No tears - Sjogren's Syndrome
Dr Sampurna Roy MD
Humans are the only species who have the capacity to shed emotional tears.
Dry eye is a classic diagnostic feature of Sjogren's Syndrome.
Sjögren’s syndrome is a chronic and progressive systemic autoimmune disease that primarily involves lacrimal and salivary glands. Involvement of extraglandular sites like thyroid, kidney and lungs is common in this condition.
The disease also affects gastrointestinal tract and many patients have difficulty in swallowing. The submucosal glands of the esophagus are infiltrated by lymphocytes.
Sjögren’s syndrome can occur alone (primary SS) or in association with another underlying autoimmune disease (secondary SS), typically rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis (scleroderma), or polymyositis.
The patients often presents initially with symptoms of dry eye (keratitis sicca or keratoconjunctivitis sicca) and dry mouth (xerostomia).
Microscopic examination of the major and minor salivary glands show non-specific sialadenitis. Well defined germinal centres are rare. The lymphoid infiltrates destroy acini and ducts. Ducts are dilated and filled with cellular debris. The stroma of the gland is preserved in Sjögren’s syndrome. This appearance helps to differentiate this disorder from a lymphoma. Image