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Study finds keratoconjunctivitis sicca that is distinct from Sjögren's syndrome
Am J Ophthalmol. 2010;149(3):405-415.
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Abnormal ocular staining scores showed a substantial number of dry eye patients with keratoconjunctivitis sicca that was distinct from Sjögren's syndrome.
The new method of assessing keratoconjunctivitis sicca will become the standard method of diagnosing Sjögren's syndome, the study authors said.
"In the process of developing the [ocular staining score] for the purpose of establishing new universal classification criteria for the diagnosis of [Sjögren's syndrome], we have identified a large subset of dry eye patients who have clinical characteristics that are distinctly different from those patients with [Sjögren's syndrome keratoconjunctivitis sicca]," they said. "The underlying cause of this condition at present is unknown and represents a new and interesting area for future study that we hope to investigate with the large database that currently is being collected as part of the [Sjögren's International Collaborative Clinical Alliance] registry."
The study included 1,208 patients who participated in the Sjögren's International Collaborative Clinical Alliance (SICCA) registry. Patients underwent testing of the ocular surface with the SICCA ocular staining score. Investigators undertook Schirmer testing, assessed tear breakup time and ocular surface staining, and performed an external slit lamp examination. They evaluated relationships between abnormal ocular staining scores, features of Sjögren's syndrome and presence of anti-Sjögren's syndrome antibodies.
Study data showed significant correlations between abnormal ocular staining scores, positive serologic results and positive labial salivary gland scores. The associations were statistically significant (P < .0001).
"Analysis of the overlapping relationships of these three measures defined a large group of participants who had [keratoconjunctivitis sicca] without other components of [Sjögren's syndrome], representing a clinical entity distinct from the [keratoconjunctivitis sicca] associated with [Sjögren's syndrome]," the authors said.
This carefully constructed study, with meticulous measurements that score the severity of numerous dry eye signs and symptoms, identifies two separate groups of keratoconjunctivitis sicca: those who have provable Sjögren syndrome and those without. An intriguing question is whether classic Sjögren syndrome will develop later in all patients or whether these are two separate and distinct entities.
– Roger F. Steinert, MD
OSN
Cornea/External Disease Board Member
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