Analysis of the first tear film break-up point in Sj\xf6gren\u2019s syndrome and non-Sj\xf6gren\u2019s syndrome dry eye patients

Songjiao Zhao,Qihua Le

doi:10.1186/s12886-021-02233-6

Abstract

BackgroundTear film instability plays an important role in the course of Sjögren’s Syndrome dry eye (SSDE) even though it is generally classified as aqueous-deficient dry eye. The measurement of the first tear film break-up point (FTBUP) helps to evaluate the most unstable position of the tear film on ocular surface. We aim to investigate FTBUP in Sjögren’s Syndrome dry eye (SSDE) and non-Sjögren’s Syndrome dry eye (NSSDE) patients, and explore its correlation with dry eye indices.MethodsTwenty-two SSDE patients (44 eyes) and 22 NSSDE patients (44 eyes) were enrolled in the study. Oculus Keratograph K5M was used to measure FTBUP, the first and average non-invasive keratographic breakup time (f-NIKBUT and av-NIKBUT), the tear meniscus height, and meibomian gland dropout. Other tests of tear film were also performed including Ocular Surface Dryness Index (OSDI), Schirmer I test, fluorescein break-up time and corneal fluorescein staining. Dry eye indices and the locations of the FTBUP were compared between SSDE and NSSDE patients. Generalized estimating equation (GEE) was used to ajusted the correlations between right and left eyes. The correlations between the FTBUP and ocular symptoms and signs were investigated using Pearson’s correlation coefficient test.ResultsThe FTBUP occurred at the supranasal quadrant in 12/88 eyes, supratemporal quadrant in 8/88 eyes, inferonasal quadrant in 34/88 eyes, and inferotemporal quadrant in 34/88 eyes. The percentage eyes with inferior FTBUP was significantly higher in the SSDE than in the NSSDE subjects (86.3% vs 68.1%, P = .049). Moreover, in SSDE subjects, temporal breakup point was seen more often in those who presented corneal fluorescein staining in any location, while nasal breakup point was more frequent in those who did not present any corneal fluorescein staining (P = .045).ConclusionThe location of the FTBUP in SSDE patients had specific characteristics. However, the diagnostic potential of FTBUP in early recognition of SSDE needs further validation.

Highlights

Tear film instability plays an important role in the course of Sjögren’s Syndrome dry eye (SSDE) even though it is generally classified as aqueous-deficient dry eye
The percentage eyes with inferior First tear film break-up point (FTBUP) was significantly higher in SSDE than in non-Sjögren’s Syndrome dry eye (NSSDE) group (P = .049, OR = 0.338)
Ocular Surface Dryness Index (OSDI) values, tear production, tear film stability and corneal fluorescein staining score The OSDI values were significantly higher in SSDE patients (56.91 ± 16.25) than in NSSDE patients (28.03 ± 13.62) (P < .001)

Summary

Introduction

Tear film instability plays an important role in the course of Sjögren’s Syndrome dry eye (SSDE) even though it is generally classified as aqueous-deficient dry eye. Sjögren’s syndrome dry eye (SSDE) is generally classified as aqueous-deficient dry eye because of the hyposecretion of lacrimal glands that were attacked by activated T-cells [7]. Other pathologic changes, such as meibomian gland dropout and mucin deficiency, are often seen in SSDE [8,9,10]. The clinical manifestations in SSDE are more severe than those in non-Sjögren’s syndrome dry eye (NSSDE), including worse tear secretion, shorter tear film breakup time, more intensive corneal epithelial staining, more severe ocular surface inflammation, fewer corneal nerve fibres and lower cellular density of epithelial cells [9,10,11,12,13,14]. Recognition is important in SS to prevent vision or life-threatening complications, unlike other autoimmune diseases, are first seen by eye care providers [15,16,17]

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