Sjogren’s Syndrome

What is Sjogren’s Syndrome?

Sjogren’s syndrome is an autoimmune disease that involves glandular tissue in the body. These glands supply lubrication for the eyes, mouth and other parts of the body. The eyes and mouth are commonly involved and is associated with rheumatoid arthritis. There is a trilogy of Sjogren’s syndrome of dry eyes, dry mouth, and rheumatoid arthritis.

What Causes Sjogren’s Syndrome?

It is not known what causes the body to attack its own body tissue. It is the same type of process as in rheumatoid arthritis, systemic lupus erythematosus, and scleroderma. Nearly all cases of Sjogren’s syndrome involve women.

Symptoms of Sjogren’s Syndrome

Dry Eyes

Scratchy, itchy, foreign body sensation, blurred vision, photophobia, and tearing

Dry Mouth

Dry mouth, soreness, irritation, trouble swallowing, and problems chewing food well

Dry Skin

Dry skin, itchy skin, and scaling

Vaginal Irritation

Dry vagina

Joint Pain

Rheumatoid arthritis symptoms of joints

Muscle and Body Pain

Aching muscles and parts of the body

Eye Exam for Evaluating Sjogren’s Syndrome

Examination of the external portion of the eye with a microscopic slit lamp is done to exam the eye and tear film status. A Schirmer’s test may be performed to measure the level of tear production of the eye. If the eyes are dry enough, the cells on the surface are damaged and die. The cells walls of the dead cells can be stained to show up with the slit lamp exam. The three dyes that are commonly used are fluorescein, lissamine green, and rose bengal. The conjunctiva of the eye can be biopsied to check for autoimmune cells involving the glands in the conjunctiva.

Other Tests and Examinations for Sjogren’s Syndrome

Biopsy of Lower Lip

A biopsy of from inside the lower lip is used to diagnose Sjogren’s syndrome.

Blood Tests

Blood tests for Sjogren’s syndrome are antinuclear antibodies tests looking for markers SS-A and SS-B.

Clinical History of Sjogren’s Syndrome

Dry Eyes

Dry eyes are a prominent feature of Sjogren’s syndrome. The dry eye syndrome can be severe in these patients. This can lead to frequent eye infections. Due to the severe dry eye, the cornea can have permanent damage with scarring and loss of vision.

Dry Mouth

Dry mouth can lead to tooth decay and other related health issues.

Arthritis

The rheumatoid arthritis can be severe as well with joint damage.

Vasculitis

Sjogren’s can be associated with other autoimmune diseases which cause inflammation of the blood vessels.

Treatment of Sjogren’s Syndrome Eye Problems

Dry Eyes and Corneal Damage

Patients will need to use artificial tears to keep their eye comfortable. Other options include punctal plugs and Restasis® in more severe cases. Patients may need to be placed on topical ocular corticosteroids to treat the eye. If the eye is still being damaged, systemic corticosteroids or other anti-inflammatory agents may be used.