For Sjögren’s patients, inflammation of tear-secreting glands reduces tear production, resulting in chronic dry eye. In addition, changes in the composition of tears contribute to dry eye. In people with dry eye, thin spots in the tear film may appear and the tears no longer adequately protect and support the health of ocular surface tissues.
In Sjögren's, a patient's white blood cells mistakenly invade tear and saliva producing glands, causing inflammation and reducing secretion. The age of onset for Sjögren's is typically in the 40s, although many patients are being diagnosed at a younger age as education about Sjögren's increases.
Normal healthy tears contain a complex mixture of proteins and other components that are essential for ocular health and comfort. Tears are important because they:
- Provide nutrients and support the health of cells in the cornea.
- Lubricate the ocular surface.
- Protect the exposed surface of the eye from infections. Clear vision depends on even distribution of tears over the ocular surface.
Treatments for Dry Eye Disease
Treatment for dry eye depend on its causes and severity, so it is important to be examined by an eye care professional who is trained to diagnose and treat ocular disease. The doctor may use tests to assess tear production, tear stability, and tear distribution to determine its' severity.
The Sjögren's Foundation also developed Dry Eye and Sjögren's clinical practice guidelines that give a treating eye care provider a roadmap for how to treat the various levels of severity in Sjögren's dry eye. Some of the treatment options are:
Artificial tears, gels and ointments are available over the counter. They can provide temporary relief from dry eye symptoms. Artificial tears contain water, salts, and polymers but lack the proteins found in natural tears. Those who frequently use drops or ointments should choose a brand without preservatives or one with special non-irritating preservatives. Artificial tears are used to treat mild forms of dry eye or to supplement other treatments. It is important to avoid over-the-counter redness reliever eye drops as they may exacerbate dry eyes and redness with chronic use. Ointments usually are reserved for night use since they tend to blur one’s vision.
Punctal occlusion blocks the small openings in the eyelid that normally drain tears away from the eye. Usually this is done by inserting plugs made of silicone or other materials into the openings. This simple in office procedure helps to retain the patient’s tears on the ocular surface for a longer time. It can improve symptoms and increase comfort for some patients.
There are also prescription products available to help treat dry eye
Restasis® (cyclosporine ophthalmic emulsion) 0.05% treats an underlying cause of chronic dry eye by suppressing the inflammation that disrupts tear secretion.
Xiidra® (lifitegrast ophthalmic solution) 5% was approved by the FDA for both the signs and symptoms of dry eye disease.
CEQUA™ (cyclosporine A, ophthalmic solution) 0.09%CEQUA is a calcineurin inhibitor immunosuppressant indicated to increase tear production in patients with dry eye.
Corticosteroids (cortisone), topically applied, are occasionally prescribed to treat acute episodes of inflammation in dry eye. The use of these medications should be limited in frequency and duration to avoid potential complications of elevated intraocular pressure and glaucoma, cataract and increased risk of infections.
Other Options & Considerations
Blepharitis or Meibomian Eyelid Gland Dysfunction (MGD)
Because excess evaporation of the tear film can occur when there is irritation of the eyelids, conditions known as blepharitis or meibomian eyelid gland dysfunction (MGD), it is often helpful to maintain eyelid hygiene. In addition to traditional management strategies for meibomian gland dysfunction or blepharitis include warm compresses, eyelid massage and eyelid scrubs, there are many promising in-office manual and mechanical treatments that may provide the potential of symptomatic relief for patients with meibomian gland dysfunction. In addition, topical azithromycin may be prescribed for those with MGD.
Additionally, ocular allergies and certain skin disorders, such as rosacea, also can aggravate dry eye and should be treated appropriately.
A scleral lens is a large-diameter contact lens that vaults across the entire corneal surface and rests on the white part of the eye, known as the sclera. Liquid fills the space between your eye and the back surface of the scleral lens. This liquid bandage protects the cornea from the ongoing mechanical shearing effect of the eyelids that occurs when you blink. It also continuously bathes your sensitive corneal tissue. If you have Sjögren’s and also require vision correction, the scleral lens is additionally helpful because other contact lens options may be limited by the compromised state of your ocular surface.
There is accumulating evidence to suggest that taking essential fatty acid supplements (Omegas) by mouth may improve dry eye symptoms and signs. Although research is not conclusive on this, many believe that Omegas may still be beneficial. Essential fatty acids are also available in food, flaxseed oil, blackcurrant seed oil, fish oil supplements and in some over-the-counter products.