Sjögren's Syndrome, Non-Sjögren's Syndrome, and Graft-Versus-Host Disease Related Dry Eye

Abstract

I have reviewed available literature on dry eye related to Sjögren's syndrome (SS), non-Sjögren's syndrome (non-SS), and graft-versus-host disease (GVHD) to examine aqueous tear deficient dry eye as a subtype of dry eye. This section will focus on clinical studies regarding those subtypes of dry eye. I searched the PubMed database from 1990-2017 for discussion of clinical features, diagnostic criteria, and risk factors of SS, non-SS, and GVHD-related dry eye. In addition, therapeutic options for each subtype of dry eye are described. Although the clinical presentations of SS and chronic graft-versus-host disease (cGVHD) are similar, ocular surface fibrotic changes are characteristic of ocular GVHD but not SS-or non-SS-related dry eye. Recently, diagnostic criteria for each disease have been proposed and include the American College of Rheumatology/European League Against Rheumatism (ACR-EULAR) for SS and the International Chronic Ocular GVHD consensus criteria. Although there has been gradual progress, there are currently no specific therapies and few approved treatment options for these intractable diseases, including SS and GVHD. As judged by the findings, these subtypes of dry eye are different clinical entities from simple dry eye. Therefore, novel therapies, specific to these subtypes of dry eye, may be required in the future.

Longitudinal Tear Protein Changes Correlate with Ocular Chronic GVHD Development in Allogeneic Hematopoietic Stem Cell Transplant Patients

“…A decrease of TP levels in the tears may generally indicate a reduction in synthesis capability by the lachrymal glands, as it has been hypothesized in Sjogren's patients [32]. Lacrimal gland dysfunction and fibrosis is a major feature of oGVHD [60], and this may explain the decreased level of the tear TP in our patients, with distinctive profiles identified in this longitudinal study earlier than the clinical diagnosis. Some results were in agreement with what was found previously in post-HSCT patients who had developed oGVHD [18,19], in particular the reduction of LACTO and LYS-C, whereas another major tear proteins such as LIPOC-1 appeared unmodified in our study.…”

Tear proteomic profile in three distinct ocular surface diseases: keratoconus, pterygium, and dry eye related to graft-versus-host disease

“…Lipocalin-1, a major component of normal tears, along with lysozyme C and lactotransferrin, both antimicrobial proteins, are produced by the lacrimal gland and are also downregulated in tears from dry eye patients [6,11,30]. Lacrimal gland dysfunction and fibrosis is a major feature of ocular GVHD [33], and it may explain the decreased level of the proteins discussed above. Interestingly, this downregulation of proteins with antibacterial activity like lysozyme and lactotransferrin may be related to the increased risk of infectious diseases of the ocular surface in dry eye patients [29].…”

Interferons and Dry Eye in Sjögren’s Syndrome

“…Aqueous-deficient dry eye in SS is treated with tear lubrication using artificial tears, mucin-producing eye drops, punctal plug, or surgical occlusion depending on the severity of the dry eye. For SS patients, it is essential to use preservative-free topical reagents [ 49 ].…”