Dry Eyes can have serious consequences and need to be aggressively managed - sometimes by a number of different specialists. One of these conditions, which we see a lot of at The Eye Practice is Sjogren's Syndrome.
Many eye doctors wind up working in conjunction with Rheumatologists in order to make sure our patients with Sjogren's are getting the best treatments possible for their symptoms and complications.
Sometimes, patients don't even know they have Sjogren's, until they see their eye doctor – and we ask about any other potential systemic problems. Once the assessment has been made, we can refer you to a Rheumatologist for a proper evaluation.
What is Sjogren's Syndrome?
Sjogren's Syndrome is a serious auto-immune disorder where the immune system attacks the mucus membranes. Considering you have mucus membranes throughout your whole body, this can become quite serious. In particular Sjogren's syndrome attacks the salivary glands of the mouth and the tear glands of the eyes. Dry mouth and dry eyes are the most common symptoms.
The major characteristic of Sjogren's Syndrome, and the reason we see patients with this disorder, is dry eye. In severe cases, because eyes are so sensitive aggressive treatment by a dry eye specialist can make the difference between success and failure.
Dry Eye Treatments for Sjogren's Disease
There are several measures that can help, that can be done in our office, and when you get home from your treatments.
This dry eye treatment is done in office with a patented medical device that uses heat and vibrations to soften and loosen blockages from the meibomian glands to increase the lipid layer output into the tear film.
The Eye Practice installed the first LipiFlow device around 5 years ago now and even though we reserve it for stubborn cases, when required can change someone's life.
Blephasteam® goggles we've talked about in the past. These goggles use warm steam to add water to the tear film, and encourage proper meibomian gland function, while maintaining humidity around the eyes.
-Often biofilm can cover the openings of the oil glands in the eye lids. This can be removed (similar to removing plaque on teeth) and allow the meibomian glands to function better and thus lubricate the ocular surfaces better.
With dry eye caused by Sjogren's Syndrome, eye infections become common, and conjunctivitis is often seen as a complication. Antibiotic gels and drops are used to control infections, and provide relief to the eyes. These need to be preservative free as preservatives of any type can cause severe irritation in Sjogren's syndrome.
The only sensible ointment to use if bacterial infection is suspected or be at significant risk for is Chlorsig ointment. It also is effective at protecting the ocular surface by lubricating it. Using Chlorsig eye drops is NOT a good idea as they come with preservatives and the eye drops just gets flushed out of the eye way too quickly to have any significant impact.
These drops encourage aqueous tear production – it is an immunomodulator that decreases swelling and inflammation in the eye. This is marketed under the name Restasis® at a concentration of 0.05%.
In our experience we prefer to compound cyclosporine the active ingredient of Restasis® in concentrations of greater than 0.2%. We also precede it by using a preservative free steroid to kick start the process.
Once you've been treated for dry eye, you can use warm compresses to help alleviate any additional eye discomfort. Use at bedtime and upon awakening for five minutes in order to get continued relief. It is important NOT to use warm compresses while there is any major inflammation as it will make it worse.
Eye drops are often recommended by your eye doctor. These can help keep your eyes comfortable when you have Sjogren's – prevention of discomfort is much better than trying to treat the discomfort once it returns!
Please there are many eye drops available over the counter. If your dry eye disease is serious do not just go to the local pharmacy and take what ever they recommend, as they are likely to do more harm than good.
These also must not have preservatives.
Avoid getting eye creams and lotions too close to your eyelids, as they can irritate the eye. Remove eye makeup completely every night, and never sleep with eye makeup on – this will help reduce risk of infections. Additionally, make sure that you wash your eyelids with proper eyelid cleansers.
DO NOT USE BABY SHAMPOO. This is a detergent and can cause significant irritation in all forms of dry eyes but especially in the presence of Sjogren's.
Scleral Contact Lenses
Sjogren's Syndrome can sometimes cause significant eye pain. When all else fails we have had some success by using these customised contact lenses. These can protect the eyes from abrasion and lack of lubrication, when all else fails. More about scleral contact lenses here.
In severe cases when all eye drops have failed it is quite common for eye doctors to prescribe the serum of patient's own blood to use as a lubricant. Studies seem to suggest that they are helpful, but in our experience they are very inconvenient to harvest, as a special appointment must be made at the blood bank and usually after a few weeks any perceived benefit seems to dissipate.
If you have Sjogren's Syndrome, or want help with chronic dry eye, give us a call on 9290 1899 or click here to book an appointment.