TNF and Keratoconjunctivitis sicca: Findings of inflammatory cell infiltration of the conjunctival epithelium and high levels of immune activator stimulants like human leukocyte antigen (HLA-DR), intercellular adhesion molecule 1 (ICAM-1) and inflammatory cytokines such as interleukin-1 (IL-1), IL-6, IL-8 and TNF-α in SS suggest that the development of dry eye is due to ocular surface inflammation.7,8,9 Studies demonstrating that proinflammatory cytokines play a role in the pathogenesis of dry eye have lead to the introduction of anti-inflammatory treatment protocols in the management of this disease.10,11,12