Sjögren’s syndrome is a chronic autoimmune disorder where the immune system attacks the glands responsible for producing moisture. This leads to the hallmark symptoms of dry eyes and dry mouth. While the most common ocular manifestation causes significant discomfort, severe, unmanaged Sjögren’s can progress to cause permanent vision impairment. Complete blindness is rare, but the condition can lead to structural damage that severely limits sight. Understanding how this disease affects the eye is important for preventing its most serious complications.
The Primary Ocular Manifestation
The most frequent way Sjögren’s syndrome affects the eyes is through keratoconjunctivitis sicca (KCS), or severe aqueous-deficient dry eye. This occurs because the immune system damages the lacrimal glands, which produce the watery component of tears. This impairment results in a chronic lack of tear fluid to lubricate the ocular surface.
The resulting tear film instability causes uncomfortable initial symptoms. Patients often report a persistent gritty or foreign body sensation, burning, and chronic redness. Sensitivity to light (photophobia) and blurred vision are common due to the unstable tear film. This chronic dryness and inflammation sets the stage for more serious damage to the eye’s surface.
Progression to Severe Vision Impairment
The chronic lack of lubrication and inflammation can lead to a breakdown of the protective outer layer of the cornea, known as the corneal epithelium. This epithelial breakdown (epitheliopathy) is an initial sign of damage caused by persistent dryness. If left unmanaged, the unprotected surface is vulnerable to further injury.
The damaged cornea can develop persistent epithelial defects, which are non-healing abrasions. These defects increase the risk of developing corneal ulcers, which are open sores that can be sterile or infectious. Infectious corneal ulcers are dangerous and can rapidly lead to severe structural damage.
When ulcers or deep abrasions heal, they often result in corneal scarring. This scar tissue is opaque and prevents light from passing through the cornea to the retina, causing permanent vision impairment. The severity of the scarring dictates the extent of vision loss, potentially resulting in legal blindness.
Systemic Effects on the Visual Pathway
Sjögren’s is a systemic disease that can, in rare instances, affect the internal visual pathway through inflammation. Systemic inflammation, particularly vasculitis or neuropathy, can target the central nervous system. One complication is optic neuritis, where the immune system attacks the optic nerve.
The optic nerve transmits visual information from the retina to the brain, and inflammation disrupts this signal. Optic neuritis can cause rapid and profound vision loss, though the course can be chronic and progressive. Although less common than dry eye complications, these neurological events can be a serious manifestation of the disease, sometimes occurring before the classic symptoms of dry eyes and mouth are noticed.
Strategies for Ocular Health Management
Aggressive management of the ocular surface is necessary to prevent progression from dryness to structural damage and vision loss. Treatment involves frequent use of lubricating artificial tears, often preservative-free formulations. Topical gels or ointments are recommended for overnight use to maintain moisture.
Prescription eye drops address the underlying inflammation that drives KCS. These include medications like cyclosporine or lifitegrast, which suppress the chronic inflammatory cycle on the ocular surface. For severe inflammation, short courses of topical corticosteroids may be prescribed, but long-term use is avoided due to the risk of side effects like cataracts or elevated eye pressure.
A common strategy is punctal occlusion, where tiny plugs are placed into the tear ducts to block the drainage of tears. This simple, in-office procedure helps retain tear volume on the ocular surface for a longer period. Regular monitoring by an ophthalmologist is crucial to detect epithelial defects or early signs of ulceration before permanent scarring occurs.