What type of doctor diagnoses sjogrens

Your doctor can measure the dryness of your eyes with a test called a Schirmer tear test. A small piece of filter paper is placed under your lower eyelid to measure your tear production.

A doctor specializing in the treatment of eye disorders ophthalmologist might also examine the surface of your eyes with a magnifying device called a slit lamp. He or she may place drops in your eye that make it easier to see damage to your cornea. Your doctor might also do a lip biopsy to detect the presence of clusters of inflammatory cells, which can indicate Sjogren's syndrome.

For this test, a sliver of tissue is removed from salivary glands in your lip and examined under a microscope.

Treatment for Sjogren's syndrome depends on the parts of the body affected. Many people manage the dry eye and dry mouth of Sjogren's syndrome by using over-the-counter eyedrops and sipping water more frequently. But some people need prescription medications, or even surgical procedures.

A minor procedure to seal the tear ducts that drain tears from your eyes punctal occlusion might help relieve your dry eyes. Collagen or silicone plugs are inserted into the ducts to help preserve your tears.

Use artificial tears, an eye lubricant or both. Artificial tears — in eyedrop form — and eye lubricants — in eyedrop, gel or ointment form — help relieve the discomfort of dry eyes. You don't have to apply eye lubricants as often as artificial tears. These dryness symptoms can occur in other conditions — including chronic fatigue syndrome and fibromyalgia — and can be side effects of a variety of commonly used medications. Your doctor must carefully review all of your symptoms to rule out any other potential causes.

These will be in addition to taking a medical history and performing a physical exam, the results of which may determine the tests your doctors will perform. Working with patients in the Jerome L. Information from references 2 through 4 , and 9. However, they provide a useful framework to make a diagnosis. Ocular symptoms at least one of the following symptoms : Daily, persistent, troublesome dry eyes for more than three months.

Oral symptoms at least one of the following symptoms : Daily feeling of dry mouth for more than three months.

Ocular signs positive results from at least one of the following tests : Schirmer test. Salivary gland involvement positive results from at least one of the following tests : Unstimulated whole salivary flow collection less than 1.

Salivary scintigraphy showing delayed uptake, reduced concentration, and delayed excretion of tracer. Ann Rheum Dis. Table 4 lists the differential diagnosis of xerophthalmia and xerostomia, and their distinguishing clinical features. Eyelid margins are erythematous and thickened with crusts and debris within the lashes; usually worse in the morning and improves as the day goes on; does not respond to lubricant drops.

Dryness caused by diminished blinking during long periods of reading, driving, or computer use. Diuretics and anticholinergic medications, including treatments for Parkinson disease, Alzheimer disease, depression, allergic rhinitis, and incontinence. Ocular symptoms e. Decreased salivary flow results from noncaseating granulomas in salivary glands. Information from references 1 , 9 , 10 , and 16 through Eye symptoms are usually evaluated with the Schirmer test or the rose bengal test.

The Schirmer test involves placing a sterile filter paper strip beneath the lower eyelid for five minutes. If the moistened area measures less than 5 mm, the test is positive. The test will identify KCS when minimal ocular symptoms are present. Oral dryness can be evaluated objectively by nonstimulated whole saliva flow collection, in which the patient spits into a graduated test tube every minute for 15 minutes. Collection of less than 1. Treatments can be grouped into regimens for KCS, xerostomia, and systemic manifestations.

Ocular treatment begins with topical tear replacement. Development of a solution that completely simulates human tears, with all of their complex constituents, has not yet been achieved.

If artificial tears do not satisfactorily relieve symptoms, the next step is increasing tear production by stimulating muscarinic receptors, which are a type of cholinergic receptor found on exocrine glands, heart muscle, and smooth muscle. Several randomized trials have shown two muscarinic agonists, pilocarpine Salagen and cevimeline Evoxac , to be effective. Other topical anti-inflammatory medications, such as steroids and cyclosporine Neoral , are of questionable benefit.

Treatment for xerostomia consists of good oral hygiene, salivary stimulation, use of saliva substitutes, and recognition of complications. Xerostomia increases the risk for dental caries and oral infections. Daily topical fluoride use and antimicrobial mouth rinses can help prevent caries in patients with reduced salivary flow.

Xylitol, a naturally occurring sugar substitute, has been shown to decrease dental caries when used in chewing gum in the general population. They contain carboxymethylcellulose, mucin, or glycerine, which help lubricate the oral mucosa. Muscarinic agonists also may be used. An RCT of 44 patients showed that pilocarpine at a dosage of 5 mg four times daily is superior to placebo in improving subjective xerostomia. Although pilocarpine and cevimeline have been shown to reduce symptomatic oral dryness and to produce transient increases in salivary flow, neither drug addresses the underlying disease process or leads to increases in basal nonstimulated salivary flow.

A study on interferon alfa, an immunomodulator, showed an improvement in subjective oral and ocular dryness and an increase in nonstimulated whole saliva flow. The largest trial of these agents showed no improvement in oral dryness, ocular dryness, or objective tests, including the Schirmer test and focus score on labial salivary gland biopsy. Multiple studies have shown an increase in the risk of lymphoproliferative disease, but no increase in all-cause mortality.

Multiple studies have shown that low levels of complement protein C3 or C4 at the time of diagnosis are associated with a higher rate of lymphoproliferative disease and a higher mortality rate.

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