Management of Dry Eye in Sjögren’s Syndrome

Abstract

The treatment of dry eye in Sjogren’s syndrome varies based on the severity of the disease. First-line therapy usually includes environmental changes and lubrication of the ocular surface with the use of artificial tears and/or ointments. Punctal occlusion may also help by extending available lubrication via natural or artificial tears. However, the occlusion of the puncta is usually recommended after ocular inflammation is addressed by topical medications. The main anti-inflammatory topical treatment for Sjogren’s syndrome-related dry eye is topical cyclosporine A. Cyclosporine A 0.05 % is the only commercially available ophthalmic emulsion approved by the US Food and Drug Administration to be used in the treatment of dry eye. In severe cases, a 1 % compounded preparation of the cyclosporine or more frequent instillation of 0.05 % cyclosporine may be more efficient. Topical steroids can be considered as a short-term “pulse treatment” for inflammatory exacerbations of the disease given the high risk of complications with chronic use. In refractory cases, other anti-inflammatory treatments including autologous serum and topical tacrolimus may be considered. Contact lenses may help with the healing of the superficial keratitis or sterile ulcers. For the proper management of Sjogren’s syndrome-related dry eye, it is important to diagnose the disease in its early stages and start topical or local anti-inflammatory treatment before irreversible damage occurs in the lacrimal glands and on the ocular surface. The ocular surface complications of such as sterile corneal ulcers, opacification, and perforation may necessitate extensive surgeries, including corneal transplantation or keratoprosthesis implantation for the restoration of vision.