, A. L., Tomiak, C., Pleyer, U., Dietrich, T., Burmester, G. R., & Dörner, T. (2017). The Diagnosis and Treatment of Sjögren’s Syndrome. Deutsches Ärzteblatt International, 114(20), 354–361. https://doi.org/10.3238/arztebl.2017.0354 
2. Mayo Clinic Staff. (2020, July 22). Sjogren’s syndrome – Diagnosis and treatment – Mayo Clinic. Mayo Clinic. Retrieved January 10, 2022, from https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/diagnosis-treatment/drc-20353221 
3. Abelson, M. B., MD, & Ingerman, A., MD. (2005, November 15). The Dye-namics of Dry-Eye Diagnosis. Review of Ophthalmology. Retrieved January 10, 2022, from https://www.reviewofophthalmology.com/article/the-dye-namics-of-dry-eye-diagnosis 
4. Beckman, K., Luchs, J., & Milner, M. (2015). Making the diagnosis of Sjögren’s syndrome in patients with dry eye. Clinical Ophthalmology, 10, 43–53. https://doi.org/10.2147/opth.s80043 
5. Harthan, J. S., & Shorter, E. (2018). Therapeutic uses of scleral contact lenses for ocular surface disease: patient selection and special considerations. Clinical Optometry, 10, 65–74. https://doi.org/10.2147/opto.s144357