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Dry Eye/Sjögren's Syndrome
Dry eye syndrome is a condition caused by inadequate secretion of the tear film or an increased loss of water from the tear film by evaporation. In other words, sometimes the eye does not produce enough tears. Other times, the tears that the eye produces are not "healthy." This change of the tear film results in irritation and changes on the eye surface that lead to characteristic symptoms, such as a sandy or burning sensation, discomfort, blurred vision, and redness of the eye that progresses as the day goes on. Evaporation of the water from the tear film can increase due to blepharitis (inflammation of the eyelid), decreased production by the oil glands of the eyelids, or thyroid disease.
Decreased tear production associated with dry eye may be caused by any condition that decreases sensation of the cornea (the transparent membrane covering the iris and pupil) or damages the tear glands, called lacrimal glands. As corneal sensation is part of the tear-making response, eyes with decreased sensation will tear less. Some of the causes of decreased corneal sensation include long-term contact lens wear and certain viral infections. The most common cause of lacrimal gland damage is Sjögren’s syndrome, a chronic inflammatory disease in which mucous membranes, especially those in the eyes and the mouth, become extremely dry. Primary Sjögren’s occurs alone with no other associated disorders, while secondary Sjögren’s is often accompanied by other autoimmune disorders such as lupus or rheumatoid arthritis.
Ophthalmologists at The Ocular Surface Diseases and Dry Eye Clinic are leading experts in the study, diagnosis and treatment of dry eye syndrome. Early diagnosis is very important because Dry Eye Syndrome causes the tear film to become unstable, with the loss of water resulting in the progressive deterioration of the ocular surface.
A battery of tests including Schirmer’s test, tear film break-up time, and staining of the ocular surface with certain dyes needs to be performed to diagnose this condition adequately. A work-up including certain blood tests may be ordered to uncover an underlying rheumatological disorder in some cases.
Patients suspected of having Sjögren’s disease should be evaluated at the Sjögren’s Disease Clinic of Johns Hopkins Hospital and may need a biopsy from their minor salivary glands located in the inner part of the lower lip for a definitive biopsy.
The selection of treatment depends largely on the severity of the disease. Mild cases of dry eye syndrome will require no more than use of artificial tear solutions and hot compresses with eyelid massage with ophthalmic ointments. If the condition is not sufficiently managed with artificial tears, the use of sustained-release ocular lubricants or prescription eye drops may be recommended. Therapy for dry eye syndrome also might include punctal occlusion by plugs or cauterization performed by Wilmer Eye Institute ophthalmologists in the clinic.
> Treated by the Ocular Surface Diseases and Dry Eye Clinic and the Johns Hopkins Jerome L. Greene Sjögren's Syndrome Center