Sjögren’s syndrome is an autoimmune condition where the body’s immune system mistakenly attacks its own healthy tissues and organs. This attack primarily targets glands responsible for producing moisture, particularly those that generate tears and saliva, resulting in significant dryness in the eyes and mouth. While dry eyes are a common symptom, Sjögren’s can lead to severe eye-related problems, including decreased vision and, in rare instances, blindness.
How Sjögren’s Impacts Eye Health
Sjögren’s syndrome significantly impacts eye health by reducing tear production. Tears are a complex mixture of water, oils, and mucus that lubricate, nourish, and protect the eye’s surface. When tear production is severely diminished, the ocular surface experiences chronic dryness, leading to persistent irritation and inflammation. This sustained lack of moisture can cause microscopic abrasions on the cornea, the clear front part of the eye, and the conjunctiva, the membrane lining the inside of the eyelids and covering the white part of the eye.
This chronic dryness makes the eye vulnerable to damage. Constant friction from blinking without adequate lubrication further irritates the surface, leading to a persistent inflammatory state. This continuous irritation and micro-damage compromise the eye’s natural defenses, increasing susceptibility to severe complications. The compromised tear film also fails to adequately wash away debris and pathogens, increasing the risk of surface infections.
Ocular Complications Leading to Vision Loss
The chronic dry eye caused by Sjögren’s can progress to several ocular complications that threaten vision. One complication is sterile keratolysis, where the cornea begins to break down without an infection. This can lead to nonhealing corneal ulcers, open sores on the cornea that can impair vision by scarring or becoming infected. In severe cases, these ulcers can advance to corneal melt or perforation (a hole in the cornea), which can lead to rapid vision loss and require emergency surgical intervention.
Beyond surface issues, Sjögren’s syndrome can also affect deeper eye structures through systemic inflammation.
Uveitis, an inflammation of the uvea (the middle layer of the eye), can cause pain, light sensitivity, and blurry vision by affecting the retina or optic nerve.
Scleritis involves inflammation of the sclera, the white outer layer of the eyeball, which can be painful and, if severe, can thin the sclera or impact adjacent structures.
Retinal vasculitis, an inflammation of the blood vessels in the retina, can reduce blood flow to the light-sensitive tissue at the back of the eye, potentially causing blind spots or overall vision decline.
Optic neuritis, an inflammation of the optic nerve that transmits visual information from the eye to the brain, can result in sudden, significant vision loss and pain with eye movement.
Preventing Severe Vision Impairment
Preventing severe vision impairment in individuals with Sjögren’s syndrome relies on early diagnosis and consistent management of ocular symptoms. Regular ophthalmological check-ups are recommended for anyone diagnosed with Sjögren’s to monitor eye health and detect potential complications early. Early detection allows for timely intervention, which can significantly alter the disease’s progression.
Treatment approaches for ocular Sjögren’s aim to restore moisture, reduce inflammation, and protect the eye’s surface. Over-the-counter artificial tears are a common first step, providing lubrication and comfort. Prescription eye drops, such as cyclosporine or lifitegrast, suppress inflammation and promote natural tear production. Punctal plugs, tiny devices in the tear ducts, can help retain natural tears on the eye’s surface by blocking their drainage. In advanced cases or for specific complications, surgical interventions may be considered to manage dry eye or address issues like corneal perforation, underscoring the need for immediate medical attention if new or worsening eye symptoms develop.