Description of disease : An autoimmune disorder with hallmark clinical presentation of dry eyes and dry mouth.
dry eye signs: Schirmer, stains
dry mouth signs: spit into cup
blood work: anti-Ro, anti-La
Epidemiology: female 90%, two main onset ages: 20-40, then > 60 yr
From an Optometric Point of View :
These patients present as contact lens failures or patients with sore and uncomfortable eyes. Do not dismiss these complaints without a full workup. Many Sjogren’s patients tell stories of attending multiple practitioners’ offices before being diagnosed.
Pathophysiology of Sjogren’s
The initial stimulation to inflammation is not known. Retroviruses and Epstein-Barr viruses have been implicated.
The lacrimal and salivary glands are infiltrated by T cells. These form clusters that on histology appear as focal sites. The focus score is used to diagnose the disease.
The glands begin to secrete less and less. Part of the reason is the death of the acinar cells but there are many apparently healthy acinar cells within the gland that do not secrete. The reasons for this breakdown in function are not well understood.
The lack of tear film on the ocular surface causes friction and damage to cells seen as staining.
The lacrimal gland begins to create cytokines that flow to the ocular surface and create part of the inflammatory response. This further causes a breakdown in cellular function.
The lacrimal and salivary glands also create antinuclear antibodies named Ro and La and these are secreted into the blood stream. They serve as markers for the disease. These markers can also be seen in other autoimmune diseases such as lupus.
Clinical Work Up of Sjogren’s
History: Any dry eye questionnaire but include any history of dry mouth and autoimmune disease.
Ocular tests: Schirmer 1, fluorescein staining of cornea, rose bengal or lissamine green staining of bulbar conjunctiva, assessment of meibomian glands.
Mouth testing: Observation of caries, tooth loss, dry tongue and gums, spit into cup for 5 minutes.