Schirmer Test Research Articles

Background: To evaluate the effectiveness of 0.1% cyclosporine A (CsA) cationic emulsion in managing advanced dry eye disease (DED), based on clinical parameters: Ocular Surface Disease Index (OSDI), best-corrected visual acuity (BCVA), Tear Break-Up Time (TBUT), corneal fluorescein staining (CFS) on the Oxford scale, Schirmer test, and intraocular pressure (IOP). Methods: This retrospective study included 20 patients (40 eyes) with severe DED unresponsive to previous therapies. All patients continued artificial tears and added 0.1% CsA once daily. Baseline assessments included OSDI, BCVA, TBUT, corneal staining, Schirmer test, and IOP. Follow-ups occurred at 1–3, 6, 12, and 24 months. Data were analyzed for treatment effect and progression over time. Results: The mean age was 53.5 ± 13.5 years; 80% were female. BCVA showed no significant changes. OSDI scores improved from severe (>53) to moderate (approximately 35). Schirmer test increased from ~6.2 mm to >10 mm (p < 0.001). TBUT improved from approximately 6 to 10 s (p < 0.001), with significant differences after 6 months. CFS scores decreased from 3.4 to 2.05 (p < 0.001), indicating reduced corneal damage. IOP remained stable throughout the study period. Conclusions: Long-term use of 0.1% cyclosporine A cationic emulsion led to marked and sustained improvement in both subjective symptoms and objective ocular surface parameters in severe dry eye disease. The therapy was safe, well tolerated, and did not affect visual acuity or intraocular pressure, supporting its value as a long-term treatment option.

Human allogeneic umbilical cord blood serum stands out as a potent adjunct to conventional therapies for ocular surface disorders related to severe Dry Eye Disease. By expediting ocular surface regeneration and fostering epithelial integrity, umbilical cord blood serum not only enhances subjective patient experiences but also improves objective clinical indicators. This makes it particularly useful in patients with corneal ulcers through ocular surface regeneration and anti-inflammatory activity. This retrospective, interventional, non-randomized clinical study aims to explore the efficacy of allogenic umbilical cord blood serum in patients who had previously received other treatments unsuccessfully. This study was a retrospective, non-comparative, interventional clinical study involving 55 patients (35 females and 20 males) aged 18–82 years with severe Dry Eye Disease who were unresponsive to standard treatments. The study was conducted at Eye Center “G.B. Morgagni-DSV”, Catania, Italy. Patients were categorized based on the etiology of severe Dry Eye Disease into four groups: group I consisted of 26 patients with filamentary keratitis and corneal ulcers associated with rheumatologic diseases such as Sjogren’s syndrome and systemic sclerosis; group II comprised 15 patients with graft-versus-host disease; group III consisted of 10 patients with corneal neurotrophic ulcers; group IV included four patients with Steven–Johnson syndrome. Outcomes evaluated before and after treatment were OSDI (Ocular Surface Disease Index) and SANDE (Symptom Assessment in Dry Eye) Questionnaires, VAS (Visual Analog Scale), Slit-Lamp Examination, Esthesiometry, Lissamine Green Staining, NIBUT (Non-Invasive Break-Up Time) and BUT, Fluorescein Staining with Photography and Oxford Classification, Schirmer Test, Best-Corrected Visual Acuity (BCVA), Meibography. We observed a significant improvement in SANDE, VAS and OSDI questionnaires, Schirmer Test, BUT, BCVA, and Oxford classification after treatment with allogeneic cord blood serum eyedrops. Clinical variables, such as corneal inflammation, conjunctivalization, corneal neovascularization, or pain, were also considered individually. Nevertheless, pain and inflammation reduced markedly over time until completely healed in all cases. Our study highlights the remarkable efficacy of allogeneic cord blood serum eyedrops in patients with severe Dry Eye Disease who have shown absent or inadequate response to usual treatments for dry eye. This underscores the need for further comprehensive investigations in this field.

Eyelid dermatitis: Work-up and future diagnostic innovative solutions.

Xerostomia, or dry mouth, often intensifies oral health problems like dental caries and periodontitis. Smoking is a key factor influencing salivary flow, potentially leading to these issues. This study assesses the prevalence of xerostomia and reduced salivary flow (hyposalivation) among smokers. As case and control groups, the study groups include 150 smokers and 150 healthy non-smokers. A detailed questionnaire was used to collect data on smoking behaviors and symptoms associated with xerostomia. A modified Schirmer test was conducted at 1, 2, and 3-minute intervals to measure unstimulated salivary flow. Descriptive statistics were calculated for age, sex, type, frequency, and duration of smoking. The Mann-Whitney test was done to compare the salivary flow between smokers and non-smokers and to compare smoking parameters with salivary flow. Correlation was also determined for salivary flow with age and smoking parameters. All the smokers were males, and most were cigarette smokers (86%). Xerostomia symptoms were reported by 19% of smokers and none by non-smokers, which was statistically significant (P<0.000). Salivary flow rates at 1, 2, and 3 minutes were significantly lower in smokers than in non-smokers. A comparison between the frequency and duration of smoking and salivary flow yielded statistically significant P values of 0.005 and 0.043, respectively. There was a weak negative correlation between age, frequency of smoking, duration of smoking, and salivary flow. This study found a clear association between long-term smoking and xerostomia, with a notable decrease in unstimulated salivary flow. This highlights the adverse effect of smoking on oral health, which could be used in effective counseling for tobacco cessation.

Introduction Dry eye disease (DED) is a prevalent condition, particularly among IT workers with prolonged screen exposure, leading to symptoms like dryness and visual fatigue due to reduced blinking and tear film instability. Preservative-free artificial tears are increasingly recommended for their safety and efficacy in managing DED. Aim This study evaluates the efficacy of preservative-free artificial tears containing 0.15 –0.4% hyaluronic acid, administered twice daily, in improving DED symptoms in IT professionals. Secondary aims include assessing changes in tear break-up time (TBUT), Ocular Surface Disease Index (OSDI), and Schirmer test scores. Materials and Methods This prospective, non-randomized study included 83 IT workers (46 men, 37 women; mean age 28.4 ± 4.7 years) with DED symptoms, working over 8 hours daily on computers. Participants used preservative-free artificial tears (0.15–0.4% hyaluronic acid) twice daily for one month. Clinical assessments (TBUT, OSDI, Schirmer test) were conducted at baseline and after 30 days. Statistical analysis used paired t-tests (p &lt; 0.05). Results Of 83 participants, 79 completed the study. The OSDI scores decreased, from 25.6 ± 8.2 to 14.3 ± 5.1 (p &lt; 0.001), indicating symptom improvement. TBUT increased, from 7.8 ± 2.1 to 11.5 ± 1.9 seconds (p &lt; 0.001), showing enhanced tear film stability. The Schirmer scores slightly improved, from 12.4 ± 4.3 mm to 14.1 ± 3.8 mm (p = 0.04). No adverse effects were reported. Conclusion Preservative-free artificial tears significantly improve DED symptoms and tear film stability in IT workers, supporting their use as a safe, effective treatment. Further studies with control groups are warranted.

The effects of vitamin d replacement therapy on ocular surface health in children with vitamin d deficiency.

BACKGROUNDDry eye, also known as keratoconjunctival dryness, refers to a group of conditions that lead to eye discomfort and visual dysfunction. Being one of the most common complications of diabetes, it can lead to vision loss and, in severe cases, blindness in patients with diabetes.AIMTo investigate ocular dryness manifestations, assess corneal neuropathy, and identify associated influencing factors in patients with type 2 diabetes (T2D) complicated with comorbid dry eye syndrome (DES).METHODSData from 81 patients with T2D admitted to Xianyang First People’s Hospital between January 2022 and June 2023 (18 months) were retrospectively reviewed. Patients were divided into the DES and non-DES groups. Additionally, 50 individuals who concurrently underwent medical examinations served as the control group. Standardized assessments were conducted, including evaluations using the standard patient evaluation of eye dryness (SPEED) tool, noninvasive tear film breakup time (NIBUT) analysis, and Schirmer I test (SIt) determination of wetting length. Under a corneal confocal microscope, subbasal corneal neuropathy evaluations were conducted to determine the density, length, number, and tortuosity of the main nerves. Associations among SPEED scores, NIBUT, SIt results, and subbasal corneal neuropathy parameters in the DES group were examined. The DES and non-DES groups were further analyzed for differences in baseline characteristics, and potential risk factors for DES in patients with T2D were identified by multivariate logistic regression modeling.RESULTSThe T2D + DES group showed an increase in the SPEED score, along with a decrease in the NIBUT and SIt wetting length, compared with the non-DES and control groups (P < 0.05); however, no marked inter-group differences were noted for fluorescein staining test scores between T2D + DES group and DES group. Compared with the non-DES groups, the DES group exhibited reductions in density, length, and number of the main nerves, as well as an increase in nerve tortuosity (all P < 0.05), and all these changes were more pronounced in the non-DES group than in the DES group (all P < 0.05). In the DES group, the SPEED score demonstrated a significant negative correlation with nerve density and the length and number of the main nerves but a positive correlation with nerve tortuosity. Conversely, both the NIBUT and SIt wetting length showed a positive association with the density and number of the main nerves; however, the SIt wetting length demonstrated an inverse correlation with nerve tortuosity. Multivariate modeling identified several independent risk factors for DES in T2D, such as age, diabetes duration, lacrimal gland dysfunction, and insufficient insulin secretion, as well as fasting blood glucose and glycated hemoglobin.CONCLUSIONPatients with T2D are more susceptible to DES. The T2D + DES group exhibited significant reductions in the density, length, and count, along with increased tortuosity, of the main nerve. These corneal nerve changes are also intimately linked to the severity of DES.

The 2016 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria (AECC) borrow from oral pathology, ophthalmology, pathology, and serology to define Sjögren disease (SjD). The objective of this study was to analyze the utility of incorporating the 2016 AECC tools into clinical practice. A cross-sectional database with 374 patients evaluated on protocol between 1993 and 2019 at the University Health Network Multidisciplinary Sjogren's Clinic was used for the purpose of this data analysis. All patients used for this analysis had a complete evaluation, including serology, ocular surface staining, and minor salivary gland (MSG) biopsy. Of the 374 patients, 263 (70.3%) were diagnosed with SjD in clinic on the basis of the Schirmer test (ST), unstimulated salivary flow (USSF), and serology results alone (group A). An additional 14% were diagnosed after further assessment with ocular surface staining (ophthalmology) and MSG biopsy (ENT; group B). Group C patients did not have SjD. Groups B and C together were frequently seronegative (for antinuclear antibody and/or anti-Ro) or antimitochondrial antibody positive. Seronegative patients with abnormal ST and USSF had a positive MSG biopsy in 70% of cases. SjD could be diagnosed according to 2016 AECC in most patients on the basis of ST, USSF, and serology results where there is concern for the disease on clinical evaluation. Patients who required further testing for diagnosis had some distinctive features. This analysis provides the practicing physician with some guidelines for establishing a diagnosis of SjD in clinic.

An objective indicator for diagnosing and evaluating the therapeutic efficacy of conjunctivochalasis (CCh) treatments is not available. Therefore, we investigated the correlation between CCh severity and the matrix metalloproteinase-9 (MMP)-9 point-of-care (POC) semi-quantitative test to determine its suitability for diagnosing and evaluating CCh. We conducted a prospective study comprising healthy participants and patients with evaporative dry eyes and CCh. The participants underwent CCh severity, tear break-up time, Schirmer test, ocular staining score, tear meniscus height, and tear MMP-9 evaluations. The MMP-9 test results were classified into negative and weakly, moderately, and strongly positive. We included 108 participants; 54 participants had CCh and 54 did not. The MMP-9 positivity rate was significantly higher for patients with ≥ CCh grade 2 than those without CCh (p < 0.001). Of the CCh-negative participants, 75.9% were MMP-9-negative, and 24.1% were moderately/strongly positive. Conversely, 37.0% of CCh-positive patients were MMP-9-negative, and 63.0% were moderately/strongly positive. Furthermore, MMP-9 positivity significantly differed among the CCh severity groups (p < 0.001). Finally, there was a positive correlation between CCh severity and MMP-9 positivity (p < 0.001, R = 0.420). The tear MMP-9 positivity correlated with CCh severity. Therefore, the MMP-9 POC test may help diagnose CCh and evaluate its severity after treatment.

Neuropathic corneal pain (NCP) is a challenging condition with limited consensus on its diagnosis and management. This study aimed to gather global insights from corneal specialists on the causes, investigative approaches, and management strategies for NCP. A 32-question survey covering demographic, causes, investigations, treatments, and multidisciplinary engagement was sent to 152 invited international corneal specialists; 51 (34%) responded. We explored descriptive statistics and examined how responder characteristics influenced their answers. The most reported causes of NCP were chronic ocular surface disease (n = 41; 41%) and post-surgical factors (n = 34; 34%). The most common investigations, routinely performed by respondents, were the anesthetic challenge test, Schirmer's test, and corneal esthesiometry. In vivo confocal microscopy (IVCM) was routinely used by 37% (n = 19), with 69% (n = 29) of specialists stating that an abnormal result influenced their management. Ocular surface and pain questionnaires were used by 69% (n = 35), with the Ocular Surface Disease Index being the most popular (n = 25; 31%). Common treatments included artificial tears (n = 48; 94%), serum/plasma-derived tears (n = 41; 80%), topical corticosteroids (n = 34; 67%), and topical cyclosporin (n = 30; 59%). Only 38% (n = 19) felt comfortable independently prescribing systemic pharmacotherapy. A multidisciplinary approach was adopted by 47% (n = 24), with the two most common specialties involved being pain management (n = 30; 37%) and neurology (n = 26, 32%). This survey provides valuable global insights into the causes, investigations, and management of NCP from the perspective of corneal specialists. These findings support further research and the development of guidelines to address this challenging condition.

Background: Despite technological advancements in cataract surgery, including Femtosecond Laser-Assisted Cataract Surgery (FLACS), postoperative dry eye disease (DED) remains a challenge, impacting patients' quality of life. Identifying preoperative predictors of ocular discomfort could improve patient management. Methods: This exploratory prospective study compared the onset of DED symptoms and ocular surface changes after FLACS and standard cataract surgery (SCS). Twenty eyes were evaluated preoperatively and postoperatively, using Ocular Surface Disease Index (OSDI), Non-Invasive Break-Up Time (NI-BUT), Schirmer I Test, and Oxford Score. One-week OSDI was analyzed as the dependent variable using multivariable quantile regression (τ = 0.5), with baseline parameters (OSDI, Oxford score, Schirmer test, NI-BUT), age, BCVA, surgical technique, and cumulative dissipated energy (CDE) as predictors. Results: FLACS was associated with a transient worsening of OSDI at one week, which resolved by three months, whereas SCS showed a milder but more gradual increase. In multivariable analysis, baseline OSDI (β = 0.61, p < 0.001) and Oxford score (β = 5.42, p = 0.045) were independent predictors, while surgical technique and perioperative parameters were not significant. In a reduced model, both predictors confirmed their association. Subgroup analyses showed baseline OSDI as predictive only in FLACS. Conclusions: Preoperative ocular surface status emerges as the main determinant of early postoperative DED symptoms. Routine assessment of OSDI and Oxford scores may help identify at-risk patients and guide preventive strategies.

Prostaglandin F2α exacerbated dry eye by promoting lacrimal gland fibrosis progression through the activation of the RhoA/ROCKs signaling pathway.

ABSTRACT Objective: To screen influencing factors of dry eye and evaluate a new diagnosis and treatment model combining tertiary hospitals with community health management. Methods: A total of 500 community residents from two Chinese hospitals between January – September, 2023 were included. Dry eye was diagnosed based on the presence of typical symptoms, an OSDI score > 13, a tear film break-up time (BUT) < 10 seconds, and/or a Schirmer I test (SIT) result < 10 mm/5 min, following the 2020 Chinese Dry Eye Expert Consensus. Diagnosed patients were randomized into a management group (community health management) and a control group (self-management). Both received standardized hospital treatment for six months. Disease cognition, symptom improvement, psychological state, eye comfort, satisfaction, and quality of life were compared. Results: Dry eye prevalence was 26.40% (132/500). Univariate analysis identified age, sex, drug use, connective tissue disease, laser corneal surgery, vitamin A deficiency, hepatitis C, mite infection, anxiety, depression, sleep disorder, and diabetes as influencing factors (p < 0.05). After six months, the management group showed better disease cognition, improved BUT and SIT, and lower OSDI scores than the control group (p < 0.05). SAS and SDS scores were lower, and VAS scores were reduced, while GQLI and management satisfaction were higher (p < 0.05). Conclusion: Factors such as drug use, laser surgery, vitamin A deficiency, hepatitis C, mite infection, and psychological and metabolic conditions influence dry eye. A combined hospital-community management model improves symptoms, psychological well-being, disease awareness, quality of life, and treatment satisfaction.

BackgroundPostoperative dry eye disease (DED) is a common complication following cataract surgery with intraocular lens (IOL) implantation, adversely affecting ocular comfort and visual outcomes. Identifying risk factors and developing predictive models may facilitate targeted interventions and improved patient management.MethodsA retrospective analysis was conducted involving 376 cataract patients who underwent phacoemulsification with IOL implantation between January 2021 and December 2024. Patients were divided into a DED group (n = 158) and a non- DED group (n = 218) based on clinical evaluation, including the Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear film break-up time (BUT), Schirmer I test (SIt), and fluorescein staining (FL) scores. Risk factors were identified using univariate and multivariate logistic regression analyses. A nomogram was constructed from significant predictors and assessed by receiver operating characteristic (ROC) analysis, bootstrap internal validation, and decision curve analysis (DCA).ResultsThe incidence of postoperative DED was 42.02% (Among the DED patients, 66.46% had mild DED, and 33.54% had moderate DED). Univariate analysis revealed that patients with DED were significantly older and had a higher prevalence of orthokeratology lens wear, diabetes, and rheumatoid arthritis, along with worse nuclear hardness grading, prolonged surgical time, abnormal ocular surface stress test (OSST) results, and impaired ocular surface parameters (all p < 0.05). Multivariate analysis identified orthokeratology lens wear (OR 3.472, p = 0.018), diabetes (OR 3.193, p = 0.016), diminished meibomian gland secretion (OR 3.228, p = 0.033), increased meibum viscosity (OR 3.548, p = 0.018), and elevated conjunctivochalasis grade (OR 3.092, p = 0.027) as independent predictors. The nomogram demonstrated an AUC of 0.761, with a sensitivity of 71.67% and specificity of 82.18%. Internal validation yielded a corrected C-index of 0.785, and DCA confirmed its clinical utility.ConclusionsIn this study, orthokeratology lens wear, diabetes, and adverse ocular surface parameters, including diminished meibomian gland secretion, increased meibum viscosity, and elevated conjunctivochalasis grades were statistically associated with the occurrence of postoperative DED following IOL implantation. The nomogram developed from these associations demonstrated moderate discriminatory ability (AUC = 0.761) and good calibration. Prospective studies and external validation in diverse populations are warranted to confirm the model’s generalizability and predictive performance.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12886-025-04369-1.

Ocular manifestations in Stevens‒Johnson syndrome/toxic epidermal necrolysis in cancer patients.

Postoperative dry eye disease (DED) remains a frequent complication that can reduce patient satisfaction and surgical outcomes. Low-level light therapy (LLLT) is a non-invasive technology that has shown positive outcomes in managing DED. This study aimed to assess the prophylactic application of perioperative LLLT for improving ocular surface parameters and symptoms in consecutive patients undergoing cataract surgery. In this prospective, double-masked, randomized sham-controlled study, patients scheduled for cataract surgery were randomized to receive either periocular LLLT or sham treatment 1week before and 1week after surgery. Ocular surface assessments, including Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (BUT), Schirmer test type I, tear osmolarity, and corneal fluorescein staining (Oxford score), were performed preoperatively before the first treatment/sham session (T0), and postoperatively 1week (T1) and 1month postoperatively (T2). All patients received the same postoperative therapy. Out of 98 patients randomized to LLLT (50 patients) or sham treatment (48 patients), 89 patients (45 males, 44 females; mean age of 73.75 ± 7.95years) completed the study. Unlike controls, the LLLT group showed significant improvements from T0 to T1 and T2 for OSDI scores (respectively, from 26.62 ± 15.42 to 15.53 ± 12.04 and 13.36 ± 11.69; p < 0.001) and BUT values (respectively, from 5.76 ± 3.99 to 6.69 ± 4.48 and 8.38 ± 4.53; p = 0.002), and from T0 to T2 for tear osmolarity (respectively, from 300.69 ± 14.19mOsm/l to 296.11 ± 12.30mOsm/l; p = 0.048). No significant differences were found in Schirmer test values within or between the two groups. No adverse effects were reported. Perioperative LLLT is a safe, well-tolerated, and effective treatment for preventing iatrogenic DED in cataract surgery. Integrating LLLT into the routine perioperative care may enhance patient satisfaction and overall outcomes in the setting of cataract surgery. NCT07067294, retrospectively registered on 05.07.2025.

Aim To assess dry eye indices, choroidal thickness, retinal and optic disc vessel density in rheumatoid arthritis (RA) patients using anterior segment optical coherence tomography (AS-OCT), enhanced depth imaging OCT, and optical coherence tomography angiography, comparing them to healthy controls. Settings and design A prospective comparative observational study was conducted at the Ophthalmology Department of Ain Shams University Hospital between November 2022 and November 2024. Patients and methods Fifty eyes of 50 RA patients and 50 eyes of 50 healthy age-matched and sex-matched controls were included in this study. All participants underwent a comprehensive ophthalmic examination, including Schirmer test (I and II) and tear break-up time. AS-OCT was used to measure epithelial thickness, central corneal thickness, tear meniscus height, and tear meniscus area. Enhanced depth imaging OCT was used to measure subfoveal choroidal thickness. OCT angiography was used to assess superficial capillary plexus vessel density (VD), deep capillary plexus (DCP) VD, foveal avascular zone size, and radial peripapillary capillary VD. Results RA patients showed significantly lower Schirmer I (13.00±2.36 vs. 15.60±1.54 mm, P &lt;0.001), Schirmer II (10.12±2.62 vs. 12.46±1.16 mm, P &lt;0.001), tear break-up time (11.32±1.94 vs. 14.98±1.90 s, P &lt;0.001), and tear meniscus area (0.02±0.01 vs. 0.03±0.01 mm 2 , P &lt;0.001) compared to controls. Superior epithelial thickness was significantly thinner in RA patients (47.28±4.98 vs. 49.20±3.61 µm, P =0.030). Superficial capillary plexus VD was significantly lower in RA patients in superior (51.22±5.35 vs. 54.22±3.34%, P =0.001), nasal (50.00±4.99 vs. 52.50±4.01%, P =0.007), temporal (49.72±5.28 vs. 52.92±4.20%, P =0.001), and foveal (16.11±5.18 vs. 20.62±9.37%, P =0.004) regions. DCP VD was significantly lower in RA patients in inferior (54.30±5.52 vs. 56.80±3.95%, P =0.011) and superior (55.24±5.44 vs. 58.02±3.56%, P =0.003) regions. Disease duration showed a significant negative correlation with DCP VD in all quadrants except the fovea. Conclusion RA patients exhibit significant changes, including tear film instability, superior corneal epithelial thinning, and reduced retinal microvascular density in multiple retinal quadrants. The correlation between disease duration and DCP VD suggests progressive microvascular decrease with longer disease duration.

To evaluate the prevalence of obesity in primary Sjögren's disease (SjD), and assess its association with clinical/serologic features, disease activity, damage, and sicca symptoms. Transversal study that included 91 patients. We registered demographics, comorbidities, glandular/extra-glandular and serologic variables. We assessed the Schirmer-I test and non-stimulated salivary flow, and scored the cumulative ESSDAI, SSDDI and ESSPRI scores. We measured the body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR). We defined obesity as a BMI ≥30 kg/m2. Central obesity was defined as WC >90 cm and >80 cm; or by a WHR >0.90 and >0.85, for men and women, respectively. All patients underwent bioimpedance analysis to measure body fat mass index (FMI). An elevated/high FMI was classified as obese. According to BMI, 18 patients were obese (19.7%), while 33 (36.2%) were obese according to WC, 48 (52.7%) according to WHR, and 37(40.6%) according to FMI. When we compared obese vs non-obese patients according to BMI, the first group had a higher prevalence of anti-Ro/SSA antibodies. When we then performed the same groups comparison, but now using the WC, WHR and FMI definitions, the multivariate analysis showed an association between SSDDI and obesity. According to BMI, at least 20% of patients were obese, this prevalence increased to 40% when BIA was used, with a higher prevalence found in central obesity. Obesity did not impact the symptoms and disease activity but might be associated with damage. Our results may have implications for weight reduction in these patients.

Sjögren's disease (SD) is a systemic autoimmune disease characterised by lymphocytic infiltration of exocrine glands, leading to xerophthalmia and xerostomia, but it may also cause extraglandular involvement, including musculoskeletal, neurological, renal and pulmonary manifestations. Although interstitial lung disease and small airway obstruction are well-documented pulmonary manifestations, pleural effusion is rare. In this report, we present a male patient in his 40s who presented with left-sided pleuritic chest pain and pleural effusion with no previous history of systemic disease, infection or malignancy. Initial laboratory and imaging findings suggested exudative pleural effusion, but further investigations excluded infectious causes, tuberculosis and malignancy. Following a detailed history and physical examination, autoimmune tests (ANA, ENA) were requested based on clinical suspicion. Anti-SSA (Ro) was positive, and the Schirmer test was positive, leading to a diagnosis of pSS. While pulmonary involvement is common in primary SD, pleural effusion is a rare manifestation.

Secondary pulmonary amyloidosis due to Sjögren's syndrome (SS) is an uncommon disease. However, pulmonary amyloidosis detected before the diagnosis of SS is exceedingly rare. Herein, we report a unique case of a 40-year-old female who presented with pulmonary calcified nodules and cysts as an initial manifestation of pulmonary amyloidosis. Further diagnostic evaluation revealed SS. A 40-year-old non-smoking female presented with a cough, whose chest computed tomography (CT) scan revealed many lung cysts along with calcified nodules. Pathology revealed nodular pulmonary amyloidosis. Subsequent investigations excluded common related lymphoproliferative disorders and plasma cell dyscrasias. Combined with elevated levels of antinuclear antibody (1:640), positivity for the anti-Sjögren's syndrome A (SS-A)/Ro antibody, abnormal tear break-up time (BUT) and Schirmer test, the diagnosis of SS was established. Pulmonary amyloidosis is a rare pulmonary manifestation of SS, especially with atypical early clinical symptoms, which can render diagnosis challenging. This case highlights that amyloidosis diagnosis precedes SS diagnosis. Moreover, it aims to alert clinicians that when multiple calcified nodules and cystic lesions are observed on chest CT, secondary pulmonary amyloidosis should be considered, and further investigations into related diseases such as SS should be conducted to avoid missed diagnoses.