Vatinee Y. Bunya, MD, Mina Massaro-Giordano, MD, Frederick B. Vivino, MD*, Stephen E. Orlin,
MD, Michael E. Sulewski, MD, and Maureen G.
Maguire, PhD
The authors are receiving research supplies from TearLab for a separate study.
Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA
*Division of Rheumatology, Penn Presbyterian Medical Center,Philadelphia, PA
PurposePurposeTo study tear film osmolarity in Sjogren’s
syndrome patients
To assess if tear film osmolarity in Sjogren’s syndrome patients is correlated with symptoms (OSDI) or unanesthetized Schirmer testing
To compare patient discomfort associated with tear osmolarity testing to unanesthetized Schirmer testing
MethodsMethodsProspective study to evaluate the tear film
osmolarity of Sjogren’s syndrome patientsDemographic information and medication usage
was recordedTear film osmolarity: TearLab osmolarity system
System calibrated daily as specified by manufacturer
Unanesthetized Schirmer testing Patient-reported pain scores (0-5 with 5 = severe
pain) after tear osmolarity and Schirmer testingOSDI self-administered Spearman (non-parametric) correlation
coefficients used due to small sample size
Age
Mean (Std), yrs 55.7 (15.5)
Range 18-88
Sex
Male 1 (5%)
Female 19 (95%)
Race/Ethnicity
White 13 (65%)
African-American 6 (30%)
Hispanic 1 (5%)
Sjogren’s Syndrome
Primary 16 (80%)
Secondary 4 (20%)
Results
Systemic Medications
Hydroxychloroquine (Plaquenil) 12 (63%)
Pilocarpine (Salagen) 12 (63%)
Fish oil (not Lovaza) 11 (58%)
Omega-3-acid ethyl esters (Lovaza) 3 (16%)
Flaxseed 6 (32%)
Prednisone (oral) 6 (32%)
Methotrexate 4 (21%)
Azathioprine (Imuran) 2 (11%)
Rituximab (Rituxan) 1 (6%)
Eye Medications
Cyclosporine (Restasis) 5 (26%)
Erythromycin Ointment 2 (11%)
*1 patient did not provide a medication list
Medication UseMedication Use
ResultsResultsAverage OSDI score: 46.6Average tear osmolarity: 311 mOsmol/LAverage unanesthetized Schirmer score: 13
mm/5 min
Median pain scores Tear osmolarity testing: 1 Unanesthetized Schirmer testing: 4
p < 0.001 (Wilcoxon signed rank test)
OSDI does not correlate well with unanesthetized Schirmer score (averaged between eyes).
OSDI correlates well with tear osmolarity (averaged between eyes).
Average unanesthetized Schirmer score does not correlate with average tear osmolarity.
r= - 0.14p= 0.56
Previous studies have suggested that tear film osmolarity may be the single best test in the diagnosis of dry eye.1, 2 To our knowledge, tear osmolarity has not been studied specifically in Sjogren’s syndrome patients.
In our study, the average tear osmolarity was 311 mOsmol/L. This is lower than the referent of 316 mOsmol/L.1 This is most likely due to the fact that 95% of our patients were on treatment at the time of the study. We would expect the tear osmolarity to be higher in untreated patients.
Tear osmolarity correlated with patient symptoms while unanesthetized Schirmer testing did not. Tear osmolarity did not correlate with unanesthetized Schirmer scores. In addition, pain scores associated with osmolarity testing were lower than for unanesthetized Schirmer testing. Tear osmolarity testing may be superior to Schirmer testing to follow dry eye disease in patients with Sjogren’s syndrome. Future larger studies would be needed to confirm this hypothesis.
1. Tomlinson A, Khanal S, Ramaesh K, Diaper C , et al. Tear film osmolarity: Determination of a Referent for Dry Eye Diagnosis. Invest Ophthalmol Vis Sci 2006; 47:4309-15.
2. Khanal S, Tomlinson A, McFadyen A, Diaper C, et al. Dry Eye Diagnosis. Invest Ophthalmol Vis Sci 2008; 49:1407-14.