scholarly journals Analysis of the first tear film break-up point in Sjögren’s syndrome and non-Sjögren’s syndrome dry eye patients

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Songjiao Zhao ◽  
Qihua Le
Keyword(s):  
Sjögren’S Syndrome ◽  
Dry Eye ◽  
Ocular Surface ◽  
Sjögren's Syndrome ◽  
Tear Film ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Fluorescein Staining ◽  
Break Up ◽  
Sjögren‘S Syndrome

Abstract Background Tear film instability plays an important role in the course of Sjögren’s Syndrome dry eye (SSDE) even though it is generally classified as aqueous-deficient dry eye. The measurement of the first tear film break-up point (FTBUP) helps to evaluate the most unstable position of the tear film on ocular surface. We aim to investigate FTBUP in Sjögren’s Syndrome dry eye (SSDE) and non-Sjögren’s Syndrome dry eye (NSSDE) patients, and explore its correlation with dry eye indices. Methods Twenty-two SSDE patients (44 eyes) and 22 NSSDE patients (44 eyes) were enrolled in the study. Oculus Keratograph K5M was used to measure FTBUP, the first and average non-invasive keratographic breakup time (f-NIKBUT and av-NIKBUT), the tear meniscus height, and meibomian gland dropout. Other tests of tear film were also performed including Ocular Surface Dryness Index (OSDI), Schirmer I test, fluorescein break-up time and corneal fluorescein staining. Dry eye indices and the locations of the FTBUP were compared between SSDE and NSSDE patients. Generalized estimating equation (GEE) was used to ajusted the correlations between right and left eyes. The correlations between the FTBUP and ocular symptoms and signs were investigated using Pearson’s correlation coefficient test. Results The FTBUP occurred at the supranasal quadrant in 12/88 eyes, supratemporal quadrant in 8/88 eyes, inferonasal quadrant in 34/88 eyes, and inferotemporal quadrant in 34/88 eyes. The percentage eyes with inferior FTBUP was significantly higher in the SSDE than in the NSSDE subjects (86.3% vs 68.1%, P = .049). Moreover, in SSDE subjects, temporal breakup point was seen more often in those who presented corneal fluorescein staining in any location, while nasal breakup point was more frequent in those who did not present any corneal fluorescein staining (P = .045). Conclusion The location of the FTBUP in SSDE patients had specific characteristics. However, the diagnostic potential of FTBUP in early recognition of SSDE needs further validation.

scholarly journals Analysis on the First Tear Film Break-up Point in Sjögren's Syndrome and non-Sjögren's Syndrome Dry Eye Patients

2020 ◽  
Author(s):  
Songjiao Zhao ◽  
Qihua Le
Keyword(s):  
Sjögren’S Syndrome ◽  
Dry Eye ◽  
Ocular Surface ◽  
Sjögren's Syndrome ◽  
Tear Film ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Fluorescein Staining ◽  
Break Up ◽  
Sjögren‘S Syndrome

Abstract Background：Tear film instability plays an important role in the course of Sjögren's Syndrome dry eye (SSDE) even though it is generally classified as aqueous-deficient dry eye. The measurement of the first tear film break-up point (FTBUP) helps to evaluate the most unstable position of the tear film on ocular surface. We aim to investigate the first tear film break-up point (FTBUP) in Sjögren's Syndrome dry eye (SSDE) and non-Sjögren's Syndrome dry eye (NSSDE) patients, and explore its correlation with dry eye indices.Methods: Twenty-two SSDE patients (44 eyes) and 22 NSSDE patients (44 eyes) were enrolled in the study. Oculus Keratograph K5M was used to measure the FTBUP, the first and average non-invasive keratographic breakup time (f-NIKBUT and av-NIKBUT), and meibomian gland dropout. Other tests of tear film were also performed including Ocular Surface Dryness Index (OSDI), Schirmer I test, fluorescein break-up time and corneal fluorescein staining. One-way ANOVA with Bonferroni adjustment was used to compare dry eye indices. The locations of the FTBUP were compared between SSDE and NSSDE patients using chi-square test. The correlations between the FTBUP and ocular symptoms and signs were investigated using Pearson’s correlation coefficient test.Results: The FTBUP occurred at the supranasal quadrant in 12/88 eyes, supratemporal quadrant in 8/88 eyes, inferonasal quadrant in 34/88 eyes, and inferotemporal quadrant in 34/88 eyes. The percentage of the FTBUPs occurring at the inferior cornea was significantly higher in the SSDE group than in the NSSDE group (86.3% vs 68.1%, P=.042). Moreover, FTBUP was more frequently observed in the temporal area in SSDE patients with positive corneal fluorescein staining, as opposed to the nasal area in SSDE patients with negative corneal staining(P=.032). Conclusion: Tear film was more unstable in the inferior cornea than other areas of cornea in both SSDE and NSSDE patients. The location of the FTBUP in SSDE patients had a close relationship with cornea fluorescein staining.

scholarly journals Ocular Surface Disease in Sjögren's Syndrome: Management in a Scleral Lens Clinical Practice

2020 ◽  
Vol 4 (1) ◽  
pp. e12-e22
Author(s):  
Daddi Fadel ◽  
Melissa Barnett
Keyword(s):  
Quality Of Life ◽  
Sjögren’S Syndrome ◽  
Dry Eye ◽  
Ocular Surface ◽  
Sjögren's Syndrome ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Autologous Serum ◽  
Sjögren‘S Syndrome

Sjögren’s syndrome is a chronic, autoimmune, systemic disease characterized by lymphocytic infiltration and malfunction of the exocrine glands, primarily the lacrimal and salivary glands, resulting in predominant symptoms of dry eye and dry mouth. Sjögren’s syndrome is a highly prevalent condition and is one of the most common systemic, rheumatic, autoimmune diseases, affecting up to 1.4% of adults in the United States, second only to rheumatoid arthritis in its prevalence in North America. Primary Sjögren’s syndrome has shown to affect patients’ health-related quality-of-life due to dryness, chronic pain, depression, anxiety,physical and mental fatigue, and neuropsychiatric symptoms. Scleral lenses (SLs) have shown to be significantly beneficial in relieving symptoms and improvingquality-of-life in patients with Sjögren’s syndrome and dry eye disease. SLs may be used concurrently with the other therapies including ocular lubricants, eyelid hygiene, punctal occlusion, topical prescription medications, and autologous serum. This manuscript reviews the implication of Sjögren’s syndrome on the ocular surface and quality-of-life and describes how SLs, in combination with other treatments, may be beneficial.

scholarly journals Evaluation of Corneal Reflectance in Sjögren's Syndrome Dry Eye

2020 ◽  
Vol 3 (2) ◽  
pp. p7
Author(s):  
Sandro Sbordone ◽  
Adele Ragucci ◽  
Gennarfrancesco Iaccarino ◽  
Domenico De Robertis ◽  
Giovan Battista Scazzi ◽  
...  
Keyword(s):  
Sjögren’S Syndrome ◽  
Dry Eye ◽  
Sjögren's Syndrome ◽  
Tear Film ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Schirmer Test ◽  
Corneal Confocal Microscopy ◽  
Study Participants ◽  
Sjögren‘S Syndrome

Introduction: To measure corneal layers’ light reflectance (LR) in eyes affected by dry eye disease caused by Sjögren's syndrome (SSDE) with corneal confocal microscopy (IVCM) and to study the correlations with tear film tests. Materials and Methods: Thirty-six patients affected by SSDE and 36 healthy subjects (HS) were enrolled in this retrospective study, participants of both groups were age and sex matched. Each study participants had a complete eye visit and break up time (BUT), Schirmer test, with and without stimulation, at the end of the visit an IVCM scan was performed. LR measured by IVCM at Bowman membrane (BM) level and at 50 µm, at 100 µm and at 200 µm deeper was compared in the two groups of participants. The correlations between LR measurements and tear film test results were investigated. Results: In SSDE eyes, LR was significantly higher (p<0.001) in SSDE patients at BM level (+14.43 ± 3.27 LRU) and also in the other levels evaluated, compared with HP. Good correlations were observed between LR values at BM and Schirmer test ones with (r = -0.82) and without (r= -0.81) stimulation and BUT (r= 0.80) in SSDE eyes. Correlations values were Adecreasing the deeper corneal layers. Conclusion: Even if need to be verified in further studies with a larger population, results obtained in this study suggest that IVCM could be an interesting and effective tool in evaluating the SSDE patients and it could be adopted by physicians’ community because it seems very promising.

Bacterial Distribution On The Ocular Surface of Patients With Primary Sjögren’s Syndrome

2021 ◽  
Author(s):  
Yong Chan Kim ◽  
Bak Noon Ham ◽  
Kui Dong Kang ◽  
Jun Myeong Yun ◽  
Man Jae Kwon ◽  
...  
Keyword(s):  
Sjögren’S Syndrome ◽  
Dry Eye ◽  
Ocular Surface ◽  
Sjögren's Syndrome ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Rrna Genes ◽  
Group A ◽  
Group B ◽  
Sjögren‘S Syndrome

Abstract Many studies have shown that gut microbial dysbiosis is a major factor in the etiology of autoimmune diseases but none have suggested that the ocular surface (OS) microbiome is associated with Sjögren’s syndrome (SS). In this prospective study, we analyzed bacterial distribution on the OS in patients with primary SS. Among the 120 subjects included in this study, 48 patients (group A) had primary SS, whereas 72 subjects (group B) had dry eye symptoms that were unrelated to SS. We evaluated clinical dry eye parameters such as the OS disease index, ocular staining score, Schirmer’s test, and tear break-up time. Conjunctival swabs were used to analyze the microbial communities from the two groups. Bacterial 16S rRNA genes were sequenced using the Illumina MiSeq platform, and the data were analyzed using the QIIME 1.9.1 program. The Shannon index was significantly lower in group A than in group B microbiota. An analysis of similarity using the Bray–Curtis distance method found no difference in beta-diversity between the two groups. In group A, Actinobacteria at the phylum level and Corynebacteria at the genus level exhibited low abundance, but the differences were not statistically significant. SS apparently decreases the diversity of the OS microbial community and may affect the abundance of some bacterial strains at the phylum and genus levels. These observations may be important for the pathophysiology of SS and should be investigated in future studies.

Dry Eye and Clinical Disease of Tear Film, Diagnosis and Management

2014 ◽  
Vol 07 (02) ◽  
pp. 109
Author(s):  
Vasilis Achtsidis ◽  
Eleftheria Kozanidou ◽  
Panos Bournas ◽  
Nicholas Tentolouris ◽  
Panos G Theodossiadis ◽  
...  
Keyword(s):  
Dry Eye ◽  
Ocular Surface ◽  
Contact Lenses ◽  
Sjögren's Syndrome ◽  
Tear Film ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Tear Production ◽  
Sjögren‘S Syndrome

Dry eye disease (DED) is a clinically significant multifactorial disorder of the ocular surface and tear film as it results in ocular discomfort and visual impairment and predisposes the cornea to infections. It is important for the quality of life and tends to be a chronic disease. It is also common, as the prevalence is estimated between 5 % to 30 % and this increases with age. Therefore, it is recognized as a growing public health problem that requires correct diagnosis and appropriate treatment. There are two main categories of DED: the deficiency of tear production (hyposecretive), which includes Sjögren’s syndrome, idiopathic or secondary to connective tissue diseases (e.g. rheumatoid arthritis), and non-Sjögren’s syndrome (e.g. age-related); and the tear evaporation category, where tears evaporate from the ocular surface too rapidly due to intrinsic causes (e.g. meibomian gland disease or eyelid aperture disorders) or extrinsic causes (e.g. vitamin A deficiency, contact lenses wear, ocular allergies). Management of the disease aims to enhance the corneal healing and reduce patient’s discomfort. This is based on improving the balance of tear production and evaporation by increasing the tear film volume (lubrication drops) and improving quality of tear film (ex omega-3 supplements, lid hygiene, tetracyclines), reducing the tear film evaporation (paraffin ointments, therapeutic contact lenses), reducing tear’s drainage (punctal plugs, cautery), and finally by settling down the ocular surface inflammation (steroids, cyclosporine, autologous serous), as appropriate. In this article we will review the clinical presentation, differential diagnosis, and treatment options for DED.

scholarly journals Thrombospondin-1 Is Necessary for the Development and Repair of Corneal Nerves

2018 ◽  
Vol 19 (10) ◽  
pp. 3191 ◽  
Author(s):  
Yukako Tatematsu ◽  
Qalbi Khan ◽  
Tomas Blanco ◽  
Jeffrey Bair ◽  
Robin Hodges ◽  
...  
Keyword(s):  
Confocal Microscopy ◽  
Sjögren’S Syndrome ◽  
Dry Eye ◽  
Ocular Surface ◽  
Sjögren's Syndrome ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Corneal Nerves ◽  
Thrombospondin 1 ◽  
Sjögren‘S Syndrome

Thrombospondin-1-deficient (TSP-1−/−) mice are used as an animal model of Sjögren’s Syndrome because they exhibit many of the symptoms associated with the autoimmune type of dry eye found in primary Sjögren’s Syndrome. This type of dry eye is linked to the inflammation of the lacrimal gland, conjunctiva, and cornea, and is thought to involve dysfunction of the complex neuronal reflex arc that mediates tear production in response to noxious stimuli on the ocular surface. This study characterizes the structural and functional changes to the corneal nerves that are the afferent arm of this arc in young and older TSP-1−/− and wild type (WT) mice. The structure and subtype of nerves were characterized by immunohistochemistry, in vivo confocal microscopy, and confocal microscopy. Cytokine expression analysis was determined by Q-PCR and the number of monocytes was measured by immunohistochemistry. We found that only the pro-inflammatory cytokine MIP-2 increased in young corneas of TSP-1−/− compared to WT mice, but tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and macrophage inflammatory protein-2 (MIP-2) all increased in older TSP-1−/− mouse corneas. In contrast, CD11b+ pro-inflammatory monocytes did not increase even in older mouse corneas. Calcitonin gene-related peptide (CGRP)-, but not Substance P (SubP)-containing corneal nerves decreased in older, but not younger TSP-1−/− compared to WT mouse corneas. We conclude that CGRP-containing corneal sensory nerves exhibit distinct structural deficiencies as disease progresses in TSP-1−/− mice, suggesting that: (1) TSP-1 is needed for the development or repair of these nerves and (2) impaired afferent corneal nerve structure and hence function may contribute to ocular surface dysfunction that develops as TSP-1−/− mice age.

Differential Diagnosis of Dry Eye Conditions

1996 ◽  
Vol 10 (1) ◽  
pp. 9-12 ◽  
Author(s):  
S.C. Pflugfelder
Keyword(s):  
Sjögren’S Syndrome ◽  
Dry Eye ◽  
Ocular Surface ◽  
Sjögren's Syndrome ◽  
Keratoconjunctivitis Sicca ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Ocular Surface Disease ◽  
Mucin Production ◽  
Sjögren‘S Syndrome

The pre-ocular tear film is a complex biochemical structure produced by the lacrimal glands and epithelial cells on the ocular surface. Clinical syndromes of ocular irritation may result from deficiencies in one or more of these layers. At a recent dry eye workshop at the National Eye Institute, dry eye conditions were classified into those with adequate aqueous tear production and those with aqueous tear deficiency. The majority of patients with aqueous adequate dry eye suffer from meibomian gland dysfunction that results in lipid tear deficiency. Aqueous tear deficiency can be subclassified into non-Sjogren's syndrome and Sjogren's syndrome (SS) groups. Patients with non-Sjögren's aqueous tear deficiency have less-severe symptoms and ocular surface disease than those with SS. The etiology of non-Sjögren's aqueous tear deficiency has not been established, but it appears to be multifactorial. In SS, immune-mediated destruction of the lacrimal gland results in severe aqueous tear deficiency. Aqueous tear deficiencies lead to ocular surface disease, termed keratoconjunctivitis sicca (KCS). KCS results from abnormal terminal differentiation of the ocular surface epithelia and is associated with marked reduction in mucin production by these cells. Clinical features helpful in differentiating the various dry eye syndromes are reviewed.

scholarly journals Ophthalmologic Manifestations of Primary Sjögren’s Syndrome

Genes ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 365
Author(s):  
Anna Maria Roszkowska ◽  
Giovanni William Oliverio ◽  
Emanuela Aragona ◽  
Leandro Inferrera ◽  
Alice Antonella Severo ◽  
...  
Keyword(s):  
Sjögren’S Syndrome ◽  
Dry Eye ◽  
Ocular Surface ◽  
Inflammatory Process ◽  
Sjögren's Syndrome ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Primary Role ◽  
Sjögren‘S Syndrome

Sjögren’s syndrome (SS) is a chronic, progressive, inflammatory, autoimmune disease, characterized by the lymphocyte infiltration of exocrine glands, especially the lacrimal and salivary, with their consequent destruction. The onset of primary SS (pSS) may remain misunderstood for several years. It usually presents with different types of severity, e.g., dry eye and dry mouth symptoms, due to early involvement of the lacrimal and salivary glands, which may be associated with parotid enlargement and dry eye; keratoconjunctivitis sicca (KCS) is its most common ocular manifestation. It is still doubtful if the extent ocular surface manifestations are secondary to lacrimal or meibomian gland involvement or to the targeting of corneal and conjunctival autoantigens. SS is the most representative cause of aqueous deficient dry eye, and the primary role of the inflammatory process was evidenced. Recent scientific progress in understanding the numerous factors involved in the pathogenesis of pSS was registered, but the exact mechanisms involved still need to be clarified. The unquestionable role of both the innate and adaptive immune system, participating actively in the induction and evolution of the disease, was recognized. The ocular surface inflammation is a central mechanism in pSS leading to the decrease of lacrimal secretion and keratoconjunctival alterations. However, there are controversies about whether the ocular surface involvement is a direct autoimmune target or secondary to the inflammatory process in the lacrimal gland. In this review, we aimed to present actual knowledge relative to the pathogenesis of the pSS, considering the role of innate immunity, adaptive immunity, and genetics.

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