{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:03:32Z","timestamp":1765382612416,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Pediatric Sj\u00f6gren\u2019s syndrome is a rare autoimmune disease with a heterogeneous clinical expression and limited pediatric-specific diagnostic criteria. Ocular involvement often represents an early manifestation, yet it may go unrecognized in children due to poor symptom reporting and the underuse of objective diagnostic tools. This retrospective study evaluated six pediatric patients with Sj\u00f6gren\u2019s syndrome, integrating systemic and ocular findings with a focus on early immunological and clinical markers. Materials and Methods: All patients underwent ophthalmological assessments, including tear break-up time, Schirmer\u2019s test, and slit-lamp examination. Results: Tear break-up time values consistently indicated tear film instability (mean RE 7.4 \u00b1 2.5 s; LE 7.7 \u00b1 2.3 s), while Schirmer\u2019s test showed greater variability. Slit-lamp examination revealed inhomogeneous tear films in all patients and blepharitis in 66.7%, consistent with Meibomian gland dysfunction. Systemic features included arthralgia, Raynaud\u2019s phenomenon, fatigue, and frequent seropositivity for ANA and anti-SSA\/Ro antibodies. Minor salivary gland biopsy confirmed lymphoepithelial sialadenitis in all cases. Conclusions: These findings highlight the importance of combining laboratory and clinical markers with ophthalmological parameters to support an early diagnosis of Sj\u00f6gren\u2019s syndrome in pediatric patients. Integrating TBUT and slit-lamp evaluation with serological and histopathological data may enhance diagnostic accuracy and guide timely, targeted intervention to prevent long-term complications.<\/jats:p>","DOI":"10.3390\/medicina61071128","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T04:50:05Z","timestamp":1750654205000},"page":"1128","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pediatric Sj\u00f6gren\u2019s Syndrome: Focus on Ocular Involvement and Diagnostic Challenges"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3334-4884","authenticated-orcid":false,"given":"Emanuela","family":"Del Giudice","sequence":"first","affiliation":[{"name":"Pediatrics and Neonatology Unit, Department of Maternal Infantile and Urological Sciences, Santa Maria Goretti Hospital, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3081-4788","authenticated-orcid":false,"given":"Maria Carmela","family":"Saturno","sequence":"additional","affiliation":[{"name":"Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Grazia","family":"Fiorino","sequence":"additional","affiliation":[{"name":"Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8532-4578","authenticated-orcid":false,"given":"Danilo","family":"Iannetta","sequence":"additional","affiliation":[{"name":"Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2229-6995","authenticated-orcid":false,"given":"Luca","family":"Spadea","sequence":"additional","affiliation":[{"name":"Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Martucci","sequence":"additional","affiliation":[{"name":"Pediatrics and Neonatology Unit, Department of Maternal Infantile and Urological Sciences, Santa Maria Goretti Hospital, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9277-9231","authenticated-orcid":false,"given":"Alessia","family":"Marcellino","sequence":"additional","affiliation":[{"name":"Pediatrics and Neonatology Unit, Department of Maternal Infantile and Urological Sciences, Santa Maria Goretti Hospital, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7935-6648","authenticated-orcid":false,"given":"Mariateresa","family":"Sanseviero","sequence":"additional","affiliation":[{"name":"Pediatrics and Neonatology Unit, Department of Maternal Infantile and Urological Sciences, Santa Maria Goretti Hospital, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7008-3409","authenticated-orcid":false,"given":"Angela","family":"Mauro","sequence":"additional","affiliation":[{"name":"Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli\u2014Sacco Hospital, 20121 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra Cinzia","family":"Carlesimo","sequence":"additional","affiliation":[{"name":"Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2040-9562","authenticated-orcid":false,"given":"Nicola","family":"Nante","sequence":"additional","affiliation":[{"name":"Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy"},{"name":"Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1469-7294","authenticated-orcid":false,"given":"Giovanni","family":"Guarducci","sequence":"additional","affiliation":[{"name":"Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy"},{"name":"Healthcare Management, Local Health Authority of Ferrara, 44100 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1190-3956","authenticated-orcid":false,"given":"Leopoldo","family":"Spadea","sequence":"additional","affiliation":[{"name":"Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8237-955X","authenticated-orcid":false,"given":"Riccardo","family":"Lubrano","sequence":"additional","affiliation":[{"name":"Pediatrics and Neonatology Unit, Department of Maternal Infantile and Urological Sciences, Santa Maria Goretti Hospital, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4395-4774","authenticated-orcid":false,"given":"Maria Pia","family":"Paroli","sequence":"additional","affiliation":[{"name":"Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16047","DOI":"10.1038\/nrdp.2016.47","article-title":"Sj\u00f6gren syndrome","volume":"2","author":"Baldini","year":"2016","journal-title":"Nat. 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