Association between objective signs and subjective symptoms of dry eye disease in patients with systemic sclerosis

The aim of this study was to evaluate the association between clinical signs and symptoms of dry eye disease (DED) in patients with systemic sclerosis (SSc). This cross-sectional observational study included 19 SSc patients and 19 normal subjects with no ocular symptoms or ocular surface disorders. Clinical parameters included tear film break-up time (tBUT), Schirmer I, lissamine green (LG) dye, and tear film osmolarity tests, tear production, and tear secretion flow. For assessment of the dry eye symptoms, the Ocular Surface Disease Index (OSDI) questionnaire was administered to all patients. The following mean values were found in SSc patients: OSDI 33.6 +/- 19.86; osmolarity of the tear fluid 310.8 mOsmol/l +/- 14.47; tBUT time 5.158 +/- 2.328 s; Schirmer I test 5.395 mm/5 min; LG grading score 2.026 +/- 0.8893; collected tear fluid volume 6.397 +/- 2.761 A mu l. The calculated average tear velocity was 4.654 +/- 1.963 A mu l/min. A significant correlation was found between the OSDI as a subjective parameter and disease duration. Early recognition of dry eye symptoms, a possible extra-intestinal manifestation of SSc, should be included in the check up of the disease to reduce ocular complications. The objective tear functional tests were strongly influenced by individual factors like age and disease duration.