Clinical Reviews in Allergy & Immunology

, Volume 49, Issue 3, pp 288–297 | Cite as

Current Approach to Dry Eye Disease

  • Valéria ValimEmail author
  • Virginia Fernandes Moça Trevisani
  • Jacqueline Martins de Sousa
  • Verônica Silva Vilela
  • Rubens BelfortJr


Dry eye disease (DED) is a multifactorial disease of the tears and ocular surface that causes tear film instability with potential damage to the ocular surface. The prevalence of dry eye in the world population ranges from 6 to 34 %. It is more common in those aged over 50, and affects mainly women. Since the introduction of the Schirmer’s test in 1903, other tests have been developed to evaluate dry eye, such as biomicroscopy, the tear film breakup time (BUT), vital dyes (lissamine green and rose bengal), fluorescein, leaf fern test, corneal sensitivity test, conjunctiva impression cytology, optical coherence tomography (OCT), and tear osmolarity measurement. Although there is no gold standard, it is advisable to combine at least two tests. Strategies for treating DED have recently been modified and include patient education, tear substitute, corticosteroids, secretagogues, fatty acids, immunomodulators, occlusion of lacrimal puncta surgery and, tarsorrhaphy. Biological therapy and new topical immunomodulators such as tacrolimus, tofacitinib and IL-1 receptor inhibitor are being tested. In this review, the evaluation tests for dry eye are compared and the main studies on treatment are presented, with emphasis on studies in patients with Sjögren’s syndrome. The authors propose an approach for the management of dry eye.


Dry eye disease Sjögren’s syndrome Cornea Ocular surface 


Conflict of interest

The authors declare that they have no conflicts of interest concerning this article.


  1. 1.
    The definition and classification of dry eye disease: report of the definition and classification subcommittee of the international dry eye workshop (2007) Ocul Surf 2007; 5(2): 75–92Google Scholar
  2. 2.
    Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD (2012) Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea 31:472–478CrossRefPubMedGoogle Scholar
  3. 3.
    Fonseca EC, Arruda GV, Rocha EM (2010) Olho seco: etiopatogenia e tratamento/Dry eye: ethyopathogenesis and treatment. Arq Bras Oftalmol 73:197–203CrossRefPubMedGoogle Scholar
  4. 4.
    Davies JB, Prakabar KT (2008) Ocular manifestations of systemic lupus erythematosus. Curr Opin Rheumatol 19:178–181Google Scholar
  5. 5.
    Waszczykpwaska A, Gos R, Waszczykpwaska E, Dziankowska-Bartkowiak B, Jurowski P (2013) Prevalence of ocular manifestations in systemic sclerosis patients. Arch Med Sci 9:1107–1113CrossRefGoogle Scholar
  6. 6.
    Fox RI (1994) Systemic diseases associated with dry eye. Int Ophtalmol Clin 34:37–56CrossRefGoogle Scholar
  7. 7.
    Fox R, Creamer P (2012) Clinical manifestations of Sjögren’s syndrome: exocrine gland disease. Wolters Kluwer Healt 7:210–235Google Scholar
  8. 8.
    Felberg S, Dantas PEC (2006) Diagnóstico e tratamento da síndrome de Sjõgren/Sjögren’s syndrome: diagnosis and treatment. Arq Bras Oftalmol 69:959–963CrossRefPubMedGoogle Scholar
  9. 9.
    Kassan SS, Moutsopoulos HM (2004) Clinical manifestations and early diagnosis of Sjögren’s syndrome. Arch Intern Med 164:1275–1284CrossRefPubMedGoogle Scholar
  10. 10.
    Van Landingham SW, West SK, Akpek EK, Muñoz B, Ramulu PY (2014) Impact of dry eye on reading in a population based sample of the elderly: the Salisbury Eye Evaluation. Br J Ophthalmol 98:639–644CrossRefPubMedGoogle Scholar
  11. 11.
    Paulsen AJ, Cruickshanks KJ, Fischer ME, Huang GH, Klein BE, Klein R, Dalton DS (2014) Dry eye in the beaver dam offspring study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol 157:799–806PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    The epidemiology of dry eye disease: report of the epidemiology subcommittee of the international dry eye workshop. Ocul Surf 2007; 5: 93–107Google Scholar
  13. 13.
    Schaumberg DA, Dana R, Buring JE, Sullivan DA (2009) Prevalence of dry eye disease among US Men: estimates from the physicians’ health studies. Arch Ophthalmol 127:763–785PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Galor A, Kumar N, Feuer W, Lee DJ (2014) Environmental factors affect the risk of dry eye syndrome in a United States veteran population. Ophthalmology 121:972–973CrossRefPubMedGoogle Scholar
  15. 15.
    Bron AJ, Tomlinson A, Foulks GN, Pepose JS, Baudouin C, Geerling G, Nichols KK, Lemp MA (2014) Rethinking dry eye disease: a perspective on clinical implications. Ocul Surf 12(2 Suppl):S1–S31CrossRefPubMedGoogle Scholar
  16. 16.
    Oden NL, Lilienfeld DE, Lemp MA, Nelson JD, Ederer F (1998) Sensitivity and specificity of a screening questionnaire for dry eye. Adv Exp Med Biol 438:807–820CrossRefPubMedGoogle Scholar
  17. 17.
    Bowman SJ, Booth DA, Platts RG, Field A, Rostron J, UK Sjögren’s Interest Group (2003) Validation of the sicca symptoms inventory for clinical studies of Sjögren’s syndrome. J Rheumatol 30:1259–1266PubMedGoogle Scholar
  18. 18.
    Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL (2000) Reliability and validity of the ocular surface disease index. Arch Ophthalmol 118:615–621CrossRefPubMedGoogle Scholar
  19. 19.
    Zeev MS, Miller DD, Latkany R (2014) Diagnosis of dry eye disease and emerging technologies. Clin Ophthalmol 2:581–590Google Scholar
  20. 20.
    Barboza MN, Barboza GN, de Melo GM et al (2008) Correlation between signals and symptoms of dry eye in Sjögren’s syndrome patients. Arq Bras Oftalmol 71:547–552CrossRefPubMedGoogle Scholar
  21. 21.
    Adatia FA, Michaeli-Cohen A, Naor J, Caffery B, Bookman A, Slomovic A (2004) Correlation between corneal sensitivity, subjective dry eye symptoms and corneal staining in Sjögren’s syndrome. Can J Ophthalmol 39:767–771CrossRefPubMedGoogle Scholar
  22. 22.
    Fox R, Kang HI (1992) Pathogenesis of Sjögren’s syndrome. Rheum Dis Clin N Am 18:517–538Google Scholar
  23. 23.
    Schirmer O (2003) Studien zur physiologie und pathologie der tranen-absonderung und tranenabfuhr. Arch Clin Exp Ophthalmol 56:197–291CrossRefGoogle Scholar
  24. 24.
    Versura P, Frigato M, Cellini M, Mulè R, Malavolta N, Campos EC (2007) Diagnostic performance of tear function tests in Sjogren's syndrome patients. Eye (Lond) 21:229–237CrossRefGoogle Scholar
  25. 25.
    de Monchy I, Gendron G, Miceli C, Pogorzalek N, Mariette X, Labetoulle M (2011) Combination of the Schirmer I and phenol red thread tests as a rescue strategy for diagnosis of ocular dryness associated with Sjögren's syndrome. Invest Ophthalmol Vis Sci 52:5167–5173CrossRefPubMedGoogle Scholar
  26. 26.
    Vitali C, Moutsopoulos HM, Bombardieri S (1994) The European community study group on diagnostic criteria for Sjögren's syndrome. Sensitivity and specificity of tests for ocular and oral involvement in Sjögren’s syndrome. Ann Rheum Dis 53:637–647PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Lemp MA (1982) Breakup of the tear film. Int Ophthalmol Clin 13:97–102CrossRefGoogle Scholar
  28. 28.
    Caffery B, Simpson T, Wang S et al (2010) Rose bengal staining of the temporal conjunctiva differentiates Sjögren's syndrome from keratoconjunctivitis sicca. Invest Ophthalmol Vis Sci 51:2381–2387CrossRefPubMedGoogle Scholar
  29. 29.
    Knezović I, Alajbeg I, Karlović D, Pavan J, Vrkić N, Bisćan A (2011) Differential diagnostic performance of Rose Bengal Score Test in Sjøgren's syndrome patients. Coll Antropol 35:1105–1113PubMedGoogle Scholar
  30. 30.
    Klaassen-Broekema N, Mackor AJ, van Bijsterveld OP (1992) The diagnostic power of the tests for tear gland related keratoconjunctivitis sicca. Neth J Med 40:113–116PubMedGoogle Scholar
  31. 31.
    Manning FJ, Wehrly SR, Foulks GN (1995) Patient tolerance and ocular surface staining characteristics of lissamine green versus rose bengal. Ophthalmology 102:1953–1957CrossRefPubMedGoogle Scholar
  32. 32.
    Hamrah P, Alipour F, Jiang S, Sohn JH, Foulks GN (2011) Optimizing evaluation of Lissamine Green parameters for ocular surface staining. Eye 25:1429–1434PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Feenstra RP, Tseng SC (1992) Comparison of fluorescein and rose bengal staining. Ophthalmology 99:605–617CrossRefPubMedGoogle Scholar
  34. 34.
    Begley C, Simpson T, Liu H et al (2013) Quantitative analysis of tear film fluorescence and discomfort during tear film instability and thinning. Invest Ophthalmol Vis Sci 54:2645–2653PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Fenner BJ, Tong L (2013) Corneal staining characteristics in limited zones compared with whole cornea documentation for the detection of dry eye subtypes. InvestigOpthalmol Vis Sci 54:8013–8019Google Scholar
  36. 36.
    Whitcher JP, Shiboski CH, Shiboski SC, Sjögren's International Collaborative Clinical Alliance Research Groups et al (2010) A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry. Am J Ophthalmol 149:405–415PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Tabbara KF, Okumoto M (1982) Ocular ferning test: a qualitative test for mucus deficiency. Ophthalmology 89:712–714CrossRefPubMedGoogle Scholar
  38. 38.
    Cochet P, Bonnet R (1961) Corneal esthesiometry, performance and practical importance. Bull Soc Ophtalmol Fr 6:541–550PubMedGoogle Scholar
  39. 39.
    Bourcier T, Acosta MC, Borderie V et al (2005) Decreased corneal sensitivity in patients with dry eye. Investig Ophtalmol Vis Sci 46:2341–2345CrossRefGoogle Scholar
  40. 40.
    Dart J (1997) Impression cytology of the ocular surface: research tool or routine clinical investigation? Br J Ophtalmol 81:930CrossRefGoogle Scholar
  41. 41.
    Lee SY, Han SJ, Nam SM et al (2013) Analysis of tear cytokines and clinical correlations in Sjögren syndrome dry eye patients and non-Sjögren syndrome dry eye patients. Am J Ophthalmol 156:247–253CrossRefPubMedGoogle Scholar
  42. 42.
    Utine CA, Bıçakçıgil M, Yavuz S, Çiftçi F (2011) Tear osmolarity measurements in dry eye related to primary Sjögren's syndrome. Curr Eye Res 36:683–690CrossRefPubMedGoogle Scholar
  43. 43.
    von Thun Und Hohenstein-Blaul N, Funke S, Grus FH (2013) Tears as a source of biomarkers for ocular and systemic diseases. Exp Eye Res 117:126–137CrossRefGoogle Scholar
  44. 44.
    Kanellopoulos AJ, Asimellis G (2014) In vivo 3-dimensional corneal epithelial thickness mapping as an indicator of dry eye: preliminary clinical assessment. Am J Ophthalmol 157:63–68CrossRefPubMedGoogle Scholar
  45. 45.
    Foulks GN, Pflugfelder SC (2014) New testing options for diagnosing and grading dry eye disease. Am J Ophthalmol. doi: 10.1016/j. ajo.2014.03.002 PubMedCentralGoogle Scholar
  46. 46.
    Behrens A, Doyle JJ, Stern L, Dysfunctional tear syndrome study group et al (2006) Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea 25:900–907CrossRefPubMedGoogle Scholar
  47. 47.
    Baudouin C, Aragona P, Van Setten G et al (2014) ODISSEY European consensus group members. Diagnosing the severity of dry eye: a clear and practical algorithm. Br J Ophthalmol. doi: 10.1136/bjophthalmol-2013-304619 PubMedCentralGoogle Scholar
  48. 48.
    Alves M, Fonseca EC, Alvers MF et al (2013) Dry eye disease treatment: a systematic review of published trials and a critical appraisal of therapeutic strategies. Ocul Surf 11:181–192CrossRefPubMedGoogle Scholar
  49. 49.
    Papas AS, Sherrer YS, Charney M et al (2004) Successful treatment of dry mouth and dry eye symptoms in Sjögren's syndrome patients with oral pilocarpine: a randomized, placebo-controlled, dose-adjustment study. J Clin Rheumatol 10:169–177CrossRefPubMedGoogle Scholar
  50. 50.
    Petrone D, Condemi JJ, Fife R, Gluck O, Cohen S, Dalgin P (2002) A double-blind, randomized, placebo-controlled study of cevimeline in Sjögren's syndrome patients with xerostomia and keratoconjunctivitis sicca. Arthritis Rheum 46:748–754CrossRefPubMedGoogle Scholar
  51. 51.
    Fife RS, Chase WF, Dore RK (2002) Cevimeline for the treatment of xerostomia in patients with Sjögren syndrome: a randomized trial. Arch Intern Med 162:1293–1300CrossRefPubMedGoogle Scholar
  52. 52.
    Ono M, Takamura E, Shinozaki K et al (2004) Therapeutic effect of cevimeline on dry eye in patients with Sjögren's syndrome: a randomized, double-blind clinical study. Am J Ophthalmol 138:6–17CrossRefPubMedGoogle Scholar
  53. 53.
    Leung KC, McMillan AS, Wong MC, Leung WK, Mok MY, Lau CS (2008) The efficacy of cevimeline hydrochloride in the treatment of xerostomia in Sjögren's syndrome in southern Chinese patients: a randomised double-blind, placebo-controlled crossover study. Clin Rheumatol 27:429–436CrossRefPubMedGoogle Scholar
  54. 54.
    Aragona P, Bucolo C, Spinella R, Giuffrida S, Ferreri G (2005) Systemic omega-6 essential fatty acid treatment and pge1 tear content in Sjögren's syndrome patients. Invest Ophthalmol Vis Sci 46:4474–4479CrossRefPubMedGoogle Scholar
  55. 55.
    Pinheiro MN Jr, dos Santos PM, dos Santos RC, Barros JN, Passos LF, Cardoso Neto J (2007) Oral flaxseed oil (Linum usitatissimum) in the treatment for dry-eye Sjögren's syndrome patients. Arq Bras Oftalmol 70:649–655CrossRefPubMedGoogle Scholar
  56. 56.
    Manthorpe R, Hagen Petersen S, Prause JU (1984) Primary Sjögren's syndrome treated with Efamol/Efavit. A double-blind cross-over investigation. Rheumatol Int 4:165–167CrossRefPubMedGoogle Scholar
  57. 57.
    Oxholm P, Manthorpe R, Prause JU, Horrobin D (1986) Patients with primary Sjögren's syndrome treated for two months with evening primrose oil. Scand J Rheumatol 15:103–108CrossRefPubMedGoogle Scholar
  58. 58.
    Theander E, Horrobin DF, Jacobsson LT, Manthorpe R (2002) Gammalinolenic acid treatment of fatigue associated with primary Sjögren's syndrome. Scand J Rheumatol 31:72–79CrossRefPubMedGoogle Scholar
  59. 59.
    Fox PC, Datiles M, Atkinson JC, Macynski AA, Scott J, Fletcher D, Valdez IH, Kurrasch RH, Delapenha R, Jackson W (1993) Prednisone and piroxicam for treatment of primary Sjögren's syndrome. Clin Exp Rheumatol 11:149–156PubMedGoogle Scholar
  60. 60.
    Fox RI, Chan E, Benton L, Fong S, Friedlaender M, Howell FV (1988) Treatment of primary Sjögren’s syndrome with hydroxychloroquine. Am J Med 85(4A):62–67CrossRefPubMedGoogle Scholar
  61. 61.
    Kruize AA, Hené RJ, Kallenberg CG, van Bijsterveld OP, van der Heide A, Kater L, Bijlsma JW (1993) Hydroxychloroquine treatment for primary Sjögren's syndrome: a two year double blind crossover trial. Ann Rheum Dis 52:360–364PubMedCentralCrossRefPubMedGoogle Scholar
  62. 62.
    Yavuz S, Asfuroğlu E, Bicakcigil M, Toker E (2011) Hydroxychloroquine improves dry eye symptoms of patients with primary Sjogren's syndrome. Rheumatol Int 31:1045–1049CrossRefPubMedGoogle Scholar
  63. 63.
    Sankar V, Brennan MT, Kok MR, Leakan RA, Smith JA, Manny J, Baum BJ, Pillemer SR (2004) Etanercept in Sjögren's syndrome: a twelve-week randomized, double-blind, placebo-controlled pilot clinical trial. Arthritis Rheum 50:2240–2245CrossRefPubMedGoogle Scholar
  64. 64.
    Mariette X, Ravaud P, Steinfeld S, Baron G, Goetz J, Hachulla E, Combe B, Puéchal X, Pennec Y, Sauvezie B, Perdriger A, Hayem G, Janin A, Sibilia J (2004) Inefficacy of infliximab in primary Sjögren's syndrome: results of the randomized, controlled Trial of Remicade in Primary Sjögren's Syndrome (TRIPSS). Arthritis Rheum 50:1270–1276CrossRefPubMedGoogle Scholar
  65. 65.
    Meijer JM, Meiners PM, Vissink A, Spijkervet FK, Abdulahad W, Kamminga N, Brouwer E, Kallenberg CG, Bootsma H (2010) Effectiveness of rituximab treatment in primary Sjögren's syndrome: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 62:960–968CrossRefPubMedGoogle Scholar
  66. 66.
    Devauchelle-Pensec V, Cagnard N, Pers JO, Youinou P, Saraux A, Chiocchia G (2010) Gene expression profile in the salivary glands of primary Sjögren's syndrome patients before and after treatment with rituximab. Arthritis Rheum 62:2262–2271CrossRefPubMedGoogle Scholar
  67. 67.
    Carubbi F, Cipriani P, Marrelli A, Benedetto P, Ruscitti P, Berardicurti O, Pantano I, Liakouli V, Alvaro S, Alunno A, Manzo A, Ciccia F, Gerli R, Triolo G, Giacomelli R (2013) Efficacy and safety of rituximab treatment in early primary Sjögren's syndrome: a prospective, multi-center, follow-up study. Arthritis Res Ther 15(5):R172PubMedCentralCrossRefPubMedGoogle Scholar
  68. 68.
    Lee JH, Ahn HS, Kim EK, Kim TI (2011) Efficacy of sodium hyaluronate and carboxymethylcellulose in treating mild to moderate dry eye disease. Cornea 30:175–179CrossRefPubMedGoogle Scholar
  69. 69.
    Rolando M, Autori S, Badino F, Barabino S (2009) Protecting the ocular surface and improving the quality of life of dry eye patients: a study of the efficacy of an HP-guar containing ocular lubricant in a population of dry eye patients. J Ocular Pharmacol Ther 25:271–278CrossRefGoogle Scholar
  70. 70.
    Brignole F, Pisella PJ, Dupas B et al (2005) Efficacy and safety of 0.18 % sodium hyaluronate in patients with moderate dry eye syndrome and superficial keratitis. Graefes Arch Clin Exp Ophthalmol 243:531–538CrossRefPubMedGoogle Scholar
  71. 71.
    Aragona P, Papa V, Micali A et al (2002) Long-term treatment with sodium hyaluronate-containing artificial tears reduces ocular surface damage in patients with dry eye. Br J Ophthalmol 86:181–184PubMedCentralCrossRefPubMedGoogle Scholar
  72. 72.
    Salib GM, McDonald MB, Smolek M (2006) Safety and efficacy of cyclosporine 0.05 % drops versus unpreserved artificial tears in dry-eye patients having laser in situ keratomileusis. J Cataract Refract Surg 32:772–778CrossRefPubMedGoogle Scholar
  73. 73.
    Sall K, Stevenson OD, Mundorf TK, Reis BL (2000) Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. Ophthalmology 107:631–639CrossRefPubMedGoogle Scholar
  74. 74.
    Sall KN, Cohen SM, Dhristensen MT, Stein JM (2006) An evaluation of the efficacy of a cyclosporine-based dry eye therapy when used with market artificial tears as supportive therapy in dry eye disease. Eye Contact Lens 32:21–26CrossRefPubMedGoogle Scholar
  75. 75.
    Gunduz K, Ozdemir O (1994) Topical cyclosporin treatment of keratoconjunctivitis sicca in secondary Sjogren’s syndrome. Acta Ophthalmol (Copenh) 72:438–442CrossRefGoogle Scholar
  76. 76.
    Ramos-Casals M, Tzioufas AG, Stone JH, Sisó A, Bosch X (2010) Treatment of primary Sjögren syndrome: a systematic review. JAMA 28:452–460CrossRefGoogle Scholar
  77. 77.
    Yavuz B, Bozdağ Pehlivan S, Unlü N (2012) An overview on dry eye treatment: approaches for cyclosporin a delivery. Sci World J 24:1–11CrossRefGoogle Scholar
  78. 78.
    Aragona P, Spinella R, Rania L et al (2013) Safety and efficacy of 0.1 % clobetasone butyrate eyedrops in the treatment of dry eye in Sjögren syndrome. Eur J Ophthalmol 23:368–376CrossRefPubMedGoogle Scholar
  79. 79.
    Lee JH, Min K, Kim SK, Kim EK, Kim TI (2014) Inflammatory cytokine and osmolarity changes in the tears of dry eye patients treated with topical 1 % methylprednisolone. Yonsei Med J 55:203–208PubMedCentralCrossRefPubMedGoogle Scholar
  80. 80.
    Farrell J, Patel S, Grierson DG, Sturrock RD (2003) A clinical procedure to predict the value of temporary occlusion therapy in keratoconjunctivitis sicca. Ophthalmic Physiol Opt 23:1–8CrossRefPubMedGoogle Scholar
  81. 81.
    Qiu W, Liu Z, Ao M, Li X, Wang W (2013) Punctal plugs versus artificial tears for treating primary Sjögren's syndrome with keratoconjunctivitis SICCA: a comparative observation of their effects on visual function. Rheumatol Int 33:2543–2548CrossRefPubMedGoogle Scholar
  82. 82.
    Lee MS, Shin BC, Choi TY, Ernst E (2011) Acupuncture for treating dry eye: a systematic review. Acta Ophthalmol 89:101–106CrossRefPubMedGoogle Scholar
  83. 83.
    Fox RI, Chan R, Michelson JB, Belmont JB, Michelson PE (1984) Beneficial effect of artificial tears made with autologous serum in patients with keratoconjunctivitis sicca. Arthritis Rheum 27:459–461CrossRefPubMedGoogle Scholar
  84. 84.
    Quinto GG, Campos M, Behrens A (2008) Autologous serum for ocular surface diseases. Arq Bras Oftalmol 71(6 Supl):47–54CrossRefPubMedGoogle Scholar
  85. 85.
    Liu L, Hartwig D, Harloff S, Herminghaus P, Wedel T, Geerling G (2005) An optimised protocol for the production of autologous serum eyedrops. Graefes Arch Clin Exp Ophthalmol 243:706–714CrossRefPubMedGoogle Scholar
  86. 86.
    Koffler BH (2006) Autologous serum therapy of the ocular surface with novel delivery by platelet concentrate gel. Ocul Surf 4:188–195CrossRefPubMedGoogle Scholar
  87. 87.
    Poon AC, Geerling G, Dart JK, Fraenkel GE, Daniels JT (2001) Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies. Br J Ophthalmol 85:1188–1197PubMedCentralCrossRefPubMedGoogle Scholar
  88. 88.
    Lee GA, Chen SX (2008) Autologous serum in the management of recalcitrant dry eye syndrome. Clin Exp Ophthalmol 36:119–122CrossRefGoogle Scholar
  89. 89.
    Kojima T, Ishida R, Dogru M et al (2005) The effect of autologous serum eye drops in the treatment of severe dry eye disease: a prospective randomized case-control study. Am J Ophthalmol 139:242–246CrossRefPubMedGoogle Scholar
  90. 90.
    Tananuvat N, Daniell M, Sullivan LJ et al (2001) Controlled study of the use of autologous serum in dry eye patients. Cornea 20:802–806CrossRefPubMedGoogle Scholar
  91. 91.
    McDonnell PJ, Schanzlin DJ, Rao NA (1988) Immunoglobulin deposition in the cornea after application of autologous serum. Arch Ophthalmol 106:1423–1425CrossRefPubMedGoogle Scholar
  92. 92.
    Rosenberg GJ (2000) Temporary tarsorrhaphy suture to prevent or treat scleral show and ectropion secondary to laser resurfacing or laser blepharoplasty. Plast Reconstr Surg 106:721–725CrossRefPubMedGoogle Scholar
  93. 93.
    Cosar CB, Cohen EJ, Rapuano CJ et al (2001) Tarsorrhaphy: clinical experience from a cornea practice. Cornea 20:787–791CrossRefPubMedGoogle Scholar
  94. 94.
    Kheirkhah A, Zavareh MK, Farzbod F, Mahbod M, Behrouz MJ (2011) Topical 0.005 % tacrolimus eye drop for refractory vernal keratoconjunctivitis. Eye (Lond) 25:872–880CrossRefGoogle Scholar
  95. 95.
    Huang JF, Yafawi R, Zhang M et al (2012) Immunomodulatory effect of the topical ophthalmic Janus kinase inhibitor tofacitinib (CP-690,550) in patients with dry eye disease. Ophthalmology 119:43–50CrossRefGoogle Scholar
  96. 96.
    Okanobo A, Chauhan SK, Dastjerdi MH, Kodati S, Dana R (2012) Efficacy of topical blockade of interleukin-1 in experimental dry eye disease. Am J Ophthalmol 154:63–71PubMedCentralCrossRefPubMedGoogle Scholar
  97. 97.
    Meiners PM, Vissink A, Kroese FG, Spijkervet FK, Smitt-Kamminga NS, Abdulahad WH, Bulthuis-Kuiper J, Brouwer E, Arends S, Bootsma H (2014) Abatacept treatment reduces disease activity in early primary Sjogren's syndrome (open-label proof of concept ASAP study). Ann Rheum Dis 73(7):1393–1396CrossRefPubMedGoogle Scholar
  98. 98.
    Adler S, Körner M, Förger F, Huscher D, Caversaccio MD, Villiger PM (2013) Evaluation of histological, serological and clinical changes in response to abatacept treatment of primary Sjögren's syndrome: a pilot study. Arthritis Care Res (Hoboken) 65:1862–1868CrossRefGoogle Scholar
  99. 99.
    Mariette X, Seror R, Quartuccio L, Baron G, Salvin S, Fabris M, Desmoulins F, Nocturne G, Ravaud P, De Vita S (2013) Efficacy and safety of belimumab in primary Sjogren’s syndrome: results of the BELISS open-label phase II study. Ann Rheum Dis. doi: 10.1136/annrheumdis-2013-203991 Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Valéria Valim
    • 1
    • 6
    Email author
  • Virginia Fernandes Moça Trevisani
    • 2
    • 3
    • 6
  • Jacqueline Martins de Sousa
    • 4
  • Verônica Silva Vilela
    • 5
    • 6
  • Rubens BelfortJr
    • 4
  1. 1.Centro de Referência de Doenças Reumáticas, Serviço de ReumatologiaUniversidade Federal do Espírito Santo, Hospital Universitário Cassiano Antonio de MoraesVitóriaBrazil
  2. 2.Disciplina de Medicina de Urgência e Medicina Baseada em EvidênciasUniversidade Federal de São PauloSão PauloBrazil
  3. 3.Universidade de Santo AmaroSão PauloBrazil
  4. 4.Escola Paulista de Medicina (EPM), Departamento de Oftalmologia e Ciências VisuaisSão PauloBrazil
  5. 5.Disciplina de ReumatologiaUniversidade do Estado do Rio de JaneiroRio de JaneiroBrazil
  6. 6.Scientific Committee on Sjögren’s SyndromeBrazilian Society of RheumatologySão PauloBrazil

Personalised recommendations