Dry eye in Sjögren's syndrome – characteristics and therapy

Abstract

Background Sjögren's syndrome is an autoimmune disease, and its important feature is the lymphocyte infiltration of exocrine glands, including lacrimal glands. It contributes to defects of their activity and causes that one of the main manifestation of Sjögren's syndrome is dry eye. Unfortunately, the discrimination between dry eye related and non-related to Sjögren's syndrome is difficult at the initial stages of diseases. In addition, the available agents for the treatment of Sjögren's syndrome-related dry eye have limited efficacy. Aim The purpose of this study was to describe and emphasize differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye together with the determination of novel therapeutic options for Sjögren's Syndrome-related dry eye. Method A review of the relevant papers describing characteristics of Sjögren's Syndrome-related dry eye and its therapy was conducted. This article is based on both pre-clinical and clinical evidences. Results On the basis of our analysis, we indicated differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye. Moreover, there are some novel markers that could be used in the diagnosis of Sjögren's Syndrome-related dry eye. In addition, expect artificial tear, other agents e.g. hydroxychloroquine can be effective in therapy of disease. Conclusions Sjögren's Syndrome-related dry eye is a disorder, whose diagnosis may be difficult and mistaken for non-Sjögren's Syndrome-related dry eye. However, Sjögren's Syndrome-related dry eye has some specific features. In addition, the development of newer and safer therapeutic agents for Sjögren's syndrome-related dry eye is needed, and therefore further clinical, randomized studies are necessary.

Vitamin D, the Vitamin D Receptor, Calcitriol Analogues and Their Link with Ocular Diseases

“…Therefore, vitamin D may be an agent supporting the available treatment of eye disorders. For example, it has been suggested that deficiency of the vitamin D occurs in patients with Sjögren’s Syndrome-related dry eye, and this may result in a modulation of the clinical course [ 201 ]. That is why vitamin D may be considered as a modulator of the clinical course of ocular diseases.…”

An Overview of the Dry Eye Disease in Sjögren’s Syndrome Using Our Current Molecular Understanding

“… Patients with SSDE may be asymptomatic or mildly symptomatic despite signs of significant ocular inflammation [ 74 ]. Reliable and effective screening tools and algorithms to determine which DED patients should be worked up for SS are lacking [ 4 ]. Ophthalmologists underestimate the importance of SS and consequently refer few patients with DED for SS workup [ 75 ].…”

“…Reliable and effective screening tools and algorithms to determine which DED patients should be worked up for SS are lacking [ 4 ].…”

“…In fact, it was shown that the sensitivity for anti-RO/SSA and anti-La/SSB antibodies varies between 69% and 77% and 39% and 44%, respectively [ 90 ]. The saliva flow rate and Schirmer’s test are rarely performed in a clinical setting since they are not specific to SS [ 4 ] and take a significant amount of time to perform in busy ophthalmology practices. Van Bijsterveld Score (VBS) and Ocular Staining Score (OSS) systems are seldom used by ophthalmologists since the rose Bengal is an irritant to the ocular surface and that the lissamine green is not available in most of the eye clinics.…”

“…Further, blurred vision tends to be worse in SSDE than in NSSDE. However, there is not a distinguishing feature to differentiate SSDE from NSSDE at the bedside [ 4 ].…”