Immune disorders increase symptoms, signs of dry eye

Liz Meszaros, MDLinx | December 13, 2017

Dry eye symptoms and signs in patients with immune-related disorders are significantly greater than in patients with simple dry eye (SDE), according to results published in the Journal of Ophthalmology.

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Immune-related disorders and dry eye

Signs and symptoms of dry eye may be significantly greater in patients with Sjögren’s syndrome, systemic lupus erythematosus, and rheumatoid arthritis.

Researchers from Xiangya Hospital and the Hunan Provincial People’s Hospital in Hunan Province, China, conducted a prospective study to analyze the clinical characteristics of immune-related dry eye (IRDE).

“Among the patients with dry eye syndrome, some patients are complicated with the systemic immune system diseases. The dry eye symptoms and signs of such patients are often more serious, the treatment effect is poorer, and the prognosis is not ideal,” wrote these authors.

They included 224 patients with SDE and no systemic lesions and 207 with dry eye complicated by diseases of the immune system (the IRDE group). The latter group included 70 patients with Sjögren’s syndrome, 72 with systemic lupus erythematosus, and 65 with rheumatoid arthritis.

Researchers found no differences between the two groups in tear break-up time (TBUT), although it was significantly shorter in both groups. Persons with IRDE were younger and more often women compared with those in the SDE group (P < 0.05 for both). The IRDE patients also exhibited significantly increased corneal staining and ocular surface inflammation (P < 0.05), as well as significantly shorter TBUT and Schirmer I test (P < 0.05). In addition, IRDE patients had fewer corneal nerve fibers, but significantly increased levels of local lymphocytes. Finally, researchers found a greater number of patients with moderate-or-above dry eye in the IRDE group (P < 0.05).

Subjects in the IRDE group also had a higher incidence of conjunctival congestion, conjunctival papillary, and follicular hyperplasia compared with those in the SDE group (P < 0.05). Researchers found no significant differences in the incidence of conjunctival sac secretions between the groups (P > 0.05).

“The dry eye symptom[s] and sign[s] and ocular surface inflammation of IRDE were significantly more severe than that of the SDE. We can reasonably infer that, on one hand, the autoimmune disease can attack lacrimal gland tissue via immune reaction to achieve the reduction of the tear secretion. On the other hand, autoimmune disease can attack the ocular surface epithelial cells and promote the ocular surface inflammatory reaction to cause the damage of accessory lacrimal glands and goblet cells and promote the occurrence and growth of ocular surface inflammatory reactions. [This] result[s] in the damage of ocular surface epithelial cells and reduction of mucin secretion,” the authors noted.

Clinicians must be aware of the connection between exacerbated dry eye symptoms and signs to systemic immune disease, and treat both in their patients.

“The progression of autoimmune diseases was closely related to the progression of ocular surface diseases. Therefore, in treatment, it is necessary to actively promote the functional recovery of lacrimal glands and tear secretion as well as the repair of ocular surface epithelial cells, actively and effectively control ocular surface inflammatory reactions, and actively and systematically treat systemic autoimmune diseases,” they concluded.

In related news, the Sjögren’s Syndrome Foundation has issued the first treatment guidelines for systemic Sjögren’s syndrome, published in Arthritis Care & Research.

The physician committee led by Steven E. Carsons, MD, Winthrop University Hospital, Mineola, NY, presented 19 recommendations focused on the use of biologic agents, management of fatigue, and inflammatory musculoskeletal pain.

One of the recommendations outlined the appropriate use of rituximab for the treatment of dry eyes. According to the committee, rituximab is only to be used in severe cases and only after consulting with the patient’s ocular specialist.

This study was supported by the grants from the National Natural Science Foundation of China (no. 81170823), Science & Technology Program Project of Hunan Provincial Science & Technology Department (nos. 2015JC3011 and 2015JC3118), Scientific Research Program Project of Hunan Provincial Health Department (no. B2015-70), Scientific Research Program Key Projects of Hunan Traditional Chinese Medicine (no. 201533), and Hunan High-Level Health Professionals “225” Project Training Foundation.

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