To help in diagnosing Sjogren's syndrome, the doctor will first gather a detailed medical history, which includes asking questions about your:
- general health
- family medical history
- alcohol consumption
- tobacco use
- use of drugs or medications
The doctor will also do a complete physical exam to check for symptoms of Sjogren's syndrome.
You may have some tests, too. First, the doctor will want to check your eyes and mouth to see whether Sjogren's is causing your symptoms and to see how severe the problem is. Common eye and mouth tests used to diagnose Sjogren's syndrome include:
- Schirmer test
- slit lamp exam
- mouth exam
This test measures tears to see how the lacrimal gland is working. It can be done in two ways. In Schirmer I, the doctor puts thin paper strips under the lower eyelids and measures the amount of wetness on the paper after five minutes. People with Sjogren's syndrome usually produce less than 8 millimeters of tears. The Schirmer II test is similar, but the doctor uses a cotton swab to stimulate a tear reflex inside the nose.
Staining with vital dyes (rose bengal or lissamine green) shows how much damage the dryness has done to the surface of the eye. The doctor puts a drop of a liquid containing a dye into the lower eyelid. These drops stain the surface of the eye, highlighting any areas of injury.
Slit Lamp Exam
A slit lamp exam shows how severe the dryness is and if the outside of the eye is inflamed. An ophthalmologist (eye specialist) uses magnifying equipment to carefully examine the eye.
The doctor will look in the mouth for signs of dryness and to see if any of the major salivary glands are swollen. Signs of dryness include:
- dry, sticky mouth
- thick saliva or none at all
- smooth look to the tongue
- redness in the mouth
- dry, cracked lips
- sores at the corners of the mouth
The doctor might also try to get a sample of saliva to see how much the glands are producing and to check its quality.
In order to help diagnose Sjogren's syndrome, the doctor may recommend a salivary gland biopsy of the lip. This test is the best way to find out if dry mouth is caused by Sjogren's syndrome. The doctor removes tiny, minor salivary glands from the inside of the lower lip and examines them under the microscope. If the glands contain lymphocytes in a particular pattern, the test is positive for Sjogren's syndrome.
Then the doctor may do other tests to see if Sjogren's syndrome is elsewhere in the body as well. These will be discussed in the next post.