High index of suspicion required for SS

A high index of suspicion is required for underlying Sjögren's syndrome (SS) in patients with clinically significant aqueous-deficient dry eye.

The industry-sponsored multicentre clinical trial, led by Dr Esen K Akpek, Department of Cornea and External Disease Service, Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Baltimore, Maryland, USA, involved 327 patients with clinically significant aqueous-deficient dry eye.

Schirmer test, corneal fluorescein staining, conjunctival lissamine green staining, and tear-film breakup time were the ocular tests used to assess all patients. The team obtained review of systems questionnaire, medical history, dry eye questionnaire and laboratory work-up (Sjögren-specific antibody A (SSA), Sjögren-specific antibody B (SSB), rheumatoid factor (RF) and antinuclear antibody (ANA).

Of the patients studied, 38 had SS with 28 primary SS (pSS), and 17 with secondary SS. It was discovered that SS patients had significantly worse conjunctival and corneal staining, Schirmer test and symptoms compared with patients without SS. Primary SS was more likely to occur in patients with positive ANA and RF.

The abstract can be found in the British Journal of Ophthalmology.