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

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 anti-rheumatic 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. The tear film composition analysis includes measurements of tear osmolarity and levels of inflammatory mediators. Elevated osmolarity of the tear film is a characteristic for DED though there is no suggested cutoff value for SS-related DED and further investigations should be conducted to establish it 28, 32, 35, 36].