How should I manage a patient with Sjögren's Syndrome who presents with severe dry eyes and mouth?

Management of severe dry eyes and dry mouth in Sjögren's syndrome involves a combination of symptomatic relief and addressing underlying inflammation to prevent complications.

For severe dry eyes, start with frequent use of preservative-free artificial tears during the day and lubricating ointments at night to protect the ocular surface and reduce discomfort ¹. Consider punctal plugs if tear conservation is inadequate, and assess for complications such as corneal ulceration or infection ¹. In cases of significant ocular inflammation, topical immunomodulatory agents like ciclosporin or lifitegrast may be indicated to reduce inflammation and improve tear production (Togizbayev et al., 2025). Regular ophthalmology review is essential to monitor for complications and treatment response ¹.

For severe dry mouth, management includes frequent sips of water, use of saliva substitutes, and meticulous oral hygiene to prevent dental caries and oral infections ¹,². Sugar-free chewing gum or lozenges can stimulate residual salivary function ¹. Pilocarpine or cevimeline, systemic muscarinic agonists, may be considered to enhance salivary secretion if no contraindications exist (Togizbayev et al., 2025). Regular dental review is important to manage complications such as candidiasis and dental decay ¹,².

Systemic treatment with hydroxychloroquine or other immunomodulatory agents may be considered in patients with systemic manifestations or refractory sicca symptoms, guided by specialist rheumatology input (Togizbayev et al., 2025). Patient education on symptom management and regular monitoring for complications is critical ¹.

In summary, management is multidisciplinary, combining local symptomatic treatments for eyes and mouth, systemic therapies for inflammation when indicated, and regular specialist follow-up to prevent and manage complications ¹; (Togizbayev et al., 2025).