How is the xerophthalmia of Sjogrens Syndrome treated?
The Sjögren Syndrome Foundation has published clinical practice guidelines for the management of oral, ocular, and systemic manifestations in SS. Treatment of dry eye varies if there is concurrent meibomian gland disease and options include:
- • Modify the environment: Increase fluid and omega-3 free fatty acid intake (controversial). Reduce caffeine intake and smoking. Limit time at computer, turn off ceiling fans, and consider using a humidifier. Consider using specialized eyewear (sometimes referred to as moisture chamber glasses) that has foam or another liner on the frame to fill the gap between the frame of the glasses and the face, reducing air movement and enclosing the eye. “Grilling goggles” or “onion goggles” are similar products that look more like sunglasses than goggles, which may be more acceptable to patients. Eliminate offending medications (see Question 10).
- • Eye drops:
- – Preservative-free artificial tears (Refresh, TheraTears, Soothe, Systane) are generally less irritating and should be used if patients use topical tears four or more times a day.
- – Topical corticosteroids for moderate-severe disease.
- – Cyclosporine (Restasis 1 drop BID) or lifitegrast (Xiidra 1 drop BID) for moderate-severe disease. Patients should be warned that cyclosporine can initially sting and may take 4 to 12 weeks to reach full effect.
- – Autologous tears may be used for severe ocular surface disease.
- • Lubricant ointments (Refresh PM, Lacrilube) are available and are typically used during the night.
- • Punctal occlusion is performed by an ophthalmologist and delays tear clearance. Temporary plugs (silicone, collagen) are generally inserted before permanent obstruction is considered.
- • Scleral contact lenses with a moisture reservoir can also be used but are costly.
- • If blepharitis is contributing to symptoms: warm compresses, avoid local irritants (mascara), topical azithromycin, and rarely systemic antibiotics (doxycycline).