Dry eyes and mouth can be sign of autoimmune disorder

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Dry eyes and mouth can be sign of autoimmune disorder
April 01, 2008 07:00 by Dr. Marla Shapiro

A lot of my patients complain about dry mouth and, on occasion, dry eyes. I remember during my chemotherapy, my eyes were so dry that they constantly produced tears as my body attempted to protect my corneas from damage. I could not wear contact lenses and I was constantly aware of a sense of dryness and burning. My mouth often felt dry, as well. Dryness of the mouth can be caused by many things. A recent review by the Mayo Clinic pointed out the fact that many medications, such as antihistamines, certain antidepressants, diuretics and other high blood pressure medications, can cause dry mouth as a side effect. But there is also a relatively unknown but common syndrome that can cause both dry eyes and dry mouth.

The syndrome is called Sjögren’s syndrome. This is an autoimmune disease. As in other autoimmune illnesses, the body does not recognize itself and attacks and can damage the salivary glands, the tear glands and other mucous-secreting glands, leading to excessive dryness. It can also cause arthritis, fatigue, weak muscles and neuropathy. As with other autoimmune disease, other organs can also be damaged through the autoimmune process.

The Canadian Arthritis Society estimates as many as 430,000 Canadians are affected. This is a difficult disease to diagnose and often is not on our radar screen. It is thought that it can take up to six to nine years to actually diagnose from the start of symptoms.

Nine out of 10 afflicted with the disease are typically women between the ages of 35 to 65. However, the disease has been described in children as well. Other risk factors include having a family history of the disease and having other rheumatic diseases such as lupus or rheumatoid arthritis.

Symptoms
Symptoms include dry eyes that might feel gritty or burning. There can be dry mouth and common oral yeast infections. With dryness of the mouth there is an increased risk of dental cavities and poor oral hygiene. Your sense of taste or smell might be altered. Your salivary glands, which sit around your jaw, might be swollen as well. Any mucous membrane can get dry, so that can present with a dry or cracked nose, dry tongue, dry skin and vaginal dryness. In addition, since Sjögren’s syndrome can have systemic effects, the symptoms can vary based on the system that is affected. Those symptoms can be as varied as joint or muscle aches, frequent upper respiratory tract infections and sinusitis. In addition, lymphoma (lymph node cancer) can be seen much more frequently in this diagnosed group compared to the general population. Some studies quote as many as 10 per cent of these patients might have a concurrent diagnosis of lymphoma at some point.

Diagnosis
Diagnosis is undertaken by the history itself, the findings on clinical examinations and a series of tests. Those tests include blood tests, ophthalmologic assessment, salivary gland function and flow tests and, on occasion, biopsy of an affected area.

Treatment
There are both over-the-counter and prescription preparations that can be used. Prescriptions include drugs for inflammation; in particular drugs to help with salivary flow, eye drops and immune suppressant medication. Increasing your fluid intake, using topical moisturizers and being in a humid environment are also helpful. It is important not to smoke and maintain good oral hygiene. As this is a chronic illness, it will require ongoing supervision and management.