Not every patient who receives a clinical diagnosis of Sjögren syndrome fulfills the proposed criteria, but the criteria provide useful guidance for evaluation and are applied to patients who have at least 1 symptom of eye or oral dryness: Eye symptoms: ≥ 3 months of daily, persistent, troublesome dry eyes, recurrent sensation of sand or gravel in the eyes, or use of tear substitutes ≥ 3 times a day Oral symptoms: > 3 months of daily dry mouth sensation or daily use of liquids to aid in swallowing dry food To fulfill the criteria, patients must have at least 1 symptom of eye or oral dryness, must also have a score of ≥ 4, and must not have any of the following exclusion criteria: History of radiation treatment to the head and neck Active hepatitis C infection (confirmed by polymerase chain reaction) AIDS Sarcoidosis Amyloidosis Graft-vs-host disease IgG4-related disease Table The most common causes of dry eyes and dry mouth (sicca symptoms) are aging and medications, but when parotid enlargement occurs in addition to sicca symptoms, diseases such as hepatitis C, HIV, bulimia, and sarcoidosis should be differentiated from Sjögren syndrome.