Dry Eye in Systemic Sclerosis Patients: Novel Methods to Monitor Disease Activity

Caterina Gagliano; Elisa Visalli; Mario Damiano Toro; Roberta Amato; Giovanni Panta; Davide Scollo; Giovanni Scandura; Salvatore Ficili; Giorgio Amato; Alessia Benenati; Roberta Foti; Giulia Malaguarnera; Giuseppe Gagliano; Raffaele Falsaperla; Teresio Avitabile; Rosario Foti

doi:10.3390/diagnostics10060404

Dry Eye in Systemic Sclerosis Patients: Novel Methods to Monitor Disease Activity

Diagnostics (Basel). 2020 Jun 13;10(6):404. doi: 10.3390/diagnostics10060404.

Authors

Caterina Gagliano^{1

2}, Elisa Visalli³, Mario Damiano Toro^{4

5}, Roberta Amato^{1

2}, Giovanni Panta¹, Davide Scollo¹, Giovanni Scandura¹, Salvatore Ficili¹, Giorgio Amato³, Alessia Benenati³, Roberta Foti⁶, Giulia Malaguarnera⁷, Giuseppe Gagliano^{2

6}, Raffaele Falsaperla⁸, Teresio Avitabile¹, Rosario Foti³

Affiliations

¹ Ophthalmology Clinic, San Marco Hospital, Catania University, 95 123 Catania, Italy.
² Neurovisual Science Technology (NEST) srl, 95123 Catania, Italy.
³ Rheumatology Unit, San Marco Hospital, Policlinico University of Catania, 95123 Catania, Italy.
⁴ Department of General Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland.
⁵ Faculty of Medical Sciences, Collegium Medicum Cardinal Stefan Wyszyñski University, 01815 Warsaw, Poland.
⁶ Faculty of Medicine, University of Catania, 95123 Catania, Italy.
⁷ Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy.
⁸ Neonatal Intensive Care, San Marco Hospital, 95123 Catania, Italy.

Abstract

Background: In systemic sclerosis (SSc) patients, dry eye syndrome (DES) is the most frequent ocular feature. The aim of this study was to investigate ocular DES-related SSc patients and to establish any correlation with the severity of the disease.

Methods: Retrospectively, data from 60 patients with SSc underwent ophthalmic examination, where non-invasive film tear break-up time (NIF-TBUT), tear film lipid layer thickness (LLT), anesthetic-free Schirmer test I, tear osmolarity measurement (TearLab System), and modified Rodnan skin score (mRSS) data were collected. The visual analog scale (VAS) and Symptom Assessment in Dry Eye (SANDE) methods were utilized. The results were correlated with mRSS and the duration of SSc.

Results: Severe DES occurred in 84% of cases, and was more severe in women. The eyelids were involved in 86.6%, secondary to meibomian gland disease (MGD). A direct correlation was found between the tear osmolarity (mean 328.51 ± 23.8 SD) and skin score (mRSS) (r = 0.79; p < 0.01). Significantly reduced NIF-TBUT, LLT, and Schirmer test I values were observed in the case of severe skin involvement.

Conclusions: SSc patients show lipid tear dysfunction related to the severity and duration of the disease due to inflammation and the subsequent atrophy of the meibomian glands.

Keywords: Schirmer test; break-up time test; dry eye syndrome; lipid tear dysfunction; meibomian gland disease; skin score; systemic sclerosis; tear osmolarity.