Korean Journal of Ophthalmology

The Korean Ophthalmological Society (대한안과학회)
권호 표지
DOI QR코드

DOI QR Code

Correlation between Tear Osmolarity and Other Ocular Surface Parameters in Primary Sjögren's Syndrome

  • Kim, Mirinae (Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyun Seung (Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Na, Kyung-Sun (Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2016.06.23
  • Accepted : 2016.11.01
  • Published : 2017.02.05
⟨ Previous Next ⟩

Abstract

Purpose: To investigate the relationships between tear osmolarity and other ocular surface parameters and to determine the diagnostic value of tear osmolarity in primary $Sj{\ddot{o}}gren^{\prime}s$ syndrome (SS) using tear film break-up time, Schirmer I test, and cornea/conjunctiva staining. Methods: We included 310 eyes of 155 patients diagnosed with dry eye disease (39 primary SS and 116 non-$Sj{\ddot{o}}gren$ dry eye disease) at Seoul St. Mary's Hospital from August 2010 to January 2015. All subjects completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent ocular examinations including tear osmolarity (TearLab Osmolarity System), Schirmer I test, slit lamp examination for tear film break-up time, and corneal and conjunctival fluorescein staining. We used the mean value of both eyes for all parameters. Fluorescein staining was assessed using the $Sj{\ddot{o}}gren^{\prime}s$ International Collaborative Clinical Alliance ocular staining score (OSS). Results: In primary SS patients (n = 39), the mean subject age was $52.5{\pm}11.9$ years, and 94.9% of the subjects were women. Mean tear osmolarity in SS was $311.1{\pm}16.4mOsm/L$, with 16 (41.0%) subjects having values ${\geq}316mOsm/L$. In SS, there was a positive correlation between mean tear osmolarity and OSDI score (${\rho}=0.405$, p = 0.011) and OSS (${\rho}=0.592$, p < 0.001). There was a negative correlation between mean tear osmolarity and the Schirmer I test (${\rho}=-0.625$, p < 0.001). There was no significant correlation between mean tear osmolarity and tear film break-up time in SS (${\rho}=0.110$, p = 0.505). Conclusions: Tear osmolarity measurements using the TearLab Osmolarity System can reflect both symptom severity (OSDI) and objective signs (Schirmer test and OSS) in SS.

Keywords

References

  1. Moutsopoulos HM, Tzioufas AG. Sjogren's syndrome. In: Kasper DL, Fauci AS, Hauser S, et al., editors. Harrison's principles of internal medicine. 19th ed. New York: Mc-Graw Hill Education Medical; 2015. p. 383.
  2. Kassan SS, Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjogren syndrome. Arch Intern Med 2004;164:1275-84. https://doi.org/10.1001/archinte.164.12.1275
  3. Voulgarelis M, Tzioufas AG. Pathogenetic mechanisms in the initiation and perpetuation of Sjogren's syndrome. Nat Rev Rheumatol 2010;6:529-37. https://doi.org/10.1038/nrrheum.2010.118
  4. Mavragani CP, Moutsopoulos NM, Moutsopoulos HM. The management of Sjogren's syndrome. Nat Clin Pract Rheumatol 2006;2:252-61.
  5. Reina D, Roig Vilaseca D, Torrente-Segarra V, et al. Sjogren's syndrome-associated interstitial lung disease: a multicenter study. Reumatol Clin 2016;12:201-5. https://doi.org/10.1016/j.reuma.2015.09.003
  6. Fox PC. Autoimmune diseases and Sjogren's syndrome: an autoimmune exocrinopathy. Ann N Y Acad Sci 2007;1098:15-21. https://doi.org/10.1196/annals.1384.003
  7. Dafni UG, Tzioufas AG, Staikos P, et al. Prevalence of Sjogren's syndrome in a closed rural community. Ann Rheum Dis 1997;56:521-5. https://doi.org/10.1136/ard.56.9.521
  8. Segal B, Bowman SJ, Fox PC, et al. Primary Sjogren's syndrome: health experiences and predictors of health quality among patients in the United States. Health Qual Life Outcomes 2009;7:46. https://doi.org/10.1186/1477-7525-7-46
  9. Research in dry eye: report of the Research Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007;5:179-93. https://doi.org/10.1016/S1542-0124(12)70086-1
  10. Sullivan BD, Crews LA, Sonmez B, et al. Clinical utility of objective tests for dry eye disease: variability over time and implications for clinical trials and disease management. Cornea 2012;31:1000-8. https://doi.org/10.1097/ICO.0b013e318242fd60
  11. Tomlinson A, Khanal S, Ramaesh K, et al. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci 2006;47:4309-15. https://doi.org/10.1167/iovs.05-1504
  12. Sullivan BD, Whitmer D, Nichols KK, et al. An objective approach to dry eye disease severity. Invest Ophthalmol Vis Sci 2010;51:6125-30. https://doi.org/10.1167/iovs.10-5390
  13. Khanal S, Tomlinson A, McFadyen A, et al. Dry eye diagnosis. Invest Ophthalmol Vis Sci 2008;49:1407-14. https://doi.org/10.1167/iovs.07-0635
  14. Lemp MA, Bron AJ, Baudouin C, et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol 2011;151:792-8.e1. https://doi.org/10.1016/j.ajo.2010.10.032
  15. Schargus M, Wolf F, Tony HP, et al. Correlation between tear film osmolarity, dry eye disease, and rheumatoid arthritis. Cornea 2014;33:1257-61. https://doi.org/10.1097/ICO.0000000000000257
  16. Miserocchi E, Iuliano L, Berchicci L, et al. Tear film osmolarity in ocular mucous membrane pemphigoid. Cornea 2014;33:668-72. https://doi.org/10.1097/ICO.0000000000000148
  17. Na KS, Yoo YS, Hwang KY, et al. Tear osmolarity and ocular surface parameters as diagnostic markers of ocular graftversus-host disease. Am J Ophthalmol 2015;160:143-9.e1. https://doi.org/10.1016/j.ajo.2015.04.002
  18. Amparo F, Jin Y, Hamrah P, et al. What is the value of incorporating tear osmolarity measurement in assessing patient response to therapy in dry eye disease? Am J Ophthalmol 2014;157:69-77.e2. https://doi.org/10.1016/j.ajo.2013.07.019
  19. Khanal S, Millar TJ. Barriers to clinical uptake of tear osmolarity measurements. Br J Ophthalmol 2012;96:341-4. https://doi.org/10.1136/bjo.2011.202754
  20. Bunya VY, Fuerst NM, Pistilli M, et al. Variability of tear osmolarity in patients with dry eye. JAMA Ophthalmol 2015;133:662-7. https://doi.org/10.1001/jamaophthalmol.2015.0429
  21. Bunya VY, Langelier N, Chen S, et al. Tear osmolarity in Sjogren syndrome. Cornea 2013;32:922-7. https://doi.org/10.1097/ICO.0b013e31827e2a5e
  22. Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjogren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 2002;61:554-8. https://doi.org/10.1136/ard.61.6.554
  23. Whitcher JP, Shiboski CH, Shiboski SC, et al. A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjogren's Syndrome International Registry. Am J Ophthalmol 2010;149:405-15. https://doi.org/10.1016/j.ajo.2009.09.013
  24. Utine CA, Bicakcigil M, Yavuz S, Ciftci F. Tear osmolarity measurements in dry eye related to primary Sjogren's syndrome. Curr Eye Res 2011;36:683-90. https://doi.org/10.3109/02713683.2011.571357
  25. Rosenthal P, Baran I, Jacobs DS. Corneal pain without stain: is it real? Ocul Surf 2009;7:28-40. https://doi.org/10.1016/S1542-0124(12)70290-2
  26. Dastjerdi MH, Dana R. Corneal nerve alterations in dry eye-associated ocular surface disease. Int Ophthalmol Clin 2009;49:11-20. https://doi.org/10.1097/IIO.0b013e31819242c9
  27. Tomlinson A, Khanal S. Assessment of tear film dynamics: quantification approach. Ocul Surf 2005;3:81-95. https://doi.org/10.1016/S1542-0124(12)70157-X
  28. Szalai E, Berta A, Szekanecz Z, et al. Evaluation of tear osmolarity in non-Sjogren and Sjogren syndrome dry eye patients with the TearLab system. Cornea 2012;31:867-71. https://doi.org/10.1097/ICO.0b013e3182532047
  29. Messmer EM, Bulgen M, Kampik A. Hyperosmolarity of the tear film in dry eye syndrome. Dev Ophthalmol 2010;45:129-38.
  30. Gaffney EA, Tiffany JM, Yokoi N, Bron AJ. A mass and solute balance model for tear volume and osmolarity in the normal and the dry eye. Prog Retin Eye Res 2010;29:59-78. https://doi.org/10.1016/j.preteyeres.2009.11.002

Cited by

  1. Clinical Symptoms and Signs of Dry Eye Disease after Allogeneic Hematopoietic Stem Cell Transplantation vol.60, pp.12, 2017, https://doi.org/10.3341/jkos.2019.60.12.1148
  2. Optimization of a Rabbit Dry Eye Model Induced by Topical Instillation of Benzalkonium Chloride vol.2020, pp.None, 2017, https://doi.org/10.1155/2020/7204951
  3. Unstimulated whole saliva flow for diagnosis of primary Sjögren’s syndrome: time to revisit the threshold? vol.22, pp.1, 2020, https://doi.org/10.1186/s13075-020-2132-3
  4. Tear Film Break-Up Time and Dry Eye Disease Severity in a Large Norwegian Cohort vol.10, pp.4, 2017, https://doi.org/10.3390/jcm10040884
  5. Evaluation of tear osmolarity measured by I-Pen osmolarity system in patients with dry eye vol.11, pp.1, 2021, https://doi.org/10.1038/s41598-021-87336-2