Abstract
PurposeTo assess the tear film and meibomian gland (MG) features in a Norwegian cohort of patients with primary Sjögren´s syndrome (pSS) and in age- and gender-matched control subjects.MethodsThirty-four female patients with pSS (age 52.9±11.9 years) and 32 female control subjects (age 49.0±11.5 years) were recruited. After completion of Ocular Surface Disease Index (OSDI) questionnaire and McMonnies Dry Eye Questionaire, participants underwent measurements of tear osmolarity, tear break-up time (TBUT), ocular surface and corneal staining, Schirmer I test, corneal sensitivity, MG expressibility evaluations, and lid margin morphology examination using slitlamp microscopy. Non-contact infrared meibography images were assessed by computer-assisted analysis. The MG loss, calculated as (tarsal area-MG area)/tarsal area, was evaluated in both upper (UL) and lower lids (LL).ResultsCompared to the control group, pSS patients demonstrated higher MG loss in both UL (33.8±13.2% vs. 24.4±8.5%, p< 0.01) and LL (52.5±15.7% vs. 43.0±9.6%, p<0.05), as well as higher lid abnormality score (0.8±0.8 vs. 0.2±0.6, p< 0.01). Furthermore, pSS patients showed higher OSDI and McMonnies questionnaire scores, elevated osmolarity, shorter TBUT, shorter blink interval, less wetting in Schirmer I test, more ocular surface staining and more corneal staining. MG loss in UL correlated negatively with TBUT (r = -0.386, p = 0.029) in the pSS group, whereas MG loss in LL correlated negatively with TBUT (r = -0.380, p = 0.035) in the control group.ConclusionsSignificantly elevated dry eye symptoms and signs were found in the pSS group compared with the control group, which might be attributed to both decreased aqueous tear production and increased tear evaporation.
Highlights
Primary Sjogrens syndrome is a systemic, progressive, autoimmune disorder characterized by lymphocytic infiltration of exocrine glands and epithelia in multiple sites
Elevated dry eye symptoms and signs were found in the Primary Sjogrens syndrome (pSS) group compared with the control group, which might be attributed to both decreased aqueous tear production and increased tear evaporation
Meibomian gland in primary Sjogrens syndrome on central five meibomian gland (MG) of the lower eyelid
Summary
Primary Sjogrens syndrome (pSS) is a systemic, progressive, autoimmune disorder characterized by lymphocytic infiltration of exocrine glands and epithelia in multiple sites. Dry eye disease (DED), as defined by the 2007 International Dry Eye Workshop (DEWS), is “a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface” [4]. It is usually classified into two major categories: aqueous tear-deficient dry eye due to failure of lacrimal tear secretion, and evaporative dry eye due to excessive water loss from the exposed ocular surface [4]. A study by Wan et al showed that among patients with DED those suffering from pSS have higher prevalence and severity of depression [7]
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