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Cornea and ocular surface
Clinical science
The eye as a window to oral and pain symptoms in Sjögren’s disease
  1. Drew C Baeza1,2,
  2. Victor Sanchez3,4,
  3. Raquel Goldhardt3,5,
  4. Sara S McCoy6,
  5. Fei Tang5,
  6. Alan Baer7,
  7. Robert Fox8,
  8. Anat Galor3,5
  1. 1 Cornea, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
  2. 2 Medicine, Nova Southeastern University Dr Kiran C Patel College of Allopathic Medicine, Fort Lauderdale, Florida, USA
  3. 3 University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
  4. 4 University of Miami Miller School of Medicine, Miami, Florida, USA
  5. 5 Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
  6. 6 University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  7. 7 Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  8. 8 Kaizen Brain Institute, Scripps Clinic La Jolla Ximed Building, La Jolla, California, USA
  1. Correspondence to Dr Anat Galor; agalor{at}med.miami.edu

Abstract

Background To investigate whether certain dry eye (DE) metrics relate to oral and pain manifestations of Sjögren’s disease (SjD).

Methods Secondary analysis of the Sjögren’s International Collaborative Clinical Alliance dataset containing 1541 individuals with 2016 American College of Rheumatology/European League Against Rheumatism defined SjD. Binary logistic regression analyses examined which of 13 DE features related to various extraocular metrics.

Results The mean age of the population was 52±13.5 years; 45% identified as white and 94% as women. Heterogeneity in DE symptoms and signs was noted in individuals with SjD, with approximately one-third of individuals reporting significant spontaneous and/or evoked pain using various descriptors and indicating certain triggers, and approximately half having low tear production. Similarly, heterogeneity was noted with respect to oral and pain complaints, with extraocular pain symptoms found in approximately one-third of the population. Different ocular phenotypes aligned with different extraocular findings. Specifically, grittiness or scratchiness in the eyes (OR=1.6), blurred vision (OR=1.4) and low tear production (OR=1.8) most closely aligned with oral dryness (‘Does your mouth feel dry?). On the other hand, burning or stinging in the eyes (OR=1.6), discomfort in low humidity (OR=1.2) and the absence of DE signs (normal tear production, OR=0.7; lack of ocular surface staining, OR=0.6) most closely aligned with pain outside the eye (‘Do you experience persistent or frequent burning discomfort?’).

Conclusions Our findings suggest heterogeneity in SjD ocular presentations that predict extraocular features of disease and hint at mechanisms that underlie heterogeneity, namely divergent neurosensory processes.

  • Cornea
  • Immunology
  • Conjunctiva
  • Ocular surface

Data availability statement

Data are available upon reasonable request. See above.

https://doi.org/10.1136/bjo-2024-326748

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    Data availability statement

    Data are available upon reasonable request. See above.

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    Footnotes

    • Contributors DB developed the project, aided in running the statistical analyses, wrote and edited the paper. VS aided in running the statistical analysis, wrote and edited. RG helped writing and editing. SSM helped develop the study and edit. FT ran the statistical analyses and provided professional interpretations. AB and RF edited and provided insight to add to the final manuscript. AG is the guarantor of this project and helped develop, run statistical analyses and edit this paper.

    • Funding This research was funded/funded in part by a 2023-2024 Sjögren’s Foundation Pilot Research Grant 2023-PltGr-109 (AG). Data and specimens used in this manuscript are from the Sjögren's International Collaborative Clinical Alliance (SICCA) Next Generation Studies, funded under contract #1U01DE028891 (and previously under N01DE-32636 and #HHSN26S201300057C) by the National Institute of Dental and Craniofacial Research. This manuscript was prepared using a publicly available SICCA data set and does not necessarily reflect the opinions or views of the SICCA investigators, the NIH or NIDCR. Other support: Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences R&D (CSRD) I01 CX002015 (AG), Biomedical Laboratory R&D (BLRD) Service I01 BX004893 (AG), Rehabilitation R&D (RRD) I21 RX003883 (AG), Clinical Science R&D (CSRD) I01 CX002633 (AG), Department of Defense Gulf War Illness Research Program (GWIRP) W81XWH-20-1-0579 (AG) and Vision Research Program (VRP) W81XWH-20-1-0820 (AG), National Eye Institute U01 EY034686 (AG), U24EY035102 (AG), R33EY032468 (AG), NIH Center Core Grant P30EY014801 (institutional) and Research to Prevent Blindness Unrestricted Grant GR004596-1 (institutional).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.