Yeh Yoon Do; Hyun Kim Joo; Sun Jeon Hyun; Ryang Wee Won; Young Hyon Joon

doi:10.3341/jkos.2017.58.8.903

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Do, Joo, Hyun, Won, and Joon: Correlations between Tear Osmolarity and Ocular and Systemic Parameters in Primary Sjögren's Syndrome

Original Article

J Korean Ophthalmol Soc 2017;58(8):903-910.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.8.903

Correlations between Tear Osmolarity and Ocular and Systemic Parameters in Primary Sjögren's Syndrome

Yeh Yoon Do, M.D.^1,², Hyun Kim Joo, M.D.², Sun Jeon Hyun, M.D.², Ryang Wee Won, M.D.¹, Young Hyon Joon, M.D.^1,^2,

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

Address reprint requests to Joon Young Hyon, MD Department of Ophthalmology, Seoul National University Bundang Hospital, #82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: 82-31-787-7379, Fax: 82-31-787-4057 E-mail: jyhyon@gmail.com

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 18 May 201715 June 2017 Accepted 24 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the relationships between tear osmolarity and various parameters for ocular and systemic disease in pri-mary Sjögren's syndrome.

Methods

The medical records of 53 patients with primary Sjögren's syndrome were reviewed. Tear osmolarity using a TearLab^®(TearLab™ Corp., San Diego, CA, USA) osmometer as well as other dry eye parameters such as tear break-up time, ocular staining score (Sjögren's International Collaboration Clinical Alliance [SICCA] ocular staining score, SICCA score), Schirmer-I score, symptoms with Ocular Surface Disease Index (OSDI), and Visual Analog Scale (VAS) were obtained. Systemic laboratory data and medication history were also collected. The correlations between the parameters were analyzed using the Spearman's rank correlation test.

Results

53 patients with a mean age of 54.1 ± 13.2 years and female predominance (96.23%) were enrolled. The majority of patients (28.3%) were receiving systemic therapy for severe Sjögren's syndrome. The tear osmolarity in Sjögren's syndrome patients was 307 ± 13.6 (mOsm/L). Higher tear osmolarity was associated with lower tear film break-up time (BUT) scores and with higher SICCA scores. Tear osmolarity and the Schirmer test results were not significantly related. Higher tear osmolarity was paradoxically associated with lower VAS scores and lower OSDI scores. Neither current medication nor the salivary gland focus score showed significant associations with tear osmolarity. Although tear osmolarity was not associated with the SSA-Ro or SSA-LA titer, serum immunoglobulin G (IgG) level and serum erythrocyte sedimentation rate (ESR) level showed positive corre-lations with tear osmolarity.

Conclusions

Tear osmolarity is positively correlated with the severity of dry eye and was associated with lower symptom severity. The significant associations of tear osmolarity with IgG and ESR suggest that high tear osmolarity may be correlated with autoantibody load and the systemic inflammatory state.

Keywords: Dry eye syndrome, Ocular surface inflammation, Primary Sjö, gren's syndrome, Tear osmolarity

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Figure 1.

Scatter plot showing significant correlations between tear film osmolarity and ocular and systemic parameters in primary Sjögren's syndrome. (A) Correlation between ocular surface disease index (OSDI) score and average tear film osmolarity (ρ = -0.471, p = 0.005). (B) Correlation between visual analog scale (VAS) score and average tear film osmolarity (ρ = -0.471, p = 0.005). (C) Correlation between average tear film break-up time (TBUT) and average tear film osmolarity (ρ = -0.202, p = 0.053). (D) Correlation between average Schirmer I test score and average tear film osmolarity (ρ = -0.046, p = 0.780). (E) Correlation between average average ocular staining score (SICCA score) and average tear film osmolarity (ρ = 0.235, p = 0.019). The Spearman rank-order correlation test was used to evaluate the relationship between variables.

Table 1.

Clinical characteristics of study participants

Variable	Value
Participant	53
Female (n, %)	51 (96.23)
Male (n, %)	2 (3.77)
Age (years)	54.06 ± 13.20
20-30 (n, %)	2 (3.77)
30-40 (n, %)	9 (16.98)
40-50 (n, %)	7 (13.21)
50-60 (n, %)	20 (37.74)
>60 (n, %)	15 (28.30)
OSDI score	45.36 ± 24.88
VAS score	14.45 ± 8.15
Tear film break-up time (s)	1.29 ± 0.68
Schirmer I test (mm)	6.74 ± 4.38
SICCA score^*	4.88 ± 3.72
Tear osmolarity (mOsm/L)	306.96 ± 13.59

Values are presented as mean ± SD or n (%) unless otherwise indicated. OSDI = ocular surface disease index; VAS = visual analog scale.

^* By Sjögren’s International Collaborative Clinical Alliance (SICCA).

Table 2.

Correlation with Systemic laboratory test results (Serum)

Variable	Mean ± SD	Correlation with tear osmolarity	p-value
C3	100.95 ± 11.91	0.089	0.448
C4	21.15 ± 5.53	-0.510	0.667
WBC	4.71 ± 1.35	-0.420	0.699
B2M	2.25 ± 0.74	0.160	0.242
IgG	1,569.19 ± 393.95	0.347	0.003^*
ESR	18.73 ± 13.34	0.277	0.010^*
Anit-Ro/SSA Ab	57.75 ± 65.53	0.199	0.170
Anit-La/SSA Ab	13.19 ± 32.99	0.169	0.247

SD = standard deviation; C = complement component; WBC = white blood cell; B2M = beta-2 microglobulin; IgG = immunoglobulin G; ESR = erythrocyte sedimentation rate.

^* Statistically significant.

Table 3.

Correlation with topical and systemic therapy

Variable	Correlation with tear osmolarity	p-value
Topical_Cyclosporin	0.027	0.846
Topical_Autoserum	0.059	0.674
Oral_Steroid	0.050	0.737
Oral_Hydroxyquinolone	-0.138	0.360
Oral_Cyclosporin	0.265	0.075

Table 4.

Correlation with salivary gland test results

Variable	Correlation with tear osmolarity	p-value
Salivary gland flow rate (unstimulated)	-0.169	0.690
Salivary gland flow rate (stimulated)	-0.132	0.756
Salivary gland focus score_Greenspan	-0.393	0.336
Salivary gland focus score_Chisholm mason	-0.185	0.660

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