#158: Understanding Sjogren's Syndrome (Part 2)

This week's blog is a continuation of the discussion I had with Dr. Pavly Moawad.  A. Pavly Moawad, MD, MRCSEd(Ophth), FICO is a Lecturer and Consultant Ophthalmologist at Cairo University Hospital in Egypt. In her ophthalmology practice she specializes in seeing patients with Sjogren's Syndrome. She has graciously agreed to share her vast knowledge on the subject of Sjogren's Syndrome with my readers.

In this part of the interview, I wanted to highlight how the eye doctor can determine whether you should be further evaluated for Sjogren's Syndrome, and the best treatment options for these patients.

Is there an Eye Exam to Determine Sjogren's Syndrome?

Sjogren's Syndrome attacks the glands that make secretions like tears and saliva.  So, the best test to determine if a patient has Sjogren's Syndrome is one that measures the production of the lacrimal gland. The Schirmer's test measures the volume of tears produced in 5 minutes of time.  If the Schirmer's test measures less than five millimeter then there is a high suspicion of Sjogren's Syndrome.  If there was also staining of the cornea and conjunctiva using vital dyes, then a referral to the rheumatologist would be warranted. 

What's the Best Way to Treat the Eyes of a Sjogren's Syndrome patients?

Dr. Moawad likes to start with frequents lubrication of the eye using preservative-free artificial tears.  If you don't already have a favorite artificial tear, download the guide here.  In addition, she also prescribes a topical immuno-modulating eyedrops like: Restasis, Cequa, or Xiidra.  Using this type of prescription eye drop is important in these patients because they have an ongoing inflammatory process on their ocular surface. The condition will not be relieved by using lubricant eye drops alone.  

In patients with more severe symptoms, Dr. Moawad also uses autologous serum eye drops (tears made from the patient's own blood), RegenerEyes, or an amniotic membrane to heal the corneal surface. If the patient has severe dryness or a persistent defect, she recommends using every, every tool in order to heal the eyes. 

Once the inflammation is under control, she will consider using a punctal plug to reserve the tears in the eyes. After the inflammation and tear volume is under control the meibomian glands will need to be managed as well.  Even though Sjogren's syndrome is considered to be a disease of low tear volume, there are a surprising number of Sjogren's patients who also have Meibomian gland dysfunction.

3 C's of Sjogren's Care:

Chronic: Sjogren's syndrome is a chronic condition. It's not a totally curable condition, but it can be managed.

Compliance: this a chronic condition and it requires compliance. It requires a very strict compliance from both the doctor and the patient.  Both parties need to be committed to going on the journey.

Cooperation: The patient and the doctor must cooperate with each other.  The journey to healing may be long and it is easy to be frustrated if expectations aren't set properly.  

Dry Eye is a Multifactorial Disease:

Even when dry eye disease is coming from a systemic cause like Sjogren's Syndrome, it is important to remember that it is multifactorial.  So, the fact that you spend your day working on a computer, wearing eye makeup, or using contact lenses can also add to the burden of dryness on your eyes. 

It is important to build routines into your lifestyle to decrease the dryness.  These habits like getting adequate sleep (7-9 hours), hydrating the body, and eating healthy food are great foundations to build your dry eye treatment upon.  Also, taking a look at how we spend our time and trying to reduce the effects of computer vision syndrome or seasonal allergies can play an important role in healing the dry eyes. 

In the case of Sjogren's patients, a team of doctors may be needed to completely treat the disease.  Having your eye doctor, dentist, dermatologist, and rheumatologist in communication can be key to getting the patients symptoms to be well managed.

CONCLUSION

Wonderful, that that is a ton of awesome information for everyone. I really appreciate Dr. Moawad taking the time to explain Sjogren's Syndrome treatment options to us so thoroughly. 

In order to treat Sjogren's related dry eye disease, prescription medications to bring down inflammation in the eyes will be necessary.  Artificial tears alone will not control the inflammation driving the dryness.

The cause of dry eye disease is multifactorial, even with a Sjogren's Syndrome diagnosis.  When you have a systemic diagnosis that is known to cause dry eyes, that doesn't mean that spending time on the computer or over wearing your contact lenses won't increase the dryness.

Learning to make simple lifestyle adjustments can make a huge difference in how your eyes feel no matter what is causing the dry eye disease.  Taking a 3 Pillar approach to dry eye treatment with the EYE Method will get the eyes feeling better.  Get started on your personalized dry eye treatment plan by scheduling a consultation call with Dr. T.