April 2011
Volume 52, Issue 14
ARVO Annual Meeting Abstract  |   April 2011
Severity of Sicca and Predictors of Sjögren’s Syndrome in Patients with Dry Eye
Author Affiliations & Notes
  • Esen K. Akpek
    Anterior Segment / Immunology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
  • Min Zhang
    Pfizer, Inc., New York, New York
  • Shiao Hui M. Liew
    Pfizer, Inc., New York, New York
  • Footnotes
    Commercial Relationships  Esen K. Akpek, Consultant: BioLux (C), Grant/research: Allergan (F), Grant/research: Inspire (F), Grant/research: Pfizer (F), Grant/research: TearLab (F), Pfizer (C); Min Zhang, Pfizer (E); Shiao Hui M. Liew, Pfizer (E)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 1135. doi:
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    • Get Citation

      Esen K. Akpek, Min Zhang, Shiao Hui M. Liew; Severity of Sicca and Predictors of Sjögren’s Syndrome in Patients with Dry Eye. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1135.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : To assess the severity grade of symptomatology and clinical findings of ocular sicca in patients with Sjögren’s syndrome (SS) compared with patients without SS (non-SS) in a cohort of dry eye patients and determine the predictors of primary SS (pSS).

Methods: : Patients (n=327) with clinically significant aqueous-deficient dry eye participating in a prospective, randomized clinical trial were assessed at 23 sites in the USA. Conjunctival staining using lissamine green, corneal staining using fluorescein, Schirmer’s test with and without anesthesia, and a general medical review to determine presence of any previously established collagen vascular diseases were performed systematically. Serological testing for antinuclear antibody test (ANA), rheumatoid factor (RTF), Sjögren-specific antibodies A and B was also performed.

Results: : 38 (11.6%) patients were identified to have SS. 21/38 (55.3%) had pSS and 17/38 (44.7%) had secondary SS associated with other collagen vascular diseases. Compared with non-SS patients, patients with SS had significantly worse symptom scores as measured by OSDI (p<0.001) and worse clinical findings including mean conjunctival lissamine green staining score (p<0.0001), corneal fluorescein staining score (p=0.0004), and Schirmer test with (p=0.0026) and without (p=0.0057) anesthesia. No significant difference was observed in tear break-up time (p=0.2103) between non-SS and SS patients. There was no correlation between the temporal conjunctival staining with lissamine green and a diagnosis of pSS. A higher percentage (80%) of SS patients had a severity of ≥2 in the inferior corneal zone than in other zones (<60% with severity ≥2). Logistic regression analysis demonstrated that pSS is 13.9 times more likely to occur in patients with a positive ANA (95% confidence interval [CI] 5.2, 36.8; p<0.0001) and 4.8 times more likely in patients with positive RTF (95% CI 1.9, 12.0; p=0.0009).

Conclusions: : In this study, patients with SS appeared to have significantly worse symptomatology and clinical findings compared with non-SS patients. There was no correlation between conjunctival staining patterns and diagnosis of SS. Positive ANA was associated with a significantly higher likelihood of pSS and could help with the diagnosis.

Clinical Trial: : http://www.clinicaltrials.gov NCT00784719

Keywords: cornea: tears/tear film/dry eye • autoimmune disease 

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