Overview
Keratoconjunctivitis sicca (dry eye) in Sjögren's syndrome is characterized by chronic dryness of the cornea and conjunctiva due to insufficient tear production, often accompanied by symptoms like irritation, foreign body sensation, and visual disturbances 5.Diagnosis
Key Diagnostic Criteria: Symptoms of dry eye, often with systemic manifestations such as dry mouth and arthritis.
Recommended Tests:
- Schirmer Test: Measures tear production; less useful in moderate to severe cases 5.
- Lactoferrin Immunologic Assay: Provides high sensitivity and specificity, especially in moderate to severe cases 5.
- Tear Film Breakup Time: Not useful in diagnosing 5.
- Rose Bengal Staining: Not useful in diagnosing 5.
Grading: Severity often correlates with symptomatology and tear film parameters 5.Management
First-Line Treatments:
- Artificial Tears: Standard initial therapy to relieve symptoms 5.
- Punctal Plugs: To reduce tear drainage 7.
Adjunctive Treatments:
- Cyclosporine: Immunosuppressive agent to increase tear production 1.
- Tacrolimus: Another immunosuppressive option, particularly useful in refractory cases 1.
- Occlusion of Puncta: To retain tears 7.
- Swimmer's Goggles: Moist chamber effect for severe cases unresponsive to conventional therapy 7.Special Populations
Comorbidities: No specific guidance provided in the abstracts regarding management adjustments for comorbidities 5.
Elderly: Management principles similar to general population, focusing on symptom relief and tear film stability 5.
Pregnancy: No specific recommendations provided in the abstracts 5.
Pediatrics: Not addressed in the provided abstracts 5.Key Recommendations
Utilize the lactoferrin immunologic assay alongside the Schirmer test for accurate diagnosis of keratoconjunctivitis sicca, especially in moderate to severe cases (Evidence: Moderate 5).
Employ artificial tears as first-line therapy for symptom relief, complemented by punctal plugs to manage tear drainage (Evidence: Expert opinion 7).
Consider immunosuppressive agents like cyclosporine or tacrolimus for patients with inadequate response to conventional treatments (Evidence: Moderate 1).References
1 Andrade F, Saldanha A, Bastos JT, Montiani-Ferreira F. A Cross-sectional Online Questionnaire-based Survey About the Use of Compounded Medications in Veterinary Ophthalmology. International journal of pharmaceutical compounding 2024. link
2 Pucino V, Turner JD, Nayar S, Kollert F, Rauz S, Richards A et al.. Sjögren's and non-Sjögren's sicca share a similar symptom burden but with a distinct symptom-associated proteomic signature. RMD open 2022. link
3 Mills G. Study shows there are lots of dry eyes in the house. The Veterinary record 2021. link
4 Warner B, Baer A. In Reply. The oncologist 2020. link
5 Goren MB, Goren SB. Diagnostic tests in patients with symptoms of keratoconjunctivitis sicca. American journal of ophthalmology 1988. link90587-9)
6 Naschitz JE, Yeshurun D. Quinidine induced sicca syndrome. Journal of toxicology. Clinical toxicology 1983. link
7 Poirier RH, Ryburn FM, Israel CW. Swimmer's goggles for keratoconjunctivitis sicca. Archives of ophthalmology (Chicago, Ill. : 1960) 1977. link