Abstract
PurposeDry Eye Disease (DED) is part of several conditions, including Sjögren’s syndrome (SS) and no single test to diagnosis DED. The present study intends to evaluate whether a set of signs and symptoms of DED can distinguish: a) SS from other non-overlapping systemic diseases related to DED; b) primary and secondary SS.Methods182 consecutive patients with DED were evaluated under five groups: SS, graft-versus-host disease (GVHD), Graves' orbitopathy (GO), diabetes mellitus (DM), glaucoma under treatment with benzalkonium chloride medications (BAK). Twenty-four healthy subjects were included as control group (CG). The evaluation consisted of Ocular Surface Disease Index (OSDI), Schirmer test (ST), corneal fluorescein staining (CFS) and tear film break up time (TFBUT). Indeed, a subset of DED patients (n = 130), classified as SS1, SS2 and nonSS (NSS) by the American-European Criteria were compared. Quadratic discriminant analysis (QDA) classified the individuals based on variables collected. The area under Receiver Operating Characteristics (ROC) curve evaluated the classification performance in both comparisons.ResultsComparing SS with other diseases, QDA showed that the most important variable for classification was OSDI, followed by TFBUT and CFS. Combined, these variables were able to correctly classify 62.6% of subjects in their actual group. At the discretion of the area under the ROC curve, the group with better classification was the control (97.2%), followed by DM (95.5%) and SS (92.5%). DED tests were different among the NSS, SS1 and SS2 groups. The analysis revealed that the combined tests correctly classified 54.6% of the patients in their groups. The area under the ROC curve better classified NSS (79.5%), followed by SS2 (74.4%) and SS1 (69.4%).ConclusionsDiseases that causes DED, and also SS1, SS2 and NSS are distinguishable conditions, however a single ocular tools was not able to detect the differences among the respective groups.
Highlights
Dry eye disease (DED) is frequent ocular condition and occurs in association with several ocular and systemic diseases
Diseases that causes DED, and SS1, SS2 and NSS are distinguishable conditions, a single ocular tools was not able to detect the differences among the respective groups
Among common chronic incurable conditions related to DED are the following: Sjogren’s syndrome (SS), Diabetes Mellitus (DM), Graves’ Orbitopathy (GO), Graft versus Host Disease (GVHD and chronic use of benzalkonium chloride (BAK) [4,5,9,10,11,12]
Summary
Dry eye disease (DED) is frequent ocular condition and occurs in association with several ocular and systemic diseases. It is unknown whether the diseases that cause DED are distinguishable from SS in terms of symptoms and signs. It is unclear which tests are necessary to diagnosis DED in different diseases. Among common chronic incurable conditions related to DED are the following: Sjogren’s syndrome (SS), Diabetes Mellitus (DM), Graves’ Orbitopathy (GO), Graft versus Host Disease (GVHD and chronic use of benzalkonium chloride (BAK) [4,5,9,10,11,12]. Iatrogenic dry eye associated to BAK chronic exposure has been recently recognized and is related to corneal denervation, ocular surface inflammation and corneal. Iatrogenic dry eye associated to BAK chronic exposure has been recently recognized and is related to corneal denervation, ocular surface inflammation and corneal. [12,15]
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