Sjögren's Syndrome Dry Eye Disease

To review the current pathophysiology of Sjögren's syndrome, the symptomatic and clinical manifestations of keratoconjunctivitis sicca in Sjögren's syndrome and therapeutic options. Review of literature involving Sjögren's syndrome, important diagnostic parameters, and clinical trials with emphasis on dry eye disease outcomes. The updated American College of Rheumatology/European League Against Rheumatism diagnostic criteria can be helpful for enrolling participants into clinical trials. The ocular staining score has a high sensitivity and specificity for identifying those with keratoconjunctivitis sicca. Topical therapy is frequently used, though many serve a primarily palliative role. Randomized clinical trials of specific B-cell–directed therapy have failed to show a significant improvement in some signs of keratoconjunctivitis sicca. To date, there is limited evidence that specific topical or systemic therapies result in notable improvements in the signs of keratoconjunctivitis sicca. There is an unmet need for additional therapies, particularly focusing on the specific pathophysiologic mechanisms that drive Sjögren's syndrome dry eye disease.