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Primary Sjögren syndrome — SCE Rheumatology MCQ

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ModerateConnective tissue diseasesPrimary Sjögren syndromeSCE Rheumatology

A 58-year-old woman with primary Sjögren disease has persistent severe ocular dryness despite frequent preservative-free lubricant eye drops and a lubricating ointment at night. Slit-lamp examination shows marked punctate epithelial keratitis, with no evidence of ocular infection. She has no active systemic organ involvement. What is the most appropriate next management?

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Correct answer: E — Arrange ophthalmology-led topical ciclosporin therapy

The correct answer is E. Persistent dry eye with punctate epithelial keratitis despite adequate tear substitutes represents refractory inflammatory ocular-surface disease. UK-licensed topical ciclosporin is indicated for moderate-to-severe keratoconjunctivitis sicca unresponsive to tear substitutes and should be initiated and supervised by ophthalmology. Punctal occlusion or serum tears may subsequently be considered by the eye team according to ocular-surface findings. Pilocarpine can improve generalized sicca symptoms but is not an adequate substitute for treating established corneal inflammation. Hydroxychloroquine has no established role for isolated keratoconjunctivitis sicca. Long-term systemic glucocorticoids and biological therapy, including etanercept, are inappropriate in the absence of active systemic organ disease.

Reference: Vevizye 1 mg/mL eye drops, Summary of Product Characteristics, sections 4.1–4.2, updated 17 November 2025. https://www.medicines.org.uk/emc/product/101529/smpc