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The relationship between ocular and oral dryness in a cohort from the 65-year-old population in Norway. Sci Rep 2022; 12:9805. [PMID: 35697848 PMCID: PMC9191758 DOI: 10.1038/s41598-022-13985-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/31/2022] [Indexed: 12/02/2022] Open
Abstract
In the present study, the relationship between dry eyes and dry mouth was explored in 150 65-year-old subjects randomly selected from the general population in Oslo, Norway. The number of drugs, including xerogenic drugs, and current and previous systemic diseases were recorded. Ocular parameters recorded were the McMonnies Dry Eye Questionnaire, the Ocular Surface Disease Index, the Schirmer I Test, tear film break-up time and ocular surface staining. The oral parameters were xerostomia frequency, Summated Xerostomia Inventory, Clinical Oral Dryness Score, and unstimulated and stimulated whole saliva. The participants with current or previous systemic diseases had significantly more ocular and oral symptoms and significantly more oral clinical findings than the participants without a history of disease. Moreover, correlation and factor analyses demonstrated an association between subjective ocular and oral parameters. A significant correlation between the total number of drugs and the presence of ocular and oral symptoms was also noted. When the participants were categorized based on their ocular symptoms, poorer values were found for the oral parameters among the participants more troubled with dry eyes. The results in the present study call for increased awareness and an interdisciplinary approach in matters related to dry eyes and dry mouth.
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Abstract
PURPOSE Systemic implications necessitate the identification of dry eye patients with Sjögren syndrome (SS). This study aims to explore the utility of tear MUC5AC and inflammatory cytokine levels in the differential diagnosis of SS-related dry eye. METHODS A prospective, observational, case-control study was conducted on 62 patients (those with a definitive diagnosis of SS dry eye, non-SS dry eye, and age-matched healthy controls with no dry eye). Clinical evaluations included the following tests in the order listed here: noninvasive tear break-up time, osmolarity, tear sampling, Schirmer test without anesthesia, and ocular surface staining (lissamine green for conjunctiva and fluorescein for cornea). Tear MUC5AC levels were assessed with enzyme-linked immunosorbent assay, and cytokines [interferon-gamma, tumor necrosis factor alpha, interleukin (IL)-6, IL-17a, IL-1β, IL-8, IL-10, and IL-12p70] were measured using a Luminex assay in a masked fashion. RESULTS The Bulbar conjunctival lissamine green staining score was significantly greater in patients or controls with SS versus non-SS dry eye. This greater conjunctival staining was associated with a reduction in tear MUC5AC (B = -17.8 ng/mL, 95% confidence interval = -31.8 to -3.9, P = 0.01). Among the tear cytokines, a significant association was found between IL-8 levels (hazard ratio [HR] = 1.002, 95% confidence interval = 1.000-1.003, P = 0.03) and SS diagnosis. When patients were stratified based on tear MUC5AC levels, significantly increased tear IL-8 levels were detected in patients with SS dry eye but not with non-SS dry eye, in comparison with healthy controls. CONCLUSIONS Tear levels of goblet cell-specific MUC5AC combined with IL-8 can potentially serve as a useful biomarker for differential diagnosis of SS dry eye from non-SS dry eye.
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Gurlevik U, Karakoyun A, Yasar E. Does Sjogren's syndrome affect only the lacrimal gland in the eye? Time to replace the missing stones. Indian J Ophthalmol 2021; 69:53-57. [PMID: 33323573 PMCID: PMC7926172 DOI: 10.4103/ijo.ijo_2383_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose: This study aimed to reveal the cause of meibomian gland disease and meibomian gland loss in patients with Sjögren's syndrome (SS) as the leading factor for dry eyes. Methods: The study included a total of 30 patients with SS and dry eye symptoms and a control group of 50 age- and gender-matched healthy subjects. The dryness parameters of all the participants were evaluated. At first, meibography was performed to measure meibomian gland loss using noninvasive methods. Later, meibomian gland expression and secretion quality were evaluated using silt-lamp biomicroscopy. Correlations between the measurements were analyzed statistically. Results: In patients with SS, MG loss was significantly greater than in the control group (19.7 ± 71%, 12.7 ± 9.6%, P < 0.001). All dry eye parameters (tear film breakup time, Schirmer's test score, OSDI, stain score, dry eye disease) were statistically significant in the SS group. There was an extremely negative correlation between upper MB loss and BUT (P = 0.08, r: 0.781). There was an extremely positive correlation between upper MB loss and staining (P = 0.015, r: 0.739). An extremely negative correlation was determined between sub-MB loss and BUT (P = 0.18, r:-0.781), and a moderately positive significant correlation was found between sub-MB loss and staining (P = 0.031, r: 0.659). Conclusion: The results of this study demonstrated that patients with SS were at a higher risk of being exposed to meibomian gland loss, which directly leads to the severe dry eye symptoms associated with SS.
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Affiliation(s)
- Ugur Gurlevik
- Department of Ophthalmology, Aksaray University Faculty of Medicine, Aksaray Education and Research Hospital, Aksaray, Turkey
| | - Ahmet Karakoyun
- Department of Rheumatology, Aksaray University Faculty of Medicine, Aksaray Education and Research Hospital, Aksaray, Turkey
| | - Erdogan Yasar
- Department of Ophthalmology, Aksaray University Faculty of Medicine, Aksaray Education and Research Hospital, Aksaray, Turkey
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Caffery B, Harthan J, Srinivasan S, Acs M, Barnett M, Edmonds C, Johnson-Tong L, Maharaj R, Pemberton B, Papinski D. Sjogren’s syndrome in optometric practices in North America. Cont Lens Anterior Eye 2018; 41:518-526. [DOI: 10.1016/j.clae.2018.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
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Acs M, Caffery B, Barnett M, Edmonds C, Johnson-Tong L, Maharaj R, Pemberton B, Papinski D, Harthan J, Srinivasan S. Customary practices in the monitoring of dry eye disease in Sjogren's syndrome. JOURNAL OF OPTOMETRY 2018; 11:232-241. [PMID: 30017867 PMCID: PMC6147754 DOI: 10.1016/j.optom.2018.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/25/2018] [Accepted: 05/26/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Diagnostic testing for dry eye disease (DED) in Sjogren's syndrome (SS) is well described. Little is published about monitoring this systemic autoimmune DED. We analyzed the SS related DED tests used in North American optometric practices and compared academic settings to private practice settings. METHODS A retrospective chart review of 123 SS charts from 6 optometric practices in North America was conducted. Testing done during the first examination following a SS diagnosis was recorded on Research Electronic Data Capture (REDCap) database. The complete data file was reviewed and testing type and methodology were compared. RESULTS Symptoms of DED (98.4% of charts),meibomian gland dysfunction (76.4% of charts), corneal staining with fluorescein (75.6% of charts) and anterior blepharitis (73.2% of charts) were the most frequently recorded variables. Clinicians used different methodologies to measure and grade these variables. Private practitioners were more likely to use symptom questionnaires and grading scales and to describe anterior blepharitis. Academic settings were more likely to record TBUT and tear meniscus height. CONCLUSIONS The monitoring of DED in SS is not uniform in optometric offices across North America. Creating accepted standards of testing will improve the ability of clinicians and researchers to communicate and understand the course of DED in SS.
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Affiliation(s)
- Mira Acs
- Toronto Eye Care, 55 Bloor Street West, Toronto, ON, Canada.
| | | | - Melissa Barnett
- UC Davis Eye Center, 4860 Y Street, Suite 2400, Sacramento, CA, USA
| | - Charles Edmonds
- Edmonds, Husz & Pemberton Eye Center, 4730 E. Pima Street, Tucson, AZ 85712, USA
| | | | - Richard Maharaj
- eyeLABS Optometry and Center for Ocular Surface Disease, 7900 Hurontario St. Suite 406, Brampton, ON, Canada
| | - Bart Pemberton
- Edmonds, Husz & Pemberton Eye Center, 4730 E. Pima Street, Tucson, AZ 85712, USA
| | - Dominik Papinski
- Centre for Contact Lens Research, School of Optometry& Vision Science University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada
| | - Jennifer Harthan
- Cornea Centre for Clinical Excellence, Illinois College of Optometry, 3241 South Michigan Avenue, Chicago, IL, USA
| | - Sruthi Srinivasan
- Centre for Contact Lens Research, School of Optometry& Vision Science University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada
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Chen X, Utheim ØA, Xiao J, Adil MY, Stojanovic A, Tashbayev B, Jensen JL, Utheim TP. Meibomian gland features in a Norwegian cohort of patients with primary Sjögren´s syndrome. PLoS One 2017; 12:e0184284. [PMID: 28886085 PMCID: PMC5590907 DOI: 10.1371/journal.pone.0184284] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/21/2017] [Indexed: 12/14/2022] Open
Abstract
Purpose To assess the tear film and meibomian gland (MG) features in a Norwegian cohort of patients with primary Sjögren´s syndrome (pSS) and in age- and gender-matched control subjects. Methods Thirty-four female patients with pSS (age 52.9±11.9 years) and 32 female control subjects (age 49.0±11.5 years) were recruited. After completion of Ocular Surface Disease Index (OSDI) questionnaire and McMonnies Dry Eye Questionaire, participants underwent measurements of tear osmolarity, tear break-up time (TBUT), ocular surface and corneal staining, Schirmer I test, corneal sensitivity, MG expressibility evaluations, and lid margin morphology examination using slitlamp microscopy. Non-contact infrared meibography images were assessed by computer-assisted analysis. The MG loss, calculated as (tarsal area-MG area)/tarsal area, was evaluated in both upper (UL) and lower lids (LL). Results Compared to the control group, pSS patients demonstrated higher MG loss in both UL (33.8±13.2% vs. 24.4±8.5%, p< 0.01) and LL (52.5±15.7% vs. 43.0±9.6%, p<0.05), as well as higher lid abnormality score (0.8±0.8 vs. 0.2±0.6, p< 0.01). Furthermore, pSS patients showed higher OSDI and McMonnies questionnaire scores, elevated osmolarity, shorter TBUT, shorter blink interval, less wetting in Schirmer I test, more ocular surface staining and more corneal staining. MG loss in UL correlated negatively with TBUT (r = -0.386, p = 0.029) in the pSS group, whereas MG loss in LL correlated negatively with TBUT (r = -0.380, p = 0.035) in the control group. Conclusions Significantly elevated dry eye symptoms and signs were found in the pSS group compared with the control group, which might be attributed to both decreased aqueous tear production and increased tear evaporation.
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Affiliation(s)
- Xiangjun Chen
- Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway
- * E-mail:
| | | | - Jiaxin Xiao
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Muhammed Yasin Adil
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Behzod Tashbayev
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Kang YS, Lee HS, Li Y, Choi W, Yoon KC. Manifestation of meibomian gland dysfunction in patients with Sjögren's syndrome, non-Sjögren's dry eye, and non-dry eye controls. Int Ophthalmol 2017; 38:1161-1167. [PMID: 28567496 DOI: 10.1007/s10792-017-0577-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 05/22/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate the manifestation of meibomian gland dysfunction in patients with Sjögren's syndrome (SS), non-Sjögren's syndrome dry eye (non-SS) patients, and non-dry eye controls. METHODS We recruited 31 participants with SS dry eye, 30 participants with non-SS dry eye, and 35 healthy controls without dry eye symptoms. Noninvasive tear breakup time (NITBUT) and meibomian gland dropout score (meiboscore) were measured using the Oculus Keratograph 5 M. Meibomian gland expressibility and secretion quality were evaluated via slit lamp biomicroscopy. The correlation between measurements was analyzed. RESULTS NITBUT was lower, and the meiboscore, meibomian gland expressibility, and secretion quality scores were significantly higher in the SS and non-SS groups than in the control group (p < 0.001). NITBUT was lower, and the meiboscore and meibomian gland expressibility were higher in the SS group than in the non-SS group. NITBUT correlated negatively with the meiboscore in both SS and non-SS groups and with meibomian gland expressibility in the SS group. A positive correlation was obtained between meiboscore and meibomian gland expressibility in both the SS and the non-SS groups. CONCLUSION Patients in both SS and non-SS groups exhibited greater impairment in meibomian gland function than the non-dry eye controls. SS patients had more severe meibomian gland dysfunction with poorer mean meiboscore and meibomian gland expressibility than non-SS patients.
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Affiliation(s)
- Yeon Soo Kang
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Hyo Seok Lee
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Ying Li
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Won Choi
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea.
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Improving Diagnosis and Outcomes of Sjögren's Disease through Targeting Dry Eye Patients: A Continuing Medical Education Enduring Material. Ocul Surf 2015. [DOI: 10.1016/j.jtos.2015.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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