Sjögren's Syndrome Dry Eye Treatment and Advanced Care with LipiFlow in Vancouver

Sjögren's Syndrome is a systemic autoimmune disease that often results in severe, chronic dry eye disease (DED). Understanding the link between these two conditions is the first step toward finding effective, long-term relief. At Perspective Optometry Vancouver, we specialize in advanced diagnostic and dry eye treatment options, including the innovative LipiFlow procedure, to help manage this complex condition.

 

What is Sjögren’s Syndrome?

 

Sjögren’s Syndrome (SS) is an autoimmune disorder where the body's immune system mistakenly attacks its own moisture-producing glands, primarily the lacrimal (tear) and salivary glands. This autoimmune attack severely reduces tear and saliva production, leading to the hallmark symptoms of dry eyes and dry mouth (sicca symptoms).

  • Prevalence: SS is considered the second most common autoimmune rheumatic disease. While prevalence estimates vary based on the criteria used, it's estimated to affect approximately 0.1% to 4% of the global population, with a significantly higher incidence in middle-aged women (Source: Adapted from Shiboski et al., 2017).

 

Dry Eye Disease as a Core Symptom of Sjögren’s

 

Dry eye disease is not just a secondary symptom—it is a pervasive and often debilitating manifestation of Sjögren’s Syndrome. This condition, known as Sjögren's Syndrome-associated Dry Eye (SSDE), is characterized by a deficient aqueous (water) layer of tears, which leads to chronic ocular surface dryness, damage, and inflammation.

  • High Incidence in SS Patients: Clinical data emphasizes the strong link, with studies showing that a vast majority—up to 94% of patients with primary Sjögren's syndrome—report and experience chronic dry eye symptoms (Source: Adapted from Ramos-Casals et al., 2012, and others).

 

Common Dry Eye Symptoms in Sjögren’s Patients

 

The severity of Sjögren's dry eye symptoms can fluctuate but frequently includes:

  • Persistent dryness, burning, and irritation

  • Grittiness or a "foreign body" sensation in the eyes

  • Redness and chronic inflammation

  • Sensitivity to light (photophobia)

  • Blurred or fluctuating vision

  • Eye fatigue that makes daily tasks like reading and computer use challenging

 

Diagnosis of Sjögren’s and Dry Eye

 

An accurate diagnosis requires a thorough evaluation, often involving collaboration between a rheumatologist and a specialized optometrist or ophthalmologist. The diagnostic process at Perspective Optometry Vancouver may include:

  • Medical History and Symptom Assessment: A detailed review of your specific eye and systemic symptoms.

  • Blood Tests: To check for specific autoantibodies (e.g., anti-Ro/SSA and anti-La/SSB) indicative of Sjögren’s Syndrome.

  • Schirmer's Test: A key measure of the severity of aqueous tear deficiency.

  • Ocular Surface Staining: Using special dyes like fluorescein or lissamine green to reveal damage to the cornea and conjunctiva, a hallmark of severe dry eye disease.

 

Comprehensive Dry Eye Treatment for Sjögren’s Syndrome

 

Effective dry eye treatment for Sjögren’s is typically a multi-faceted, personalized approach aimed at replacing moisture, controlling inflammation, and preserving natural tears.

 

Foundational and Prescription Treatments

 

  1. Artificial Tears and Lubricants: Over-the-counter preservative-free artificial tears are essential for immediate, ongoing moisture relief.

  2. Anti-inflammatory Eye Drops: Prescription medications are crucial to address the underlying inflammation.

    • Cyclosporine (e.g., Restasis, Cequa): This drug helps suppress the immune-driven inflammation in the tear glands, promoting increased natural tear production. Studies have shown its efficacy in improving both the signs and symptoms of DED, including those associated with Sjögren's Syndrome (Source: Clinical trial information and reviews).

    • Lifitegrast (e.g., Xiidra): This medication works by blocking a specific inflammatory pathway, also reducing ocular surface inflammation and improving symptoms. Clinical trials, including those involving DED patients with SS, have supported its use (Source: Clinical trial information and reviews).

  3. Punctal Plugs: Tiny medical devices inserted into the tear ducts to block tear drainage, keeping the patient's natural tears and artificial tears on the eye's surface longer.

 

Lifestyle Support

 

  • Diet and Hydration: Maintaining excellent hydration and supplementing with Omega-3 fatty acids (EPA and DHA) can be beneficial. A number of studies and a meta-analysis suggest that Omega-3 supplementation can improve tear quality and key clinical measures like tear breakup time (TBUT) and Schirmer's test results in dry eye patients, including those with Sjögren's (Source: Omega-3 Essential Fatty Acids Therapy for Dry Eye Syndrome: A Meta-Analysis of Randomized Controlled Studies).

 

Advanced Treatments: Addressing the Evaporative Component

 

Even in Sjögren's Syndrome-related DED (primarily an aqueous deficiency), Meibomian Gland Dysfunction (MGD)—the leading cause of evaporative dry eye—is a frequent co-morbidity. Advanced treatments target this component for a more complete solution.

 

LipiFlow Thermal Pulsation for MGD

 

LipiFlow is an innovative, in-office treatment that provides gentle heat and pulsatile pressure to the inner eyelids. It is specifically designed to unblock clogged meibomian glands, restoring the production of healthy oils (lipids) that prevent tears from evaporating too quickly.

According to a  study published in the journal Clinical Ophthalmology , Sjögren’s patients may benefit from treatments like cyclosporine that addresses aqueous tear film deficiency combined with treatments like LipifFlow that address Meibomian gland dysfunction. The study concluded that LipiFlow treatment in MGD patients who were Sjögren’s Syndrome-positive for novel bio-markers of Sjögren’s demonstrated improvement in signs and symptoms of dry eye. Source: Clin Ophthalmol. 2017; 11: 701–706.

How LipiFlow Treatment Works

 

  1. Assessment: A thorough evaluation confirms MGD as a contributor to your dry eye disease.

  2. Device Application: A disposable applicator is placed over the eyelid, isolating the meibomian glands.

  3. Thermal Pulsation: Controlled therapeutic heat melts the solidified oils (blockages), while proprietary pressure gently massages and expresses the oils, restoring the glands’ natural function.

  4. Duration: The entire procedure is quick, typically taking only 12 minutes per eye.

 

Scleral Lenses and Autologous Serum Drops

 

For patients with severe ocular surface damage from SSDE, these advanced methods offer critical healing and protection:

  • Scleral Lenses: These large-diameter custom contact lenses vault entirely over the cornea, resting on the sclera. They create a protective, fluid-filled reservoir over the eye, providing continuous hydration and a bandage-like barrier against blinking friction.

  • Autologous Serum Eye Drops (ASEDs): These highly specialized drops are made from the patient's own blood serum and contain essential growth factors, vitamins, and proteins that promote the healing and regeneration of the damaged ocular surface.