Clinicians with patients who have clinically significant dry eye should be on the alert for underlying Sjögren's syndrome (SS), report researchers in the British Journal of Ophthalmology.
Their findings indicate that almost 12% of patients with aqueous-deficient dry eye (ADDE) have SS, with over half (55%) of these cases classed as the primary form of the syndrome (pSS), and the remainder classed as secondary SS, which is accompanied by a known, underlying autoimmune connective tissue disease - most commonly, rheumatoid arthritis.
"Patients with SS are likely to experience greater pain, fatigue, and disability, as well as depressed mood and cognitive symptoms," say Esen Akpek (Johns Hopkins Medical Institutions, Baltimore, Maryland, USA) and colleagues, who add that lymphoma is one of the most serious complications of SS.
The study results also revealed that patients with ADDE were significantly more likely to have pSS if they were positive for antinuclear antibody (ANA). Specifically, serologic testing revealed that patients positive for ANA were 13.9 times more likely to have SS than were their counterparts who were negative for ANA.
The study included a total of 327 adult patients with ADDE, of whom 11.6% had SS, and the majority were female.
Clinical examinations revealed that those with either form of SS had significantly worse mean conjunctival lissamine green staining, corneal fluorescein staining, Schirmer test results, and total Ocular Surface Disease Index results than their peers without SS.
Indeed, more severe staining scores were observed in the inferior corneal zone (81.6% with severity score ≥2) than the superior zone (71.1% with score <2), which could be a result of constant direct contact between the tear meniscus containing inflammatory mediators, and the inferior portion of the cornea, write Akpek et al.
Tear breakup times and Ocular Comfort Index scores did not differ by SS status.
In addition to a significant association with ANA, positive SS status was also significantly more likely among patients who were positive for rheumatoid factor (RF), with an odds ratio of 4.8.
"Although not clinical practice, patients with significant dry eye signs and symptoms plus a positive RF or ANA result should be offered diagnostic testing," concludes the team.
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