Skip to main content
Top
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 7/2012

01-07-2012 | Cornea

Evaluation of dry eye signs and symptoms in patients with systemic sclerosis

Authors: Beatriz de A. F. Gomes, Marcony R. Santhiago, Mário N. L. de Azevedo, Haroldo V. Moraes Jr.

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 7/2012

Login to get access

Abstract

Background

One of the most frequent ocular features of systemic sclerosis (SSc) is dry eye disease (DED), which has been identified to occur in 37–79% of patients. Although several studies have found weak or no correlations between symptoms and signs of dry eye, symptoms are often the motivation for seeking eye care, and are therefore a critical outcome measure when assessing treatment effect. The aim of this study is to evaluate the impact of symptoms of dry eye on vision-related quality of life in patients with systemic sclerosis, and to investigate the relation between clinical tests and symptoms of dry eye in these patients.

Methods

In this cross-sectional study, 45 consecutive patients with SSc were enrolled. For evaluation of the symptoms the “Ocular Surface Disease Index (OSDI)” questionnaire was applied to all patients. After that, all individuals were submitted to a full ophthalmic examination, including the following tests: tear break-up time, Schirmer I, rose bengal staining. Patients were then grouped into dry eye and non-dry eye groups with regard to the diagnosis of dry eye. Mann–Whitney test was used to compare continuous variables, whereas the Fisher exact test was used to compare categorical data between groups. Spearman’s correlation test was used to analyze the correlations between clinical tests and OSDI scores. P values <0.05 were considered significant.

Results

Dry eye disease was diagnosed in 22 patients (48.9%). Other ocular surface abnormalities found were: blepharitis (40% of the patients), pterygium (15.6%), pinguecula (82.2%), and superficial punctate keratitis (26.7%). Among the 45 patients, 29 patients (64.4%) had symptoms of ocular surface disease. The mean OSDI score was 26.8 ± 25.8 (SD). There were no statistically significant differences in OSDI scores between DED and non-DED patients. No substantive correlations were found between OSDI scores and TBUT, Schirmer I, or rose bengal staining score, and none of the observed correlations reached statistical significance.

Conclusion

Symptoms of dry eye have a moderate impact on vision-related quality of life in patients with systemic sclerosis and do not correlate well with clinical findings.
Literature
1.
go back to reference Black CM, Stephens C (1993) Systemic sclerosis (scleroderma) and related disorders. In: Maddison PJ, Isenberg DA, Woo P, Glass DN (eds) Textbook of rheumatology. Oxford University Press, Oxford Black CM, Stephens C (1993) Systemic sclerosis (scleroderma) and related disorders. In: Maddison PJ, Isenberg DA, Woo P, Glass DN (eds) Textbook of rheumatology. Oxford University Press, Oxford
2.
go back to reference Coral-Alvarado P, Pardo AL, Castaño-Rodriguez N, Rojas-Villarraga A, Anaya JM (2009) Systemic sclerosis: a worldwide global analysis. Clin Rheumatol 28:757–765PubMedCrossRef Coral-Alvarado P, Pardo AL, Castaño-Rodriguez N, Rojas-Villarraga A, Anaya JM (2009) Systemic sclerosis: a worldwide global analysis. Clin Rheumatol 28:757–765PubMedCrossRef
3.
go back to reference Hudson M, Thombs BD, Steele R, Panopalis P, Newton E, Baron M, Canadian Scleroderma Research Group (2009) Health-related quality of life in systemic sclerosis: a systematic review. Arthritis Rheum 61:1112–1120PubMedCrossRef Hudson M, Thombs BD, Steele R, Panopalis P, Newton E, Baron M, Canadian Scleroderma Research Group (2009) Health-related quality of life in systemic sclerosis: a systematic review. Arthritis Rheum 61:1112–1120PubMedCrossRef
4.
go back to reference Tailor R, Gupta A, Herrick A, Kwartz J (2009) Ocular manifestations of scleroderma. Surv Ophthalmol 54:292–304PubMedCrossRef Tailor R, Gupta A, Herrick A, Kwartz J (2009) Ocular manifestations of scleroderma. Surv Ophthalmol 54:292–304PubMedCrossRef
5.
go back to reference Gomes BAF, Santhiago MR, Magalhães P, Kara-Junior N, Azevedo MNL, Moraes HV Jr (2011) Ocular findings in patients with systemic sclerosis. Clinics 66:379–385CrossRef Gomes BAF, Santhiago MR, Magalhães P, Kara-Junior N, Azevedo MNL, Moraes HV Jr (2011) Ocular findings in patients with systemic sclerosis. Clinics 66:379–385CrossRef
6.
go back to reference Limburg H, Barria von-Bischhoffshausen F, Gomez P, Silva JC, Foster A (2008) Review of recent surveys on blindness and visual impairment in Latin America. Br J Ophthalmol 92:315–319PubMedCrossRef Limburg H, Barria von-Bischhoffshausen F, Gomez P, Silva JC, Foster A (2008) Review of recent surveys on blindness and visual impairment in Latin America. Br J Ophthalmol 92:315–319PubMedCrossRef
7.
go back to reference Miljanović B, Dana R, Sullivan DA, Schaumberg DA (2007) Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol 143:409–415PubMedCrossRef Miljanović B, Dana R, Sullivan DA, Schaumberg DA (2007) Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol 143:409–415PubMedCrossRef
8.
go back to reference Hay EM, Thomas E, Pal B, Hajeer A, Chambers H, Silman AJ (2008) Weak association between subjective symptoms or and objective testing for dry eyes and dry mouth: results from a population based study. Ann Rheum Dis 57:20–24CrossRef Hay EM, Thomas E, Pal B, Hajeer A, Chambers H, Silman AJ (2008) Weak association between subjective symptoms or and objective testing for dry eyes and dry mouth: results from a population based study. Ann Rheum Dis 57:20–24CrossRef
9.
go back to reference Nichols KK, Nichols JJ, Mitchell GL (2004) The lack of association between signs and symptoms in patients with dry eye disease. Cornea 23:762–770PubMedCrossRef Nichols KK, Nichols JJ, Mitchell GL (2004) The lack of association between signs and symptoms in patients with dry eye disease. Cornea 23:762–770PubMedCrossRef
10.
go back to reference Schein OD, Tielsch JM, Munõz B, Bandeen-Roche K, West S (1997) Relation between signs and symptoms of dry eye in the elderly. A population-based perspective. Ophthalmology 104:1395–1401PubMed Schein OD, Tielsch JM, Munõz B, Bandeen-Roche K, West S (1997) Relation between signs and symptoms of dry eye in the elderly. A population-based perspective. Ophthalmology 104:1395–1401PubMed
11.
go back to reference Vitale S, Goodman LA, Reed GF, Smith JA (2004) Comparison of the NEI-VFQ and OSDI questionnaires in patients with Sjögren’s syndrome-related dry eye. Health Qual Life Outcomes 1(2):44CrossRef Vitale S, Goodman LA, Reed GF, Smith JA (2004) Comparison of the NEI-VFQ and OSDI questionnaires in patients with Sjögren’s syndrome-related dry eye. Health Qual Life Outcomes 1(2):44CrossRef
12.
go back to reference Barboza MN, Barboza GN, de Melo GM, Sato E, Dantas MC, Dantas PE, Felberg S (2008) Correlation between signals and symptoms of dry eye in Sjögren’s syndrome patients. Arq Bras Oftalmol 71:547–552PubMedCrossRef Barboza MN, Barboza GN, de Melo GM, Sato E, Dantas MC, Dantas PE, Felberg S (2008) Correlation between signals and symptoms of dry eye in Sjögren’s syndrome patients. Arq Bras Oftalmol 71:547–552PubMedCrossRef
13.
go back to reference Wilson SE, Stulting RD (2007) Agreement of physician treatment practices with the international task force guidelines for diagnosis and treatment of dry eye disease. Cornea 26:284–289PubMedCrossRef Wilson SE, Stulting RD (2007) Agreement of physician treatment practices with the international task force guidelines for diagnosis and treatment of dry eye disease. Cornea 26:284–289PubMedCrossRef
14.
go back to reference Shiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL (2000) Reliability and validity of the ocular surface disease index. Arch Ophthalmol 118:615–621CrossRef Shiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL (2000) Reliability and validity of the ocular surface disease index. Arch Ophthalmol 118:615–621CrossRef
15.
go back to reference Johnson ME, Murphy PJ (2007) Measurement of ocular surface irritation on a linear interval scale with the ocular comfort index. Invest Ophthalmol Vis Sci 48:4451–4458PubMedCrossRef Johnson ME, Murphy PJ (2007) Measurement of ocular surface irritation on a linear interval scale with the ocular comfort index. Invest Ophthalmol Vis Sci 48:4451–4458PubMedCrossRef
16.
go back to reference Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee (1980) Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 23:581–590CrossRef Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee (1980) Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 23:581–590CrossRef
17.
go back to reference Walt J (2004) Ocular Surface Disease Index (OSDI) administration and scoring manual. Allergan, Inc., Irvine, CA Walt J (2004) Ocular Surface Disease Index (OSDI) administration and scoring manual. Allergan, Inc., Irvine, CA
18.
go back to reference Miller KL, Walt JG, Mink DR, Satram-Hoang S, Wilson SE, Perry HD, Asbell PA, Pflugfelder SC (2010) Minimal clinically important difference for the ocular surface disease index. Arch Ophthalmol 128:94–101PubMedCrossRef Miller KL, Walt JG, Mink DR, Satram-Hoang S, Wilson SE, Perry HD, Asbell PA, Pflugfelder SC (2010) Minimal clinically important difference for the ocular surface disease index. Arch Ophthalmol 128:94–101PubMedCrossRef
19.
20.
go back to reference Homma M, Tojo T, Akizuki M, Yamagata H (1986) Criteria for Syogren’s syndrome in Japan. Scand J Rheumatol 18:26–27 Homma M, Tojo T, Akizuki M, Yamagata H (1986) Criteria for Syogren’s syndrome in Japan. Scand J Rheumatol 18:26–27
21.
go back to reference Manthrope R, Oxholm P, Prause JU, Schiødt M (1986) The Copenhagen criteria for Syogren’s syndrome. Scand J Rheumatol 18:19–21 Manthrope R, Oxholm P, Prause JU, Schiødt M (1986) The Copenhagen criteria for Syogren’s syndrome. Scand J Rheumatol 18:19–21
22.
go back to reference Report of the International Dry Eye Workshop (DEWS) (2007) Ocul Surf 5:65–204CrossRef Report of the International Dry Eye Workshop (DEWS) (2007) Ocul Surf 5:65–204CrossRef
23.
go back to reference Rasker JJ, Jayson MI, Jones DE, Matthews R, Burton JL, Rhys Davies E, Burton PA (1990) Sjögren’s syndrome in systemic sclerosis. A clinical study of 26 patients. Scand J Rheumatol 19:57–65PubMedCrossRef Rasker JJ, Jayson MI, Jones DE, Matthews R, Burton JL, Rhys Davies E, Burton PA (1990) Sjögren’s syndrome in systemic sclerosis. A clinical study of 26 patients. Scand J Rheumatol 19:57–65PubMedCrossRef
24.
go back to reference Alarcón-Segovia D, Ibánez G, Hernández-Ortíz J, Velázquez-Forero F, González-Jiménez Y (1974) Sjögren’s syndrome in progressive systemic sclerosis (scleroderma). Am J Med 57:78–85PubMedCrossRef Alarcón-Segovia D, Ibánez G, Hernández-Ortíz J, Velázquez-Forero F, González-Jiménez Y (1974) Sjögren’s syndrome in progressive systemic sclerosis (scleroderma). Am J Med 57:78–85PubMedCrossRef
25.
go back to reference Avouac J, Sordet C, Depinay C, Ardizonne M, Vacher-Lavenu MC, Sibilia J, Kahan A, Allanore Y (2006) Systemic sclerosis-associated Sjögren’s syndrome and relationship to the limited cutaneous subtype: results of a prospective study of sicca syndrome in 133 consecutive patients. Arthritis Rheum 54:2243–2249PubMedCrossRef Avouac J, Sordet C, Depinay C, Ardizonne M, Vacher-Lavenu MC, Sibilia J, Kahan A, Allanore Y (2006) Systemic sclerosis-associated Sjögren’s syndrome and relationship to the limited cutaneous subtype: results of a prospective study of sicca syndrome in 133 consecutive patients. Arthritis Rheum 54:2243–2249PubMedCrossRef
26.
27.
go back to reference Horan EC (1969) Ophthalmic manifestations of progressive systemic sclerosis. Br J Ophthalmol 53:388–392PubMedCrossRef Horan EC (1969) Ophthalmic manifestations of progressive systemic sclerosis. Br J Ophthalmol 53:388–392PubMedCrossRef
28.
go back to reference Mancel E, Janin A, Gosset D, Hatron PY, Gosselin B (1993) Conjunctival biopsy in scleroderma and primary Sjögren’s syndrome. Am J Ophthalmol 115:792–799PubMed Mancel E, Janin A, Gosset D, Hatron PY, Gosselin B (1993) Conjunctival biopsy in scleroderma and primary Sjögren’s syndrome. Am J Ophthalmol 115:792–799PubMed
29.
go back to reference Ozcura F, Aydin S, Helvaci MR (2007) Ocular surface disease index for the diagnosis of dry eye syndrome. Ocul Immunol Inflamm 15:389–393PubMedCrossRef Ozcura F, Aydin S, Helvaci MR (2007) Ocular surface disease index for the diagnosis of dry eye syndrome. Ocul Immunol Inflamm 15:389–393PubMedCrossRef
30.
go back to reference Singh Bhinder G, Singh Bhinder H (2005) Reflex epiphora in patients with dry eye symptoms: role of variable time Schirmer-1 test. Eur J Ophthalmol 15:429–433PubMed Singh Bhinder G, Singh Bhinder H (2005) Reflex epiphora in patients with dry eye symptoms: role of variable time Schirmer-1 test. Eur J Ophthalmol 15:429–433PubMed
31.
go back to reference Serin D, Karsloğlu S, Kyan A, Alagöz G (2007) A simple approach to the repeatability of the schirmer test without anesthesia: eyes open or closed? Cornea 26:903–906PubMedCrossRef Serin D, Karsloğlu S, Kyan A, Alagöz G (2007) A simple approach to the repeatability of the schirmer test without anesthesia: eyes open or closed? Cornea 26:903–906PubMedCrossRef
32.
go back to reference Wangkaew S, Kasitanon N, Sivasomboon C, Wichainun R, Sukitawut W, Louthrenoo W (2006) Sicca symptoms in Thai patients with rheumatoid arthritis, systemic lupus erythematosus and scleroderma: a comparison with age-matched controls and correlation with disease variables. Asian Pac J Allergy Immunol 24:213–221PubMed Wangkaew S, Kasitanon N, Sivasomboon C, Wichainun R, Sukitawut W, Louthrenoo W (2006) Sicca symptoms in Thai patients with rheumatoid arthritis, systemic lupus erythematosus and scleroderma: a comparison with age-matched controls and correlation with disease variables. Asian Pac J Allergy Immunol 24:213–221PubMed
33.
go back to reference Pflugfelder SC, Tseng SC, Sanabria O, Kell H, Garcia CG, Felix C, Feuer W, Reis B (1998) Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea 17:38–56PubMedCrossRef Pflugfelder SC, Tseng SC, Sanabria O, Kell H, Garcia CG, Felix C, Feuer W, Reis B (1998) Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea 17:38–56PubMedCrossRef
34.
go back to reference Bekibele CO, Baiyeroju AM, Ajaiyeoba A, Akang EE, Ajayi BG (2010) Case control study of dry eye and related ocular surface abnormalities in Ibadan, Nigeria. Int Ophthalmol 30:7–13PubMedCrossRef Bekibele CO, Baiyeroju AM, Ajaiyeoba A, Akang EE, Ajayi BG (2010) Case control study of dry eye and related ocular surface abnormalities in Ibadan, Nigeria. Int Ophthalmol 30:7–13PubMedCrossRef
35.
go back to reference Viso E, Gude F, Rodríguez-Ares MT (2011) The association of meibomian gland dysfunction and other common ocular diseases with dry eye: a population-based study in Spain. Cornea 30:1–6PubMedCrossRef Viso E, Gude F, Rodríguez-Ares MT (2011) The association of meibomian gland dysfunction and other common ocular diseases with dry eye: a population-based study in Spain. Cornea 30:1–6PubMedCrossRef
36.
go back to reference Ribeiro RT, Fialho LM, de Souza LT, Barsottini OG (2009) Trigeminal sensory neuropathy associated with systemic sclerosis: report of three Brazilian cases. Arq Neuropsiquiatr 67:494–495PubMedCrossRef Ribeiro RT, Fialho LM, de Souza LT, Barsottini OG (2009) Trigeminal sensory neuropathy associated with systemic sclerosis: report of three Brazilian cases. Arq Neuropsiquiatr 67:494–495PubMedCrossRef
37.
38.
go back to reference Korb DR (2000) Survey of preferred tests for diagnosis of the tear film and dry eye. Cornea 19:483–486PubMedCrossRef Korb DR (2000) Survey of preferred tests for diagnosis of the tear film and dry eye. Cornea 19:483–486PubMedCrossRef
39.
go back to reference Jacobi C, Jacobi A, Kruse FE, Cursiefen C (2011) Tear film osmolarity measurements in dryeye disease using electricalimpedance technology. Cornea 30:1289–1292PubMedCrossRef Jacobi C, Jacobi A, Kruse FE, Cursiefen C (2011) Tear film osmolarity measurements in dryeye disease using electricalimpedance technology. Cornea 30:1289–1292PubMedCrossRef
40.
go back to reference Benito A, Pérez GM, Mirabet S, Vilaseca M, Pujol J, Marín JM, Artal P (2011) Objective optical assessment of tear-film quality dynamics in normal and mildly symptomatic dry eyes. J Cataract Refract Surg 37:1481–1487PubMedCrossRef Benito A, Pérez GM, Mirabet S, Vilaseca M, Pujol J, Marín JM, Artal P (2011) Objective optical assessment of tear-film quality dynamics in normal and mildly symptomatic dry eyes. J Cataract Refract Surg 37:1481–1487PubMedCrossRef
Metadata
Title
Evaluation of dry eye signs and symptoms in patients with systemic sclerosis
Authors
Beatriz de A. F. Gomes
Marcony R. Santhiago
Mário N. L. de Azevedo
Haroldo V. Moraes Jr.
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 7/2012
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-012-1938-3

Other articles of this Issue 7/2012

Graefe's Archive for Clinical and Experimental Ophthalmology 7/2012 Go to the issue