Dry eyes and a dry mouth could mean you have Sjogren’s Syndrome.
Sjogren’s Syndrome is a long-term autoimmune disease, where the body sees its own moisture producing glands as foreign and attacks them – particularly the salivary and lacrimal (tear) glands. This leads to the most common symptom of dry eyes and dry mouth. It can also affect other parts of the body, causing weakness and fatigue.
The disease can be primary – where only the moisture glands are affected – or secondary, where there is other connective tissue disease present, such as rheumatoid arthritis. Sjogren’s can present at any age, however is most common in women over 40.
Other systemic disorders associated with the condition include: Systemic Lupus Erythematosus (SLE); Rheumatoid arthritis; Hashimoto’s Thyroiditis; Scleroderma; Coeliac disease; Fibromyalgia; Multiple Sclerosis; Non-Hodgkin Lymphoma.
Signs and symptoms
The hallmark symptoms of Sjogren’s Syndrome are a combination of dry eyes and a dry mouth. The lacrimal glands are situated behind the brows, and are the ones that produce the aqueous (watery) tears.
This gland is stimulated by emotion (e.g. crying if upset) and irritation (cutting an onion). It is also stimulated on an ongoing basis by the nerves in your cornea (or front surface of the eye). If your cornea is dry, the nerves will send a signal to produce more watery tears. If you have Sjogren’s Syndrome however, the gland is unable to produce these tears.
Ocular symptoms include:
• Dry eyes
• Blurred vision
• Discomfort ranging from mild to debilitating
• Inability to cry tears
The salivary glands are situated under the tongue, on each side of your lower jaw as well as below the ear. They are stimulated by food in the mouth as well as thoughts of food. Saliva not only moistens chewed food in preparation for swallowing, it also contains enzymes that break down starch in particular, so there is less digestion required in your gut.
Oral symptoms include:
• Dryness and burning sensation of the tongue
• Difficulty swallowing dry food
• Tooth decay
• Rough, dry tongue
• Inability to spit
• Needing a glass of water beside the bed at night
Although the salivary and lacrimal gland are principally affected, there are many other symptoms of this disease:
• Dry skin
• Vaginal dryness
• Dry nasal passages
• A chronic cough (due to dry bronchial mucosa)
• Numbness in limbs
• Muscle and joint pain
• Thyroid problems
Diagnosis of Sjogren’s Disease
Diagnosis can take some time, as the disease is often misdiagnosed as the normal reduction in moisture of the eyes and mouth that comes with age. An optometrist who suspects you have Sjogren’s Syndrome is likely to refer you to a rheumatologist for definitive diagnosis.
This will usually involve a blood test looking for the presence of certain autoimmune markers in the blood. A detailed history of symptoms and medical history will also be taken.
A Rose Bengal test (a special non-toxic dye is used to reveal damaged cells on the eye’s surface) may also be conducted, as well as a Phenol red thread test (replaces the Schirmer test) to measure the production of aqueous tears.
Patients may also have a spit test, where the volume of saliva produced over time is measured and/or a biopsy of salivary gland tissue.
Additionally there may be a radiological procedure where dye is injected into the salivary gland and imaged and an ultrasound procedure to examine the salivary glands.
Management and treatment
Sjogren’s Syndrome cannot currently be cured, and treatment focuses around the management of dry eye and dry mouth. Dry eye management includes the following strategies:
Artificial tears – preservative free are best, as these are required long-term
Short-term course of cortico-steroids.
Cyclosporin (Restasis) is an immune-suppressant that can help limit damage to the lacrimal glands
Goggles / moisture chambers
Once the inflammation has been brought under control, punctal plugs or surgery to permanently seal off the puncta – or openings to the drainage ducts from the eyes
Lifestyle factors including a gluten-free diet and moderate exercise are believed to help limit the severity of the disease.
Dry mouth is managed with frequent use of sprays and drinks. Also, preventative dental treatment is essential to prevent tooth decay.
Other symptoms of the disease, such as dry skin and vaginal dryness, are managed with moisturisers and lubricants.
Joint and muscle pain may require the use of steroids or non-steroidal anti-inflammatory drugs.
The Australian Sjögren’s Syndrome Association Inc. (TASSA) is a not for profit organisation that provides education and support for people with Sjogren’s Syndrome. More information can be found on their website: https://www.sjogrens.org.au/