Eyeworld

FALL 2025 | EYEWORLD | 55 C Contact Akpek: esakpek@jhmi.edu Bunya: Vatinee.Bunya @pennmedicine.upenn.edu Church: jchurch@sjogrens.org Relevant disclosures Akpek: None Bunya: Kowa Church: None blepharitis and/or meibomian gland dysfunc- tion, I will start them on treatment for those diseases as well," Dr. Bunya said, adding, "Sjögren's patients with low aqueous tear production may benefit from punctal occlusion or cautery, as well as autologous serum drops earlier than non-Sjögren's patients. Finally, for moderate to severe Sjögren's-related dry eye dis- ease, scleral lenses can be helpful. If a Sjögren's patient's ocular surface disease cannot be controlled with local measures or treatments, I will work with his or her rheumatologist to start or modify their systemic treatments. Sjögren's patients often require frequent follow-up and a combination of therapies to control their ocular surface disease." Dr. Akpek said if patients are diagnosed at an earlier stage, topical and systemic anti-in- flammatories, such as steroids, topical lifite- grast, and topical cyclosporine, can be helpful. For patients who are more advanced, while it's not too late to start, the efficacy of these options might not be as good. An anti-inflamma- tory that's not yet approved is ILYX-002 (Iolyx Therapeutics). In May 2025, Iolyx Therapeutics announced positive Phase 2 topline data for the topical immunomodulator specifically targeting autoimmune dry eye and ongoing Phase 3 study design, which is expected to begin enrolling this year. "It's good news that there's at least one company that is working on this and that their results seem extremely promising. It is import- ant that we develop specific treatments for Sjögren's-related dry eye," Dr. Akpek said. Ms. Church tried but could not tolerate topical cyclosporine or lifitegrast. She has had a positive experience with hydroxychloroquine for fatigue symptoms. Dr. Bunya said there are several investiga- tional treatments in Phase 3 clinical trials or with recent FDA approval that could be helpful for Sjögren's dry eye. "For example, acoltremon [Tryptyr, Alcon], a first-in-class transient recep- tor potential melastatin 8 (TRPM8) receptor agonist, was recently approved by the FDA for the treatment of dry eye disease," she said. "In addition, Stuart Therapeutics announced the initial results of its Phase 3 clinical trial evalu- ating ST-100 (vezocolmitide). The company re- ported that vezocolmitide is part of a novel drug class of collagen mimetic peptides and works by targeting and repairing damaged collagen. However, further larger studies are needed." Cenegermin (Oxervate, Dompe) is under in- vestigation for severe Sjögren's-related dry eye. Dr. Akpek said this is an interesting option be- cause it's an indirect mechanism of action to re- verse the damage to the sub-basal corneal nerve plexus and corneal sensation for these patients. Lacripep (Tear Solutions) was also investigated for patients with primary Sjögren's, demonstrat- ing improvements in signs and symptoms that will be used as areas for future studies. 3 As a final message to ophthalmologists, from a Sjögren's patient and Sjögren's patient advocate, Ms. Church said that these patients can go blind from this disease and "the way to blindness is pretty painful." She said cataract surgeons should also understand that improving dryness for a Sjögren's patient prior to surgery should be a priority, and to remember that heal- ing for these patients is slower. "The thing I want doctors to understand is this dry eye is not your typical dry eye, and it needs to be diagnosed; patients need to be on treatment and more than just over-the-counter eye drops. They should be on treatment with lifitegrast, cyclosporine, or whatever is coming … but they should also be talking with their doctor about systemic therapy such as an immu- nomodulator (like hydroxychloroquine) or anti- inflammatory depending on their symptoms." She said that more studies are needed to better understand the disease and how it shows up differently in people. "It can attack anyone at any age, and doctors need to include Sjögren's in their differential diagnosis when they see unusual fatigue, dryness, or neurological symp- toms," Ms. Church said. Dr. Akpek agreed that heightened aware- ness is needed in the field, in addition to de- velopment of point-of-care testing for Sjögren's biomarkers in the tear film. She said ideally, a systemic treatment targeted based on expres- sion profiles of cytokines and chemokines is needed as well. Dr. Bunya said her wish list is for better screening tests, treatments that slow or stop the disease's progression, and eye drops that specifically target the underlying pathophys- iology that causes ocular surface disease in Sjögren's patients.

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