Abstract
Evaluation of a patient with dry eye symptoms and possible Sjögren’s syndrome (SS) requires a complete review of systems and a thorough ocular surface examination that includes staining of the conjunctiva. SS patients may have a variety of clinical presentations, and it is important to have a low threshold for referring dry eye patients to a rheumatologist for a SS workup. A stepwise approach to the management of ocular surface disease is advised starting with topical anti-inflammatory therapy, autologous serum tears, and scleral lenses for the more advanced cases. For SS patients undergoing surgery, aggressive ocular surface treatment preoperatively and careful postoperative monitoring is the key to ensuring a successful outcome. In advanced cases of SS with corneal melting or perforation, aggressive local therapy, treatment of the underlying systemic disease with early immunosuppressive therapy, and close collaboration with a rheumatologist are critical to controlling the disease.
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References
Segal B, Bowman SJ, Fox PC, et al. Primary Sjogrens Syndrome: health experiences and predictors of health quality among patients in the United States. Health Qual Life Outcomes. 2009;7:46.
Fox PC, Bowman SJ, Segal B, et al. Oral involvement in primary Sjogren syndrome. J Am Dent Assoc. 2008;139(12):1592–601.
Markusse HM, Oudkerk M, Vroom TM, Breedveld FC. Primary Sjogren’s syndrome: clinical spectrum and mode of presentation based on an analysis of 50 patients selected from a department of rheumatology. Neth J Med. 1992;40(3-4):125–34.
Kassan SS, Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjogren syndrome. Arch Intern Med. 2004;164(12):1275–84.
Kruszka P, O'Brian RJ. Diagnosis and management of Sjogren syndrome. Am Fam Physician. 2009;79(6):465–70.
Manthorpe R, Asmussen K, Oxholm P. Primary Sjogren’s syndrome: diagnostic criteria, clinical features, and disease activity. J Rheumatol Suppl. 1997;50:8–11.
Zintzaras E, Voulgarelis M, Moutsopoulos HM. The risk of lymphoma development in autoimmune diseases: a meta-analysis. Arch Intern Med. 2005;165(20):2337–44.
Fox RI. Sjogren’s syndrome. Lancet. 2005;366(9482):321–31.
Nichols KK, Nichols JJ, Zadnik K. Frequency of dry eye diagnostic test procedures used in various modes of ophthalmic practice. Cornea. 2000;19(4):477–82.
Korb DR. Survey of preferred tests for diagnosis of the tear film and dry eye. Cornea. 2000;19(4):483–6.
Whitcher JP, Shiboski CH, Shiboski SC, et al. A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjogren’s syndrome international registry. Am J Ophthalmol. 2010;149(3):405–15.
Garcia-Carrasco M, Ramos-Casals M, Rosas J, et al. Primary Sjogren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore). 2002;81(4):270–80.
Shen L, Suresh L, Lindemann M, et al. Novel autoantibodies in Sjogren’s syndrome. Clin Immunol. 2012;145(3):251–5.
Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61(6):554–8.
Shiboski SC, Shiboski CH, Criswell L, et al. American College of Rheumatology classification criteria for Sjogren’s syndrome: a data-driven, expert consensus approach in the Sjogren’s International Collaborative Clinical Alliance cohort. Arthritis Care Res (Hoboken). 2012;64(4):475–87.
Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X, International Sjögren’s Syndrome Criteria Working Group 2013. American College of Rheumatology/European League against rheumatism classification criteria for primary Sjögren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis. 2017;76(1):9–16.
Ram J, Sharma A, Pandav SS, Gupta A, Bambery P. Cataract surgery in patients with dry eyes. J Cataract Refract Surg. 1998;24(8):1119–24.
Sambursky R, Davitt WF III, Latkany R, et al. Sensitivity and specificity of a point-of-care matrix metalloproteinase 9 immunoassay for diagnosing inflammation related to dry eye. JAMA Ophthalmol. 2013;131(1):24–8.
Kaufman HE. The practical detection of mmp-9 diagnoses ocular surface disease and may help prevent its complications. Cornea. 2013;32(2):211–6.
Sambursky R, Davitt WF III, Friedberg M, Tauber S. Prospective, multicenter, clinical evaluation of point-of-care matrix metalloproteinase-9 test for confirming dry eye disease. Cornea. 2014;33(8):812–8.
Sullivan BD, Crews LA, Sonmez B, et al. Clinical utility of objective tests for dry eye disease: variability over time and implications for clinical trials and disease management. Cornea. 2012;31(9):1000–8.
Tomlinson A, Khanal S, Ramaesh K, Diaper C, McFadyen A. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci. 2006;47(10):4309–15.
Versura P, Profazio V, Campos EC. Performance of tear osmolarity compared to previous diagnostic tests for dry eye diseases. Curr Eye Res. 2010;35(7):553–64.
Epitropoulos AT, Matossian C, Berdy GJ, Malhotra RP, Potvin R. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015;41(8):1672–7.
Bunya VY, Fuerst NM, Pistilli M, et al. Variability of tear osmolarity in patients with dry eye. JAMA Ophthalmol. 2015;133(6):662–7.
Menzies KL, Srinivasan S, Prokopich CL, Jones L. Infrared imaging of meibomian glands and evaluation of the lipid layer in Sjogren’s syndrome patients and nondry eye controls. Invest Ophthalmol Vis Sci. 2015;56(2):836–41.
Villani E, Beretta S, De Capitani M, Galimberti D, Viola F, Ratiglia R. In vivo confocal microscopy of meibomian glands in Sjogren’s syndrome. Invest Ophthalmol Vis Sci. 2011;52(2):933–9.
Kangari H, Eftekhari MH, Sardari S, et al. Short-term consumption of oral omega-3 and dry eye syndrome. Ophthalmology. 2013;120(11):2191–6.
Asai T, Nakagami T, Mochizuki M, Hata N, Tsuchiya T, Hotta Y. Three cases of corneal melting after instillation of a new nonsteroidal anti-inflammatory drug. Cornea. 2006;25(2):224–7.
Vivino FB, Minerva P, Huang CH, Orlin SE. Corneal melt as the initial presentation of primary Sjogren’s syndrome. J Rheumatol. 2001;28(2):379–82.
Krachmer JH, Laibson PR. Corneal thinning and perforation in Sjogren’s syndrome. Am J Ophthalmol. 1974;78(6):917–20.
Pfister RR, Murphy GE. Corneal ulceration and perforation associated with Sjogren’s syndrome. Arch Ophthalmol. 1980;98(1):89–94.
Kervick GN, Pflugfelder SC, Haimovici R, Brown H, Tozman E, Yee R. Paracentral rheumatoid corneal ulceration. Clinical features and cyclosporine therapy. Ophthalmology. 1992;99(1):80–8.
Gottsch JD, Akpek EK. Topical cyclosporin stimulates neovascularization in resolving sterile rheumatoid central corneal ulcers. Trans Am Ophthalmol Soc. 2000;98:81–7. discussion 87–90
Colon LE, Enzenauer RJ. Corneal thinning as the sole manifestation of active undifferentiated connective tissue disease. South Med J. 1990;83(1):48–50.
Bernauer W, Ficker LA, Watson PG, Dart JK. The management of corneal perforations associated with rheumatoid arthritis. An analysis of 32 eyes. Ophthalmology. 1995;102(9):1325–37.
Seror R, Ravaud P, Bowman SJ, et al. EULAR Sjögren’s Syndrome Disease Activity Index: development of a consensus systemic disease activity index for primary Sjögren’s syndrome. Ann Rheum Dis. 2010;69:1103–9.
Acknowledgments
Financial Disclosure: Dr. Vivino is a consultant and/or participant in clinical trials for Immco Diagnostics, Inc.
Conflict of Interest: Dr. Vivino is a consultant and/or participant in clinical trials for Immco Diagnostics, Inc.
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Bunya, V.Y., Fuerst, N.M., Orlin, S.E., Massaro-Giordano, M., Vivino, F.B., Sulewski, M.E. (2018). Diagnosis and Management of Ocular Involvement in Sjögren’s Syndrome. In: Djalilian, A. (eds) Ocular Surface Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-15823-5_5
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DOI: https://doi.org/10.1007/978-3-319-15823-5_5
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