Characteristics of dry eye associated with autoimmune diseases

“Dry eye is a common manifestation in autoimmune disease, and Sjögren syndrome is a typical autoimmune disease that causes aqueous-deficiency type of dry eye, with its diagnostic criteria including a Schirmer test value of 5 mm or less and keratoconjunctival epithelial disorder," the investigators stated.

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Ayano Yoshimura, MD, PhD, and colleagues from the Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan, conducted a study to investigate the characteristics of dry eye disease in patients with autoimmune diseases. The results indicated that the type of dry eye was that with a short fluorescein break-up time (FBUT) in more than half of the dry eyes associated with autoimmune diseases in the study.¹ Fumi Gomi, MD, PhD, was the senior author of the study.

The investigators explained that many studies have reported that patients with autoimmune diseases have ocular manifestations as well as the well-known systemic effects. “Dry eye is a common manifestation in autoimmune disease,^2-4 and Sjögren syndrome (SS) is a typical autoimmune disease that causes aqueous-deficiency type of dry eye, with its diagnostic criteria including a Schirmer test value of 5 mm or less and keratoconjunctival epithelial disorder."⁵

They cited a report by the Asia Dry Eye Society that proposed new definitions and diagnostic criteria for dry eye,⁶ with short BUT type of dry eye^7-9 that is characterized by an abnormal BUT and severe symptoms, despite a normal tear volume and minimal ocular surface epithelial damage.

Alongside the new definitions, a new movement in Japan is afoot that is promoting new concepts for the diagnosis and therapy of dry eye, referred to as tear film-oriented diagnosis (TFOD) and tear film therapy (TFOT),^6,10,11 Regarding the latter, Yokoi et al. classified fluorescein breakup patterns (FBUPs) into five types^11,12 for diagnosing the insufficient component of the ocular surface causing tear film breakup, classifying dry eye subtypes, and selecting the best available topical therapy for dry eye.

Although dry eye research from the perspective of TFOD and TFOT is progressing in Japan, Only a few reports have classified dry eye using TFOD associated with autoimmune diseases, according to the authors, and that was the focus of their study.

Retrospective clinical study investigates autoimmune disease and dry eye

The study under discussion included 252 eyes (252 patients; 240 women; mean age, 59.8 years) with autoimmune disease and dry eye. Patients were divided into those with primary SS, secondary SS, and autoimmune disease without SS.

The mean FBUT of all cases was 2.7 ± 1.6 seconds, the van Bijesterveld corneal score was 0.8 ± 0.8, the conjunctival score was 1.5 ± 1.7; and the Schirmer 1 test value was 8.4 ± 8.2 mm. Among all cases, the FBUPs was the tear-deficiency type of dry eye in 43% of eyes (area 11%, line 32%) and the short FBUT-type dry eye type in 57% (dimple 31%, spot 10%, random 16%). The conjunctival scores were significantly positively correlated with anti-SS-A and anti-SS-B antibody titers in the primary and secondary SS groups, the investigators found.

Interestingly, the authors explained, based on the current literature, they had expected that most of their cases would be in the SS groups and would have the aqueous-deficient type of dry eye. However, they found that half of the SS groups had the short FBUT-type of dry eye.

This led them to advise clinicians that in patients with autoimmune disease, “it is necessary to suspect the presence of short FBUT-type of dry eye, even without the presence of tear volume loss. If dry eye can be diagnosed by measuring the FBUT and observing FBUPs, it should be possible to use this information to contribute to improving the quality of life of patients with autoimmune disease,” they commented.

The authors concluded, “Patients with autoimmune diseases can develop dry eye with or without a diagnosis of SS, and the short FBUT type of dry eye is common and should be diagnosed and treated according to TFOD and TFOT.”

References

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