Sjögren's Syndrome and Dry Eye: The Role of Optometrists in Diagnosis and Management

Sjogren's Syndrome (SS) is an autoimmune disorder that affects approximately 0.5-1% of the general population, and up to 30% of patients with rheumatoid arthritis or lupus (Shiboski et al., 2017). SS is characterized by lymphocytic infiltration and destruction of the exocrine glands, resulting in dryness of the eyes, mouth, and other mucosal surfaces (Fox, 2021). Dry eye is one of the most common and debilitating manifestations of SS, with up to 90% of patients experiencing symptoms of ocular dryness and irritation (Akpek et al., 2017). Early detection and treatment of dry eye in SS is critical to prevent irreversible damage to the ocular surface and improve patients' quality of life (Baudouin et al., 2021).




Sjogren's Syndrome and Dry Eye

The relationship between SS and dry eye is well-established, with the ocular surface being one of the most commonly affected areas in the disease (Akpek et al., 2017). The mechanisms of dry eye in SS are multifactorial and include decreased tear production, increased tear film evaporation, and altered composition of the tear film (Fox, 2021). Symptoms of dry eye in SS include ocular dryness, irritation, foreign body sensation, and blurry vision, among others (Shiboski et al., 2017).


Diagnosis and Management

The diagnosis of SS and dry eye is based on a combination of clinical and laboratory criteria, including the presence of ocular and oral dryness, characteristic histopathologic features, and autoantibody seropositivity (Baudouin et al., 2021). Accurate diagnosis and assessment of dry eye in SS is critical to guide appropriate management and prevent disease progression (Akpek et al., 2017). Management of dry eye in SS includes a range of interventions, such as topical lubricants and artificial tears, punctal occlusion, anti-inflammatory therapy, autologous serum eye drops, and moisture chamber goggles (Fox, 2021).


Role of Optometrists in Treatment

Optometrists play a crucial role in the detection and management of dry eye in SS, as they are often the first healthcare professionals to encounter patients with ocular symptoms (Baudouin et al., 2021). Optometrists can assess the severity of dry eye, prescribe appropriate lubricants and other topical agents, and perform punctal occlusion procedures as needed (Shiboski et al., 2017). Optometrists can also educate patients about the condition and treatment options, and collaborate with other healthcare providers, such as rheumatologists, ophthalmologists, and primary care physicians, to provide comprehensive care (Akpek et al., 2017).


Conclusion

In conclusion, dry eye is a common and debilitating manifestation of Sjogren's Syndrome that can have a significant impact on patients' quality of life. Early detection and accurate diagnosis of dry eye in SS is critical to prevent ocular surface damage and improve outcomes. Optometrists play a crucial role in the detection and management of dry eye in SS, and their collaboration with other healthcare providers is essential for optimal patient care.


References:

  1. Akpek, E. K., Bunya, V. Y., Saldanha, I. J., & Taneja, M. (2017). Sjogren's Syndrome: More Than Just Dry Eye. Cornea, 36(8), 1021-1029.
  2. Baudouin, C., Messmer, E. M., Aragona, P., Geerling, G., Akova, Y. A., Benitez-Del-Castillo, J., . . . Craig, J. P. (2021). Revisiting the Definition and Classification of Dry Eye Disease: Report of the Definition and Classification Subcommittee of the International Dry Eye Workshop (DEWS II). Ocular Surface, 19(2), 173-192. doi: 10.1016/j.jtos.2020.09.003
  3. Fox, R. I. (2021). Sjogren's Syndrome. The Lancet, 397(10275), 231-244. doi: 10.1016/S0140-6736(20)30763-6
  4. Shiboski, C. H., Shiboski, S. C., Seror, R., Criswell, L. A., Labetoulle, M., Lietman, T. M., . . . Vitali, C. (2017). 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjogren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Annals of the Rheumatic Diseases, 76(1), 9-16. doi: 10.1136/annrheumdis-2016-210571


Dr. Zeyad Zaben

Optometrist, Spain

Location: 08500 Vic, Barcelona, Spain

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