Sjögren Disease and the Corneal Surface

ABSTRACT: Dry eye in Sjögren disease is characterized by lacrimal gland dysfunction, often resulting in decreased lacrimal fluid secretion, tear film thinning, epithelial cell damage, and ocular surface inflammation. Beyond lacrimal gland impairment, corneal nerves play a crucial role in the disease, with patients exhibiting a spectrum of symptoms depending on structural and functional nerve abnormalities. Two phenotypes are recognized in patients with Sjögren disease: one with diminished symptoms despite worsening clinical signs (neurotrophic aspect), and another with heightened symptoms such as hyperalgesia or photoallodynia that are disproportionate to clinical findings (neuropathic aspect). A comprehensive understanding of corneal nerve status may enable more personalized treatment approaches.