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Analysis of ocular surface damage and visual impact in patients with primary and secondary Sjögren syndrome


The objective of this study is to review the ocular surface changes and complications of patients with Sjögren syndrome and assess their visual impact. A retrospective, cross-sectional, observational, and descriptive study of patients with Sjögren syndrome diagnosed according to the American–European Consensus Group criteria was designed. Data including age, gender, the reason for consultation, associated systemic disease, visual acuity, and ocular complications were recorded. Dry eye tests including tear meniscus thickness; tear film break-up time; ocular surface staining (fluorescein and lissamine green); and Schirmer I test were performed. A total of 249 patients, 233 women (93.6%) and 16 men (6.4%) were studied. Meibomian gland dysfunction was found in 46% (n = 229 eyes) patients; shortened tear film break-up time in 44% (n = 220 eyes); decreased tear meniscus in 49% (n = 243 eyes); significant superficial punctate keratopathy in 49% (n = 242 eyes); a mean ocular surface staining score of 5.92 points; and a low score for Schirmer I test (mean = 5.4 mm). Eyes with a 4 + corneal fluorescein score showed the worst BCVA (mean = 0.63 ± 0.66 LogMAR, ≤ 20/80 Snellen eq., 95% CI 0.29–0.97), compared to 1 + to 3 + scores (mean = 0.211 ± 0.37 LogMAR, 20/32 Snellen eq., 95% CI 0.53–1.15). Ten eyes (4.0%) presented central corneal ulceration with a mean visual acuity of 20/500 (96% visual loss). Ocular surface alterations related to severe dry eye and complications from Sjögren syndrome may have a significant impact on visual acuity. Secondary Sjögren syndrome to rheumatoid arthritis had the worse dry eye prognosis, visual outcome, and ocular complications.

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The authors would like to thank Jose Juan Gongora Cortes for statistical assistance. The study was partly funded by The Immuneye Foundation, Monterrey, Mexico.

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All authors contributed to the study conception and design, material preparation, data collection, and analysis in line with the ICMJE 4 authorship criteria. All authors read and approved the final manuscript and take full responsibility for the integrity of the study.

Corresponding author

Correspondence to Alejandro Rodriguez-Garcia.

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The authors declare that they have no conflict of interest.

IRB/Ethical approval

Review of clinical records and keeping privacy of patient identification and sensible data were in adherence to the Comites de Etica e Investigacion, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey with the registration numbers, CONBIOETICA-19-CEI-011-20161017 and 13CI19039138, respectively.

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Villarreal-Gonzalez, A.J., Jocelyn Rivera-Alvarado, I., Rodriguez-Gutierrez, L.A. et al. Analysis of ocular surface damage and visual impact in patients with primary and secondary Sjögren syndrome. Rheumatol Int 40, 1249–1257 (2020).

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  • Sjögren syndrome
  • Dry eye
  • Superficial punctate keratitis
  • Lissamine green
  • Tear film