Tratamento do olho seco na doença de Sjögren: princípios gerais e terapia inicial

Abstract

Introduction: Sjögren's disease (SjD) is a chronic multisystem inflammatory disorder characterized by impaired lacrimal and salivary gland function, with consequent dryness of the eyes and mouth. A variety of other manifestations of the disease may also be present, including ocular or systemic extraglandular features. Attention to ambient humidity and other environmental factors, attention to medications that exacerbate dryness that are being used for other indications, and the use of physical barriers to prevent drying or irritation of the eyes are important first-line measures. Special attention to ocular exposure and care should be given to patients undergoing surgical procedures. Objectives: discuss the treatment of dry eye in Sjögren's disease. Methodology: Integrative literature review based on scientific databases from Scielo, PubMed and VHL, from January to April 2024, with the descriptors “Treatment”, “dry eye”, “adults” and “Sjogren's syndrome”. Articles from 2019-2024 (total 56) were included, excluding other criteria and choosing 5 full articles. Results and Discussion: Patients with Sjögren's disease (SjD) benefit from multidisciplinary care. An ophthalmologist must evaluate and manage dry eye in patients with SjD for several reasons. Several tests to diagnose and monitor dry eye, including ocular surface coloration and tear breakup time, require a slit lamp and therefore an eye exam. Furthermore, hydroxychloroquine therapy, if prescribed for systemic manifestations of the disease, needs to be monitored at least annually for potential retinal toxicity. For most patients with SjD, we recommend regular use of artificial tears as needed; identifying the agent that provides the most comfort for an individual patient is best determined by trying different agents. At night, a longer-acting lubricating ointment may be helpful. In patients with increased irritation of the eye with the use of artificial tears containing preservatives, stabilizers, or solubilizers, and in patients requiring artificial tears and other topical ocular medications containing preservatives more than four times a day, an alternative preparation should be tried. that is preservative-free or contains a different preservative. Blepharitis can complicate SjD, and increased ocular irritation due to lid margin inflammation and infection may be misinterpreted as an inadequate response to therapies. It is important to differentiate from aqueous tear deficiency because it requires separate treatment rather than intensified ocular lubricant therapy. Blepharitis is often associated with redness of the eyelids, episodes of excessive tearing, and evidence of meibomian gland blockage and telangiectasia. Blepharitis can be improved with warm compresses with or without topical/oral antibiotics. Patients with SjD may be at greater risk compared to the general population if they undergo certain ophthalmologic procedures, including keratoplasty and blepharoplasty. Laser treatment of refractive errors, such as LASIK or PRK, is contraindicated in patients with SjD. Surgeons performing blepharoplasty should be aware of dry eye syndrome, as elective eyelid surgery can aggravate subclinical disease and markedly worsen dry eye. Conclusion: It is a chronic multisystem inflammatory disorder characterized by impaired lacrimal and salivary gland function, with consequent dryness of the eyes and mouth. SjD can occur alone or in association with other autoimmune rheumatic conditions, including rheumatoid arthritis and systemic lupus erythematosus.