Current treatments of xerophthalmia in Sjogren's syndrome

Purpose. - To describe the large variety of treatments currently used in Sjogren's syndrome for one of its major manifestations, keratoconjunctivitis sicca or xerophthalmia. Current knowledge and key points. - Sjogren's syndrome causes a diffuse immunoinflammatory disturbance of main lacrimal Glands and the whole ocular surface. Dry eye syndrome is responsible for chronic and deep impairment of quality of life. Many different tear substitutes have been widely developed that are poorly efficient for relieving patients from their complaints. Tear substitutes of various viscosity from standard artificial tears to synthetic gels may be used. Hyaluronic acid is Currently the most promising tear substitute, but all eye drops and gels are only efficient in mild to moderate dry eyes and keratoconjunctivitis sicca mostly resists to lubricants. Moreover, the latter may increase patients' complaints when they are associated to preservatives, antiseptic drugs that have widely demonstrated their toxic or irritating potential. Preservatives are, therefore, to be avoided whenever possible in keratoconjunctivitis sicca, by using monodose disposable packaging or specific bottle fiItering or eliminating the preservative. Stimulation of lacrimal and salivary secretions with systemic pilocarpine, or obturation of lacrimal puncta in order to limit the drainage of tears in lachrymal ducts may be useful in most severe forms of Sjogren's syndrome. However, the development of topical cyclosporine and other immunomodulating agents is the most relevant progress in the treatment of keratoconjunctivitis sicca in Sjogren's syndrome. Perspectives. -The future for treating Sjogren's syndrome is most likely to pass through the use of new drugscapable of treating the disease or at least its mechanisms, and not only to try to relieve symptoms with poorly efficient tear substitutes. (C) 2003 Elsevier SAS. Tous droits reserves.