Abstract
Abstract: :
Purpose: We investigated whether rose bengal (RB) staining of superior bulbar conjunctiva in Sjögren's syndrome (SS)–related dry eye implies possible involvement of superior limbic keratoconjunctivitis (SLK). Methods: Enrolled in this study were 30 SS–related dry eye patients (all female; 62.7±8.2 yrs.). SS diagnosis was based on criteria proposed by Fox et al. Eleven superior limbic keratoconjunctivitis (SLK) patients (2 males and 9 females; 47.4±9.5 yrs.) with no aqueous deficiency were enrolled as control. Clinical manifestations regarding superior bulbar conjunctiva characteristic to SLK were evaluated. Positive rose bengal (RB) staining was scored from 0 to 3 according to the severity. Then following 3 manifestations were evaluated in RB staining positive group (score 1–3); 1) hyperemia and thickening of the upper bulbar conjunctiva were evaluated as positive or negative. 2) Conjunctival laxity (CL) was scored from 0 to 3, using fluorescein staining by squeezing the upper lid inferiorly with the thumb as to make conjunctival folds. 3) Impression cytology was performed to explore the existence of goblet cells using periodic acid–Schiff and hematoxylin staining. Results: Eighteen out of 30 patients (60%) in SS group showed positive RB staining (1.1 ± 1.1, mean ± SD), whereas all of the SLK patients showed positive RB staining which was significantly higher in score than SS (2.4 ± 0.5, P=0.0006). Fourteen out of 30 patients (73.7%) in SS group showed CL (0.9 ± 0.8), whereas all of the SLK patients showed CL which is significantly higher in score than SS (2.5 ± 0.7, P=0.0006). The frequency of hyperemia and thickening of the upper bulbar conjunctiva in SS group were 24.1% (7/19) and 5.3% (1/19) which were significantly lower than those respective values in the SLK group [100% (11/11) and 45.5% (5/11); p=0.0008 and p=0.0001, respectively]. Impression cytology disclosed only 3 out of 13 SS (23.8%) patients lost goblet cells, whereas all of SLK patients lost goblet cells (p=0.0036). Conclusions: RB staining of superior bulbar conjunctiva in Sjögren's syndrome (SS)–related patient may not be necessarily associated with the involvement of superior limbic keratoconjunctivitis (SLK). CR: None
Keywords: cornea: tears/tear film/dry eye • conjunctiva • conjunctivitis