Diagnosis and management of ocular involvement in Sjogren's Syndrome

Evaluation of a patient with dry eye symptoms and possible Sjögren's syndrome (SS) requires a complete review of systems and a thorough ocular surface examination that includes staining of the conjunctiva. SS patients may have a variety of clinical presentations, and it is important to have a low threshold for referring dry eye patients to a rheumatologist for a SS workup. A stepwise approach to the management of ocular surface disease is advised starting with topical anti-inflammatory therapy, autologous serum tears, and scleral lenses for the more advanced cases. For SS patients undergoing surgery, aggressive ocular surface treatment preoperatively and careful postoperative monitoring is the key to ensuring a successful outcome. In advanced cases of SS with corneal melting or perforation, aggressive local therapy, treatment of the underlying systemic disease with early immunosuppressive therapy, and close collaboration with a rheumatologist are critical to controlling the disease.