Sjögren’s syndrome is a chronic autoimmune condition that primarily targets the body’s moisture-producing glands, leading to some of its most common and distressing symptoms: dry eyes and dry mouth. These symptoms can significantly affect a person's quality of life and may even lead to complications if not properly managed. But what causes this dryness, and why is it so central to Sjögren’s? In this article, we’ll explore the underlying mechanisms, common symptoms, and approaches to managing the dryness associated with Sjögren’s syndrome.

What Is Sjögren’s Syndrome?

Sjögren’s syndrome is an autoimmune disease, meaning that the body’s immune system mistakenly attacks its own tissues. In this condition, the immune response is directed primarily at the exocrine glands, especially the salivary glands (which produce saliva) and the lacrimal glands (which produce tears).

There are two types of Sjögren’s:

  • Primary Sjögren’s syndrome: Occurs on its own, without the presence of another autoimmune disease.

  • Secondary Sjögren’s syndrome: Develops alongside another autoimmune condition, such as rheumatoid arthritis or lupus.

While the syndrome can affect various parts of the body, the dryness it causes is often the first and most persistent symptom.

Why Does Sjögren’s Cause Dryness?

The hallmark dryness in Sjögren’s is due to immune system dysfunction. Here’s how it works:

  1. Immune cell infiltration: White blood cells, particularly lymphocytes, invade the moisture-producing glands.

  2. Inflammation and tissue damage: These immune cells cause inflammation that disrupts the normal structure and function of the glands.

  3. Reduced secretion: Over time, the damaged glands produce less saliva and fewer tears.

This process doesn’t happen overnight. The progression of glandular damage varies from person to person, and some individuals may experience more severe dryness than others.

Dry Eyes (Keratoconjunctivitis Sicca)

Dry eyes are a common and often early sign of Sjögren’s. The lacrimal glands, responsible for tear production, become inflamed and produce insufficient tears. Symptoms include:

  • A gritty or sandy feeling in the eyes

  • Redness and irritation

  • Sensitivity to light (photophobia)

  • Blurred vision

  • Eye fatigue

  • Excessive tearing (a paradoxical response due to irritation)

Without enough tears, the surface of the eye becomes dry and vulnerable to damage. Long-term dryness can increase the risk of eye infections, corneal abrasions, or ulcers.

Dry Mouth (Xerostomia)

Dry mouth occurs when the salivary glands are affected. Saliva plays a crucial role in oral health by lubricating the mouth, aiding digestion, and protecting against bacteria. In Sjögren’s, saliva production is significantly reduced, leading to:

  • Difficulty swallowing (especially dry foods)

  • A sticky, dry feeling in the mouth

  • Cracked lips or split corners of the mouth

  • Burning sensation in the tongue

  • Difficulty speaking

  • Tooth decay and gum disease

  • Bad breath

Saliva also helps neutralize acids and maintain a healthy balance of oral bacteria. When it's lacking, the risk of cavities, oral infections, and dental erosion increases.

Diagnostic Clues

Doctors may use several tests to evaluate dryness and determine whether Sjögren’s is the cause:

  • Schirmer’s test: Measures tear production using filter paper strips placed under the eyelids.

  • Ocular surface staining: Dyes are used to assess eye surface damage.

  • Salivary flow rate: Determines how much saliva is produced in a set period.

  • Imaging or biopsy of salivary glands: Helps detect gland damage or inflammation.

These tests, combined with blood tests that look for specific antibodies (e.g., anti-SSA/Ro, anti-SSB/La), can confirm a diagnosis of Sjögren’s syndrome.

Managing Dry Eyes

While there is no cure for Sjögren’s, several treatments can help relieve eye dryness:

  • Artificial tears: Over-the-counter drops provide temporary moisture.

  • Lubricating ointments: Thicker products used at night to prevent dryness.

  • Prescription eye drops: Medications like cyclosporine (Restasis) or lifitegrast (Xiidra) reduce inflammation in the lacrimal glands.

  • Punctal plugs: Small devices inserted into tear ducts to slow drainage and retain moisture.

  • Warm compresses and eyelid hygiene: Improve oil gland function in the eyelids.

  • Moisture chamber glasses: Help protect the eyes from wind and evaporation.

It’s important to avoid dry environments, use a humidifier at home, and take frequent breaks when reading or using screens.

Managing Dry Mouth

Dry mouth can be challenging, but multiple strategies can help:

  • Frequent sips of water: Keep the mouth moist throughout the day.

  • Sugar-free gum or lozenges: Stimulate saliva production.

  • Saliva substitutes: Gels or sprays that mimic natural saliva.

  • Prescription medications: Pilocarpine (Salagen) or cevimeline (Evoxac) can stimulate saliva in some patients.

  • Good oral hygiene: Brushing with fluoride toothpaste, flossing, and regular dental visits are crucial.

  • Avoid irritants: Stay away from alcohol, caffeine, and tobacco, which worsen dryness.

People with dry mouth should also be cautious with certain medications that may contribute to dryness, such as antihistamines, antidepressants, or diuretics.

When Dryness Extends Beyond the Eyes and Mouth

In some cases, Sjögren’s-related dryness can affect other areas:

  • Nose and throat: Causing nasal crusting, hoarseness, or chronic cough.

  • Skin: Leading to dry, itchy patches.

  • Vaginal tissue: Resulting in discomfort or pain during intercourse.

These symptoms can often be managed with local moisturizers, lubricants, or prescribed treatments.

Long-Term Outlook

The chronic nature of dryness in Sjögren’s requires ongoing management and regular monitoring. Without proper care, complications like corneal damage, oral infections, and significant dental problems can arise. However, with the right treatment plan and support, many individuals successfully manage their symptoms and maintain a good quality of life.

Conclusion

Dry eyes and dry mouth are hallmark symptoms of Sjögren’s syndrome, caused by the immune system’s attack on moisture-producing glands. These symptoms are not only uncomfortable but can lead to further health problems if left untreated. Fortunately, various treatments are available to alleviate dryness and protect against complications. Understanding why dryness occurs in Sjögren’s and how to manage it is essential for improving daily comfort and long-term health outcomes. With attentive care and support, people with Sjögren’s can live active, fulfilling lives despite the challenges of chronic dryness.