American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most appropriate treatment for dry eyes in patients with primary Sjögren syndrome who have not responded to topical lubricants?

1. Topical cyclosporine

2. Artificial tears

3. Oral steroids

4. Punctal occlusion

The correct answer is: Topical cyclosporine

Topical cyclosporine is considered the most appropriate treatment for dry eyes in patients with primary Sjögren syndrome who have not responded adequately to topical lubricants. Sjögren syndrome is an autoimmune condition characterized by dry eyes and dry mouth due to inflammation of the exocrine glands, leading to reduced tear production. Topical cyclosporine works by inhibiting inflammation in the lacrimal glands, which can enhance tear production, making it particularly beneficial for patients with this syndrome. Unlike artificial tears, which merely provide lubrication without addressing the underlying inflammation, topical cyclosporine targets the disease process itself, offering a potential improvement in the tear production over time. While punctal occlusion can also help in managing dry eyes by preventing tear drainage and prolonging the effect of the tears that are produced, it does not address the underlying inflammatory issue present in Sjögren syndrome. Thus, topical cyclosporine is a more comprehensive option for treating dry eyes in this context. Oral steroids could provide some anti-inflammatory effect, but they are not typically a first-line treatment for ocular manifestations of Sjögren syndrome due to potential systemic side effects and lack of specific action on the lacrimal glands.