Sjogren’s Syndrome and Diving

A chronic, systemic inflammatory disorder of unknown etiology, characterized by dryness of the mouth, eyes, and other mucous membranes and often associated with rheumatic disorders sharing certain autoimmune features (eg, RA, scleroderma, and SLE) and in which lymphocyte infiltration into affected tissues is seen. The syndrome is more common than SLE (systemic lupus erythematosus) but less common than RA (rheumatoid arthritis). The effects of pressure are unknown. The condition causes keratoconjunctivitis and dry mouth, both conditions possibly inimical to the diver.

The diver with Sjogren’s Syndrome should be in good physical conditioning, be in remission from the acute processes of the disease, be capable of physically managing his/her entry, exit, scuba gear and be capable of assisting a buddy with a diving problem. They should be taking no medication that would alter their ability to function or make decisions.

Pathophysiology, Symptoms, and Signs
In some, SS affects only the eyes or mouth (primary SS; sicca complex; sicca syndrome); in others, there is an associated generalized collagen-vascular disease (secondary SS).
Ocular symptoms occur when atrophy of the secretory epithelium of the lacrimal glands causes desiccation of the cornea and conjunctiva (keratoconjunctivitis sicca. In advanced cases, the cornea is severely damaged and epithelial strands hang from the corneal surface (keratitis filiformis). This would be adverse to diving.

One third of SS patients develop enlarged parotid glands that are usually firm, smooth, fluctuating in size, and mildly tender. Chronic salivary gland enlargement is rarely painful. When salivary glands atrophy, saliva diminishes, and the resulting extreme dryness of the mouth and lips (xerostomia) inhibits chewing and swallowing and promotes tooth decay and calculi formation in the salivary ducts. Taste and smell faculties may be lost. This may reduce the diver’s ability to manage the mouthpiece of the regulator or snorkel.

Drying out may also develop in the skin and in mucous membranes of the nose, throat, larynx, bronchi, vulva, and vagina. Alopecia may occur. Dryness of the respiratory tract often leads to lung infections and sometimes to fatal pneumonia. Associated mucous membrane problems could lead to difficulties equalizing the middle ears or pulmonary barotrauma.


Ernest S. Campbell, M.D., FACS

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