title: Clinical guidelines for management of dry eye associated with Sjögren disease.
abstract: OBJECTIVE
  To provide a consensus clinical guideline for management of dry eye disease associated with Sjögren disease by evaluating published treatments and recommending management options.
  
  
  METHODS
  Consensus panel evaluation of reported treatments for dry eye disease.
  
  
  METHODS
  Using the 2007 Report of the International Workshop on Dry Eye (DEWS) as a starting point, a panel of eye care providers and consultants evaluated peer-reviewed publications and developed recommendations for evaluation and management of dry eye disease associated with Sjögren disease. Publications were graded according to the American Academy of Ophthalmology Preferred Practice Pattern guidelines for level of evidence. Strength of recommendation was according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.
  
  
  RESULTS
  The recommendations of the panel are briefly summarized herein. Evaluation should include symptoms of both discomfort and visual disturbance as well as determination of the relative contribution of aqueous production deficiency and evaporative loss of tear volume. Objective parameters of tear film stability, tear osmolarity, degree of lid margin disease, and ocular surface damage should be used to stage severity of dry eye disease to assist in selecting appropriate treatment options. Patient education with regard to the nature of the problem, aggravating factors, and goals of treatment is critical to successful management. Tear supplementation and stabilization, control of inflammation of the lacrimal glands and ocular surface, and possible stimulation of tear production are treatment options that are used according to the character and severity of dry eye disease.
  
  
  CONCLUSIONS
  Management guidelines for dry eye associated with Sjögren's disease are presented.
authors.affiliation: University of Louisville Department of Ophthalmology and Vision Science, Louisville, KY. Electronic address: foulksgary@gmail.com.
authors.forename: Gary N
authors.initials: GN
authors.lastname: Foulks
authors.affiliation: Corneal Consultants of Colorado, Denver, CO.
authors.forename: S Lance
authors.initials: SL
authors.lastname: Forstot
authors.affiliation: University of Connecticut Health Center Division of Ophthalmology, Farmington, CT.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Donshik
authors.affiliation: Rheumatology Associates of South Florida, Boca Raton, FL.
authors.forename: Joseph Z
authors.initials: JZ
authors.lastname: Forstot
authors.affiliation: Tufts University School of Medicine, Boston, MA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Goldstein
authors.affiliation: Georgetown University, Washington, DC.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Lemp
authors.affiliation: HealthPartners Medical Group, St. Paul, MN.
authors.forename: J Daniel
authors.initials: JD
authors.lastname: Nelson
authors.affiliation: University of Alabama Birmingham School of Optometry (formerly University of Houston School of Optometry, Houston, TX).
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Nichols
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Pflugfelder
authors.affiliation: University of Connecticut School of Dental Medicine, Farmington, CT.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Tanzer
authors.affiliation: Icahn School of Medicine at Mount Sinai, NewYork, NY.
authors.forename: Penny
authors.initials: P
authors.lastname: Asbell
authors.affiliation: Sjogren's Syndrome Foundation, Bethesda, MD.
authors.forename: Katherine
authors.initials: K
authors.lastname: Hammitt
authors.affiliation: Boston Foundation for Sight, Needham, MA.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Jacobs
mesh_terms: D019468:Disease Management; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007765:Lacrimal Apparatus / Q000378:metabolism*; D009994:Osmolar Concentration; D017410:Practice Guidelines as Topic; D012859:Sjogren's Syndrome / Q000150:complications*; D013666:Tears / Q000502:physiology*
keywords: Anti-inflammatory agents; Sjögren disease; autologous serum; corticosteroids; cyclosporine; dry eye disease; mucolytics; omega 3 essential fatty acids; punctal occlusion; secretogogues; therapeutic contact lenses