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Bridgette McCabe, Mina Massaro-Giordano, Nicole Fuerst, Maxwell Pistilli, Gui-Shuang Ying, Ilaria Macchi, Rebecca Salvo, Vatinee Bunya; Differences among signs and symptoms of dry eye among patients with Sjogren's syndrome, blepharitis, or no ocular surface disease. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5423. doi: https://doi.org/.
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To examine the differences in dry eye clinical signs and symptoms among patients with Sjogren’s syndrome, blepharitis, and controls.
Seventy-four eyes of thirty-seven subjects (18 Sjogren’s syndrome, 10 blepharitis, and 9 controls) were evaluated. 94% of Sjogren's syndrome patients and 80% of blepharitis patients were on systemic or topical medications at the time of enrollment. Symptoms were assessed using the Ocular Surface Disease Index (OSDI), Symptom Assessment in Dry Eye (SANDE), and Visual Function Questionnaire-25 (VFQ-25) questionnaires. Tear film breakup time (TBUT), ocular surface staining, meibomian gland evaluation and Schirmer tests were performed on both eyes. Tear osmolarity was measured using the TearLab Osmolarity system. The comparison of dry eye symptoms and measures among the three groups of subjects were made using analysis of variance, and the correlation among eye symptoms and measures was estimated with Pearson’s correlation coefficient (r).
We found a significant difference among groups in mean values for OSDI (p<0.001), SANDE (p<0.001), VFQ (p<0.01), TBUT (p<0.01), fluorescein staining of the cornea (p=0.02), and conjunctival lissamine green staining (p<0.01). Tear osmolarity was not significantly different among the 3 groups and was not correlated with age, sex, race, symptoms, TBUT, corneal fluorescein staining or Schirmer scores (all r<0.15 and p>0.23). Tear osmolarity was moderately correlated with lissamine green conjunctival staining scores (r=0.32, p=0.04). The OSDI scores were strongly correlated with the scores of the other 2 questionnaires (r=0.66 for SANDE frequency, r= 0.73 for SANDE severity, r=-0.75 for VFQ-25). VFQ was weakly correlated with SANDE frequency (r=-0.35) and moderately correlated with SANDE severity (r=-0.53).
Except tear osmolarity, all dry eye symptoms and measurements differed among subjects with Sjogren's syndrome, blepharitis, or no ocular surface disease. Tear film osmolarity was not strongly correlated with dry eye symptoms, and was moderately correlated with conjunctival lissamine green staining. The high correlation among the OSDI and SANDE questionnaires indicates that the choice between the two symptom questionnaires may not be critical in summarizing patient symptoms.
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