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Claudia Henrich, Esen Akpek; Dry Eye and Systemic Diseases. Invest. Ophthalmol. Vis. Sci. 2013;54(15):931.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the prevalence of associated inflammatory systemic diseases in a cohort of patients with dry eye syndrome.
Medical records of patients who presented to the Wilmer Eye Institute Ocular Surface Diseases and Dry Eye Clinic with dry eye symptomatology during a period of two years (January 2010 to December 2011) were reviewed retrospectively. Patients were divided into two groups: patients with clinically significant dry eye disease (defined as Schirmer test result without topical anesthesia ≤10 mm at 5 minutes in either eye or bulbar conjunctival staining with lissamine green scored based on Oxford scale ≥1 in either eye) and patients with dry eye symptomatology but without the clinical findings.
A patient list of 326 patients was generated electronically using a diagnostic code of ICD 375.15. Sixty two patients were excluded as they presented primarily with other ocular surface problems and dry eye was a secondary diagnosis. Two hundred and sixty four patients with a primary diagnosis of dry eye were included in the analysis. The majority of the patients (215/264, 81.4%) were female. Two hundred and seventeen (217/264; 82.2%) had clinically significant dry eye. About half of the patients (121/264, 45.8%) had an underlying inflammatory systemic disease on presentation. One hundred and nine of them (109/121, 90.1%) had a clinically significant dry eye. Thirty one patients (31/264, 11.7%) had primary Sjögren Syndrome, 38 (38/264; 14.4%) had thyroid disease (either hypothyroidism, Graves disease or Hashimotos thyroiditis), 13 (13/264, 4.9%) had rheumatoid arthritis, 42 (42/264, 15.9%) had other rheumatic diseases. In 50 patients (50/143, 35.0%) without a previously known systemic disease (regardless of the severity of the dry eye) a further work up was performed based on review of systems. In 12 patients (12/50, 24.0%) a diagnosis based on the work up was established: 10 patients (10/50, 20.0%) were diagnosed with thyroid eye disease, 2 patients (2/50, 4.0%) were diagnosed with Sjögren syndrome or presumed Sjögren syndrome, one (1/50, 2.0%) was diagnosed with a mixed connective tissue disease.
Dry eye is a very common condition. Although usually a local disease with a benign course, prevalence of systemic disease association seems to be significant. Based on clinical suspicion and review of systems, further diagnostic testing might uncover some of these previously undiagnosed conditions.
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