Treatment of Sjögren Syndrome with Ocular Dryness or Abnormal Ocular Tests

Ocular dryness is a cardinal manifestation of Sjögren syndrome. When patients present with symptomatic eye dryness or objective abnormalities on ocular testing, a structured first-line intervention is indicated to protect the ocular surface and reduce discomfort.

Clinical Scenario

Patients with confirmed Sjögren syndrome who present with ocular dryness and/or abnormal ocular tests — whether symptomatic, objective, or both — require targeted ocular surface management as a first-line priority.

First-Line Approach

Management centres on restoring and maintaining tear volume and ocular surface lubrication. Specific lubricating preparations — selected according to their polymeric or viscosity-active components — form the backbone of therapy, with formulation type and application frequency individualised to symptom burden and objective findings. Overnight symptom management is also addressed. The complete protocol specifies preparation selection, frequency guidance, and formulation criteria — see the full regimen.

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References

DOI: 10.1136/annrheumdis-2019-216114

We recommend that all SjS patients presenting with ocular dryness and/or abnormal ocular tests should use AT containing methylcellulose or hyaluronate at least twice daily, with the frequency increased to as often as hourly, as indicated by symptoms and/or objective signs.

The first line of therapy for ocular dryness should be volume replacement and lubrication using artificial tears (AT) and ocular gels, whose main ingredients are lubricants with a polymeric base or viscosity agent (methylcellulose, hyaluronate) with the aim of adding volume to the tear lake, increasing the time the AT remain on the ocular surface, and cushioning the ocular surface to reduce friction between lid and globe.

The use of preservative-free formulations of AT is mainly recommended in patients requiring four or more applications per day.

Ophthalmic ointments are thicker than AT and may be used to provide symptom control overnight; they are typically used before bedtime because they produce blurred vision and their use should be followed by morning lid hygiene to prevent blepharitis.

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