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Evaluation of patients with dry eye for the presence of primary or secondary Sjӧgren’s syndrome

Authors Abd-Allah NM, Hassan AA, Omar G, Hamdy M, Abdelaziz STA, Abd El Hamid WM, Moussa RA

Received 28 May 2019

Accepted for publication 16 August 2019

Published 11 September 2019 Volume 2019:13 Pages 1787—1797


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Nashwa M Abd-Allah,1 Amal Aly Hassan,1 Gihan Omar,1 Mona Hamdy,1 Sahar Torky A Abdelaziz,2 Waleed Mahmoud Abd El Hamid,3 Rabab A Moussa4

1Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt; 2Ophthalmology Department, Faculty of Medicine, Minia University, Minia, Egypt; 3Clinical Pathology Department, Faculty of Medicine, Minia University, Minia, Egypt; 4Pathology Department, Faculty of Medicine, Minia University, Minia, Egypt

Correspondence: Nashwa M Abd-Allah
Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, New Minia City, first district, Youssef El-Sbaie Street, building (1), Minia 61511, Egypt
Tel +20 111 667 2116

Purpose: To assess the frequency of Sjӧgren’s syndrome (SS), either primary or secondary to rheumatic disease, in a cohort of patients with aqueous-deficient dry eye and to determine the most accurate objective test for diagnosis of SS.
Methods: A total of 111 patients with dry eye were recruited from Minia University’s ​Ophthalmology Outpatient Clinic (69 patients) and Rheumatology Outpatient Clinic (42 patients). The patients were screened for aqueous tear–deficient dry eye by abnormal test results of Schirmer test I (<10 mm) and tear-film break-up time (<10 seconds) in at least one eye. The diagnosis of SS was made according to the 2012 American College of Rheumatology​ criteria. A complete work up for SS was performed, including clinical examination, serological tests, ocular tests, and labial salivary–gland biopsy (LSGB).
Results: Of the 111 patients, 58 had aqueous-deficient dry eye: 23 in the ophthalmology clinic cohort (group I) and 35 in the rheumatology clinic cohort (group II). Three patients had pSS, and its frequency was 13% in group I and 5.2% among all studied patients. The ocular staining score is the most diagnostic ocular test (sensitivity 100% and specificity 90.9%). Anti-SSA/Ro antibody is the most accurate serological method (sensitivity 33.3% and specificity 100%). LSGB histopathology is the most diagnostic method for SS, with sensitivity, specificity, and positive and negative predictive values of 100%.
Conclusion: SS was detected with reasonable frequency among dry-eye patients, particularly pSS. Screening of dry eye for SS can select SS patients early in the disease course.

Keywords: dry eye, Sjӧgren’s syndrome, rheumatic disease, ocular staining score, OSS, labial salivary–gland biopsy, LSGB

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