Which autoimmune rheumatic disease is considered the second most common and known to cause aqueous-deficient dry eye?

• A. Rheumatoid arthritis
• B. Systemic lupus erythematosus
• C. Ankylosing spondylitis
• D. Sjogren's syndrome

Answer: (D)

Sjogren's syndrome is an autoimmune exocrinopathy where the immune system targets the lacrimal glands, leading to reduced tear production. This loss of aqueous tear flow produces aqueous-deficient dry eye, the characteristic type associated with Sjogren's. Among autoimmune rheumatic diseases, it is the classic cause of this specific dry-eye pattern, whereas other conditions like rheumatoid arthritis, SLE, or ankylosing spondylitis tend to cause ocular inflammation or surface issues but not primary lacrimal gland–driven tear deficiency. Sjogren's can occur alone or with other autoimmune diseases (secondary Sjogren's) and is often associated with SSA/SSB antibodies.