• corticosteroids
• dry-eye
• hydrocortisone
• ocular surface
• Schirmer test
• Sjögren syndrome
• tear film osmolarity

Dry-eye disease (DED) is a highly prevalent ocular condition in patients with Sjögren syndrome (SS) with a significant burden on affected patients. Regardless of the underlying aetiology, DED is associated with increased ocular surface inflammation and alterations in tear film osmolarity and composition. Retrospective data from 40 patients with moderate to severe SS, treated for at least six months with pulsed topical low dose hydrocortisone 0.335% (PFH), were collected. The safety and efficacy of PFH were tested. Clinical evaluation at each time point included best corrected visual acuity (BCVA), slit lamp biomicroscopy, assessment of conjunctival hyperaemia, non-invasive break-up time (NIBUT), corneal and conjunctival staining, Schirmer I test, Meibomian gland imaging, Goldmann application tonometry and funds examination. Data from 37 female and 3 males were collected. Mean age was 56.30 ± 13.91 years. Clinical signs and symptoms, including tear film osmolarity and Ocular Surface Index (OSDI) score, significantly improved (all p<0.001) after 3 and 6 months of treatment. IOP remained unchanged. No adverse events were recorded. This retrospective data review confirms that topical PFH with a pulsed posology, 6 days every month (three times a day for 2 days, twice daily for 2 days and then once daily for 2 days) for 3 months and then alternating, significantly improves clinical signs and symptoms in patients with moderate to severe SS-related DED with no safety issues.