The Dry Eye Zone

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Abstract: Prevalence of dry eye in rheumatoid arthritis patients


Holy toledo. Look at those whacko results.

On the one hand:
 Fifty-two percent of patients had a history of dry eye and dry mouth
On the other hand:
Dry eye interpreted from OSDI, Schirmer 1 test, tear break-up time and rose bengal staining was 16.4%, 46.7%, 82% and 3.3% respectively. 
Does it not strike you as really weird that four different dry eye tests' results ranged from 3.5% to 82%?

How can you have an established history of dry eye yet not appear to on OSDI? 

And yes, it's also weird that OSDI could produce far fewer positives than Schirmer - but then, it was unanaesthetized, and if somebody sticks one of those horrible strips in MY eyes I can tell you I'll have tears running down my chin... it's a great test (OK in a crude, sadistic sort of way) to determine whether you're producing reflex, but not basal, tears.


BACKGROUND:
Rheumatoid arthritis has manifestations in various organs including ophthalmic involvement. The present study evaluates prevalence of dry eye and secondary Sjogren's syndrome using salivary scintigraphy which has not been used in previous reports.
OBJECTIVE:
To evaluate the prevalence of secondary Sjogren's syndrome in patients with rheumatoid arthritis, including clinical characteristics and dry eye, compared with non-Sjogren's syndrome.
DESIGN:
Descriptive cross sectional study
MATERIAL AND METHOD:
Sixty-one patients with rheumatoid arthritis were recruited at Siriraj Hospital during March 2009-September 2010 and filled in the questionnaires about dry eye for Ocular Surface Disease Index (OSDI) with a history taking of associated diseases, medications, duration of symptoms of dry eyes and dry mouth. The Schirmer I test without anesthesia, tear break-up time, rose bengal staining score, severity of keratitis and salivary scintigraphy were measured and analyzed.
RESULTS:
Prevalence of secondary Sjogren's syndrome and dry eye were 22.2% (95% CI 15.4 to 30.9) and 46.7% (95% CI 38.0 to 55.6), respectively. Dry eye interpreted from OSDI, Schirmer 1 test, tear break-up time and rose bengal staining was 16.4%, 46.7%, 82% and 3.3% respectively. Fifty-two percent of patients had a history of dry eye and dry mouth with mean duration 27.4 and 29.8 months, respectively. Superficial punctate keratitis and abnormal salivary scintigraphy were found in 58.2% and 77.8%. Duration of rheumatoid arthritis, erythrocyte sedimentation rate were not correlated with secondary Sjogren's syndrome. Dry eye from OSDI with secondary Sjogren's syndrome (33.3%) compared with non-Sjogren's syndrome (9.5%) was significant difference (p = 0.008). Adjusted odds ratio for secondary Sjogren's syndrome in OSDIL score > 25 was 13.8 (95% CI 2.6 to 73.8, p = 0.002) compared to OSDI score < 25.
CONCLUSION:
Awareness and detection of dry eye syndrome and secondary Sjogren's syndrome in rheumatoid arthritis was crucial for evaluation of their severity and proper management.

J Med Assoc Thai. 2012 Apr;95 Suppl 4:S61-9.
Source
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sipks@mahidol.ac.th

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