• Comprehensive Ophthalmology

    This outcomes-based review of treatment options for dry eye secondary to Sjögren's syndrome (SS) found a paucity of rigorous clinical trials to support therapy recommendations. Despite this, the review's authors say that recommended treatments for SS-associated dry eye include topical lubricants, topical anti-inflammatory therapy and tear-conserving strategies.

    They searched electronic databases to identify English-language articles published after 1975 on prospective, interventional studies of treatments for SS-associated dry eye. They found 62 relevant papers for inclusion in this review.

    However, these articles consisted almost exclusively of short-term studies with small sample sizes. Some of these studies demonstrate improvement of ocular symptoms or objective signs of dry eye, but there is no strong evidence that any of the suggested treatments alter the natural course of SS-related ocular sicca.

    The authors found that the efficacy of oral secretagogues seems greater in the treatment of oral dryness than ocular dryness. Although oral hydroxychloroquine is commonly prescribed to patients with SS to alleviate fatigue and arthralgias, the literature lacks strong evidence for the efficacy of this treatment for dry eye.

    They say that although topical artificial tears are used widely, many of them are available over the counter and few have been studied for the treatment of SS-associated dry eye. However, they found that all published studies demonstrate an improvement over baseline using artificial tear substitutes. Hypotonic (150 mOsm/L) 0.4% sodium hyaluronate eye drops seem to improve symptoms of dry eye syndrome, as well as ocular surface staining associated with SS. Schirmer levels do not seem to improve with short-term treatment. In addition, 0.5% hydroxypropyl methylcellulose inserts and Carbopol 974P also show some efficacy.

    While studies evaluating 1% topical methylprednisolone were open label and retrospective, the effect was robust. Side effects do not seem to be serious with short-term use. There was sufficient clinical and histopathologic evidence of the effectiveness of topical cyclosporine and its safety for long-term use.

    The authors found no prospective, randomized trials on outcomes of punctal plug insertion, a common treatment for SS-related dry eye syndrome. However, all published studies demonstrate significant improvements over baseline. Replacement of plugs is a significant issue in about one-third of patients, possibly requiring permanent surgical closure.