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Sjogrens Syndrome

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What is Sjogren's?

Sjogren's is an autoimmune disease that most commonly affects women over the age of 40. Sjogren’s can possibly be inherited from their parents but studies have shown that there is also an environmental component that activates the condition such as a bacterial or viral infection. Sjogren's can be further divided into two categories, primary or secondary Sjogren's. Primary Sjogren's occurs without any additional autoimmune disorders while secondary Sjogren's includes an additional autoimmune disorder such as rheumatoid arthritis or lupus. An autoimmune disease is characterized by an unruly immune response to the body’s own natural cells and tissues. This commonly manifests as complaints of dry eye and dry mouth in patients with this condition. In Sjogren's, the body attacks the glands that are responsible for producing tears that coat the eyes and saliva that lines the mouth. Ultimately, this can lead to dry eyes that can further transform to other ocular issues, including blurry vision and corneal damage. Timely and proper diagnosis of the condition will allow for proper treatment that will help in preventing complications.

Signs/ Symptoms of Sjogren's

Some common presenting symptoms of Sjogren's include:

  • Persistent chronic dry eyes
  • Stinging
  • Blurred vision
  • Irritated and swollen lids
  • Itchy eyes
  • Heavy eyes
  • Sandy eyes
  • Feeling of having something in your eye

  • Mucus discharge
  • Light sensitivity
  • Skin rashes
  • Dry cough
  • Joint pain or stiffness
  • Swollen salivary glands
  • Vaginal dryness
  • Fatigue

Diagnosing Sjogren's

Your eye doctor can perform a series of assessments that would assist in diagnosing Sjogren's related dry eyes. Your doctor can use a slit lamp, a microscope examination tool, in order to view the front surface of the eye for signs of damage. Your doctor could use special dyes such as fluoresceine that would help illuminate surface damage to the eye. A few tests can be performed such as Schirmers tear test would help determine your tear production. Speak to your eye doctor if you feel you are experiencing symptoms of dry eye.

Systemically, your primary care doctor can help determine the diagnosis of Sjogren’s syndrome by ordering blood tests in addition to a thorough case history. The blood test can be used to analyze blood cells, antibodies common in this condition, inflammatory markers, and indication of other bodily problems. In addition, your primary care physician may order imaging that would help determine function of your salivary glands. A biopsy can be performed on your salivary glands in order to detect signs of inflammation. A diagnosis of Sjogren's may be a difficult one but having a thorough conversation with your doctor may put you on the right path.

Complications of Sjogren's

Sjogren’s can affect various aspects of the body, resulting in complications that range from mild to severe, such as those listed below.

  • Ocular complications
    • Vision problems including blurred vision
    • Eye discomfort
    • Corneal damage including ulcers or infections
  • Other complications
    • Tooth decay
    • Difficulty speaking
    • Oral infections
    • Lymphoma
    • Numbness in your hands and feet
  • Pneumonia or bronchitis

Risk factors for Sjogren's

Some known risk factors for Sjogren's involve:

  • Sex: Females are more likely to develop Sjogren's than males
  • Age: Sjogren's most commonly develops after the age of 40.
  • History of rheumatic disease: patients with previous history of lupus or rheumatoid arthritis are more likely to develop Sjogren's.
  • Family history

Treatment and management

Sjogren's is a chronic disease and therefore no treatment is curative. All treatment methods are aimed at improving the quality of everyday life and decreasing common complaints. Treatment for Sjogren's varies widely depending on the patient’s major complaints. Most patients require treatment for dry mouths and dry eyes. Below are some treatment options for eye related issues that arise in Sjogren’s:

  • To decrease eye inflammation and improve lubrication of the eye’s surface, your eye doctor may prescribe artificial tears or prescription eye drops such as Restasis (Cyclosporine). Preservative free artificial tears can be used as needed throughout the day to improve comfort and protect the corneal surface. Restasis is a prescription drop that works as an immunosuppressive medication that reduces the inflammation in the glands that produce your tears. This helps prevent further damage to your glands and improves tear production over time.
  • Increasing the humidity of indoor areas could help improve daily comfort. Avoiding exposure to excessive air blowing into your eyes from things such as overhanging ceiling fans could also serve to improve comfort.
  • Your eye doctor may insert silicone or collagen plugs into your tear drainage pathway in order to block drainage and allow more tears to remain on your eye. The plugs can be removed at any time and are not permanent.
  • In severe cases, a doctor may perform surgery that would seal the drainage pathway of tears, preventing tear drainage and therefore allowing more tears to remain on the surface of the eye. - Eye drops that are made from the person’s blood serum can be special made in cases of extreme dryness. The use of one’s own blood improves the efficacy of the drug because it contains the same biochemistry as the patient.

Scleral Contact Lenses for Sjogren’s

Sjogren’s syndrome patients most commonly complain of severe dry eyes. This can be exacerbated by the use of traditional soft contact lenses because of its tendency to dry out. This can increase feelings of dry eye and a foreign body sensation in patients, decreasing wear time. Scleral contact lenses can be a great option for patients suffering from Sjogren’s syndrome because they are made a little differently. Scleral contact lenses are gas permeable lenses that are larger than traditional contact lenses and rest on the white part of the eye rather than the cornea. This produces a dome over the cornea that is filled with saline, forming a protective and lubricative barrier. The saline will act as a buffer between the lens and the cornea, improving feelings of irritation or dryness. This also prevents mechanical rubbing of the eyelids on the cornea, further exacerbating symptoms of irritation. The lenses are larger and custom fit to each individual’s eye. This improves overall vision by reducing movement of the lenses. If you are a Sjogren’s patient and are having trouble wearing soft contact lenses, speak to your eye doctor regarding the use of scleral contact lenses. Many patients have had success with these lenses, noting both quality of life and vision improvement with the use of scleral contact lenses.

Common questions regarding Sjogren’s

  • Is there anything I can do at home to help with symptoms?
    • Some lifestyle changes can be made to improve the quality of life and comfort. Drinking more fluids, chewing sugarless gum, using artificial tears regularly, and using saline nasal spray are some things you can do to improve dryness. Using a humidifier at home can improve moisture in the air and reduce dry eyes and mouth. Limit consumption of alcohol and smoking to prevent further complications.
  • Who treats Sjogren’s syndrome?
    • Treatment of Sjogren’s syndrome involves a team of doctors due to the effects on multiple parts of the body. A primary care physician, optometrist/ ophthalmologist, internist, ENT specialist, and rheumatologist may all be involved and play different roles in the patient’s care.

Find out how we were able to help a patient with Sjogren’s syndrome by viewing a case report.

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