Sjogren’ Syndrome (SS) is a chronic autoimmune disease 
presenting with clinical hallmark of dry eyes, dry mouth and 
salivary gland swelling and histological hallmark of lymphocytic 
infiltration of exocrine glands.  
There are three key items for approaching towards Sjogren’s 
Syndrome (SS) including: 
• Dry eyes 
• Dry mouth 
• Salivary gland swelling 
A. If there are at least 2 items of above in a patient he/she has to 
be referred to a Rheumatologist by General Practitioners (GP). 
B. If there is only one item of above in a patient, he/she will be 
referred to a Rheumatologist, when a GP 
i.   Confirms that the finding is pathologic and 
ii.   Rule outs its other causes in cooperation with related 
specialists. 
C. If there is not any item of above: the GP should forget about 
Sjogren’s syndrome for the time being. 
The dryness of eyes is pathologic if there is at least one of below 
features: 
• Duration of at least 3 months 
• Gritty or sandy sensation in the eyes 
• Use of a tear substitute more than 3 times daily 
Dry mouth is pathologic if there is at least one of below 
features: 
• Duration of at least 3 months 
• Patient has to wake up at night to drink water because 
his/her mouth is too dry 
• Patient frequently drinks liquids to help in swallowing 
dry foods 
We have to know that salivary gland swelling is always 
pathologic and chronic or recurrent bilateral parotid glands enlargement is the compatible state with Sjogren’s syndrome 
when its other etiologies can be ruled out. 
 
Keywords: Dry Eye; Dry Mouth; Salivary Gland Swelling; 
Sjogren’s syndrome