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Sarah P. Chen, Giacomina Massaro-Giordano, Maxwell Pistilli, Vatinee Y. Bunya; Tear Osmolarity in Sjögren's Syndrome. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3796.
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The unanesthetized Schirmer test is one of two ocular surface tests included in the diagnostic criteria for Sjögren’s Syndrome (SS). However, the Schirmer I test is uncomfortable for patients and can produce many false negatives. Tear film osmolarity may be a more accurate test for the diagnosis of dry eye disease. Recent improvements in technology now allow tear osmolarity measurements to be performed rapidly in the office with minimal discomfort to patients. The purpose of this study was to examine associations between tear osmolarity, Schirmer I test, and dry eye symptoms in SS.
Tear osmolarity testing was performed using the TearLab Osmolarity System (TearLab, Inc., San Diego, CA) in both eyes of 49 patients with the diagnosis of SS in accordance with the American-European Consensus Classification Criteria. Symptoms were assessed using the Ocular Surface Disease Index (OSDI). Spearman (π) rank-order correlations were used to examine the relationship between tests, and Wilcoxon's signed rank test was used to test for a difference between the pain scores.
The mean age of patients was 53.7 years (18-89 years) with a female (92%) predominance. Forty-one (84%) patients were diagnosed with primary SS and 8 (16%) with secondary SS. Forty-two (86%) patients were taking at least one systemic therapy, with 29 (59%) taking hydroxychloroquine. The mean ± SD for tear osmolarity, Schirmer I test, and OSDI was 314.5 ± 22.2 mOsm/L, 12.9 ± 10.3 mm, and 37.5 ± 24.0, respectively. Thirty-five (71.4%) patients had tear osmolarity >305 mOsm/L, 17 (34.7%) had Schirmer I test less than or equal to 5mm/5 min, and 37 (75.5%) had moderate to severe dry eye (OSDI >22) in at least one eye. Tear osmolarity was less painful than Schirmer I test by a median of 2.75 on a pain scale from 0-5 (Wilcoxon test, p < 0.0001) and showed a modest negative correlation with Schirmer I test (π = -0.39, p < 0.01). OSDI correlated with tear osmolarity (π = -0.45, p < 0.01) but not with Schirmer I test (π = 0.13, p = 0.38).
In our study, there was an absent to weak association between signs and symptoms of dry eye in treated SS patients. There was no significant correlation between OSDI and Schirmer I test and a negative, statistically significant correlation between OSDI and tear osmolarity. Tear osmolarity was associated with significantly lower discomfort than the Schirmer I test. Further studies in untreated patients are needed to determine the utility of tear osmolarity as an addition to the SS diagnostic criteria.
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