**5. Cicatrizing conjunctivitis as complication of dry eye disorders**

In course of pSS, a slow progressive cicatrizing conjunctivitis (PCC) may also develop with complications such as an impairment of vision (and even blindness), pain, and corneal damage. Cicatrizing is a type of scarring, which can occur as a complication of dry eye accompanied by autoimmune diseases like Sjögren's syndrome or ocular cicatrical pemphigoid. Chronic conjunctival cicatrization (CCC) can also occur as an effect of thermal and chemical burns, postinfectious conjunctivitis, ocular rosacea, atopic keratitis, graft versus host disease, and Stevens-Johnson syndrome (in the latter case prognosis being particularly poor) [18,19]. The presence of cicatrizing conjunctivitis predisposes to microbial keratitis, especially in Sjögren's syndrome. Ormerod et al. [20] described that almost 50% of studied Sjögren's syndrome patients had microbial keratitis as a complication of sterile ulcerations and were subject to recurrent infections. Most common infection in that group was Gram-positive bacteria such as *S. aureus*. It was also noted that patients with conjunctival cicatrization (CC) in the course of Sjögren's syndrome had higher complication rate compared to those in which CC was caused by other factors; such complications included corneal perforation, endophthalmitis, and descementocele. Interestingly, the authors also point out that a long-term therapy with topical corticosteroids and application of bandage contact lenses used in refractive surgery enhanced a risk of microbial keratitis.

Treatment strategies in CC depend on the cause of the underlying disease. In case of microbial keratitis, topical antibiotic use is recommended.
