Topical Treatment for Dry Eye Disease Related to Sjögren's Syndrome: A Systematic Review

Abstract Introduction & Objectives : Sjögren’s syndrome (SS) is a systemic autoimmune disorder characterized by dry eyes and dry mouth caused by inflammation in exocrine glands. Dry eye with SS is often more severe than non-SS dry eye and can greatly affect patients’ quality of life, thus treatment modalities must be selected carefully. This study aims to evaluate the recent studies on topical treatment for dry eye disease related to SS and provide evidence based recommendation for clinical practice. Methods : Electronic literature search was performed through the PubMed and Cochrane database from the last 10 years. We only included studies with prospective clinical trial design, a follow-up period of at least 4 weeks, and had outcome parameters among the following: Ocular Surface Disease Index, Schirmer test, tear break up time, tear meniscus height, and corneal fluorescein staining. Results : Fifteen studies were selected from 125 articles retrieved. We identified clinical trials using tacrolimus, cyclosporine, cortisol phosphate, diquafosol, rebamipide, fluorometholone, hydrocortisone, clobetasone butyrate, autologous serum, autologous platelet lysate, artificial tear, and various type of vehicles including hyaluronic acid, sodium hyaluronate, almond oil, ceftazidime,or saline solution. Conclusion : Cyclosporine has comparably equal efficacy to corticosteroid eye drops in improving signs and symptoms of dry eye in SS, but with a better safety for long-term use. Autologous serum is also an effective therapy with the best concentration being 100% serum (no dilution). Diquafosol is a promising therapy but more research is needed to confirm its efficacy and safety.