Sjögren’s syndrome is a chronic autoimmune condition where the body’s immune system mistakenly targets its own moisture-producing glands. While it commonly affects the salivary glands, leading to dry mouth, a less frequent yet notable symptom involves the lacrimal glands, resulting in swelling. This manifestation, known as dacryoadenitis, arises from the immune system’s attack on these tear-producing structures. Understanding this swelling, its presentation, and approaches to diagnosis and treatment is important for those affected.
The Role of Lacrimal Glands and Sjögren’s Syndrome
The lacrimal glands, located above the outer corner of each eye, produce the aqueous layer of the tear film. This tear layer serves several purposes, including lubricating the ocular surface, protecting the eye from foreign particles, and providing nutrients to the avascular cornea. Tears also contain antimicrobial proteins, offering a protective barrier against microorganisms.
In Sjögren’s syndrome, the immune system becomes dysregulated and attacks healthy tissues. Immune cells, primarily lymphocytes, infiltrate and aggregate within the lacrimal glands. This immune response leads to inflammation within the glandular tissue, impeding its normal function and causing lacrimal gland swelling, or dacryoadenitis.
The sustained inflammation and immune cell presence gradually damage the glandular tissue. This destruction impairs the lacrimal glands’ ability to produce adequate tears, leading to the hallmark dryness associated with Sjögren’s syndrome.
Symptoms and Physical Manifestations
Lacrimal gland swelling in Sjögren’s syndrome often presents as a noticeable physical change. Individuals may observe puffiness or a distinct lump in the outer upper eyelid, near the temple. This swelling can be unilateral or bilateral, varying in prominence. The enlarged gland might feel firm to the touch, indicating inflammation.
Individuals commonly experience physical sensations in the affected area. There can be a feeling of pressure or fullness behind the eye, accompanied by tenderness upon palpation. Some people report mild discomfort or pain in the region of the swollen gland, especially with eye movement or direct pressure.
Dry eye is a common symptom in Sjögren’s syndrome. This dryness manifests as a gritty or sandy sensation, as if foreign particles are present in the eye. Burning, itching, and redness of the eyes are also frequently reported. Light sensitivity and episodes of blurred vision can occur.
The Diagnostic Process
Confirming lacrimal gland swelling linked to Sjögren’s syndrome involves a diagnostic approach, often coordinated by an ophthalmologist or rheumatologist. The initial step includes a physical examination of the eyes and eyelids to assess the swelling and rule out other potential causes.
Imaging tests visualize the lacrimal glands and surrounding orbital structures. CT or MRI scans provide detailed views, confirming glandular enlargement and distinguishing it from other conditions like tumors or abscesses. Ultrasound of the salivary glands, which often mirrors lacrimal gland involvement, can also reveal structural changes supporting a Sjögren’s diagnosis.
Blood tests detect specific autoantibodies characteristic of Sjögren’s syndrome, including anti-SSA/Ro and anti-SSB/La antibodies. Other serological markers, such as an elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or rheumatoid factor, may also support the diagnosis, indicating systemic inflammation.
In certain instances, a minor salivary gland biopsy, typically taken from the inner lip, may be performed. This procedure involves excising a small piece of tissue to examine under a microscope for characteristic lymphocytic infiltration, where clusters of 50 or more lymphocytes in a 4 mm² area indicate Sjögren’s. A positive salivary gland biopsy helps confirm the autoimmune nature of the condition.
Management and Treatment Approaches
Managing lacrimal gland swelling in Sjögren’s syndrome involves addressing both acute inflammation and long-term consequences of impaired tear production. For acute swelling and significant inflammation, corticosteroids are often prescribed. These medications, such as oral prednisone or injected corticosteroids, work by suppressing the immune response, thereby reducing inflammation and the size of the swollen glands. Short-term use might be sufficient for acute flares, with dosages gradually reduced as symptoms improve.
Long-term management focuses on alleviating chronic dry eye, which results from the ongoing damage to the lacrimal glands. A primary approach involves the regular use of lubricating eye drops, commonly known as artificial tears. These over-the-counter solutions help to supplement the natural tear film, providing moisture and reducing irritation. Preservative-free formulations are often recommended for frequent use to avoid potential irritation.
Prescription eye drops that aim to increase tear production or reduce ocular surface inflammation are also widely used. Cyclosporine (e.g., Restasis) and lifitegrast (e.g., Xiidra) are two such medications that work by modulating the immune response in the lacrimal glands, promoting tear secretion and reducing inflammation over time. These drops typically require consistent use for several weeks or months before their full benefits are observed. Oral medications like pilocarpine (Salagen) or cevimeline (Evoxac) can also stimulate tear and saliva production by activating cholinergic receptors in the glands.
Procedures like punctal occlusion can help conserve the remaining natural tears on the eye’s surface. This involves inserting small, temporary collagen or more permanent silicone plugs into the puncta, the tiny openings in the eyelids that drain tears away from the eye. By blocking this drainage, tears remain on the ocular surface longer, improving lubrication and comfort. Punctal plugs have shown effectiveness in improving symptoms and reducing corneal damage in individuals with Sjögren’s dry eye, even in the presence of ocular surface inflammation.