Sjogren's Syndrome Symptoms Explained: Dry Mouth & Eyes

Sjögren's syndrome, also called Sjogren’s disease, is an autoimmune disorder. In people with this condition, the immune system attacks the moisture-producing glands in the eyes and mouth that make tears and saliva. This results in symptoms of dry eyes and dry mouth, which are the hallmarks of Sjogren’s (SHOW-grins). 

According to the Sjogren’s Syndrome Foundation, there are about 4 million Americans living with Sjogren’s disease and potentially another 2.5 million who are undiagnosed. There is no cure for Sjogren’s syndrome. Treatment focuses on symptom relief by lubricating the eyes and increasing saliva production.

What Are The Hallmark Symptoms of Sjogren’s Syndrome?  

Common Symptoms: Dry Eyes and Dry Mouth  

The main symptoms of Sjogren’s syndrome are:

• Dry eyes with burning, itching, grittiness (like you have something in your eye), and light sensitivity.

• Dry mouth with a cottony feeling in the mouth and mouth sores which can make it hard to eat and speak.

Other Symptoms of Sjogren’s Syndrome

• Joint pain, swelling, and stiffness

• Tender and swollen glands, especially the submandibular glands located behind the jaw and the parotid glands located in front of the ears

• Dry nose and nosebleeds

• Dry throat and a chronic dry cough

• White patches in the mouth (signs of a fungal infection)

• Trouble swallowing

• Loss of taste

• Dry skin and skin rashes

• Vaginal dryness

• Chronic fatigue 

• Muscle pain and weakness

• Brain fog

• Dental cavities

• Numbness and tingling in the hands and feet

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Causes and Triggers  

Autoimmune Nature and Pathophysiology

As mentioned, Sjogren's syndrome is an autoimmune disease. It often occurs secondarily to other autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), commonly called “lupus.” 

Normally, the immune system protects us against infections. In people with autoimmune diseases, the immune system mistakenly attacks healthy tissues and cells in the body. 

In Sjogren's syndrome, the immune system damages glands in the eyes and mouth that make tears and saliva. But it can also attack other parts of the body, such as the joints, skin, nerves, liver, kidneys, thyroid gland, digestive organs, and lungs.

Genetic and Environmental Factors  

Researchers aren’t sure what triggers autoimmune conditions, but both genetic and environmental factors are involved. Several genes can increase the risk of developing Sjögren's syndrome, and some viral and bacterial infections can act as a trigger for the condition to develop.  

What is the Trigger for Sjogren’s Syndrome?

Primary Sjögren's syndrome is an autoimmune condition and has no known cause or trigger. 

Secondary Sjögren's syndrome is triggered by viral infections such as COVID-19, hepatitis, Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human T-lymphocytic virus (HTLV). Other autoimmune diseases can trigger Sjogren’s syndrome, including lupus, rheumatoid arthritis, and psoriatic arthritis. 

Risk Factors

• Gender: Women are much more likely to develop Sjogren's syndrome than men. About 9 out of 10 Sjogren’s patients are women.

• Age: Sjogren's syndrome can occur at any age, but most people are in their 40s and 50s at the time of diagnosis. While less common, children, younger adults, and older individuals can also be diagnosed with Sjogren's syndrome.

• Rheumatic disease: People with Sjogren’s syndrome commonly have another autoimmune disease such as rheumatoid arthritis or lupus.

Diagnosis of Sjogren’s Disease

Diagnosing Sjogren’s syndrome can be challenging because the signs and symptoms are nonspecific (they can be due to many other medical conditions) and affect the entire body. Your healthcare provider can diagnose Sjogren’s syndrome based on your symptoms, medical history, physical exam, and tests such as:

• Blood tests to check blood cell counts, inflammatory markers, antibody levels, and liver and kidney function.

• Eye tests such as the Schirmer tear test to check tear formation and a slit lamp exam to assess the cornea.

• Imaging tests such as a sialogram or salivary scintigraphy to evaluate swollen salivary glands.

• Lip biopsy to examine a small sample of salivary gland tissue examined under the microscope for evidence of inflammatory cell clusters that may be a sign of Sjogren’s syndrome. Find out What to Expect When Doctors Take a Biopsy. 

Importance of Early Diagnosis

Early diagnosis and treatment of Sjogren’s disease can help to prevent complications such as:

• Vision problems related to dry eyes, such as blurred vision, light sensitivity, and damage to the cornea (the clear outer layer of the eye).

• Dental cavities due to the lack of saliva which protects against cavity-causing bacteria in the mouth. 

• Yeast infection (oral thrush) in the mouth due to dry mouth. Compare yeast infection treatments.

Inflammatory, Neurological, and Lymphatic Complications

Sjögren's syndrome can also cause musculoskeletal and skin diseases and other serious complications such as:

• Nerve damage leading to peripheral neuropathy (numbness, tingling, burning) in the hands and feet.

• Inflammation in other parts of the body (kidneys, liver, lungs): Bronchitis, pneumonia, and other lung problems; decreased kidney function; hepatitis or cirrhosis in the liver.

• Lymphoma (cancer of the lymph nodes) occurs in a small number of people with Sjogren’s syndrome. 

Management: What is the Best Treatment for Sjogren’s Syndrome?

Medications for Sjogren’s Syndrome

Many people with mild Sjogren’s syndrome can manage the dry eye and dry mouth symptoms by using over-the-counter eye drops and sipping on water throughout the day. However, people with moderate to severe Sjögren's syndrome may need prescription medications and even surgery. 

Some of the medications used for treating Sjogren’s syndrome include:

• Prescription eye drops to increase tear production and relieve dryness in the eyes. For example, cyclosporine (Restasis) or lifitegrast (Xiidra). 

• Cholinergic agonists to increase saliva production. For example, pilocarpine (Salagen) and cevimeline (Evoxac).

• Nonsteroidal anti-inflammatory drugs (NSAIDs) and other arthritis medications for joint pain, swelling, and stiffness.

• Antifungal medications for oral thrush (yeast infections in the mouth).

• Anti-rheumatic / antimalarial drugs such as hydroxychloroquine (Plaquenil) to treat body-wide symptoms of Sjogren's syndrome. 

• Drugs such as methotrexate (Trexall) to suppress the immune system.

In addition, your healthcare professional (rheumatologist) will prescribe appropriate treatment for other conditions that develop from complications of Sjogren’s syndrome.

Surgery for Sjogren’s Syndrome

Some people with Sjogren’s syndrome may benefit from a minor surgical procedure to seal off the tear ducts with silicone or collagen plugs. This prevents drainage of tears out of the eyes and helps keep them moist. 

Innovations in Treatment and Future Directions

Some new and emerging treatments for Sjögren's syndrome include:

• Nipocalimab: The U.S. Food and Drug Administration (FDA) granted nipocalimab the “Breakthrough Therapy” designation for treating moderate-to-severe Sjögren's disease in adults. A phase 2 study showed that nipocalimab treatment led to a more than 70% relative average improvement in Sjögren's disease activity compared to placebo. 

• Lanalumab: This is a monoclonal antibody that blocks the activity of B-cell activating factor (BAFF), a protein that is over-produced in Sjogren’s disease. A 2022 study found that Ianalumab improved inflammation, salivary gland production, and dryness in patients with Sjögren's syndrome. 

• PROSE devices and scleral lenses: These devices can help with moderate to severe dry eye syndrome and prevent eye complications related to Sjögren's syndrome. A PROSE device creates a reservoir between the cornea and the lens and bathes and hydrates the eye.

Living with Sjogren's Syndrome  

Artificial tears and eye lubricants for dry eye are available in the form of eyedrops, gels, and ointments. Talk to your eye doctor about using artificial tears without preservatives to avoid irritating dry eyes further. Consider using lubricants overnight if they cause blurry vision. 

For dry mouth, the following methods can improve symptoms:

• Use saliva substitutes (saliva replacement sprays and lozenges) which act as lubricants to keep your mouth moist. 

• Increase fluid intake. Take frequent sips of water throughout the day. Avoid caffeine and alcohol which have a dehydrating effect. Also avoid carbonated drinks and acidic beverages which can cause dental damage. 

• Eat soft, moist foods to avoid irritating your mouth.

• Chew on sugarless gum to stimulate saliva flow. Avoid sugary candies as they can increase the risk of dental cavities. 

• Avoid smoking. Cigarette smoke can dry out and irritate your mouth. 

For dryness in other areas:

• Use a saline nasal spray to moisturize your nasal passages and improve breathing. This will also help to prevent mouth breathing which can have a drying effect. 

• Use vaginal lubricants and moisturizers to relieve vaginal dryness.

• Avoid hot water baths and showers if you have dry skin. Pat, don’t rub, when you dry your skin with a towel. Use a moisturizer on damp skin to seal in the moisture. 

• Wear rubber gloves when doing household chores such as dishwashing and cleaning. 

• Increase humidity indoors and avoid sitting directly in front of a fan or air conditioner. Wear protective eyewear outdoors.

For oral health:

• Brush your teeth twice a day and floss daily.

• Use an antimicrobial mouthwash as recommended by your dentist.

• Get regular dental checkups every 6 months so that dental cavities can be detected and treated early.

What is the Life Expectancy of a Person with Sjogren’s Syndrome?

People with Sjogren's syndrome who only have dry eye and dry mouth symptoms have a life expectancy comparable to people without the condition. However, life expectancy may be lower in people who develop Sjogren’s complications such as lung disease or lymphoma.