Sjogren’s Syndrome is an autoimmune disorder in which the body’s immune system attacks(inflames) tissues which secrete tears, saliva and other bodily fluids. The exact cause is not known but is thought to be both genetic and environmental. Unfortunately, there is no cure for Sjogren’s disease and patients with Sjogren’s often experience significant dry eye and other systemic complications.
Many different inflammatory diseases can affect various tissues in your body and are usually caused by a similar mechanism of inflammation. Essentially, your immune system is largely mediated by white blood cells (lymphocytes) and other factors that act as the defensive army of your body. Normally, this system is wonderfully well orchestrated and quickly identifies foreign invaders and uses all the tools in its arsenal to defeat invaders before they get foothold and cause serious disease. Unfortunately, the immune system sometimes identifies your own tissues as being foreign resulting in inflammation of targeted tissues.
In Sjogren’s Syndrome, the inflammation involves the tissues that produce saliva, tears, and other bodily moisturizing fluids. This inflammation often results in dry mouth, increased tooth decay, and dry eyes. Ocular symptoms can include eye redness, burning, foreign body sensation, and contact lens intolerance. Ironically, chronic eye watering can also be a sign of dry eye as the eyes reflexively overwater themselves to compensate for the underlying dryness.
The treatment of dry eye associated with Sjogren’s Syndrome varies with the level of symptoms.
Preservative free tears: Most dry eye symptoms can be controlled with consistent use of preservative free lubrication drops. Avoid eyedrops in bottles as these will contain preservatives to extend their expiration dates. These preservatives can cause further inflammation and reduce tear production. Especially avoid Visine, Murine, Clear Eyes, and other “eye whitening” drops which can temporarily “take the red out” but contain chemicals and preservatives which increase can inflammation and dry eye symptoms. Retaine Preservative Free is our lubrication eyedrop of choice and is available in our clinic.
Non-Steroidal Anti Inflammatory (NSAI) Eyedrops: Restasis, Xiidra and Meibo are prescription drops which when used as prescribed, can increase tear production but can be expensive and require three to six months of use to achieve full benefit. Anti-allergy drops such as our recommended Extra Strength Pataday can be helpful in reducing allergic reactions and eye itching which can aggravate dry eye problems.
Steroids: Inflammatory problems can be quickly and greatly reduced with the use of steroid eyedrops such as prednisolone or dexamethasone. Often, a short burst of steroid eyedrops can be prescribed (in addition to Retaine drops) to quickly reduce inflammation and increase tear production. However, steroid eyedrops will need a prescription from Dr. Steve or Dr. Sarah and patients will require monitoring of possible side effects while under treatment. This is not a long-term fix.
Environment: In addition to these treatments, staying well hydrated and on a diet low in inflammatory foods can also help minimize dry eye associated with Sjogren’s syndrome. Staying away from a fan when sleeping at night and wearing an eye mask if using C-pap machine can also be beneficial. Increase humidity in your home if possible.
If you have been diagnosed with Sjogren’s Syndrome or are having dry eye symptoms, please schedule an appointment to determine the best course of treatment.
Best Wishes for Great Vision!
Dr. Steve and Dr. Sarah