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Evaluation of Dry Eye Disease in Children With Systemic Lupus Erythematosus and Healthy Controls

Ong Tone, Stephan MDCM, PhD, FRCSC*; Elbaz, Uri MD*; Silverman, Earl MD, FRCPC; Levy, Deborah MD, MSc, FRCPC; Williams, Sara MSc*; Mireskandari, Kamiar MBChB, FRCSEd, FRCOphth, PhD*; Ali, Asim MD, FRCSC*

doi: 10.1097/ICO.0000000000001902
Clinical Science

Purpose: To compare the symptoms and signs of dry eye disease (DED) in children with systemic lupus erythematosus (SLE) with those in healthy children using common diagnostic tools.

Methods: Prospective, observational, single-center cohort study. Thirty-four subjects with SLE and 15 healthy subjects were recruited from the Hospital for Sick Children in Toronto, Canada. Subjects underwent subjective and objective dry eye assessments using the Canadian Dry Eye Assessment (CDEA) questionnaire, tear film osmolarity, slit lamp examination, tear film break-up time, corneal fluorescein staining, Schirmer test 1, and conjunctival lissamine green staining.

Results: No difference in symptoms was found between children with SLE and healthy children (CDEA score 6.4 ± 5.4 vs. 3.8 ± 3.2; P = 0.09). Corneal staining was more prevalent in children with SLE than in healthy children (58.8% vs. 20.0%; P = 0.01), and children with SLE had higher mean corneal fluorescein staining scores (1.7 ± 1.7 vs. 0.2 ± 0.4; P = 0.002). No statistically significant differences in tear osmolarity, inter-eye differences in tear osmolarity, tear film break-up time, Schirmer test 1, or lissamine green staining scores were observed between the 2 groups. In healthy children, CDEA scores weakly correlated with corneal fluorescein staining score (r = 0.53, P = 0.04). In children with SLE, no correlation between CDEA score and any of the diagnostic test outcomes was found.

Conclusions: There is discordance between symptoms and signs of DED in children with SLE. Corneal fluorescein staining is essential for the diagnosis of DED in these children.

*Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and

Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Correspondence: Asim Ali, MD, FRCSC, Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada (e-mail:

This work was supported through the Brandan's Eye Research Foundation.

K. Mireskandari and A. Ali are consultants for Santen Inc. (Japan). The remaining authors have no conflicts of interest to disclose.

S. Ong Tone and U. Elbaz contributed equally to this work.

Presented at the Canadian Ophthalmological Society Annual Meeting, June 17, 2017; Montreal, Canada.

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Received November 18, 2018

Received in revised form December 07, 2018

Accepted December 14, 2018

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