More than just dry eyes

Linda Phillips usually feels like she's standing in the Sahara Desert in a sandstorm: Her eyes are dry and achy and closing them is "excruciating."

She ignored it for a while, blaming years with hard contact lenses. But a few years ago, after visits to various eye specialists and other types of doctors, Dr. Majid Moshirfar, a Moran Eye Center ophthalmologist, diagnosed Sjogren's syndrome. That's a chronic, serious autoimmune disease caused when white blood cells destroy moisture-producing glands, resulting in painfully dry eyes and dry mouth and sometimes dry organs, including the kidneys, lungs and liver, among others.

The Sjogren's Syndrome Foundation list of symptoms includes burning, gritty dry eyes; trouble talking, chewing or swallowing; a dry, sore tongue or throat; increased dental decay; joint pain; digestive trouble; dry skin or fatigue. It's different for everyone.

It's often a missed diagnosis because it mimics other conditions, but about 4 million Americans, mostly women over 40, have Sjogren's. It may occur alone or with a connective tissue disease, such as rheumatoid arthritis, lupus or scleroderma. It affects the entire body, ranging from mild to disabling like Phillips'.

Moshirfar measured her tear production and performed other tests. He used dye to look for abnormal cells and damage on the eyes' surfaces. Blood tests may be used to diagnose Sjogren's. Dentists test for it by measuring saliva production, and may order a salivary-gland function test, X-ray of the salivary-duct system and/or a lip biopsy. Many people need extensive dental work because the lack of saliva, which protects the teeth, leads to severe decay.

Various dry-eye syndromes, says Moshirfar, are more prevalent than people realize and much more complex. They don't all result from inadequate lubrication. Some patients make more tears than normal, but they evaporate too quickly. Inflammation plays a role, not yet well understood, for some. The National Institutes of Health defines dry-eye syndrome as an ocular inflammatory disease that can seriously damage the eye. And it's not unique to humans, either. Bulldogs, for instance, have a terrible time with inflamed, dry eyes.

Many ophthalmologists, like Moshirfar, wonder about the immune system and about hormonal changes and other factors.