Sjögren’s is an autoimmune inflammatory disease primarily affecting the lacrimal and salivary glands (Bjordal et al, 2020). The mean age of diagnosis is 56 years old, with women significantly affected more than men (Stefanski et al, 2017). A Sjögren’s patient’s first symptom is often dry eye, putting eyecare practitioners (ECPs) at the frontline of diagnosis.

Resulting dry eye is typically first therapeutically managed with lubricants, anti-inflammatory drops, and topical biologics. Scleral lenses are often utilized when palliative and medical management fail to completely manage symptoms or if the patient has poor vision secondary to epithelial erosions.

Here is a look at three Sjögren’s cases and how scleral lenses were used as part of the treatment.

Making the Diagnosis

A 62-year-old female complained of decreased vision with her glasses. She reported that she had been examined by numerous ECPs without any improvement. The patient’s medical history was unremarkable, and she wasn’t on any medications. Visual acuity with her glasses was 20/25 OD and 20/40 OS. Slit lamp exam revealed a reduced tear breakup time of three seconds in both eyes as well as punctate erosions of both corneas.

Upon further questioning, she did report having xerostomia (dry mouth) and recent dental issues. She was diagnosed with dry eye and fit with scleral lenses to provide immediate vision improvement. The patient was referred for testing, which confirmed a diagnosis of Sjögren’s. With a positive diagnosis, the patient can now be properly managed for her condition, including systemic, dental, and ocular treatment.

Improving Vision

A 65-year-old female patient with Sjögren’s was referred for contact lens evaluation. She reported a recent flare-up that primarily affected her left eye. The patient was currently using meibomian gland dysfunction ophthalmic emulsion eye drops and non-preserved artificial tears. Her current best-corrected visual acuity was 20/25 OD and 20/200 OS. Slit lamp examination revealed significant punctate erosions OS (Figure 1). A primary motivation for contact lenses was visual improvement. She was fit with free-form 16.5mm scleral lenses that improved her vision to 20/20 OD and 20/25 OS. With daily scleral lens wear, her punctate erosions resolved.

Improving Comfort

A 72-year-old female patient with Sjögren’s reported for specialty contact lens evaluation. She complained of increased symptoms of dryness despite near maximum medical management, including cyclosporine and autologous serum. She was fit with free-form 16.5mm scleral lenses for protection and continuous hydration of her ocular surface. A polyethylene glycol treatment was added to the lenses to improve comfort during wear.

After struggling with application, she was successfully trained to apply the lenses using a lighted stand. At follow-up, she reported significantly improved comfort with scleral lens wear. The lighted stand was critical to her success, as it allowed her to apply the lenses correctly.

Conclusion

Remember to have Sjögren’s on your differential list when diagnosing or managing a dry eye patient. Scleral lenses can provide substantially improved vision and comfort for patients who have this condition. CLS

References

1. Bjordal O, Norheim KB, Rødahl E, Jonsson R, Omdal R. Primary Sjögren’s syndrome and the eye. Surv Ophthalmol. 2020 Mar-Apr;65:119-132.
2. Stefanski AL, Tomiak C, Pleyer U, Dietrich T, Burmester GR, Dörner T. The Diagnosis and Treatment of Sjögren’s Syndrome. Dtsch Arztebl Int. 2017 May 26;114:354-361.