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Medical Author:

Kanchan Pema, MD

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Many of the most widely used preparations in Sjögren's syndrome are available over the counter (without a prescription). Most of these treatments are used on a "trial and error" basis. Often a specific brand of a product will work for an individual while another brand will not work as well. It is worth trying different products to find the ones that work best for you.

Artificial tears

Artificial tears should be applied liberally for dry eyes. These products are safe and may be used as often as needed. They are available without prescription at pharmacies. They all contain water, salts, thickening agents, stabilizers, and pH buffers. Examples include Celluvisc, Murine, Refresh, and Tears Naturale.

• You may need to apply artificial tears more often if you enter an environment with low humidity (such as air conditioned rooms and airplanes).



• Artificial-tear preparations with hydroxymethylcellulose or dextran are more viscous and may last longer before reapplication is needed. An example is hydroxypropyl methylcellulose (Lacrisert).



• Some artificial-tear preparations contain preservatives to protect against infection. Preservatives may be noxious to the eye surface and can cause a burning sensation when used more often than four times a day. You may want to use a preservative-free preparation to avoid eye irritation if you need to use artificial tears more frequently. These are packaged in one-time-use dispensers. Once the seal is opened, it should not be used again.



• If your eyes are matted closed when you wake up in the morning, try a more viscous preparation, such as Lacri-Lube, at night. While the more viscous preparations can be applied less often, they can make your vision filmy. Therefore, they are best used at night.



• The more viscous preparations can occasionally lead to blepharitis (inflammation of the eyelid), which can make sicca symptoms worse. Important to use only 1/8 inch (3 mm) of the ointment because overuse can block the tear ducts.



• Restasis (cyclosporin A) is a prescription eyedrop treatment. It decreases inflammation in the eye and also allows the gland's function to recover. It may take at least three to six months before you notice any improvement.



• With advanced disease, other therapies include antibiotics, autologous (derived from patient's own body) serum, systemic anti-inflammatory therapy including acetylcysteine, and topical vitamin A.

Artificial saliva

Artificial saliva can be used as needed for dry mouth. Some people do not tolerate these preparations very well. Try different products, such as Salivart, Saliment, Saliva Substitute, MouthKote, and Xero-Lube, to find one that works for you.

• See your dentist regularly. You may need to have preventive treatments more often than the standard six months. Your dentist may advise fluoride treatments. Use a toothpaste without detergents to reduce mouth irritation. Brands include Biotene toothpaste, Biotene mouth rinse, Dental Care toothpaste, and Oral Balance gel.



• Dry mouth increases your susceptibility to oral infections. Watch for thrush (redness with overlying white patches) and tender sores that don't heal quickly. If you develop these conditions frequently, keep topical antifungal agents, such as nystatin troches, on hand and use them as needed. Fluconazole (Diflucan), an antifungal medication taken in pill form, may be needed occasionally.



• Seek treatment for sinusitis or blocked sinuses, because these problems may contribute to mouth breathing, which can worsen drying of the mouth.



• A humidifier may help keep your mouth moist.



• Systemic medications that can increase salivation may be needed if topical therapy does not work.

Other treatments

Skin, nose, and vaginal dryness often can be relieved with topical treatments.

• Skin creams, such as Eucerin, or lotions, such as Lubriderm, can help with dry skin.



• Saline nasal sprays can help keep the inside of the nose moist. Decongestant sprays should be avoided, as these can worsen the dryness.



• Vaginal lubricants, such as Replens, may be used to treat vaginal dryness.



• Postmenopausal women can use vaginal estrogen creams in some cases.



• Women with Sjögren's syndrome may be susceptible to vaginal yeast infections, which should be treated promptly.



• Reflux (heartburn) is common in people with Sjogren's and is treated similarly to other people.



• Fatigue may be a symptom on its own or accompanied by vague symptoms of poor concentration, muscle aching and impaired memory. This may suggest fibromyalgia. See treatment section of fibromyalgia.

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