

Answer to Medical Mystery Monday #113


The Schirmer test for tear production. From

The answer to yesterday’s mystery is … Sjögren’s syndrome! Many readers were able to answer the mystery correctly: k, colleen (with a little c), Ken, Priscilla, Stefan, F, Federica, Dave, Francine, Angelita, Erin, Pooh54, D2, Mrs. Mac, CB, Theresa, Mike, jcleclerc, Kate, Heather, LG, ElleKay, Ashley, JP, ED Doc, Hopefulpremed, and Safia.

Sjögren’s syndrome is a chronic, inflammatory, autoimmune disease that causes dysfunction of the body’s glands. This syndrome is most common among middle-aged women. The classic glands that are affected in this disease include the tear ducts and the salivary glands. Therefore, the most common symptoms of Sjögren’s are dry eyes and mouth. The parotid glands in the cheeks that produce saliva may swell as they did in our patient, even though they are nonfunctional.  Patients who suffer from Sjögren’s may complain of needing a glass of water nearby at all times because they are not producing saliva, and the tongue can become cracked because it is so dry. They are prone to cavities because they lack saliva to wash away bacteria in the mouth. Patients may also report a feeling of sand in their eyes, which is a common manifestation of lack of tears.

There is no definitive test for Sjögren’s, but the Schirmer test is often used to document lack of tear production. A piece of paper is placed in the eyelid, and a patient with Sjögren’s will produce less than five millimeters of tears on the paper in five minutes (shown in the picture). There is no cure that can make the glands functional again, so the dry mouth and dry eyes are treated with topical lubricants. There are medications that can be added if these conservative measures do not help.

Hope you liked learning about Sjögren’s syndrome! Let me know if you have any questions about the case.

Marianne DiNapoli

Comments are closed.