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Association of Dry Eye and Inflammatory Systemic Diseases in a Tertiary Care–Based Sample

Henrich, Claudia F. MD; Ramulu, Pradeep Y. MD, PhD; Akpek, Esen K. MD

doi: 10.1097/ICO.0000000000000173
Clinical Science

Purpose: The aim of this study was to review the frequency and types of inflammatory systemic diseases in a cohort of patients with dry eye, and identify clinical features suggesting the presence of these.

Methods: Consecutive new patients with a primary diagnosis of dry eye evaluated at a tertiary dry eye center between January 2010 and December 2011 were reviewed retrospectively. Standardized questionnaires were used to obtain data regarding systemic symptoms, previous medical diagnoses, and family history. Dry eye evaluations included Schirmer testing, tear film break-up time, corneal fluorescein staining, and bulbar conjunctival lissamine green staining. Clinically significant dry eye was defined as having a Schirmer test score without anesthesia of ≤10 mm or conjunctival lissamine green staining of ≥1 using the Oxford scale.

Results: A total of 228 new patients were analyzed. Of these, 47.4% (108/228) presented with a known diagnosis of inflammatory disease. Based on a review of systems and ocular examination, 81 patients (81/228) underwent a further work-up that revealed 25 additional diagnoses that were not known on presentation. The most common newly identified conditions included occult thyroid eye disease (n = 20), primary Sjögren Syndrome (4), and Sjögren Syndrome suspect (1). Female gender, family history of autoimmune disease, self-reported joint pain or dry mouth, external signs of orbital inflammation, and conjunctival chemosis were more common in patients with inflammatory systemic disease as compared with that in patients with no identifiable condition (P < 0.05 for all).

Conclusions: Systemic inflammatory diseases are frequently associated with dry eye in patients evaluated at a tertiary academic center. Diagnostic evaluations may help uncover previously undiagnosed significant conditions in about one-third of tested patients.

Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.

Reprints: Esen K. Akpek, MD, Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe St, Maumenee #317, Baltimore, MD 21287-9238 (e-mail:

E. K. Akpek has been supported in part by an unrestricted grant provided by Jerome L. Greene Sjogren's Center, Johns Hopkins University, Baltimore, MD. P. Y. Ramulu received support from a Research to Prevent Blindness Special Scholar Award and NEI EY018595.

The authors have no other funding or conflicts of interest to disclose.

Received January 25, 2014

Accepted May 03, 2014

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.