A case of Sjögren's syndrome preceded by diplopia

We observed a case of Sjögren's syndrome (SjS) that was preceded by diplopia. A 74-year-old female noticed visual disturbance of her right eye and diplopia leading her to visit a local hospital concerning the symptoms. No abnormality was found by brain MRI. Her condition improved briefly, however it worsened once more and she visited our hospital. At the time of the first examination the visual acuity of her right eye was 16/20 and abduction of her right eye was limited. One week later, her right eye was found to have total ptosis and ophthalmoplegia. The Schirmer test, rose bengal stain and lip biopsy indicated keratoconjunctivitis sicca. Patients with SjS often develop various extra glandular complications. We suggest that ptosis and ophthalmoplegia should be added to the list of the neurological manifestations of SjS. Ptosis and eye movement disturbances of an unknown cause require careful examinations to determine if SjS is present.