What’s causing my dry and itchy eyes. Allergies? Sjogren’s? Or……

Well, it’s that time of year when many of us will battle with allergies. Stuffy, clogged up, or runny nose and dry itchy eyes. But maybe it’s not just allergies.

Today, we are focus on Sjogren’s, but first, let’s look at having dry eyes in general. There are many potential causes for dry, itchy, irritated eyes The most common causes include……

Common Causes For Dry, Irritated Eyes:

  • Medications: – Antihistamines – Antidepressants / Anti-anxiety / Pain pills – Some blood pressure medications (beta blockers) – Diuretics (“water pills”) – Birth control medications – Estrogen replacement in the absence of progesterone after menopause will produce more eye dryness
  • Physical Imbalances (medical conditions) – Sjogren’s Syndrome, Rheumatoid Arthritis, Lupus, Sarcoidosis – Diabetes (usually worsening or “uncontrolled”) – Thyroid dysfunction – Allergies – Structural problems with eyelid resulting in incomplete closure of the lid
  • Others: – Menopause – Pregnancy -Consequence following LASIX corrective surgery – Infrequent blinking (such as when using computer/ watching TV) – Chemical fumes, tobacco smoke, the draft from A.C. or heating duct . . . and, age.
  • Vitamin deficiencies/imbalances: most literature is on….. – Vitamin A some examples of rich sources of Vitamin A include (highest source listed first) – sweet potatoes, carrots, spinach, kale, greens, Swiss cheese, cantaloupe, whole milk – Vitamin D some examples of rich sources of Vitamin A include (highest source listed first) – cod liver fish oil (Omega 3), salmon, sardines, tuna, cow’s milk, orange juice, eggs, mushrooms. Other vitamins that have been cited: -Potassium -Zinc

Other than being annoyed with dry eyes, what are the potential complications?

1. chronic dry eyes can increase the risk of eye infection

2. can increase the risk of thinning and perforation of the cornea

3. can lead to loss of vision

So what about Sjogren’s?

First, what was it? Like RA and Lupus, Sjogren’s is another autoimmune disease in which our immune system generates an ‘inflammatory’ response against ourselves.

What causes my eyes (and possibly my mouth) to be dry if I have Sjogren’s?

In short, the symptoms of Sjogren’s are caused by our own white blood cells. The white blood cells are cells of our immune system that are normally called into action to fight infections and other things that are not a part of our own body. In Sjogren’s, they attack our glands and, in doing so, decrease their ability to work properly. Eventually, the inflammation inhibits our ability to produce secretions and we get “dry.” There are many specific types of white blood cells and the ones involved with Sjogren’s are known as “lymphocytes.” The lymphocytes do not only attack our glands but can affect other organs as well.

Fast Facts About Sjogren’s:

1. Affects 1/1000 people (which is the same frequency as lupus).

2. Affects women 9 times more commonly than men.

3. Typically starts midlife (40-50 years of age) but can occur at any age (rare in childhood).

4. On average, individuals go 9 years before being properly diagnosed.

What’s the difference between “Primary” and “Secondary” Sjogren’s?

Sjogren’s is broken down into “Primary Sjogren’s” and “Secondary Sjogren’s.”

Primary Sjogren’s: Absence of another underlying rheumatic disease – Associated with + SSA and/or SSB antibody blood test

Secondary Sjogren’s: Accompanying evidence of another rheumatic disease (most commonly RA, can be Lupus and others as well). 30% of those with RA also have Sjogren’s

What are the common symptoms of Sjogren’s?

  • dry eyes (47% of the time)
  • dry mouth (42% of the time)
  • joint pain (28% of the time)
  • parotid gland enlargement (24% of the time)
  • Raynauds (fingers turning white, blue or purple when cold) (21% of the time)
  • fever (10% of the time)
  • fatigue (10% of the time)
  • painful intercourse (women due to vaginal dryness) (5% of the time)

How is Sjogren’s Diagnosed?

Mmmm, not easily. There is no single test that can confirm it, although a biopsy of a minor salivary gland known as a “lip biopsy” is probably the best we have. If a certain amount of “lymphocytes” are seen in the tissue from a biopsy, it is highly likely Sjogren’s is present.

Most often, a biopsy is not done and the diagnosis is based on symptoms and the tests noted below:

1. Schirmer’s test- filter paper placed under the bottom eyelid and the moisture collected on the paper is then measured- less than 5 mm indicates decreased tear production

2. Specific dyes can be administered by eye docs looking for a damaged cornea due to dryness which can suggest Sjogren’s

3. Blood tests that assess the presence of inflammation and antibodies.

  • sed rate and CRP – markers for systemic inflammation
  • SSA/SSB – autoantibodies for Sjogren’s
  • RF and CCP – autoantibodies that can be seen in Rheumatoid
  • ANA – autoantibody that can be seen in Lupus, Sjogren’s, and Mixed Connective Tissue Disease

Does Sjogren’s just cause my eyes and mouth to be dry?

No. Sjogren’s is a systemic inflammatory issue meaning it can affect many different parts of our body. This includes: esophagus 30-35% of cases lymph nodes (being enlarged) 15-20% of cases vasculitis (inflamed blood vessels) 5-10% of cases lung 10-20% of cases kidney 10-15% of cases liver 5-10% of cases neuropathy 2-5% of cases muscle 1-2% of cases lymphoma 5-8% of cases

How is Sjogren’s treated? What can I do?

  • Dry eyes: Over the counter artificial tears and prescription eye drops such as Restasis and Xiidra Dry mouth: sucking on sugar-free candies and prescription medications such as Salagen and Evoxac
  • Arthritis/ Joint pain: Anti-Inflammatory medications
  • Additional treatment options include the use of prednisone to suppress or reduce the inflammation (although this is a bit controversial) and a medication known as Plaquenil (generic is Hydroxychloroquine). Other Rheumatic meds can be used as well and in the setting of secondary Sjogren’s, often the treatment of RA or Lupus does treat the Sjogren’s as well.
  • Alternative therapies include increasing Omega 3 fatty acids as well as ginger and turmeric (potentially due to their anti-inflammatory effects).

I hope this helps explain a bit about dry eyes, what might be causing it, and what can be done.

Remember, today and every day, live your value one choice at a time . . . regardless if it is your mind, your heart, or your eyes

-Dr. D