Sjogren's Syndrome (Dry Eyes & Dry Mouth)

Key Takeaways

• Sjogren's syndrome is an autoimmune disorder that causes dryness of the mouth and the eyes.
• Risk factors include older age, female sex, and other rheumatic diseases. Sjogren's syndrome affects more women than men.
• When it occurs alone, it's known as primary Sjogren's syndrome. When it occurs alongside other autoimmune diseases, it's known as secondary Sjogren's syndrome.
• Although the real cause is unknown, research shows that genetics may play a role in the development of this chronic disorder.
• Treatment options include non-steroidal anti-inflammatory drugs for pain management and prescription drugs like pilocarpine. 
• Minor surgery may also be recommended to seal the tear ducts for better tear preservation.
• If you've been diagnosed with Sjogren's syndrome, maintain a healthy diet and consult your doctor in case of any severe symptoms.

What is Sjogren's Syndrome?

Sjogren's syndrome is an autoimmune disorder.¹ An autoimmune disease develops when the immune system mistakenly attacks healthy cells and tissues.

In cases of Sjogren's syndrome, white blood cells attack exocrine glands (glands that produce body moisture). These include the tear glands, salivary glands, and sebaceous glands, among others.

The result of this is a decrease in body fluid production. Low saliva and tear production further leads to dry mouth and dry eyes. Dryness also occurs in the nose, skin, respiratory tract, and vaginal canal.

Sjogren's syndrome is one of the most prevalent autoimmune diseases in the United States. 

It affects up to 4 million Americans, 90 percent being women.² However, it's often underdiagnosed.

There are two types of Sjogren's syndrome. it's referred to as 

• Primary Sjogren's syndrome. When it occurs alone.
• Secondary Sjogren's syndrome. It occurs alongside other autoimmune disorders such as lupus erythematosus (SLE) and rheumatoid arthritis.³

There is no cure for Sjogren's syndrome. Treatment mainly focuses on relieving symptoms.

Sjogren's can occur at any age, although most diagnoses are made in people aged 40 and above.   

Causes of Sjogren's Syndrome

The cause of Sjogren's syndrome remains unknown. 

However, limited research shows that certain bacteria and viruses can trigger the immune system to attack healthy cells.⁴

Some studies also suggest that some genes may increase the risk of Sjogren's syndrome. 

There's ongoing research analyzing DNA samples from Sjogren's patients to understand the responsible genes. This will help create new diagnosis treatment strategies for Sjogren's syndrome.

Risk Factors 

• People above 40 years are more likely to be affected
• Women are more prone to the disease
• Presence of other rheumatic conditions

Symptoms of Sjogren's Syndrome

Symptoms of Sjogren's syndrome differ from one person to the other. You may experience one symptom or a combination of different symptoms. 

The most common symptoms include dry eyes, dry mouth, and joint pain or stiffness.⁵ 

Others include:

• Sensitivity to light
• Dryness in the nose
• Abnormal sense of taste and smell
• Recurrent oral thrush (fungal infection)
• Increase in oral cavity infections
• Swollen salivary glands
• Blurred vision 
• Dry cough and shortness of breath
• Headache
• Feeling exhausted
• Problems with concentration
• Vaginal dryness
• Pain and stiffness in the joints
• Heartburn

The symptoms of dry eyes associated with Sjogren's syndrome include:

• Itchy or burning eyes
• Irritation in the eyes
• Persistent dryness due to low tear production
• Blurred vision
• A feeling of an object inside the eye
• Swollen eyelids
• Mucus discharge from the eyes
• Sensitivity to light (photophobia)

Potential Complications of Sjogren's Syndrome

Mucous membranes protect moist surfaces from infections. 

Therefore, when eyes or mouths run dry, they become more susceptible to infectious bacteria and viruses.

The most significant complication of Sjogren's syndrome involves the mouth and eyes. They include:

• Dental cavities. Occur due to reduced saliva that fights most bacteria in your mouth. 
• Yeast infections. People who have Sjogren's syndrome are prone to oral yeast infection (oral thrush).
• Vision problems. Sensitivity to light and friction due to dry eyes can lead to corneal damage or blurred vision.

Complications that affect other body parts include:

• Organ inflammation. This may occur in the lungs, liver, and kidneys.
• Lymphoma. In rare cases, some people with Sjogren's syndrome may develop cancer of the lymph nodes (non-Hodgkin lymphoma.)⁶
• Peripheral neuropathy. It's characterized by numbness or a tingling sensation in the hands and feet.

What to Avoid if You Have Sjogren's Syndrome

According to the Sjogren's Syndrome Foundation, Sjogren's is associated with gastrointestinal problems such as irritable bowel syndrome and gastroesophageal reflux disease (GERD).⁷ 

Since there is no cure for this condition, most of the therapy focuses on symptom management. 

Dietary choices are essential. Certain foods are recommended while others are discouraged.

Foods to avoid include:

• Fried foods 
• Saturated fats
• Refined grains
• Red meat
• Processed foods
• Allergenic foods such as peanuts, gluten, dairy, and poultry products
• Sugars and sweets
• Acidic foods (can worsen dry mouth sores)
• Artificial sweeteners and preservatives
• Refined oils
• Alcohol

Recommended foods include:

• Green leafy vegetables rich in vitamins and other minerals
• Minimal amounts of organic meat
• Whole grains
• Spices like ginger, garlic, and turmeric
• Fruits and vegetables
• Sugar free gum

Excessive vitamin consumption may result in poor absorption or metabolism of other nutrients. Don’t take vitamins or supplements unless you have spoken with your doctor first.

How is Sjogren's Syndrome Diagnosed?

It's challenging to diagnose Sjogren's syndrome since symptoms differ from one patient to the other. 

The signs may also appear similar to other conditions like chronic fatigue syndrome.

To begin, your doctor will do a physical exam and ask you a few questions to determine the following:

• Whether you have an itching or burning sensation in the eye
• Presence of stubborn cavities in your teeth
• Dryness in your mouth or lips
• Stiff or painful joints

Below are standard diagnostic procedures for Sjogren's syndrome:

• Labial gland (lip) biopsy. Your physician will cut a small part of the tissue or cell from your gland or inner lip. This sample is then examined for any sign of inflammation.
• Blood and urine tests.⁸ Your physician might request blood tests to check for blood cell count, Sjogren's antibodies, organ infections, and inflammatory diseases.
• Schirmer tear test. The physician may check your eyes using the Schirmer tear test to understand the level of dryness.⁹
• Dye tests. Your doctor will administer eye drops to enable examination of the ocular surface.
• Imaging. A number of imaging tests may be done to check if your salivary gland is functioning correctly. They include sialography and salivary scintigraphy. 
• Health history. If you have any preexisting autoimmune condition combined with dry mouth and eyes, the doctor may conclude that you have secondary Sjögren's syndrome.

Treatment for Sjogren's Syndrome 

Currently, there is no effective cure for Sjogren's syndrome. The treatment options available are meant to manage symptoms. 

Treatment includes:

• Eye drops. If your eyes are severely dry, your doctor will prescribe eye drops such as cyclosporine or lifitegrast to lubricate your eyes.
• Artificial tears. Useful in lubricating the eyes and are available over the counter.
• Moisture chamber goggles. These are goggles that protect the eyes from irritants and keep in moisture to prevent dry eyes.
• Throat prescription medications. These are prescribed in case of respiratory dryness.
• Vaginal lubricants. In cases of vaginal dryness, water-based vaginal lubricants such as Lubrin, Surgilube, and Maxilube can be effective solutions.
• Punctal occlusion (surgery). This is a surgical option that blocks the tear drainage system, enabling tear preservation in the eye.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).¹⁰ Aspirin, or ibuprofen, or other arthritis treatments may help manage complications. 
• Cholinergic agonists. Medications such as pilocarpine (Salagen) and cevimeline (Evoxac) can enhance saliva and tear production.
• Antifungals: Antifungal drugs can also be used to treat oral yeast infections.