Dry Eye in Sjögren's Syndrome: Managing Persistent Symptoms After Anti-Inflammatory Therapy
This protocol addresses patients with Sjögren's syndrome presenting with both dry eye and dry mouth, whose ocular symptoms have not responded adequately to prior anti-inflammatory treatment.
Clinical Scenario
Sjögren's syndrome is a systemic autoimmune inflammatory disease that causes dry eye and dry mouth. In this population, dry eye is driven by the underlying systemic disease, and management must account for both the ocular surface and the systemic condition together.
Previous Treatment Line — Inadequate Response
The prior treatment line included an anti-inflammatory agent — a short-term ophthalmic corticosteroid or cyclosporine ophthalmic emulsion — with or without an oral cholinergic secretagogue such as cevimeline or pilocarpine. Escalation to this protocol is indicated when the following targets were not reached: significant improvement in dry eye symptoms, and decreased signs and symptoms including reduced itching and blurred vision (full effect expected at four to eight weeks).
Next-Line Approach — Overview
For persistent dry eye in Sjögren's syndrome after anti-inflammatory therapy, the structured protocol moves to physical interventions — including measures targeting tear-duct drainage — along with protective options and, in severe disease, a specialised biological tear substitute. The complete protocol, including specific intervention selection and sequencing, is in the full regimen.
Treatment Goal
Improvement of patient symptoms, including reduced eye pain.
References
- Sjogren's syndrome is a systemic autoimmune inflammatory disease that causes dry eye and dry mouth.
- Punctal occlusion, eye side shields, or autologous serum tears may be used in patients with moderate-to-severe DED.
- Punctal plugs are placed by the ophthalmologist in the punctal (tear duct) orifice to occlude tear-duct drainage in patients with aqueous tear deficiency.
- Thermal or laser cautery has been used to produce permanent punctal occlusion.
- Eyeglass side shields that mountain climbers or cyclists use may help prevent tear evaporation and may be of benefit in some patients.
- In severe DED, ophthalmic autologous serum tears are used to decrease inflammation and improve patient signs and symptoms if other treatment modalities are not sufficient.
- Autologous serum tears regimens have improved patient symptoms, including pain, compared with artificial tears.
DOI: 10.4140/TCP.n.2016.96
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