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B. Caffery, The Sjogren's Syndrome Clinic Group; Clinical Comparison of Sjogren’s Syndrome and Severe Dry Eye Patients. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5325.
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To compare the clinical characteristics of Sjogren’s Syndrome (SS) patients versus Severe Dry Eye (SDE) patients.
A review of charts from the Sjogren’s Syndrome Clinic of the Toronto Western Hospital was conducted. 257 SS patients (231 primary, 58 secondary) were compared with 89 SDE patients to determine the differences in their ocular surface symptoms and clinical characteristics. SDE patients were defined as those who: 1) had been referred by ophthalmologists or rheumatologists to verify an SS diagnosis and 2) had symptoms of dryness for over 3 months and 3) Schirmer scores of < 10mm. Analysis of variance was used to compare the interval-scaled measurements. Chi-squared tests were used to compare the dichotomous measurements.
There was no difference in the severity of ocular symptoms in SS versus SDE patients, using a simple linear scale of 0-10 (p=0.26). The presence and severity of symptoms of oral dryness were higher in SS patients versus SDE, using a similar 0-10 linear scale (p=0.003, p<0.001). Schirmer scores were significantly lower in SS patients (2.83mm vs 3.67mm, p<0.001). Rose Bengal staining scores were higher in SS patients, using a 0-3 grading scale in each of nasal and temporal conjunctival and corneal areas (5.66/9 vs 3.52/9, p<0.001). Using the worst staining eye, temporal corneal fluorescein staining was present in 38.6% of SS patients and 15.5% of SDE patients (p<0.001). Nasal corneal fluoresecein staining was present in 42% of SS patients and 24.7% of SDE patients (p=0.004). There was no difference found in the presence of corneal staining in the superior, inferior and central areas of the cornea between groups.
Patients with Non-SS Severe Dry Eye present with ocular symptoms of similar magnitude to SS patients and therefore require further evaluation. SS patients have lower Schirmer scores, higher Rose Bengal scores and more frequent corneal fluorescein staining than SDE patients. SS patients also differ in the presence and severity of dry mouth symptoms. This information may help clinicians in classifying their dry eye patients and in making appropriate referrals for further testing for autoimmune disease.
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