Sjogren’s Disease: Autoimmune dry eye Part 1

Sjogren’s Disease - or; When our immune system starts throwing “smart bombs” at our water-producing glands and what that can mean to our eyes (& to our life!).

 Until relatively recently, Dry Eye Disease was called Dry Eye Syndrome – probably for several reasons. First, is that we didn’t understand it very well (not to imply we now understand it particularly well – just “better”). Second, saying “disease” sounds more “harsh” or “serious” – while “syndrome” somehow seems less severe or serious - and since we didn’t have a lot of understanding – or ways to treat it - it seemed better to “downplay” it.

 This terminology also applies to Sjogren’s Disease, as it was also referred to as “Sjogren’s Syndrome” until relatively recently, perhaps for many of the same reasons. While we now understand it better, we still have a long way to go – and since it can have a huge impact on our being, it is good to know that there are many studies underway to help improve our understanding and give us more tools to treat it.

 Early in my posts, I covered the “accidental” damage to our tear glands that commonly occurs when our eyes become dry and irritated, as irritation begets inflammation and inflammation leads to damage to our tear glands. As the glands become damaged, we get more dry and more irritated, which leads to more inflammation and more dryness – the so called “vicious cycle” of dry eye disease. As our immune system spools up, it can act like “gas on the fire” of this vicious cycle.

 Sadly in the case of Sjogren’s Disease, our immune system becomes more confused and starts making antibodies that attack the water-producing glands throughout our bodies “on purpose” (versus the more typical “accidental” damage from dry irritation) and can become a hydrant of gas on that fire. This affects our eyes by drying up the water in our tears and since water makes up most of a healthy tear, the tear volume drops and eyes suffer.

 But Sjogren’s frequently goes far beyond affecting our eyes, as the white cells (Lymphocytes) from our immune system can also attack our nerves, our organs and especially, our gut. This post serves as a basic introduction - and for future posts, I’ll cover more details about how broadly this can affect us, current aspects of diagnosis and some of the commonly accepted current treatments – but will attempt to touch on some of the newer approaches and possible treatments being investigated.

As these immune cells (Lymphocytes) go after nerves, they will cause an “autoimmune neuropathy” – where nerves can become weaker and lead to numbness or pain (and sometimes, degrees of both). In an earlier post, I noted how corneal nerves are the “maestro” that conducts the “orchestra” of tear production and of the delicate dance of cells that constantly turn over and renew the surface of our eyes. Poor tears can weaken that surface, but when the cells lose their “marching orders” the surface can get very rough and damaged. These eyes may need every trick in our book to survive. Commonly, this includes some degree of anti-inflammatory drops like Cyclosporine, Lifitigrast and topical steroids, biologic support from Autologous Serum Tears and Amnion products and higher levels of attention to ancillary dry eye issues like Meibomian Gland obstruction, Rosacea-related inflammation, blepharitis, allergies and surface issues pertaining to the conjunctiva and eyelids.

I harp on use of preservative free artificial tears (so we don’t punish the tear glands and eye surface with harsh chemicals designed to kill germs that may gain access to the bottles through air or contact of the tip with our eyelids or fingers) – but as a final portion of this post, I will also mention that this opens the door to bad germs gaining access through contamination at the factory level – as appears may be the case from this CDC notice: CDC Urges Discontinued Use of EzriCare Artificial Tears (as they may be the source of some terrible eye infections and possibly one death)! Stay tuned for more…