Ophthalmic Treatments and Evolving Management of Sjögren's Disease: An Overview

Background: Sjögren's disease (SjD) causes severe ocular surface desiccation, progressing from aqueous-deficient dry eye (ADDE) to vision-threatening corneal ulceration, stromal melting, and perforation. Recent consensus guidelines and therapeutic innovations have transformed ophthalmic diagnosis and management. Methods: A comprehensive narrative overview of PubMed and Google Scholar (July 2016-July2026) was conducted to evaluate updates in SjD diagnostics, ocular surface mechanics, topical/biological pharmacotherapies, neurostimulation, and meibomian gland interventions. Results: Diagnostic parameters have shifted towards non-invasive salivary metabolomics (lactate, alanine, malate), regulatory non-coding RNAs (H19 ICR hypomethylation), tear point-of-care MMP-9 testing, and salivary gland ultrasonography (SGUS). Large-diameter scleral lenses provide continuous corneal fluid shielding, though edge design and surface modification are required to mitigate midday fogging. Additionally, emerging therapeutics are shifting care from palliative lubrication to targeted secretomotor and biological reactivation, including cold thermosensory TRPM8 agonists (acoltremon 0.003%), water-free formulations (0.1% cyclosporine, perfluorohexyloctane), reactive aldehyde species (RASP) modulators (reproxalap), syndecan-1 receptor agonists (Lacripep), systemic B-cell depleting biotherapy (ianalumab), trigeminal neurostimulation, and combined intense pulsed light with meibomian gland expression (IPL + MGX). Conclusions: Ophthalmic SjD management has evolved from palliative lubrication toward a stepwise, mechanism-directed paradigm integrating novel diagnostics, secretomotor stimulation, mechanical protection, and biologic disease modification; dedicated SjD-specific trials remain essential to validate these emerging interventions.