Dry Eyes and Dry Mouth: Sjogren’s Syndrome

Are dry eyes and persistent dryness of the mouth more than just minor annoyances for you? These symptoms, which might seem trivial at first, can actually be the early warning signs of a condition known as Sjogren’s Syndrome.

Sjogren’s Syndrome, a complex autoimmune disorder, primarily targets the body’s moisture-producing glands, which results in its hallmark symptoms: chronic dry eyes and dry mouth. This condition not only causes significant discomfort but can also signal deeper systemic issues, as these glands play a crucial role in overall bodily hydration and function.

It’s important to be aware that eye-related symptoms can often appear before other signs of the disease. This is why spotting and diagnosing dry eye disease early on is a key step in identifying and treating Sjogren’s Syndrome effectively.

I recently had a patient, a 38-year-old graphic designer, who came to me with persistent dry eyes and mouth. At first, she thought it was just due to her job and the dry Canberra air, but then she started experiencing joint pain and a tingling sensation in her hands. After a thorough examination and blood tests, we discovered it was Sjogren’s Syndrome. Together, we developed a treatment plan to manage her symptoms, which significantly improved her quality of life.

I’m Juliet Menakaya, owner and principal optometrist at Junic Eye Care. The above story illustrates the importance of early intervention and holistic care in managing such complex conditions. At my clinic, our approach to patients exhibiting signs of Sjogren’s Syndrome is thorough and multidisciplinary. We coordinate with other healthcare professionals, including rheumatologists, to ensure comprehensive care. This begins with a referral to a GP, followed by necessary blood tests, paving the way for an effective management plan.

Would you like to learn more? Keep reading to get a better understanding of Sjogren’s Syndrome and learn when to seek a professional examination from an eye care professional.

Understanding Sjogren’s Syndrome

So what is Sjogren’s Syndrome, exactly?

As mentioned, it’s an autoimmune disorder where the body’s immune system mistakenly attacks its own moisture-producing glands. This results in the most noticeable symptoms: dry eyes and dry mouth. It’s like the glands responsible for keeping these areas moist start underperforming because of the immune system’s mixed up signals.

Let’s look at the two types of Sjogren’s Syndrome – primary and secondary:

• Primary Sjogren’s Syndrome: This type occurs by itself, without being associated with any other autoimmune disorder. It’s like having a stand-alone issue where the main problem is the body’s attack on its moisture-producing glands, leading primarily to dry eyes and mouth.
• Secondary Sjogren’s Syndrome: This type occurs alongside other autoimmune diseases, such as rheumatoid arthritis or lupus. In this case, the dry eyes and mouth are part of a broader set of immune system-related problems. It’s like Sjogren’s Syndrome has teamed up with another condition, creating a combination of symptoms.

Understanding whether Sjogren’s Syndrome is primary or secondary helps in tailoring the treatment approach. This distinction is key in managing your symptoms effectively and ensuring overall health and well-being.

Beyond Dry Eyes and Dry Mouth

Sjogren’s Syndrome sometimes brings along a few additional symptoms.

• Joint Pain: Manifests as a constant, dull ache in the arms and legs – similar to the feeling one might have the day after a long, strenuous hike.
• Persistent Fatigue: A deep sense of tiredness that doesn’t improve with rest.
• Neuropathy: Characterized by tingling or numbness in the hands and feet, akin to the feeling of them ‘falling asleep.’
• Organ Complications: Sjogren’s Syndrome can have a domino effect on other body systems. Once it starts, it can lead to additional issues in the kidneys, liver, lungs, and pancreas.
• Increased Infection Risk: Due to the altered functioning of the immune system, there’s a heightened risk of infections. The immune system, which usually guards the body against external attack, has its defenses compromised.

These atypical symptoms highlight the diverse ways Sjogren’s Syndrome can affect the body, adding layers of complexity to its management and treatment.

Causes and Risk Factors

When we talk about what causes Sjogren’s Syndrome, it’s a bit like piecing together a jigsaw puzzle. The exact cause isn’t entirely clear, but it’s often linked to a combination of genetic, environmental, and possibly viral factors. Imagine your immune system as a well-trained guard dog that suddenly starts reacting to the wrong cues. In Sjogren’s Syndrome, something triggers the immune system to mistakenly attack the body’s moisture-producing glands, leading to dry eyes and a dry mouth.

Some researchers believe that certain viral infections might act like a switch, turning on this autoimmune response. It’s as if a virus holds the key that unlocks this unwanted immune reaction. However, it’s important to note that not everyone who gets these viruses will develop Sjogren’s Syndrome – it’s more like they’re just one piece of the puzzle.

In terms of who’s most likely to be affected, Sjogren’s Syndrome is kind of choosy. It primarily targets women, particularly those in their 40s and 50s, especially if there’s a family history of the syndrome or other autoimmune disorders. It’s less common in men and younger individuals, but they’re not entirely off the hook.

Understanding these risk factors is like having a roadmap. It doesn’t tell us everything, but it guides us on where to pay more attention. Early recognition and seeking advice from healthcare professionals can make a significant difference in managing this condition effectively.

Diagnosis and Testing

Diagnosing Sjogren’s Syndrome can be a bit like detective work, as it involves piecing together various clues from symptoms, examinations, and tests. The process usually starts with a thorough examination of the eyes and mouth, the two areas most commonly affected by the syndrome.

• Eye Examination: Here at Junic Eye Care, we conduct specialized tests to measure tear production and assess the health of the eyes. One common test is the Schirmer test, where a small strip of paper is placed under the lower eyelid to measure tear production. Another is a slit-lamp examination, where we use a microscope to closely examine the surface of your eye for signs of dryness and other issues. We also use the very latest in advanced optometry diagnostic equipment – the OCULUS Keratograph 5M (more about that below!)
• Mouth Examination: This might involve a dentist or a specialist checking for signs of dryness and any related dental issues. They may also measure the saliva flow and look for any changes in the tissues of the mouth.

In addition to these examinations, blood tests play a crucial role in the diagnosis:

• Autoantibody Tests: Tests for specific antibodies like Anti-SSA (Ro) and Anti-SSB (La) are vital. The presence of these antibodies can strongly suggest Sjogren’s Syndrome.
• Inflammation Markers: Blood tests such as ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) help assess the level of inflammation in the body, which is often elevated in autoimmune conditions.
• Complete Blood Count (CBC): This gives an overall picture of health and can point out any underlying issues like anemia, which can accompany Sjogren’s Syndrome.
• Immunoglobulin Levels: Abnormal levels of these proteins can indicate an ongoing autoimmune process.

As an optometrist, I always emphasize the importance of regular eye check-ups, not just for vision correction but also as a vital part of overall health monitoring.

Advanced Diagnostic Equipment

At Junic Eye Care, the OCULUS Keratograph 5M diagnostic tool represents a significant advancement in our ability to diagnose and manage conditions like Sjogren’s Syndrome. This sophisticated device is a top-tier corneal topographer and dry eye analysis tool, offering a comprehensive assessment of the ocular surface.

For patients exhibiting symptoms of Sjogren’s Syndrome, such as persistent dry eyes, the Keratograph 5M can be invaluable. It provides detailed imaging and analysis of the tear film and meibomian glands, crucial for diagnosing dry eye disease, which is often a key indicator of Sjogren’s Syndrome.

The device’s non-invasive tear film break-up time test and meibography help us understand the quality and stability of the tear film and the health of the oil-producing glands in the eyelids. This level of detail enables us to detect subtle abnormalities that might be missed with standard examinations.

By integrating the OCULUS Keratograph 5M into our diagnostic process, we can offer patients a more accurate diagnosis and tailor specific treatment plans to manage their symptoms effectively.

Watch this video to learn more about how this modern optometry tool can help your you and your optometrist to better understand what’s going on with your eyes.

Treatment and Management

Managing Sjogren’s Syndrome is all about improving your day-to-day comfort and addressing the “dry eyes and dry mouth” symptoms that can really make life uncomfortable. Here’s a quick rundown of some treatment and management strategies:

Alleviating Dry Eyes:

• Artificial Tears: Artificial tears usually contain ingredients that help maintain eye moisture and may also include electrolytes to heal the eye’s surface. They are free from irritating preservatives and are suitable for frequent use.
• Punctal Plugs: These are small medical devices inserted into the tear ducts to block drainage. This process effectively conserves your natural tears on the eye’s surface for a longer duration, helping to maintain moisture and alleviate dryness associated with conditions like dry eye syndrome. Think of them as valves that regulate the flow of tears away from the eye, ensuring that they remain lubricated and comfortable.
• Special Eyewear: Glasses equipped with a moisture chamber are designed to create a controlled environment around your eyes. This helps to retain moisture and protect against external irritants. Much like a climate-controlled room, these glasses provide a stable, humid atmosphere that can significantly alleviate dryness and discomfort associated with dry eye conditions.
• Prescription Eye Drops: These are specialized medications prescribed to stimulate tear production, effectively addressing the underlying issue of dry eyes. Unlike over-the-counter artificial tears which mainly offer temporary relief, prescription eye drops aim to enhance your eyes’ natural ability to produce tears e.g. Restasis, Xiidra.

Addressing Dry Mouth:

• Saliva Substitutes: These products are designed to mimic the natural function of saliva. They help in moistening the mouth, which is crucial for both comfort and oral health. Examples include over-the-counter sprays, gels, or lozenges that contain ingredients to lubricate the mouth. They’re akin to a backup system, stepping in to provide moisture when the body’s natural saliva production falls short.
• Good Oral Hygiene: Maintaining excellent oral hygiene becomes even more critical when dealing with dry mouth. Regular brushing and flossing help prevent tooth decay and gum disease, which are risks heightened by reduced saliva. Think of this routine as a shield for your teeth, protecting against potential harm caused by dryness. Additionally, using fluoride toothpaste and mouthwash can offer extra protection against cavities.
• Sipping Water Regularly: Staying well-hydrated is a simple yet effective way to manage dry mouth. Regularly sipping water throughout the day can help keep the mouth moist. It’s similar to keeping a plant adequately watered; just as plants need a steady supply of water for health, your mouth needs a constant moisture level to function properly. This practice not only relieves the discomfort of dryness but also aids in digestion and helps maintain a healthy oral environment.

Lifestyle Changes

When living with Sjogren’s Syndrome, making certain lifestyle adjustments can greatly improve your daily comfort by alleviating symptoms like dry eyes and mouth. Here are some effective strategies:

• Humidifiers at Home: Using a humidifier in your home helps add moisture to the air, creating a more comfortable environment for your eyes and mouth. It’s akin to bringing a bit of a tropical, humid climate into your living space. This can be particularly soothing during dry seasons or in heated indoor environments, where dry air can exacerbate your symptoms.
• Avoiding Dry Environments: It’s beneficial to avoid environments that can dry out your eyes and mouth. This includes places with strong winds, heavy smoke, and areas with high air conditioning or heating.
• Regular Breaks During Screen Time: In our digital age, prolonged screen time is common, but it can strain your eyes, especially when they’re prone to dryness. Taking regular breaks is crucial. It’s like stretching your legs on a long journey; just as your body needs movement, your eyes need rest. Follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds.

Incorporating these lifestyle changes into your daily routine can make a significant difference in managing the symptoms of Sjogren’s Syndrome. They not only provide relief but also contribute to the overall health of your eyes and mouth. Remember, small steps can lead to big improvements in how you feel every day.

Remember, each person’s experience with Sjogren’s Syndrome is unique, so the management plan should be personalized to fit your specific needs.

Conclusion

Managing Sjogren’s Syndrome involves targeting its primary complaints: dry eyes and dry mouth. Treatment strategies vary based on the severity of the symptoms. For some, simple environmental modifications can provide relief. In cases of moderate to severe Dry Eye Disease, we may consider the insertion of punctal plugs, a procedure designed to help maintain adequate moisture in the eyes. Living with Sjogren’s Syndrome can be challenging, but with the right care and treatment, many of the symptoms can be managed effectively.

If you’re in Canberra and experiencing persistent dry eyes and dry mouth, it’s important not to dismiss these symptoms. Early detection and intervention can make a significant difference in managing the condition and maintaining your quality of life.

To visit our optometry practice, click the “Book Online” button at the top of the page or call (02) 6152 8585 today.

You’ll find our clinic conveniently located in the Molonglo Health Hub, just a short 10 minute drive from central Canberra, with plenty of free parking when you get here.