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Roni M. Shtein, David A. Williams, Daniel J. Clauw; Dry Eye Disease and Fibromyalgia. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3856.
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To explore possible systemic associations of the symptom-to-sign mismatch characteristic of many patients with dry eye symptoms.
Prospective, cross-sectional study of 40 patients with dry eye symptoms without known systemic disease and 20 age- and gender-matched (positive control) patients with fibromyalgia and 20 age- and gender-matched healthy (negative control) patients. Dry eye symptoms were assessed with the Ocular Surface Disease Index (OSDI) and Visual Function Questionnaire (VFQ-25). Individuals underwent eye examination including corneal sensation (Cochet-Bonnet esthesiometry), Schirmer’s testing with anesthesia, fluorescein and lissamine green staining. Statistical comparisons were made using ANOVA with post hoc Tukey’s range test and two-sample t-tests.
Sixty-two percent of patients with fibromyalgia had dry eyes based on OSDI scores. Self-reported ocular and visual symptoms as measured by the OSDI and VFQ-25 were significantly higher in both the dry eye and fibromyalgia groups as compared to healthy controls (p<.0001), but not significantly different between the two patient groups. Corneal sensation was similar in all three groups of patients (p=.18). Schirmer’s test results were different in the three groups (p=.0002), with significant reduction in patients with dry eyes as compared to healthy controls. There was no difference in surface staining among the three groups (p=.25). The relationship between dry eye symptoms and signs was quantified as the OSDI:Schirmer’s ratio; the distribution of this ratio was similar in the dry eye and fibromyalgia patients (p=.10), but significantly different in both groups as compared to healthy control patients (p<.0001, p=.0008, respectively).
The symptom-to-sign mismatch commonly known to exist in dry eye disease might be due to altered sensory integration, similar to that seen in the spectrum of diseases associated with fibromyalgia.
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