“…These viruses have been identified in the lacrimal and/or salivary tissues of Sjögren's patients (Burns, 1983;Fox et al, 1986;Fox, 1988;Krueger et al, 1990;Garry et al, 1990;Mariette et al, 1991;Pflugfelder et al, 1993;Tsubota et al, 1995;Pepose et al, 1996) and may possibly stimulate the inappropriate epithelial cell human leukocyte antigen-DR and Toll-like receptor expression, T helper/inducer cell activation, B cell hyperactivity, and autoantibody production evident in these affected tissues (Moutsopoulos and Talal, 1987;Maini, 1987;Fox, 1988;Homma et al, 1994;Berglova et al, 2011;Lambiase et al, 2011). In support of this possibility, certain viral infections in experimental animals exert a striking effect on the lacrimal gland and induce a periductular infiltration of plasma cells, lymphocytes, and macrophages; distinct nonsuppurative periductular inflammation; significant interstitial edema; widespread necrosis of the acinar and ductal epithelium; degenerative and atrophic alterations in epithelial cells; diminished tear flow; and keratoconjunctivitis sicca (Jacoby et al, 1975;Green et al, 1989). Moreover, herpes viruses (i.e., cytomegalovirus) and coronaviruses (i.e., sialodacryoadenitis virus) may invade and replicate in rat lacrimal gland acinar cells Wickham et al, 1997), Epstein-Barr virus may bind to specific receptors in ductal epithelium of the human lacrimal gland (Levine et al, 1990), and HIV infection may predispose patients to keratoconjunctivitis sicca (Couderc et al, 1987;Ulirsch and Jaffe, 1987;De Clerck et al, 1988;Lucca et al, 1990;Neves et al, 1994).…”