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Table 7. Summary of Evidence for the Treatment of
Dry Eye Associated With Sjögren Syndrome
Treatment Modality
Strength of
Evidence
a
Clinical
Recommendation
b
Topical lubricants II A
Systemic secretagogues II B
Topical corticosteroids III B
Topical cyclosporine II A
Topical nonsteroidal anti-inflammatories Insufficient NR
Punctal occlusion II B
Serum tears II B
Systemic dietary supplements Insufficient NR
Systemic immunomodulatory treatments Insufficient NR
a
Strength of evidence is classified as follows:
Indicates that the data provided strong
evidence for the recommendation, the
study design addressed the issue in
question, and the study
was performed in the population of interest
and in a manner that ensured accurate and
reliable data, using appropriate statistical
methods.
Level I
Indicates that the data provided substantial
evidence for the recommendation but
lacked some components of level I.
Level II
Indicates a weaker body of evidence not
meeting the criteria of levels I or II, such as
expert opinions, small case series, and case
reports.
Level III
b
Clinical recommendations are classified as follows:
Indicates that the recommendation is very
important or crucial to a good clinical
outcome.
A
Indicates that the recommendation is
moderately important to clinical outcome.
B
Indicates that the recommendation is not
definitively related to clinical outcome.
C
Not recommended NR
Adapted with permission from Akpek EK, Lindsley KB, Adyanthaya RS, et al. Treatment of Sjögren's
syndrome-associated dry eye. An evidence-based review. Ophthalmolog y 2011;118:1242-52.
