When should I consider referring a patient with suspected Sjögren's Syndrome to a specialist?

Consider referring a patient with suspected Sjögren's syndrome to a specialist if:

• There is suspicion of an underlying systemic condition such as Sjögren's syndrome in a patient presenting with dry eye symptoms or other related features.
• The diagnosis is uncertain, especially if the patient is a child with unexplained symptoms or suspected corneal changes.
• Symptoms are persistent or severe and do not respond to primary care management after 4 to 12 weeks, depending on clinical judgement.
• There are abnormal eyelid anatomy or function contributing to symptoms.

Specialist assessment may include detailed ocular examination and specific tests such as Schirmer test, tear break-up time, tear osmolarity, ocular surface staining, and lacrimal gland function tests, which require specialist equipment and expertise.

Referral urgency should be guided by clinical judgement, considering disease severity and impact on the patient.

These recommendations are based on the UK College of Optometrists clinical management guideline, the American Academy of Ophthalmology clinical guideline, and NICE technology appraisal guidance for dry eye disease.

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