Is Sjögren’s syndrome dry eye similar to dry eye caused by other etiologies? Discriminating different diseases by dry eye tests

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.

Neutrophil extracellular traps (NETs) contribute to pathological changes of ocular graft-vs.-host disease (oGVHD) dry eye: Implications for novel biomarkers and therapeutic strategies

“…Currently, DED clinical tests classify individuals in their correct group (Sjogren's syndrome or oGVHD) in only 40% cases even when all clinical tests are combined. 84 While we used clinical signs and symptoms to diagnose ocular GVHD using the Chronic Ocular GVHD consensus scoring algorithm, we also investigated emerging in-office diagnostic modalities. Our data shows that bulbar redness, non-invasive tear break up time, meibomian gland dropout and lipid layer thickness measurements are significantly worse in ocular GVHD patients (Table 1).…”

The Innate Immune Cell Profile of the Cornea Predicts the Onset of Ocular Surface Inflammatory Disorders

“…It is comprised of both the innate and adaptive immune system, and the prevention of ocular surface diseases depends on the appropriate activation and regulation of these inter-connected branches of the immune system, which in turn rely on various molecular sensors and receptors. This wide spectrum of diseases can occur as a result of pure infection, stemming from "external'" factors, such as contact lens injury, or 'internal' factors, including autoimmune diseases such as rheumatoid arthritis and Sjögren's syndrome [1,2]. Ocular surface diseases represent a significant unmet medical need and are a substantial burden to patients, families, and healthcare systems.…”

Assessment of Corneal Fluorescein Staining in Different Dry Eye Subtypes Using Digital Image Analysis

“…On the contrary, other DED subtypes (i.e., SS and oGVHD) are harder to be differentiated not only using CFS alone, but also combining it with the whole armamentarium of ocular surface tests 28. In fact, Garcia et al18 recently evaluated whether corneal staining combined with discomfort symptoms, Schirmer test, and break-up time could be used to distinguish DED associated with different systemic diseases. The authors concluded that those tests, even when combined, presented a limited capacity to discriminate SS and oGVHD, two overlapping DED subtypes clinically considered as “undistinguishable,” in the absence of an adequate medical history collection 18…”

“…This analysis would be of great interest to distinguish certain DED subtypes, as the other available DED diagnostic techniques (e.g., Schirmer test, break-up time) have limited capacity in the differential diagnosis of different DED etiologies. Among these, Sjögren syndrome (SS) and ocular graft versus-host disease (oGVHD), previously called Sjögren-like syndrome, represent two major causes of severe DED with similar clinical picture 18–21…”