Clinical Guidelines for Management of Dry Eye Associated with Sjögren Disease

• Published in: The ocular surface Vol. 13; no. 2; pp. 118 - 132
• Main Authors: Foulks, Gary N., MD, FACS, Forstot, S. Lance, MD, FACS, Donshik, Peter C., MD, Forstot, Joseph Z., MD, FACP, FACR, Goldstein, Michael H., MD, MM, Lemp, Michael A., MD, Nelson, J. Daniel, MD, FACS, Nichols, Kelly K., OD, MPH, PhD, Pflugfelder, Stephen C., MD, Tanzer, Jason M., DMD, PhD, Asbell, Penny, MD, MBA, FACS, Hammitt, Katherine, MA, Jacobs, Deborah S., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Anti-inflammatory agents; autologous serum; corticosteroids; cyclosporine; Disease Management; dry eye disease; Dry Eye Syndromes - diagnosis; Dry Eye Syndromes - etiology; Dry Eye Syndromes - therapy; Humans; Lacrimal Apparatus - metabolism; mucolytics; omega 3 essential fatty acids; Ophthalmology; Osmolar Concentration; Practice Guidelines as Topic; punctal occlusion; secretogogues; Sjogren's Syndrome - complications; Sjögren disease; Tears - physiology; therapeutic contact lenses; cyclosporine; omega 3 essential fatty acids; secretogogues; therapeutic contact lenses; corticosteroids; autologous serum; Sjögren disease; mucolytics; punctal occlusion; dry eye disease; Anti-inflammatory agents
• ISSN: 1542-0124; 1937-5913
• DOI: 10.1016/j.jtos.2014.12.001

Abstract Purpose To provide a consensus clinical guideline for management of dry eye disease associated with Sjögren disease by evaluating published treatments and recommending management options. Design Consensus panel evaluation of reported treatments for dry eye disease. Methods Using the 2007 Report of the International Workshop on Dry Eye (DEWS) as a starting point, a panel of eye care providers and consultants evaluated peer-reviewed publications and developed recommendations for evaluation and management of dry eye disease associated with Sjögren disease. Publications were graded according to the American Academy of Ophthalmology Preferred Practice Pattern guidelines for level of evidence. Strength of recommendation was according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Results The recommendations of the panel are briefly summarized herein. Evaluation should include symptoms of both discomfort and visual disturbance as well as determination of the relative contribution of aqueous production deficiency and evaporative loss of tear volume. Objective parameters of tear film stability, tear osmolarity, degree of lid margin disease, and ocular surface damage should be used to stage severity of dry eye disease to assist in selecting appropriate treatment options. Patient education with regard to the nature of the problem, aggravating factors, and goals of treatment is critical to successful management. Tear supplementation and stabilization, control of inflammation of the lacrimal glands and ocular surface, and possible stimulation of tear production are treatment options that are used according to the character and severity of dry eye disease. Summary Management guidelines for dry eye associated with Sjögren’s disease are presented.