Abstract
Purpose :
The selection of proper treatment for dry eye syndrome (DES) remains an issue of routine clinical care since no therapies have been found superior to others. We performed a cross-sectional study to estimate the associations of topical DES therapies, including artificial tears, punctal occlusion, steroids, cyclosporine, antibiotics, and other medicated drops, with DES-related symptoms and signs.
Methods :
2430 participants aged 21 to 89 years from the Sjögren's International Collaborative Clinical Alliance (SICCA) cohort who met eligibility criteria comprised our study population. DES-related symptoms, topical DES therapy use, and covariates were obtained from baseline questionnaires. Schirmer I, tear break-up time (TBUT) and ocular staining score (OSS) values were evaluated by trained ophthalmologists at study entry. A linear regression on a modified ocular surface disease index (OSDI) was applied to assess the association between DES therapies and DES symptoms. Logistic and linear mixed-effects models were fitted to estimate the associations of DES therapies with dichotomized Schirmer I score (< 5mm, ≥5 mm at 5 min), TBUT (< 10 sec, ≥10 sec), and OSS.
Results :
Having punctal occlusion in place was statistically significantly associated with a higher OSDI score (4.27; 95% CI: 1.19 - 7.49) compared with using artificial tears. Participants who used multiple DES therapies demonstrated even higher OSDI score (9.08; 95% CI: 5.94 – 12.22). Nevertheless, people who took other types of medicated drops had 3.41 lower OSDI score (95% CI: 0.84 – 5.98) than those in the artificial tears group. The treatment effect on OSDI score did not differentiate among the remaining groups of steroid, cyclosporine or antibiotics. Regarding OSS, using punctal plugs and multiple therapies were associated with increased OSS, 0.92 (95% CI: 0.47 – 1.37) and 0.58 (95% CI: 0.13 – 1.02), respectively, compared with using artificial tears. No significant associations were observed between DES therapies and dichotomized Schirmer I score or TBUT.
Conclusions :
We found that having punctal occlusion or multiple DES therapies was associated with more symptoms and signs of DES. However, our findings do not necessarily suggest causality due to its cross-sectional design. Further randomized controlled trials are warranted to assess the effects.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.