Dry eyes and mouth Is it both eyes? Where in the mouth or around the mouth does it feel dry? When did this begin? Is it always dry or in episodes? If episodic? How often Episode duration How has this changed over time? If has gotten worse ->, when have you noticed it getting worse? Have you had anything like this before? Is it worse at any times of the day? Can you think of anything that might have caused? Did anything in your life change around that time? How has it impacted on your life? Associated features: Is the dryness followed by excessive tearing -> paradoxical response to dryness Sensitivity to light Difficulty wearing contact lens -> If they wear lens. Difficulty swallowing Difficulty speaking Change in taste Increase thirst Fatigue Joint pain Joint stiffness Dry skin or rashes Swelling of salivary glands Medication history Medical history Diseases On dialysis Allergies and vaccinations Surgical history Menstrual history Menopause Family history Social history Diet Exercise Smoking Recreational drugs Alcohol Differentials Sjogren’s syndrome Decreased tera production Eye itching Eye burning sensations Dental caries or dental infections Parotid gland enlargement -> often bilateral Tingue fissures Vaginal dryness -> dyspareunia RA Polyarthralgia Symmetrical Which joints affected Morning stiffness Joint deformities SLE Arthritis Arthralgia Malar rash Raynaud phenomenon Photosensitivity -> maculopapular rash Oral ulcers Nonscarring alopecia Periungual telangiectasia Kidney disease treatment -> haemodialysis or dehydration Diabetes Intestinal or metabolic disorders Aging Radiation therapy Nerve damage due to HIV, Hep C, EBV Anxiety and stress Smoking Alcohol Nutritional deficiency Vit A deficiency Vit B deficiency Dehydration