Scleroderma and Dry Eye: Why Systemic Sclerosis Hits the Ocular Surface Hard
Scleroderma and Dry Eye at a Glance
If you have scleroderma and your eyes feel gritty, sore, and tired by the afternoon, you are noticing something common and real, not imagining it. In one study of people with systemic sclerosis, dry eye disease was among the most common eye findings, affecting about 65 of every 100 patients.1 Dry eye is often the first way scleroderma shows up at the front of the eye, and it is very treatable once it is recognized.
The reassuring part is that dry eye is managed, not simply endured. Scleroderma is a long-term autoimmune condition that has no cure and is followed with ongoing medical monitoring over time.2 Your eye comfort is one part of that steady, long-term care.
Scleroderma is a disease of scarring, and that scarring does not stop at the skin. In systemic sclerosis, fibrosis (scarring) of the tear-producing gland and a drop in the conjunctiva's mucin-making goblet cells reduce both the watery and the coating layers of the tears, which can lead to dry eye disease.1 In other words, the glands that make your tears and the eyelids that spread and seal them in can both be affected at once.
Most treatment starts simple and low-risk before anything stronger is considered. Care for meibomian gland dysfunction usually starts with gentle eyelid hygiene and warm compresses before more advanced options.3 The sections below explain each step, what your eye doctor looks for, and when a new symptom is worth a call.
What Scleroderma Is and Why It Touches the Eye
Scleroderma is not a skin problem alone; it is a whole-body autoimmune disease. Systemic sclerosis, also called scleroderma, is a chronic autoimmune rheumatic disease in which the body overproduces collagen, causing scarring (clinical: fibrosis) in the skin, joints, blood vessels, and internal organs.4 That extra collagen is what stiffens tissue, and stiff tissue behaves differently, including around the eye.
Scleroderma is more common in women and most common in people aged 20 to 50, and it is rare in children.4 Knowing this helps explain why the topic comes up so often among younger and middle-aged adults with new, unexplained dryness.
The disease usually announces itself away from the eyes first. Scleroderma often begins with Raynaud phenomenon and puffy, tightening fingers, and it can also affect the digestive tract, lungs, heart, and kidneys.4 Because it can involve many organs, your eye care is one thread in a larger plan.
Eye problems reported in systemic sclerosis include dry eye disease, eyelid and conjunctival changes, retinal abnormalities, cataracts, and telangiectasia (small dilated blood vessels).1 Of all of these, the ocular surface, meaning the tear film and the exposed front of the eye, takes the most direct hit, which is why dry eye leads the list and why this page focuses on it.
Why Systemic Sclerosis Dries Out the Ocular Surface
A comfortable eye depends on a stable film of tears, and that film needs oil to last. The meibomian glands in the eyelids release an oily layer that keeps the watery part of the tears from evaporating too quickly.3 When that oil layer thins or fails, tears evaporate fast and the surface dries between blinks even if your eyes still make plenty of water.
In scleroderma, the same scarring process that stiffens skin can reach the glands around the eye. In systemic sclerosis, scarring (clinical: fibrosis) of the tear-producing gland reduces the watery part of the tears, and fewer mucin-making goblet cells reduce the tears' coating layer, which together can lead to dry eye disease.1 That means two things can go wrong at once: fewer tears made, and the tears that are made drying up too fast.
The tear-making system tends to work less well over time in this disease. In systemic sclerosis, the speed of tear production can drop by as much as about two thirds compared with people who do not have the disease, and the tear film becomes less stable.1 That steady drop in tears is part of why the dryness in scleroderma can feel more stubborn than everyday dry eye.
The lids do more work than most people realize; they spread tears and seal the eye shut during sleep. In scleroderma, fibrosis (a buildup of collagen) can stiffen the eyelid skin and limit how well the lids move, which can keep them from closing fully (lagophthalmos) and lets the tear film evaporate so the surface dries out.1 When the lids cannot close over the eye at night, the exposed surface dries out further.
Signs of Dry Eye When You Have Scleroderma
Dry eye happens when the eyes do not make enough tears, the tears dry up too fast, or the tears do not work well, causing a scratchy or burning feeling, redness, light sensitivity, and blurry vision.5 A confusing but common sign is watery eyes: a dry, irritated surface can trigger a reflex flood of tears that still do not coat the eye well.
Two dry-eye problems often stack together here: too little tear fluid and a film that breaks up too quickly. On examination in systemic sclerosis, eye doctors can find reduced tear production together with a less stable tear film.1 That combination tends to feel worse than either problem alone, which is why scleroderma dryness can be harder to satisfy with drops.
Dryness in scleroderma is not always limited to the eyes. In Sjogren syndrome, white blood cells attack the glands that make moisture, including the tear glands and salivary glands, causing dry eyes and dry mouth.6 If your mouth is dry too, mention it to your care team, because that pattern points to something worth checking, as the next section explains.
How the Dry Eye Is Diagnosed
An eye doctor examines your lids, your tear film, and the front surface of the eye, and may measure how much tear you make and how fast the film breaks up. Because dry eye has several causes, identifying the type of dry eye is important for choosing an effective treatment.3 Sorting out whether the problem is too few tears, too little oil, or both is what points the treatment in the right direction.
When dryness is widespread, doctors look for an overlapping condition. Doctors can measure tear and saliva production to help diagnose Sjogren syndrome.6 These simple measurements, along with blood tests your rheumatology team may order, help tell ordinary dry eye apart from a second autoimmune process.
When Sjogren syndrome occurs together with another autoimmune disease such as systemic sclerosis, it is called secondary Sjogren syndrome, and the other disease is also treated.6 Finding it does not change your scleroderma diagnosis, but it can change how aggressively the dryness is managed.
Your eye care and your scleroderma care belong together, so your eye doctor and the clinician who manages your scleroderma should stay in touch. Scleroderma is a long-term autoimmune condition that has no cure and is followed with ongoing medical monitoring over time.2 Bringing a current medication list and a note of your eye symptoms to each visit keeps that shared plan accurate.
Treating and Managing the Dry Eye
Most people start with measures they can do at home. Dry eye is managed with artificial tear drops, prescription anti-inflammatory eye drops, tear-duct plugs, and everyday steps such as humidifiers and screen breaks.5 Preservative-free artificial tears are gentle enough to use often, and small changes like aiming vents away from your face can make a real difference.
Because the oil glands are so often part of the problem in scleroderma, warming and clearing them is a key step. Treatment for meibomian gland dysfunction usually begins with conservative measures such as eyelid hygiene and warm compresses before higher-risk options.3 A warm compress softens the oil so it can flow again; lid hygiene keeps the gland openings from crusting over.
If stiff lids leave part of the surface exposed, protecting it becomes important. In scleroderma, stiff eyelids can fail to close fully (lagophthalmos), which lets the tear film evaporate and leaves the surface exposed and prone to drying.1 Lubricating ointment at night and, for some people, moisture goggles can shield an eye that does not close all the way; ask your eye doctor which options suit you.
Managing the ocular surface works best when the underlying disease is managed too. When Sjogren syndrome occurs together with systemic sclerosis, it is called secondary Sjogren syndrome, and the underlying disease is also treated.6 Your rheumatology and eye-care teams coordinate so that treating the whole body and treating the eyes pull in the same direction.
Risks, Complications, and Long-Term Outlook
Left unattended, a very dry surface can move from uncomfortable to harmful. If severe dry eye is not treated, it can sometimes damage the cornea, the clear front layer of the eye.5 This is uncommon and largely preventable with steady care, which is exactly why keeping up with drops and follow-up visits matters.
Dry eye is the most common eye issue in scleroderma, but it is not the only one. In one study, eyelid changes affected about 57 of every 100 people with systemic sclerosis, and retinal changes have been reported in about 34 of every 100.1 These findings are a reason to keep regular comprehensive eye exams, so anything beyond the surface is caught early.
Dry eye in scleroderma is usually a long-term condition to manage, not a quick fix. In systemic sclerosis, reduced tear production and a less stable tear film tend to persist rather than resolve on their own.1 Because these tear changes tend to persist, steady daily tear and eyelid care matters; with consistent treatment many people keep their eyes comfortable and their vision stable, though results vary from person to person.
When to Call Your Eye Doctor
Some changes are worth a call rather than waiting for your next scheduled visit. Dry eye can cause a scratchy or burning feeling, redness, light sensitivity, and blurry vision.5 Call your eye clinic if these are new, clearly worse, or getting in the way of reading, driving, or work, so your treatment can be adjusted.
Rarely, an eye problem in scleroderma becomes urgent. If severe dry eye is not treated, it can sometimes damage the cornea.5 Because of that, sudden severe eye pain, a very red and painful eye, light sensitivity that is suddenly much worse, or a sudden drop in vision are reasons to seek same-day eye care rather than wait.
Your eyes and your scleroderma are best managed together. Scleroderma is a long-term autoimmune condition that has no cure and is followed with ongoing medical monitoring over time.2 Keep your regular eye-care appointments, and tell the clinician who manages your scleroderma about any new eye symptoms between visits.
Common Questions About Scleroderma and Dry Eye
Yes. Dry eye is the most common eye problem in systemic sclerosis. In one study of people with systemic sclerosis, dry eye disease was among the most common eye findings, affecting about 65 of every 100 patients.1 So if your eyes feel dry, gritty, or tired, that experience fits the disease and is worth mentioning to your eye doctor, who can confirm it and start treatment.
It comes down to scarring of the glands that keep the eye moist. In systemic sclerosis, scarring (fibrosis) of the tear-producing gland and fewer mucin-making goblet cells reduce the tears, which can lead to dry eye disease.1 In plain terms, the glands that make tears are damaged and the eyelids can stiffen so tears are not spread or held well, so the surface dries from two directions at once.
It can if very dry eyes go untreated for a long time, but this is uncommon and largely preventable. If severe dry eye is not treated, it can sometimes damage the cornea, the clear front layer of the eye.5 Keeping up with lubricating drops, eyelid care, and regular eye exams is what keeps everyday dryness from reaching that point.
They overlap, and one can sit on top of the other. When Sjogren syndrome occurs together with another autoimmune disease such as systemic sclerosis, it is called secondary Sjogren syndrome, and the other disease is also treated.6 If you have dry eyes and a dry mouth, your team may test for Sjogren, because finding it can change how firmly the dryness is treated.
For milder dryness they often are, but many people with scleroderma need a few tools together. Dry eye is managed with artificial tear drops, prescription anti-inflammatory eye drops, tear-duct plugs, and everyday steps such as humidifiers and screen breaks.5 Your eye doctor builds the plan up from the gentlest options and adds more only if your symptoms call for it.
They can, especially when the oil glands are involved, which is common in scleroderma. Treatment for meibomian gland dysfunction usually begins with conservative measures such as eyelid hygiene and warm compresses before more advanced options.3 A warm compress softens hardened oil so the glands can release it, and doing it consistently tends to matter more than doing it occasionally.
More Questions People Ask
Eyelid tightness is a recognized part of scleroderma. In scleroderma, fibrosis can stiffen the eyelid skin and limit lid movement, which can keep the lids from closing fully (lagophthalmos).1 Because lids that do not close fully let the surface dry out, tell your eye doctor if you notice tightness or a sense that your eyes stay open during sleep.
With a focused eye exam and a few quick tests. Because dry eye has several causes, identifying the type of dry eye is important for choosing an effective treatment.3 Your eye doctor checks your lids and tear film and may measure your tear production and how fast the film breaks up, then matches the treatment to what they find.
Not a cure, but real, effective control. Scleroderma is a long-term autoimmune condition that has no cure and is followed with ongoing medical monitoring over time.2 Dry eye is handled the same way: managed steadily over time, so that comfort and vision stay as good as possible rather than fixed once and forgotten.
Both, working together. In Sjogren syndrome, white blood cells attack the glands that make moisture, including the tear glands and salivary glands, causing dry eyes and dry mouth.6 Your eye doctor manages the ocular surface, while the specialist who treats your scleroderma manages the disease behind it; the two coordinating is what gives your eyes the best outcome.
- Which type of dry eye do I have: too few tears, too little oil, or both?
- Should I be tested for secondary Sjogren syndrome?
- Which artificial tears and eyelid routine do you recommend for me?
- Do my eyelids close fully, and do I need protection for my eyes at night?
- How often should I have a comprehensive eye exam given my scleroderma?
- What new eye symptoms should prompt a same-day call?
- Reumatologia (open-access review, Termedia) (2020). Ocular manifestations in patients with systemic sclerosis.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2024). Scleroderma.
- American Academy of Ophthalmology, EyeNet Magazine (2023). Treating Evaporative Dry Eye Associated With Meibomian Gland Dysfunction.
- Merck Manual Consumer Version (2024). Systemic Sclerosis.
- National Eye Institute (NEI) (2024). Dry Eye.
- Merck Manual Consumer Version (2024). Sjogren Syndrome.