This article was originally published in a sponsored newsletter.

Sjögren’s syndrome is a chronic autoimmune systemic disease that involves the entire body. In addition to extensive ocular and oral dryness symptoms, other devastating complications include profound fatigue, chronic pain, major organ involvement, neuropathies, and lymphomas.¹

It is well established that the monitoring of dry eye disease in Sjögren’s is not uniform in diverse practices.² In a retrospective chart review from six practices in North America, the most commonly recorded variables were dry eye symptoms (98.4% of charts), meibomian gland dysfunction (76.4% of charts), corneal fluorescein staining (75.6% of charts), and anterior blepharitis (73.2% of charts). Acs and colleagues recommended that creating accepted standards of testing will advance the ability of practitioners and researchers to communicate and understand the course of dry eye disease in Sjögren’s.

The goal of another study was to use anterior segment images to identify the characteristic features of Sjögren’s-related dry eye disease to create an uncomplicated method to screen for dry eye disease.³ The retrospective study of 502 eyes included all patients examined between August 2020 and January 2021. The study included 64 women and four men with a variety of autoimmune disorders including Sjögren’s (68), ocular graft-versus-host disease (50), other conditions (27), simple dry eye disease (72), and no dry eye disease (97).

In the Sjögren’s group, the inferior corneal fluorescein staining score was significantly higher. Additionally, the nasal lissamine green staining score was high in the Sjögren’s group. These are significant signs for autoimmune-related dry eye disease, specifically Sjögren’s, and may be beneficial in the early diagnosis of Sjögren’s-related dry eye disease.

Limitations of this study included a retrospective design and prominent age-related and sex-related differences in the study population. The authors recommend age-matched and sex-matched prospective future studies.

Scleral lenses are a viable management option for patients who have ocular surface disease, including Sjögren’s. Current scleral lenses are also prescribed for the management of simple refractive errors, including presbyopia, especially when other modalities are unsuccessful due to vision or comfort issues.

REFERENCES

1. Negrini S, Emmi G, Greco M, et al. Sjögren's syndrome: a systemic autoimmune disease. Clin Exp Med. 2022 Feb;22:9-25.

2. Acs M, Caffery B, Barnett M, et al. Customary practices in the monitoring of dry eye disease in Sjogren's syndrome. J Optom. 2018 Oct-Dec;11:232-241.

3. Shimizu E, Sato S, Asai K, Ogawa Y, Shimmura S, Negishi K. Clinical Features of Sjögren Syndrome-Related Dry Eye Disease in Anterior Segment Photographs. Cornea. 2024 Jan 1;43:18-25. 

Melissa Barnett, OD, FAAO, FSLS, is the Director of Optometry at the University of California, Davis, specializing in anterior segment disease and specialty contact lenses. She is the past president of the Scleral Lens Education Society and is past chair of American Optometric Association Contact Lens and Cornea Section. She is an advisor to and/or has received honoraria or travel expenses from AccuLens, Alcon, Allergan, Bausch + Lomb, Bruder, Contamac, CooperVision, Johnson & Johnson Vision, Ocusoft, ScienceBased Health, Tarsus, and Visus Therapeutics.