title: Advances in the treatment of ocular dryness associated with Sjögren׳s syndrome.
abstract: BACKGROUND
  Sjögren´s syndrome (SS) is an autoimmune rheumatic disease that is characterised by decreased exocrine gland function and frequent ocular symptoms associated with eye dryness. Significantly, dry eyes can lead to corneal abrasions, infection, ulceration, chronic scarring and, in severe cases, perforation. The available conventional therapies have limited efficacy and there are no biologic therapies licensed for use in SS patients.
  
  
  METHODS
  A literature search of PubMed (MEDLINE) and EMBASE electronic data bases was performed covering the period from January 1994 to September 2014. Evidence was graded in categories I-IV and a treatment algorithm, comprising first line, second line and rescue therapies for ocular dryness associated with SS was proposed. It is based on the current evidence of efficacy of different therapies and explores their link with the pathogenesis of ocular dryness associated with SS.
  
  
  RESULTS
  Recent developments in the understanding of the pathogenesis of SS provided evidence that the ocular dryness is associated with pathologic infiltration and dysfunction of the lacrimal glands and changes in the tear composition, together with abnormalities involving the neurosecreting circuits. There is good evidence for the efficacy of topical artificial tears, antiinflammatories and Cyclosporine, and oral Pilocarpine and Cevimeline in controlling the symptoms of ocular dryness associated with SS.
  
  
  CONCLUSIONS
  Conventional DMARDs are not particularly effective in addressing the symptoms of ocular dryness associated with SS, despite being commonly prescribed for other SS manifestations. Emerging evidence suggests that B cell and co-stimulatory targeted therapy may play a role in the future.
authors.affiliation: Department of Rheumatology, University College London Hospital, 3rd Floor Central, 250 Euston Rd, London NW1 2PG, UK. Electronic address: c.ciurtin@ucl.ac.uk.
authors.forename: Coziana
authors.initials: C
authors.lastname: Ciurtin
authors.affiliation: Division of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Anca
authors.initials: A
authors.lastname: Ostas
authors.affiliation: Department of Ophthalmology, L׳Hôpital Schweitzer, Colmar, France.
authors.forename: Viorica M
authors.initials: VM
authors.lastname: Cojocaru
authors.affiliation: Division of Medicine, Royal Free Hospital, University College London Hospitals NHS Trust, London, UK.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Walsh
authors.affiliation: Department of Rheumatology, University College London Hospital, 3rd Floor Central, 250 Euston Rd, London NW1 2PG, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Isenberg
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D015352:Dry Eye Syndromes / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D065346:Lubricant Eye Drops / Q000627:therapeutic use; D012859:Sjogren's Syndrome / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D065346:Lubricant Eye Drops; D016572:Cyclosporine
keywords: Ocular dryness pathogenesis in SS; Ocular dryness treatment; Sjogren׳s syndrome (SS)