Relieving Eye Dryness (Question and Answer)

By W. Leroy Griffing, M.D., Chair, Division of Rheumatology, Mayo Clinic Scottsdale, Scottsdale, Ariz. (originally published in "Scleroderma Voice," 2003 #2)

Question: I recently had an eye infection and was placed on antibiotic eyedrops. I did not have any improvement and soon found out that I was reacting to the preservatives in the drops.

An ophthalmologist informed me that persons with Sjögren's Syndrome should not use drops that contain preservatives. He has recommended preservative-free Refresh Plus and Celluvisc and I am amazed at how much better my eyes feel.

He would like to use punctal plugs to further improve my dry eye problem. I am concerned as the temporary plugs are made of collagen and the permanent plugs are made of silicone.

Would these products make my scleroderma worse? Should I be concerned about the use of these plugs?

Answer: Dryness of the eyes, mouth, skin, and other areas of the body due to Sjögren's Syndrome commonly occurs with rheumatic illnesses including scleroderma.

Several artificial tear and saliva products are available over the counter to help alleviate eye and mouth symptoms. Many brands of the artificial tears contain a preservative which itself can be irritating to the eye, causing discomfort that is easily mistaken for the symptoms of dryness. Use of preservative-free artificial tears such as Refresh and several others avoids this potential problem.

Another way to relieve eye dryness besides replenishing moisture is to conserve moisture by plugging the tear ducts. The lower lid of each eye has a small duct that connects with the inside of the nose, acting as a drain to take excessive moisture away from the eye.

The opening of this duct can be plugged temporarily with tiny collagen plugs, keeping moisture over the eye. People with mildly dry eyes may find this causes their eyes now to water too much, while people with excessively dry eyes may not find any benefit.

The collagen plugs are removable. For people who find the plugs to be "just right," the collagen plugs are replaced with longer-lasting silicone plugs. Although these are spoken of as being permanent, the silicone plugs can be removed later if necessary.

There is no evidence to suggest that either type of these tear duct plugs is unsafe for patients with scleroderma or other autoimmune illness.