If symptoms do not improve with the usual lid hygiene routine, then I recommend below blood work up to rule out an internal inflammation causing the lacrimal glands to malfuntion:
A full Sjogren’s panel is recommended including anti-Ro, anti-La, RF, CBC.
Sandra Lora Cremers, MD, FACS
- Antinuclear antibodies (ANA) — positive in most cases
- Rheumatoid factor (RF) — may be positive
- Antibodies more specific to Sjögren syndrome — Anti-SS-A (also called Ro) and Anti-SS-B (also called La); the tests for these antibodies are often performed as part of an ENA panel and are frequently positive.
- Salivary gland biopsy — to look for accumulation of lymphocytes and inflammation
- Schirmer test — to measure tear production
- Rose Bengal or lissamine green staining of eye (cornea or conjunctiva) — to evaluate the extent to which dryness has damaged the surface of the eye