Sjogren's Syndrome

I have been told I have Sjogren's Syndrome based on systemic symptoms and a Schirmers Test which showed absolutely no lacrimal secretion at all. The test strips were literally stuck to my eyeball and painful to remove. My ana's were normal but I am waiting the results of the special sjogren's antibody test. I have been told, however, that there is no doubt from my Schirmer Test that I do have at least a mild form of Sjogren's / Sicca even if the blood tests are normal. I just want to ask, I know that certain medications dry the eye particularly as a result of evaporation whereas Sjogren's causes decrease in the aqueous component in particular. I would like to ask if taking Diazepam every other day could cause a total lack of secretion from the lacrimal gland as shown on the Schirmer Test by drying up the aqueous part as well as the evaporation. Or if Diazepam would only cause just the evaporationn only. In other words, is this diagnoses correct, that is to say for the eye to show absolultely no secretion this proves that it can only be Sjogren's. Thank you very much.

[Michael J Kutryb, MD]

The diazepam will definitely make the eyes more dry and worsen dry eye symptoms.  You clearly have dry eyes, so I would try to get off the diazepam and use artificial tears like Thera Tears often.  Consider punctum plugs, oral flax and fish oil supplements, and possible restasis drops.  I would stop the diazepam and if you want have the shirmers test repeated - but if you were that dry before, you're probably going to be dry to some degree regardless.  In the end, I often treat the symptoms as much as the signs and if the patient complains of dry scratchy eyes, I will treat even if the shirmers test shows decent tear production.

MJK MD