Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 1:17:993-1005.
doi: 10.2147/OPTH.S375505. eCollection 2023.

Corneal Epithelial Thickness Changes After Topical Treatment of Dry Eye Disease in Primary Sjögren Syndrome

Tomas Loureiro  1 , Sandra Rodrigues-Barros  1 , Ana Rita Carreira  1 , Filipe Gouveia-Moraes  1 , Pedro Carreira  1 , Ana Vide Escada  1 , Paul Campos  1 , Ines Machado  1 , Nuno Campos  1 , Renato Ambrosio Jr  2 , Timothy J Archer  3 , Dan Z Reinstein  3
Affiliations

Corneal Epithelial Thickness Changes After Topical Treatment of Dry Eye Disease in Primary Sjögren Syndrome

Tomas Loureiro et al. Clin Ophthalmol. .

Abstract

Purpose: To evaluate the changes on epithelial thickness before and after topical treatment in primary Sjögren syndrome-associated dry eye disease (SS-DED).

Methods: This was a prospective study that included referred women with SS-DED and healthy age-matched controls. Corneal epithelial thickness was evaluated using high-definition anterior segment optical coherence tomography (Cirrus 5000 HD-OCT) in the baseline first consultation, and four weeks after treatment with preservative free 1mg/1mL sodium hyaluronate. Schirmer test 1 (ST1), tear break-up time (TBUT), tear meniscus height (TMH), SICCA Ocular Surface Score (SICCA OSS) and Ocular Surface Disease Index (OSDI) were evaluated. Statistical significance was defined as p-value <0.05.

Results: The study included 40 eyes, 20 with SS-DED and 20 controls. At baseline, SS-DED patients had lower ST1 (11.1 ± 2.2mm vs 14.1 ± 3.1mm, p<0.01), faster TBUT (9.1 ± 1.8s vs 13.2 ± 1.1s, p<0.01) and lower TMH (211.2 ± 68.4 µm vs 217.2 ± 60.1µm; p<0.01) than the control group, whereas SICCA OSS and OSDI were higher (p<0.01). The superior epithelium was thinner in SS-DED group (41.1 ± 3.2 µm vs 43.1± 2.3 µm, p<0.01). After treatment, ST1, TBUT, TMH, SICCA OSS, and OSDI improved (p<0.01), and superior epithelium thickened (p<0.01) in the SS-DED group.

Conclusion: Treatment with sodium hyaluronate improved ST1, TBUT, TMH, SICCA-OSS, and OSDI score. Superior epithelium tends to be thinner in SS-DED but becomes thicker with treatment. Our results seem to illustrate the morphological changes in the corneal epithelium in DED, which could be further recognized as a clinical biomarker of SS-DED.

Keywords: AS-OCT; Sjogren's syndrome; dry eye disease; epithelial thickness.

PubMed Disclaimer

Conflict of interest statement

Dr Renato Ambrósio Jr is a consultant for Oculus, Alcon, Zeiss, Essilor, Genom, Mediphacos. Dr Reinstein is a consultant for Carl Zeiss Meditec (Carl Zeiss Meditec AG) and CSO Italia; has a proprietary interest in the Artemis Insight 100 technology (ArcScan, Inc) through patents administered by the Cornell Center for Technology Enterprise and Commercialization (CCTEC), Ithaca, New York. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of ocular surface evaluation.
Figure 2
Figure 2
Epithelial thickness profile in SS-DED group at the baseline (µm).
Figure 3
Figure 3
Epithelial thickness profile in control group at the baseline (µm).
Figure 4
Figure 4
Epithelial thickness profile in SS-DED group after treatment (µm).
Figure 5
Figure 5
Epithelial thickness difference between after treatment and baseline in SS-DED group (µm). An asterisk denotes significant difference in mean epithelial thickness between after treatment and baseline evaluation.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Lemp MA, Baudouin C, Baum J, et al. The definition and classification of dry eye disease: report of the definition and classification subcommittee of the international dry eye workShop (2007). Ocular Surface. 2007;5(2):75–92. doi:10.1016/s1542-0124(12)70081-2 - DOI - PubMed
    1. Montés-Micó R. Role of the tear film in the optical quality of the human eye. J Cataract Refract Surg. 2007;33:1631–1635. doi:10.1016/j.jcrs.2007.06.019 - DOI - PubMed
    1. Pflugfelder SC. Tear dysfunction and the cornea: LXVIII Edward Jackson memorial lecture. Am J Ophthalmol. 2011;152:900–909.e1. doi:10.1016/j.ajo.2011.08.023 - DOI - PMC - PubMed
    1. Akpek EK, Klimava A, Thorne JE, et al. Evaluation of patients with dry eye for presence of underlying Sjogren syndrome. Cornea. 2009;28:493–497. doi:10.1097/ICO.0b013e31818d3846 - DOI - PMC - PubMed
    1. Foulks GN, Forstot SL, Donshik PC, et al. Clinical guidelines for management of dry eye associated with Sjögren disease. Ocular Surface. 2015;13:118–132. doi:10.1016/j.jtos.2014.12.001 - DOI - PubMed