Abstract
ObjectiveTo investigate the differences in ocular surface characteristics, tear film quality, and the incidence of dry eye disease (DED) between Systemic Lupus Erythematosus (SLE) patients and healthy populations.MethodsThis age and gender-matched cross-sectional study included 96 SLE patients without secondary Sjögren's syndrome (SS) and 72 healthy subjects. The Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), non-invasive tear film breakup time (NIKBUT), meibography, and tear film lipid layer grade were assessed. A receiver operative characteristic (ROC) curve was constructed to evaluate the predictive value of risk factors.ResultsCompared with the control subjects, a significantly greater proportion of SLE patients met the TFOS DEWS II DED diagnostic criteria (34.3 vs. 18.1%, P = 0.019). SLE patients without SS had higher OSDI scores [10.0 (4.5,18.0) vs. 5.0 (2.5,11.9), P < 0.001], and shorter NIKBUT [9.6 (6.6,15.0) vs. 12.3 (8.4, 15.8), P = 0.035]. Furthermore, TMH, Tear film lipid layer grade, and Meibomian gland (MG) dropout in SLE patients were worse than those in control subjects (all P < 0.05). For ROC analysis, the area under curve (AUC), sensitivity and specificity of prediction were 0.915, 75.8 and 92.1% for the combination of SLE disease activity index (SLEDAI), age and NIKBUT.ConclusionsSLE patients without SS exhibited a higher risk for DED than healthy subjects, and the poorer Meibomian gland function in SLE patients may potentially contribute to the development of DED. The combined parameters of SLEDAI, age and NIKBUT showed a high efficiency for the diagnosis of DED in SLE patients, with practical clinical applications.
Highlights
Dry eye disease (DED) is a multifactorial disease of the ocular surface, which is characterized by the loss of tear film homeostasis accompanied by ocular surface symptoms [1, 2]
Ocular Surface Disease Index (OSDI) scores were higher in systemic lupus erythematosus (SLE) patients than in healthy subjects [10.0 (4.5,18.0) versus 5.0 (2.5,11.9), P < 0.001, Figure 2A]
According to the five-point Meiboscale, greater levels of meibomian gland (MG) dropout were observed in SLE patients than in healthy subjects [2(1,3) vs. 1(1,2), P = 0.013, Figure 3]
Summary
Dry eye disease (DED) is a multifactorial disease of the ocular surface, which is characterized by the loss of tear film homeostasis accompanied by ocular surface symptoms [1, 2]. The etiology includes tear film instability, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities [3, 4]. In 2017, The Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) redefined DED and emphasized the need for further research examining the associations of the DED with autoimmune disease and noted that autoimmune disease was a high risk factor for DED. There is an association between aqueous-deficient DED and autoimmune diseases, especially Sjögren’s syndrome (SS), which is characterized by chronic inflammation of the salivary and lacrimal glands [5]. The persistence of ocular surface inflammation plays an important role in the decline of tear film homeostasis in SS patients [9]. Whether the SLE activity is a risk factor for DED is unclear
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