Background/Purpose: Dry eyes can compromise quality of life in Sjogren’s Syndrome (SS) and is often one of the most troublesome symptoms.  Clinical practice guidelines were developed to provide evidence based consensus recommendations for SS dry eyes management.

Methods: Following the principles of AGREE, a national panel of eye care providers and consultants with representation from rheumatology and oral medicine was convened to evaluate peer-reviewed publications and develop guidelines for the evaluation and management of SS dry eye disease. Definitions from the 2007 Report of the International Workshop on Dry Eye (DEWS) were used to identify patient subsets and clinical issues. Studies on non-SS dry eye disease guided management when considered essential or helpful. Bias was reduced as much as possible by pre-defining parameters for literature searches. Publications were graded for level of evidence according to the American Academy of Ophthalmology Preferred Practice Pattern guidelines and, for strength of the recommendation according to GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Recommendations were formulated and revised using a Delphi consensus process with 75% agreement required for consensus.  Revision of guidelines that failed to achieve consensus was permitted up to 3 rounds before the recommendation was discarded.

Results: Key recommendations for all SS dry eye patients included: 1) evaluation of symptoms of discomfort and visual disturbance 2) determination of the relative contribution of aqueous tear deficiency vs. evaporative tear loss to the patient’s dry eyes 3) use of objective parameters (tear film stability, tear osmolality, degree of lid margin disease, ocular surface damage) to stage  the severity of dry eye disease and 4) a stepwise treatment algorithm based on disease severity that includes patient education as to the nature of the problem, aggravating factors, and goals of treatment; tear supplementation and stabilization, control of inflammation of the lacrimal glands and ocular surface, systemic therapy with secretogogies, and tear preservation measures. 

Conclusion: Management of dry eyes in SS necessitates a comprehensive evaluation to identify the cause or causes of dry eyes as well as the gradation of severity based upon symptoms and objective parameters.  A stepwise algorithm based on overall dry eye disease severity and response to prior therapy is recommended.

The Sjögren’s Syndrome Foundation (SSF) Clinical Practice Guidelines are fully supported by the SSF with no pharmaceutical support.  No compensation was paid to any author. All participating authors completed Conflict of Interest forms of the American College of Rheumatology.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sjogrens-syndrome-foundation-clinical-practice-guidelines-for-management-of-dry-eyes/