Sjögren's syndrome as seen by an ophthalmologist

Ocular surface involvement is a frequent feature of Sjögren syndrome characterized by the presence of typical symptoms such as burning and foreign body sensation and by wide spread epithelial damage of the cornea and on the conjunctiva. There is now evidence that local inflammatory changes and lacrymal gland-derived tear-borne pro-inflammatory agents have an important role in the build up and the maintenance, of ocular surface damage by the instauration of self maintaining vicious cycles. Inflammation causing decreased ocular surface sensation, resulting in further decreased tear secretion and decreased tear clearance, with growing concentration of pro inflammatory agents on the ocular surface. From the anatomic pathological point of view there is a not clarified discrepancy between the early highly depressed tear fluid production and the limited extension of involvement of the lacrymal gland. Proper gland stimulatory agents and control of inflammation could result in a better treatment than the palliative therapy available to day.