An Overview of Sjogren's Syndrome

Sjogren's syndrome was named after Henrik Sjögren, a Swedish eye doctor. Sjogren's Syndrome is a condition in which the body's immune system attacks its own moisture-producing glands. For most sufferers, it attacks the salivary gland and the lacrimal glands, which produce tears. It can also affect the bowels and other moisture glands in the body. Sjogren's is a syndrome that is well known in the eye care profession because people with the condition often suffer from severe dryness of the eyes and often times eye doctors diagnose and treat dry eye syndrome before the patient actually is formally diagnosed with Sjogren's by their primary care doctor or rheumatologist.

This condition affects more women than men and occurs in about 0.1—4% of the population.

Dry eyes can often express themselves in different ways. Besides just dryness, dry eyes may cause the following:

• Foreign body sensation
• Sandy, gritty feeling
• Light sensitivity
• Fluctuating, blurry vision

People with Sjogren's syndrome may also have the following symptoms:

• Dry mouth
• Difficulty swallowing
• Frequent cavities or dental decay
• Muscle and joint aches and pains
• Dry skin or skin rashes
• Coughing
• Vaginal dryness
• Numbness in the arms and legs
• Extreme fatigue

Researchers are not sure what causes Sjogren's syndrome. However, the condition tends to run in families. It is thought to be related to a certain gene that some people carry that predisposes them to express the disease when triggered. This trigger, which may be a viral infection, bacterial infection, or even stress, activates the body's immune system. When this occurs, the immune system may become overly aggressive. Sjogren's syndrome also tends to occur alongside other serious autoimmune health disorders such as lupus, rheumatoid arthritis, or scleroderma.

Your doctor will review your complete medical and family history to uncover symptoms or other illnesses that may be related. Blood tests may be ordered to look for certain antibodies that are present. Also, your doctor will check your kidney and liver function. Your doctor may also refer you to a dentist to check for an increase in dental decay.

Your doctor may refer you to an optometrist or ophthalmologist to perform certain tests to check for signs of dry eye syndrome. These tests may include the following:

• Slit lamp examination: Eye doctors use a special bio-microscope called a slit lamp to microscopically examine the front part of the eye for signs of dryness. Dyes are instilled into the eye to highlight areas that may be damaged by dry eyes or show dead or devitalized cells.
• Schirmer tear test: A Schirmer tear test is a way to quantify how much tears you have by placing two strips of medical grade paper into the eyes to measure the amount of tear production. Although the test is not extremely precise it does give doctors a good idea about how dry your eyes may be compared to normal.

Several treatment options are available for treating dry eye syndrome.

• Artificial tears: Artificial tears are the first line of defense in treating dry eyes. Artificial tears are available over the counter and come in many different types and brands. Artificial tears must be instilled several times per day to achieve the desired effect. Artificial tears act to both heal the dry surface of the eye and treat the dry eye symptoms patient may have. Artificial tears are available in preserved and non-preserved forms. Because artificial tears are taken several times per day, non-preserved tears are thought to be a much healthier alternative.
• Gels and ointments: In more severe dry eye patients, gels and ointments are suggested. Gels and ointments coat the eye longer and may provide a more protective effect. Gels and ointments can be instilled into the eye at bedtime providing protection overnight.
• Pellets: Pellets are usually made of hydroxypropyl methylcellulose, a chemical found in some artificial tears, gels, and ointments. These pellets can be placed under the eyelid. The body's temperature slowly allows them to melt and provide a slow, continued source of lubrication.
• Cyclosporin A: Cyclosporin A, available by the brand name Restasis (Allergan, Inc.), is an immunomodulatory drug that changes the local immune system around the lacrimal gland so that your own eye can manufacture more of its own tears.
• Punctal occlusion (plugs): Punctal occlusion is a procedure in which an optometrist or ophthalmologist inserts a small plug, usually made of silicone, into the puncta (opening of the tear drainage system) to slow or prevent the drainage of normal tears. Some physicians will choose to cauterize these ducts, although this can cause scarring and is permanent.
• Mask wearing or patching: Severe dry eye patients should turn down or off any ceiling fans in the room in which they sleep. Also, some patients may find it less drying to wear a patch or sleeping mask over their eyes at night to reduce exposure.
• Blink often: This may sound strange, but dry eye patients should try to think about blinking more. The more you blink, the more you spread a new tear layer over the surface of the eye. Also, If you use the computer or read for prolonged periods of time, take frequent breaks. When you focus on near objects such as a computer screen, your blink rate tends to decrease.
• Review medications: You and your physician should take care and review other medications you may take, such as antihistamines, that can potentially cause even more dryness. Other medications that may cause dryness are decongestants, diuretics, anti-diarrhea drugs, some antipsychotic drugs, tranquilizers, some blood pressure medicines, and antidepressants.
• Add a humidifier to your bedroom: A humidifier will cause fewer tears to evaporate from the surface of the eye.
• Drink plenty of water: Drinking plenty of water will prevent dehydration and minimize excessive dryness.
• Tarsorrhaphy: In severe cases of dry eye, surgeons may consider a partial closure of the eyelids. This is known as a tarsorrhaphy. This procedure simply reduces the surface area that requires lubrication.

Most of us have experienced dry eye symptoms at some point in our lives. However, the dryness that occurs in Sjogren's is much more severe. Severe, chronic dry eyes can cause dry spots on the cornea, the clear dome-like structure on the front part of the eye. These spots can worsen and become ulcers that may become infected. Also, chronic dryness can cause scarring of the cornea and conjunctiva. If the condition worsens further, patients may suffer vision loss.