Inclusion Criteria:  Age≥ 18 and ≤ 70 years old . Able to provide inform consent Patients diagnosed as syndrome according to 2016 ACR(American college of Rheumatology)/ EULAR(European league Against Rheumatism classification criteria for Sjögren's syndrome  Exclusion Criteria:  any preexisting ocular disease or on eye drops lubricants. patients on (Beta blockers, Diuretics , anticholinergic, α 1antagonist and α 2 agonist ,anticoagulant, antidepressant, antihistamine ,pilocarpine, cevimeline ) . past history of diabetes, psychiatric disorder. pregnancy, lactating mother malignancy