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Wu J, Liang Y, Shi F, Tu X, Zhang J, Qiu Q. Meibomian gland dropout of upper eyelids as a novel biomarker for early diagnosis of primary Sjögren's syndrome: a pilot study. Ther Adv Musculoskelet Dis 2024; 16:1759720X241274726. [PMID: 39228398 PMCID: PMC11369872 DOI: 10.1177/1759720x241274726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/30/2024] [Indexed: 09/05/2024] Open
Abstract
Background Early diagnosis of primary Sjögren's syndrome (pSS) remains difficult due to its insidious onset. Objectives To identify whether meibomian gland dropout (MGD) is a sensitive and noninvasive predictor of pSS by studying its association with histopathology in labial salivary gland biopsy in patients with clinically suspected pSS. Design Prospective, randomized, multicenter, comparative effectiveness study. Methods The study was conducted from July 2022 to July 2023. In all, 56 eligible participants with clinically suspected pSS were recruited from three combined ophthalmology medicine/rheumatology SS clinics. All participants with suspected pSS were evaluated and diagnosed by ophthalmology and rheumatology consultants and underwent infrared imaging of the meibomian glands using Keratograph 5M and histopathological evaluation of labial salivary gland biopsies. The length, width, and tortuosity of the meibomian glands were measured; the dropout rate in the nasal, temporal, and total eyelids was analyzed; and the dropout score was calculated using meibography grading scales. Results Among the 56 participants, 34 were identified with pSS, and 22 were diagnosed with non-SS dry eye (NSSDE) and served as the control group. We recorded significant differences in the temporal and total MGD rates of the upper eyelids between the pSS and NSSDE groups (all p < 0.01). Improved prediction accuracy was achieved with the temporal and total MGD rates in the upper eyelids, with area under the curve values of 0.94 and 0.91, and optimal cutoff points of 0.78 and 0.75, respectively. Conclusion MGD in the upper eyelids, especially in the temporal portion, is strongly associated with the histopathological outcome of labial salivary gland biopsy in pSS and is proposed as a highly predictive and noninvasive biomarker for the early diagnosis of pSS. Trial registration ClinicalTrials.gov identifier: ChiCTR2000038911.
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Affiliation(s)
- Jing Wu
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongying Liang
- Department of Rheumatology, Shanghai University of Traditional Chinese Medicine Affiliated Guanghua Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China
| | - Fanjun Shi
- Department of Ophthalmology, Wuhu Eye Hospital, Anhui, China
| | - Xianghong Tu
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingfa Zhang
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, 518000 China. C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, 518000 China. C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, 999077 China
| | - Qinghua Qiu
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Price EJ, Benjamin S, Bombardieri M, Bowman S, Carty S, Ciurtin C, Crampton B, Dawson A, Fisher BA, Giles I, Glennon P, Gupta M, Hackett KL, Larkin G, Ng WF, Ramanan AV, Rassam S, Rauz S, Smith G, Sutcliffe N, Tappuni A, Walsh SB. British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease. Rheumatology (Oxford) 2024:keae152. [PMID: 38621708 DOI: 10.1093/rheumatology/keae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/02/2024] [Indexed: 04/17/2024] Open
Abstract
Sjögren disease (SD) is a chronic, autoimmune disease of unknown aetiology with significant impact on quality of life. Although dryness (sicca) of the eyes and mouth are the classically described features, dryness of other mucosal surfaces and systemic manifestations are common. The key management aim should be to empower the individual to manage their condition-conserving, replacing and stimulating secretions; and preventing damage and suppressing systemic disease activity. This guideline builds on and widens the recommendations developed for the first guideline published in 2017. We have included advice on the management of children and adolescents where appropriate to provide a comprehensive guideline for UK-based rheumatology teams.
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Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Stuart Benjamin
- The Academy Library and Information Service, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Michele Bombardieri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Barts Health NHS Trust, London, UK
- Centre for Experimental Medicine and Rheumatology, The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Simon Bowman
- Department of Rheumatology, Milton Keynes University Hospital, Milton Keynes, UK
- Department of Rheumatology, University Hospitals Birmingham NHSFT, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sara Carty
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Coziana Ciurtin
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Bridget Crampton
- Patient Representative, Sjogren's UK Helpline Lead, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Annabel Dawson
- Patient Representative, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Giles
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Peter Glennon
- General Practice, NHS Staffordshire & Stoke on Trent ICB, Stafford, UK
| | - Monica Gupta
- Department of Rheumatology, Gartnavel General Hospital, Glasgow, UK
| | - Katie L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | | | - Wan-Fai Ng
- Translational and Clinical Research Institute & Newcastle NIHR Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Department of Rheumatology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Saad Rassam
- Haematology and Haemato-Oncology, KIMS Hospital, Maidstone, Kent, UK
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Guy Smith
- Department of Ophthalmology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | | | - Anwar Tappuni
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - Stephen B Walsh
- London Tubular Centre, University College London, London, UK
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Storås AM, Fineide F, Magnø M, Thiede B, Chen X, Strümke I, Halvorsen P, Galtung H, Jensen JL, Utheim TP, Riegler MA. Using machine learning model explanations to identify proteins related to severity of meibomian gland dysfunction. Sci Rep 2023; 13:22946. [PMID: 38135766 PMCID: PMC10746717 DOI: 10.1038/s41598-023-50342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/19/2023] [Indexed: 12/24/2023] Open
Abstract
Meibomian gland dysfunction is the most common cause of dry eye disease and leads to significantly reduced quality of life and social burdens. Because meibomian gland dysfunction results in impaired function of the tear film lipid layer, studying the expression of tear proteins might increase the understanding of the etiology of the condition. Machine learning is able to detect patterns in complex data. This study applied machine learning to classify levels of meibomian gland dysfunction from tear proteins. The aim was to investigate proteomic changes between groups with different severity levels of meibomian gland dysfunction, as opposed to only separating patients with and without this condition. An established feature importance method was used to identify the most important proteins for the resulting models. Moreover, a new method that can take the uncertainty of the models into account when creating explanations was proposed. By examining the identified proteins, potential biomarkers for meibomian gland dysfunction were discovered. The overall findings are largely confirmatory, indicating that the presented machine learning approaches are promising for detecting clinically relevant proteins. While this study provides valuable insights into proteomic changes associated with varying severity levels of meibomian gland dysfunction, it should be noted that it was conducted without a healthy control group. Future research could benefit from including such a comparison to further validate and extend the findings presented here.
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Affiliation(s)
- Andrea M Storås
- Department of Holistic Systems, Simula Metropolitan Center for Digital Engineering, Oslo, Norway.
- Department of Computer Science, OsloMet - Oslo Metropolitan University, Oslo, Norway.
| | - Fredrik Fineide
- Department of Computer Science, OsloMet - Oslo Metropolitan University, Oslo, Norway
- The Norwegian Dry Eye Clinic, Oslo, Bergen, Norway
| | - Morten Magnø
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Bernd Thiede
- Department of Biosciences, University of Oslo, Oslo, Norway
| | - Xiangjun Chen
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Inga Strümke
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Halvorsen
- Department of Holistic Systems, Simula Metropolitan Center for Digital Engineering, Oslo, Norway
- Department of Computer Science, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Hilde Galtung
- Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Janicke L Jensen
- Department of Oral Surgery and Oral Medicine, University of Oslo, Oslo, Norway
| | - Tor P Utheim
- Department of Computer Science, OsloMet - Oslo Metropolitan University, Oslo, Norway
- The Norwegian Dry Eye Clinic, Oslo, Bergen, Norway
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Michael A Riegler
- Department of Holistic Systems, Simula Metropolitan Center for Digital Engineering, Oslo, Norway
- Department of Computer Science, OsloMet - Oslo Metropolitan University, Oslo, Norway
- Department of Computer Science, UiT The Arctic University of Norway, Tromsø, Norway
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Gao M, Zhao L, Liang R, Zhu Q, Zhao Q, Kong X. Evaluation of the Efficacy and Safety of Topical 0.05% Cyclosporine Eye Drops (II) in the Treatment of Dry Eye Associated with Primary Sjögren's Syndrome. Ocul Immunol Inflamm 2023; 31:1662-1668. [PMID: 35914303 DOI: 10.1080/09273948.2022.2094812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/20/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of 0.05% cyclosporine eye drops (II) for the treatment of primary Sjögren's syndrome-associated dry eye (PSSDE). METHODS Sixty patients with PSSDE were randomly divided into three groups, received treatment with 0.05% cyclosporine (C group), artificial tears (S group) or their combination (CS group). The evaluation indicators were evaluated at baseline and at weeks 2, 4 and 12. RESULTS The symptoms of C and CS groups were reduced significantly. The signs [schirmer I test (F = 4.838, p = .011), ocular staining score (F = 7.961, p = .001) and tear break-up time (F = 9.283, p < .001)] were significantly different between S and C groups as well as S and CS groups. The tear meniscus height (F = 3.197, p = .048) was significantly different between S and CS groups. No serious adverse events occurred. CONCLUSION 0.05% cyclosporine is an effective and safe treatment for patients with PSSDE.
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Affiliation(s)
- Mingjun Gao
- Department of Ophthalmology, Dalian Medical University, Dalian, China
| | - Lin Zhao
- Department of Rheumatology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Ran Liang
- Department of Ophthalmology, Dalian Medical University, Dalian, China
| | - Qing Zhu
- Department of Ophthalmology, Dalian Medical University, Dalian, China
| | - Qi Zhao
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Xiaodan Kong
- Department of Rheumatology, The Second Hospital of Dalian Medical University, Dalian, China
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5
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Greenan E, Pilson Q, Ní Gabhann-Dromgoole J, Murphy CC. Relationship between clinical parameters and quality of life in primary Sjögren's Syndrome: a prospective study. Eye (Lond) 2023; 37:2685-2692. [PMID: 36658430 PMCID: PMC10482965 DOI: 10.1038/s41433-023-02386-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To quantify the impact of dry eye disease (DED) on health and vision related quality of life (HR-QOL, VR-QOL) in patients with Primary Sjögren's Syndrome (pSS). METHODS Thirty-four participants with a confirmed diagnosis of pSS as per the 2016 ACR EULAR criteria participated. Main outcome measures included ocular surface parameters and HR-QOL and VR-QOL questionnaires. Clinical examination included visual acuity, Schirmer I testing, ocular surface staining (OSS) and measurement of tear film breakup time. The questionnaires included Ocular Surface Disease Index, National Eye Institute Visual Function Questionnaire-25, Short Form-36 (SF-36) and EULAR Sjogren's Syndrome Patient Reported Index. RESULTS Despite the majority of participants (28 female, 6 male, mean age 61.3 years) having attained LogMAR 0.3 or better visual acuity, participants scored low on VR-QOL measures, representing DED related fluctuation in functional vision. All participants suffered from moderate to severe DED. OSS did not correlate with DED symptoms or QOL parameters. Lubricant usage and symptom severity had a statistically moderate to strong negative correlation with VR-QOL and HR-QOL. This was most evident in relation to physical and physiological wellbeing. Compared with normative data, participants had a lower HR-QOL in all scales of the SF-36 ((MD = 9.91 ± 5.16); t(7) = 5.43, p = 0.001). CONCLUSIONS Participants with pSS have a lower perceived QOL especially in relation to physical and mental wellbeing, correlating to severity of DED symptoms and treatment burden. Clinical signs do not align with symptoms. Therefore, clinicians should remain cognisant, adjusting treatment in accordance with patient reported perceptions.
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Affiliation(s)
- E Greenan
- Royal Victoria Eye and Ear Hospital, Adelaide Rd, Dublin 2, D02 XK51, Ireland
- Department of Ophthalmology, RCSI, University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland
- School of Pharmacy and Biomolecular Sciences, RCSI, University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland
| | - Q Pilson
- Department of Ophthalmology, Stepping Hill Hospital, Poplar Grove, Hazel Grove, Stockport, SK2 7JE, UK
| | - J Ní Gabhann-Dromgoole
- Department of Ophthalmology, RCSI, University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland.
- School of Pharmacy and Biomolecular Sciences, RCSI, University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland.
| | - C C Murphy
- Royal Victoria Eye and Ear Hospital, Adelaide Rd, Dublin 2, D02 XK51, Ireland
- Department of Ophthalmology, RCSI, University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland
- School of Pharmacy and Biomolecular Sciences, RCSI, University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland
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Amano S, Shimazaki J, Yokoi N, Hori Y, Arita R. Meibomian Gland Dysfunction Clinical Practice Guidelines. Jpn J Ophthalmol 2023; 67:448-539. [PMID: 37351738 DOI: 10.1007/s10384-023-00995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 06/24/2023]
Affiliation(s)
- Shiro Amano
- Ochanomizu Inoue Eye Clinic, 4-3 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Omori Medical Center, Tokyo, Japan
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7
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Zhang Z, Wang Y, Zhang H, Samusak A, Rao H, Xiao C, Abula M, Cao Q, Dai Q. Artificial intelligence-assisted diagnosis of ocular surface diseases. Front Cell Dev Biol 2023; 11:1133680. [PMID: 36875760 PMCID: PMC9981656 DOI: 10.3389/fcell.2023.1133680] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/08/2023] [Indexed: 02/19/2023] Open
Abstract
With the rapid development of computer technology, the application of artificial intelligence (AI) in ophthalmology research has gained prominence in modern medicine. Artificial intelligence-related research in ophthalmology previously focused on the screening and diagnosis of fundus diseases, particularly diabetic retinopathy, age-related macular degeneration, and glaucoma. Since fundus images are relatively fixed, their standards are easy to unify. Artificial intelligence research related to ocular surface diseases has also increased. The main issue with research on ocular surface diseases is that the images involved are complex, with many modalities. Therefore, this review aims to summarize current artificial intelligence research and technologies used to diagnose ocular surface diseases such as pterygium, keratoconus, infectious keratitis, and dry eye to identify mature artificial intelligence models that are suitable for research of ocular surface diseases and potential algorithms that may be used in the future.
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Affiliation(s)
- Zuhui Zhang
- The First People's Hospital of Aksu District in Xinjiang, Aksu City, China.,National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ying Wang
- The First People's Hospital of Aksu District in Xinjiang, Aksu City, China
| | - Hongzhen Zhang
- The First People's Hospital of Aksu District in Xinjiang, Aksu City, China
| | - Arzigul Samusak
- The First People's Hospital of Aksu District in Xinjiang, Aksu City, China
| | - Huimin Rao
- The First People's Hospital of Aksu District in Xinjiang, Aksu City, China
| | - Chun Xiao
- The First People's Hospital of Aksu District in Xinjiang, Aksu City, China
| | - Muhetaer Abula
- The First People's Hospital of Aksu District in Xinjiang, Aksu City, China
| | - Qixin Cao
- Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Huzhou, China
| | - Qi Dai
- The First People's Hospital of Aksu District in Xinjiang, Aksu City, China.,National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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8
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Nguyen CB, Su CT, Morgan M, Alva AS. Case report: Immune-mediated meibomian gland dysfunction following pembrolizumab therapy for advanced urothelial carcinoma. Front Oncol 2022; 12:1000023. [PMID: 36276085 PMCID: PMC9582237 DOI: 10.3389/fonc.2022.1000023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Ocular immune-related adverse events are a relatively rare complication of immune checkpoint inhibitors. Common ocular toxicities range from dry eyes to inflammatory uveitis and ocular myasthenia gravis. Here, we present the case of a 55-year-old woman with recurrent urothelial carcinoma of the ureter after initially being managed with neoadjuvant cisplatin-based chemotherapy and surgical resection. She was treated with pembrolizumab which was complicated by immune-mediated pneumonitis after the eighth cycle, which was managed with a prolonged steroid course. The patient also developed red eyes along with recurrent styes. Eye examination revealed decreased tear breakup time, expression of thick and turbid meibum, and meibomian gland atrophy on infrared meibography. The patient was diagnosed with suspected immune-mediated meibomian gland dysfunction (MGD) as a result of pembrolizumab, a previously unreported complication of immunotherapy. The goal of MGD therapy is to stabilize the tear film and minimize evaporation with lipid-based lubricants and other conservative treatments.
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Chen D, Chen X, Xie HT, Hatton MP, Liu X, Liu Y. Expression of extracellular matrix components in the meibomian gland. Front Med (Lausanne) 2022; 9:981610. [PMID: 36148459 PMCID: PMC9486096 DOI: 10.3389/fmed.2022.981610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Extracellular matrix (ECM) is a key component of the stem cell local microenvironment. Our study aims to explore the periglandular distribution of major components of ECM in the Meibomian gland (MG). Methods Human eyelids and mouse eyelids were collected and processed for immunofluorescence staining. Results Human MG tissues stained positive for collagen IV α1, collagen IV α2, collagen IV α5, and collagen IV α6 around the acini and duct, but negative for collagen IV α3 and collagen IV α4. The mouse MG were stained positive for the same collagen IV subunits as early as postnatal day 15. Laminin α2, laminin β1 and perlecan stained the regions surrounding the acini and the acinar/ductal junction in the human MG, but not the region around the duct. Tenascin-C was found specifically located at the junctions between the acini and the central ducts. Neither agrin nor endostatin was found in the human MG tissues. Conclusion The ECM expresses specific components in different regions around the MG, which may play a role in MG stem cell regulation, renewal, and regeneration.
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Affiliation(s)
- Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaomin Chen
- Department of Ophthalmology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Mark P. Hatton
- Ophthalmic Consultants of Boston, Boston, MA, United States
| | - Xiaowei Liu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Xiaowei Liu
| | - Yang Liu
- Department of Ophthalmology, Zhongnan Hospital, Wuhan University, Wuhan, China
- Yang Liu
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Association of Serum Lipid Level with Meibum Biosynthesis and Meibomian Gland Dysfunction: A Review. J Clin Med 2022; 11:jcm11144010. [PMID: 35887773 PMCID: PMC9323051 DOI: 10.3390/jcm11144010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
The primary role of meibomian glands (MGs) is to actively synthesize and secret lipids and proteins spread onto the tear film, and the glandular lipids promote tear stability, prevent evaporation, and reduce friction. Meibomian gland dysfunction (MGD) is the leading cause of dry eye disease and one of the most common ophthalmic problems worldwide. MGs are densely innervated and regulated by hormones and growth factors. However, since the polar and nonpolar lipids are produced through processes in MGs that are not completely understood, a relevant question has been raised: Would the altered systemic lipids metabolism affect the physiology and structure of MGs? This review introduces the recent update regarding the relationships between serum lipid and MGD in clinical and basic research while providing answers to this question. A causal relationship remains to be established; however, serum lipid level or dyslipidemia may be related to MGD directly or indirectly, or both. Further studies are warranted to establish the role of serum lipid level and meibocyte differentiation/maturation and lipid synthesis.
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Jüngert K, Paulsen F, Jacobi C, Horwath-Winter J, Garreis F. Prolactin Inducible Protein, but Not Prolactin, Is Present in Human Tears, Is Involved in Tear Film Quality, and Influences Evaporative Dry Eye Disease. Front Med (Lausanne) 2022; 9:892831. [PMID: 35847789 PMCID: PMC9279896 DOI: 10.3389/fmed.2022.892831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Decreased production of the aqueous component of the tear film is an important cause of the development of dry eye disease (DED). Tear production is influenced by hormones and hormone-like factors. Prolactin (PLR), a multifunctional pituitary gland hormone, is regularly present in the lacrimal gland of rats and rabbits. In humans, serum PLR concentration correlates with tear quality. To gain deeper insights of possible effects of PRL, prolactin receptor (PRLR) and prolactin inducible protein (PIP), we analyzed the three proteins in the human lacrimal apparatus and in reflex tears of healthy volunteers as well as patients suffering from DED. Methods Gene expression of PRLR and PIP was analyzed by RT-PCR in cadaveric human lacrimal gland and ocular surface tissues, immortalized human corneal epithelial cells (HCE and hTEPI) and human Meibomian gland epithelial cells (HMGECs). At the protein level, the expression and localization of PRL, PRLR and PIP in formalin-fixed paraffin sections of the lacrimal apparatus were studied by immunohistochemistry. In addition, tear fluid from DED patients and healthy volunteers was analyzed by ELISA to determine the concentration of PRL and PIP. Results RT-PCR analyses revealed gene expression of PRLR and PIP in human tissue samples of cornea, lacrimal glands, and eyelids, whereas only PIP, but not PRLR, was detectable in immortalized corneal epithelial cells. Immunohistochemistry revealed for the first time the expression and localization of PRL, PRLR, and PIP in human tissues of the lacrimal apparatus and at the ocular surface. PRL and PRLR were detectable in corneal epithelium, lacrimal glands, and Meibomian glands. Reflex tears from DED patients revealed significantly increased PIP concentrations, whereas PRL was undetectable in tears of DED patients and healthy volunteers. Conclusion PRL, PRLR, and PIP are found in the lacrimal apparatus and on the ocular surface. PIP, but not PRL, is present in human tears and appears to be involved in the physiology of tear film quality. Our clinical data revealed that PIP may affect tear quality, but further functional analyses are needed to fully elucidate the effects of PRL and PIP-associated factors in tear secretion as well as in the connection of DED.
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Affiliation(s)
- Katharina Jüngert
- Department of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Friedrich Paulsen
- Department of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christina Jacobi
- Eyes and Skin Practice Dr. Jacobi, Nürnberg, Germany
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Fabian Garreis
- Department of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- *Correspondence: Fabian Garreis
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Correlations between clinical parameters of dry eye disease and serologic profiles in Sjögren's syndrome. Graefes Arch Clin Exp Ophthalmol 2022; 260:2925-2932. [PMID: 35460362 DOI: 10.1007/s00417-022-05671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/25/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To investigate the difference in clinical parameters of dry eye disease (DED) according to the presence of serum anti-La antibodies and evaluate the correlations of autoantibody titers with DED parameters in patients with primary Sjögren's syndrome (pSS). METHODS Sixty-two patients diagnosed with pSS according to the 2016 ACR-EULAR classification criteria were classified into two groups depending on the presence of anti-La antibodies: group 1 (anti-Ro positive alone, n = 31) and group 2 (both anti-Ro and anti-La positive, n = 31). DED parameters (conjunctival and corneal ocular staining score (OSS), tear film break-up time (TBUT), Schirmer I test, lipid layer thickness (LLT), meiboscore, and ocular surface disease index), serum autoantibodies (anti-Ro, anti-La, rheumatoid factor (RF), and antinuclear antibody) and focus score were assessed. RESULTS The DED parameters were not significantly different between the two groups (P > 0.05). The anti-Ro titers, RF-positive rate, and the focus score were significantly higher in group 2 than in group 1 (P = 0.001, P = 0.049, P = 0.001, respectively). The anti-Ro titers had a significant positive correlation with conjunctival OSS (r = 0.273, P = 0.033) and the focus score had a positive correlation with LLT and meiboscore (r = - 0.358, P = 0.072; r = 0.379, P = 0.056). CONCLUSION In this study, anti-Ro titers significantly correlated with conjunctival staining score, whereas anti-La did not statistically correlated with clinical DED parameters in SS. Meanwhile, anti-Ro titers and focus score were significantly higher in patients positive for both anti-Ro and anti-La, which suggests that examining anti-La with anti-Ro would be helpful in predicting clinical severities of SS patients.
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Caban M, Omulecki W, Latecka-Krajewska B. Dry eye in Sjögren's syndrome - characteristics and therapy. Eur J Ophthalmol 2022; 32:3174-3184. [PMID: 35354331 DOI: 10.1177/11206721221091375] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Sjögren's syndrome is an autoimmune disease, and its important feature is the lymphocyte infiltration of exocrine glands, including lacrimal glands. It contributes to defects of their activity and causes that one of the main manifestation of Sjögren's syndrome is dry eye. Unfortunately, the discrimination between dry eye related and non-related to Sjögren's syndrome is difficult at the initial stages of diseases. In addition, the available agents for the treatment of Sjögren's syndrome-related dry eye have limited efficacy. AIM The purpose of this study was to describe and emphasize differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye together with the determination of novel therapeutic options for Sjögren's Syndrome-related dry eye. METHOD A review of the relevant papers describing characteristics of Sjögren's Syndrome-related dry eye and its therapy was conducted. This article is based on both pre-clinical and clinical evidences. RESULTS On the basis of our analysis, we indicated differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye. Moreover, there are some novel markers that could be used in the diagnosis of Sjögren's Syndrome-related dry eye. In addition, expect artificial tear, other agents e.g. hydroxychloroquine can be effective in therapy of disease. CONCLUSIONS Sjögren's Syndrome-related dry eye is a disorder, whose diagnosis may be difficult and mistaken for non-Sjögren's Syndrome-related dry eye. However, Sjögren's Syndrome-related dry eye has some specific features. In addition, the development of newer and safer therapeutic agents for Sjögren's syndrome-related dry eye is needed, and therefore further clinical, randomized studies are necessary.
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Affiliation(s)
- Miłosz Caban
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
| | - Wojciech Omulecki
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
| | - Beata Latecka-Krajewska
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
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14
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Liu T, Liu S, Gan M, He Y, Fu H, Xu M. Changes of Dry Eye Parameters Especially Meibomian Gland Functions After Punctal Plugs Insertion in Aqueous-Deficient Dry Eye Patients. Front Med (Lausanne) 2022; 9:849700. [PMID: 35308530 PMCID: PMC8925321 DOI: 10.3389/fmed.2022.849700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background The study aimed at investigating the changes of dry eye parameters, especially the meibomian gland function in dry eye patients with primary Sjögren's syndrome (SS) and non-Sjögren's syndrome (non-SS) before and after punctal plugs insertion. Material and Methods The SS and non-SS dry eye patients that received punctal plugs insertion were prospectively investigated. This study recruited fifty patients. The standardized patient evaluation of eye dryness (SPEED), ocular surface disease index (OSDI), tear meniscus height (TMH), non-invasive Keratographic breakup time (NIKBUT), Schirmer test without anesthesia (Schirmer I Test, SI T), corneal fluorescein staining (CFS), the meibomian gland dropout (meiboscore), meibum expressibility score (MES), meibum quality score (MQS), lid margin abnormalities and the lipid layer thickness (LLT) were analyzed at pre-obstruction, 2 weeks, 2 months and 6 months following the obstruction. Results Our study observed a statistically significant improvement in ocular symptom scores (SPEED and OSDI scores) after punctal plugs insertion at every visit in both SS and non-SS patients (all p < 0.05). A similar pattern was observed in TMH, SI T, NIKBUT and CFS score in both groups (all p < 0.05), except that NIKBUT and CFS score had no obvious change in SS group at 6 months (P > 0.05). In terms of the meibomian gland evaluation, meiboscore did not change significantly, MES decreased at 2 and 6 months and MQS decreased only at 2 months in both groups. The lid margin abnormalities of the non-SS group were significantly improved at 2 and 6 months, while that of the SS group had changes only at 2 months. Interestingly, LLT in non-SS group continued to rise, reaching a higher level at 2 months (p < 0.05), while LLT in SS group increased only at 2 months (p < 0.05). Meanwhile, after the puntcal plugs insertion, non-SS group showed better outcomes concerning some parameters, such as lower ocular symptom scores, higher TMH and significantly greater LLT, compared with that in SS group (all p < 0.05). Conclusions Our study revealed that dry eye symptoms and signs, including meibomian gland function, improved for at least 6 months in non-SS dry eye patients as well as in SS dry eye patients after punctal plugs insertion.
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Affiliation(s)
- Tingting Liu
- Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shulin Liu
- Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Meiqi Gan
- Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuqin He
- Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongxue Fu
- Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mei Xu
- Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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15
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Li Y, Ou S, Lin S, Qian H, Zhao Z, Zhang M, Li S, Liu Y, Shi G. Meibomian gland alteration in patients with systemic lupus erythematosus. Lupus 2022; 31:407-414. [PMID: 35246003 DOI: 10.1177/09612033221079760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate meibomian gland (MG) alteration in patients with systemic lupus erythematosus (SLE). METHODS This study included 23 SLE patients evaluated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and 21 healthy controls (HCs). All the subjects were evaluated with Ocular Surface Disease Index (OSDI) questionnaire, and the eyes were performed examinations of tear meniscus height (TMH), non-invasive keratographic tear film break-up time (NIKBUT), Schirmer I Test, MG eyelid score, meibography score, and in vivo confocal microscopy (IVCM) on the meibomian gland. RESULTS There was no significant difference between the SLE patients and the HCs in the TMH, NIKBUT, and Schirmer I Test. However, the SLE patients had higher MG eyelid scores and meibography scores on both upper eyelid and lower eyelid than the HCs. Through meibography observation, 34.8% of the SLE patients presented MG deficiency in Grade 3, whereas that of all the HCs were less than Grade 3. The SLE patients were found to have significant MG atrophy and vascular enrichment around the meibomian glands (MGs). The SLE patients were also found to have excessive inflammatory cell infiltration around the MGs, especially the typical lymph node-like foci of inflammatory cell infiltration. CONCLUSIONS MG alteration can be found in the SLE patients. Examinations of the MGs can help diagnose or infer ocular diseases at an early stage of SLE.
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Affiliation(s)
- Yixuan Li
- Department of Rheumatology and Clinical Immunology, 117892The First Afiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 12466Xiamen University, Xiame, China
| | - Shangkun Ou
- Fujian Provincial Key Laboratory of Cornea & Ocular Surface Diseases, 12466Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China.,School of Medicine, 12466Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Sijie Lin
- Fujian Provincial Key Laboratory of Cornea & Ocular Surface Diseases, 12466Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China.,School of Medicine, 12466Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Hongyan Qian
- Department of Rheumatology and Clinical Immunology, 117892The First Afiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 12466Xiamen University, Xiame, China
| | - Zhongyang Zhao
- Fujian Provincial Key Laboratory of Cornea & Ocular Surface Diseases, 12466Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China.,School of Medicine, 12466Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Mengqin Zhang
- Department of Rheumatology and Clinical Immunology, 117892The First Afiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 12466Xiamen University, Xiame, China
| | - Siyang Li
- School of Medicine, 12466Xiamen University, Xiamen, Fujian, China
| | - Yuan Liu
- Department of Rheumatology and Clinical Immunology, 117892The First Afiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 12466Xiamen University, Xiame, China
| | - Guixiu Shi
- Department of Rheumatology and Clinical Immunology, 117892The First Afiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 12466Xiamen University, Xiame, China
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Efficacy of Topical Hydrocortisone in Combination with Topical Ciclosporin A for the Treatment of Dry Eye Disease in Patients with Sjögren Syndrome. J Ophthalmol 2021; 2021:7584370. [PMID: 34888098 PMCID: PMC8651369 DOI: 10.1155/2021/7584370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of this randomized, observer-masked, parallel group study was to evaluate the short-term and long-term effects of topical hydrocortisone administered in addition to topical ciclosporin A for the first 2 weeks of the treatment in patients with dry eye disease associated with Sjögren syndrome. Materials and Methods 24 eyes of 12 patients with severe dry eye disease associated with Sjögren syndrome were included in this study. Both eyes of all patients were treated with preservative-free Ciclosporin A eye drops once daily for 6 months. Additionally, one eye of each patient received hydrocortisone eye drops three times daily for the first two weeks of treatment. The study parameters were assessed before treatment, after 2 weeks, and after 6 months of treatment. Results Tear BUT and corneal fluorescein Oxford staining grade showed significant differences with respect to the baseline when treated with ciclosporin A and hydrocortisone (CsA + Hc) and a nonsignificant increase when treated with ciclosporin A (CsA) alone. After 6 months of treatment, significant increases of tear BUT and corneal Fluorescein Oxford staining grade compared to baseline could be observed in both treatment groups. Aberrometry measurements showed significantly increased optical image quality after 6 months in the CsA + Hc group, while no significant changes could be detected in the eyes treated with CsA alone. However, no significant differences between the two treatment groups could be detected. Discussion. This study indicates that hydrocortisone combined with ciclosporin A therapy may provide fast improvement of clinical symptoms and could have long-term positive effects on the optical image quality in severe DED patients with Sjögren syndrome.
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17
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Magno MS, Olafsson J, Beining M, Moschowits E, Lagali N, Wolffsohn JS, Craig JP, Dartt DA, Vehof J, Utheim TP. Chambered warm moist air eyelid warming devices - a review. Acta Ophthalmol 2021; 100:499-510. [PMID: 34750979 DOI: 10.1111/aos.15052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/11/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Eyelid warming is an important treatment for meibomian gland dysfunction (MGD). Specialized chambered devices, using warm moist air have been developed. PURPOSE To critically evaluate the literature on the safety and efficacy of chambered warm moist air devices in MGD treatment and pinpoint areas of future research. METHODS PubMed and Embase were searched on 06 June 2021. The search term was '(warm OR heat OR steam OR goggle OR spectacle OR moist air) AND (meibomian OR MGD OR blepharitis OR eyelid OR dry eye OR DED)'. All relevant articles with available English full text were included. RESULTS Eighteen articles assessing the application of chambered warm moist air eyelid warming devices were identified. In single-application studies, steam-based eyelid warming increased the eyelid temperature and improved symptoms, lipid layer thickness, and tear film breakup time (TBUT). In treatment studies, the steam-based devices improved TBUT and symptom scores. However, in the only randomized controlled trial (RCT) comparing chambered steam-based heat to hot towel treatment, there was no difference between groups for the primary outcome measure; the proportion of subjects noting symptom improvement after 4 weeks. CONCLUSION Currently available chambered warm moist air eyelid warming devices are safe and effective at raising eyelid temperature to therapeutic levels and improving signs and symptoms of dry eye. However, it is not clear if they provide a greater benefit than other eyelid warming therapies. Further well-conducted RCTs comparing moist and dry heat devices should be conducted on patients across the range of DED severities and subtype spectrum.
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Affiliation(s)
- Morten Schjerven Magno
- Department of Medical Biochemistry Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Ophthalmology University Medical Center Groningen University of Groningen Groningen The Netherlands
- Department of Plastic and Reconstructive Surgery Oslo University Hospital Oslo Norway
| | - Jonatan Olafsson
- Department of Medical Biochemistry Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Marie Beining
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Emily Moschowits
- Department of Medical Biochemistry Oslo University Hospital Oslo Norway
| | - Neil Lagali
- Department of Ophthalmology Faculty of Health Sciences Institute for Clinical and Experimental Medicine Linköping University Linköping Sweden
- Department of Ophthalmology Sørlandet Hospital Arendal Arendal Norway
| | - James S. Wolffsohn
- School of Optometry College of Health & Life Sciences Aston University Birmingham UK
| | - Jennifer P. Craig
- School of Optometry College of Health & Life Sciences Aston University Birmingham UK
- Department of Ophthalmology New Zealand National Eye Centre The University of Auckland Auckland New Zealand
| | - Darlene A. Dartt
- Department of Ophthalmology Harvard Medical School Schepens Eye Research Institute/Massachusetts Eye and EarBoston Massachusetts USA
| | - Jelle Vehof
- Department of Ophthalmology University Medical Center Groningen University of Groningen Groningen The Netherlands
- Department of Ophthalmology Vestfold Hospital Trust Tønsberg Norway
- Department of Epidemiology University Medical Center Groningen University of Groningen Groningen The Netherlands
- Dutch Dry Eye Clinic Velp The Netherlands
| | - Tor P. Utheim
- Department of Medical Biochemistry Oslo University Hospital Oslo Norway
- Department of Plastic and Reconstructive Surgery Oslo University Hospital Oslo Norway
- Department of Ophthalmology Sørlandet Hospital Arendal Arendal Norway
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Department of Ophthalmology Stavanger University Hospital Oslo Norway
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Kyei S, Asiedu K, Ephraim RKD, Animful S, Adanusa M, Ali-Baya SK, Akorsah B, Sekyere MA. Meibomian Gland Dysfunction and Lipid Profile: A Study Among Pregnant Women. Eye Contact Lens 2021; 47:598-603. [PMID: 34224447 DOI: 10.1097/icl.0000000000000815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to estimate the frequency of meibomian gland dysfunction (MGD) and its associated factors among pregnant women. METHODS This was a hospital-based cross-sectional study of consecutive pregnant women visiting the University of Cape Coast hospital's antenatal clinic. Meibomian gland assessment and tear function test were performed along with the administration of a symptom questionnaire. Correlation, analysis of variance, and logistic regression analyses were used to examine predictors of MGD. RESULTS All 201 pregnant women who met the inclusion criteria and gave informed consent were included in the study. The mean age of the entire sample was 29.96 (±4.74) years. The frequency of MGD among the cohort of pregnant women was 22.9% (95% confidence interval, 17.4%-28.9%). Univariate logistic regression revealed that the following factors were significantly associated with MGD: high-density lipoprotein (HDL) (odds ratio [OR] 1.017; 95% confidence interval [CI], 1.001-1.034; P=0.042), total cholesterol (TC) (OR 1.009; 95% CI, 1.003-1.016; P=0.006), and low-density lipoprotein (LDL) (OR 1.008; 95% CI, 1.00-1.016; P=0.049). In multivariate analysis, the model confirmed that MGD was not significantly associated with TC, LDL, and HDL. CONCLUSIONS In summary, this study showed a high frequency of MGD in pregnant women but comparable with that reported in the normal population. Clinicians examining pregnant women for dry eye disease may need to pay attention to other causative instigators aside MGD to enable the clinicians to make an appropriate etiology-based diagnosis.
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Affiliation(s)
- Samuel Kyei
- Department of Optometry and Vision Science (S.K., S.A.), College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana; School of Optometry & Vision Science (K.A.), Faculty of Medicine and Health, University of New South Wales, Australia ; Eye Clinic (K.A.), Cosmopolitan Medical Center, North-Dzorwulu, Accra Ghana; Department of Medical Laboratory Science (R.K.D.E., S.K.A.-B., B.A., M.A.S.), School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana ; and Division of Family Medicine (M.A.), Directorate of University Health Services, University of Cape Coast, Cape Coast, Ghana
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Autoimmune Epithelitis and Chronic Inflammation in Sjögren's Syndrome-Related Dry Eye Disease. Int J Mol Sci 2021; 22:ijms222111820. [PMID: 34769250 PMCID: PMC8584177 DOI: 10.3390/ijms222111820] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/18/2022] Open
Abstract
Autoimmune epithelitis and chronic inflammation are one of the characteristic features of the immune pathogenesis of Sjögren’s syndrome (SS)-related dry eye disease. Autoimmune epithelitis can cause the dysfunction of the excretion of tear fluid and mucin from the lacrimal glands and conjunctival epithelia and meibum from the meibomian glands. The lacrimal gland and conjunctival epithelia express major histocompatibility complex class II or human leukocyte antigen-DR and costimulatory molecules, acting as nonprofessional antigen-presenting cells for T cell and B cell activation in SS. Ocular surface epithelium dysfunction can lead to dry eye disease in SS. Considering the mechanisms underlying SS-related dry eye disease, this review highlights autoimmune epithelitis of the ocular surface, chronic inflammation, and several other molecules in the tear film, cornea, conjunctiva, lacrimal glands, and meibomian glands that represent potential targets in the treatment of SS-related dry eye disease.
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Comparative of meibomian gland morphology in patients with evaporative dry eye disease versus non-dry eye disease. Sci Rep 2021; 11:20729. [PMID: 34671059 PMCID: PMC8528818 DOI: 10.1038/s41598-021-00122-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
Many recent studies have showed that morphological changes are one of the key signs of meibomian gland disease (MGD). These changes can be seen even before symptom onset, potentially underestimating the prevalence of MGD; however, until now, there is no conclusive information about the impact of meibomian gland (MG) morphology in tear film physiology and disease. This study aimed to investigate the prevalence of anatomical and morphological MG alterations between patients with evaporative dry eye disease (DED) and healthy controls. Retrospective chart review of seventy-five patients with evaporative DED and healthy individuals who had dry eye assessments included Ocular Surface Disease Index questionnaire, meibum quality, meibum expressibility, lid margin abnormality, ocular staining, non-invasive tear film break-up time, and meibography. We did not find significant differences in MG alterations in the upper lid between healthy and DED subjects. Patients with evaporative DED presented MG alterations in the lower lid more frequently than healthy subjects (54.8 vs. 30.3%; p = 0.03). The presence of shortened glands was the only MG alteration that was more prevalent in the lower lid in dry-eye patients than in healthy subjects (p < 0.05). Subjects with evaporative DED presented more alterations in the lower lid than healthy subjects.
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21
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Deng Y, Wang Q, Luo Z, Li S, Wang B, Zhong J, Peng L, Xiao P, Yuan J. Quantitative analysis of morphological and functional features in Meibography for Meibomian Gland Dysfunction: Diagnosis and Grading. EClinicalMedicine 2021; 40:101132. [PMID: 34541482 PMCID: PMC8435692 DOI: 10.1016/j.eclinm.2021.101132] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To explore the performance of quantitative morphological and functional analysis in meibography images by an automatic meibomian glands (MGs) analyser in diagnosis and grading Meibomian Gland Dysfunction (MGD). METHODS A cross-sectional study collected 256 subjects with symptoms related to dry eye and 56 healthy volunteers who underwent complete ocular surface examination was conducted between January 1, 2019, and December 31, 2020. The 256 symptomatic subjects were classified into MGD group (n = 195) and symptomatic non-MGD group (n = 61). An automatic MGs analyser was used to obtained multi-parametric measurements in meibography images including the MGs area ratio (GA), MGs diameter deformation index (DI), MGs tortuosity index (TI), and MGs signal index (SI). Adjusted odds ratios (ORs) of the multi-parametric measurements of MGs for MGD, and the area under the receiver operating characteristic (AUC-ROC) curves of multi-parametric measurements for MGD diagnosing and grading were conducted. FINDINGS When consider age, sex, ocular surface condition together, the estimated ORs for DI was 1.62 (95% CI, 1.29-2.56), low-level SI was 24.34 (95% CI, 2.73-217.3), TI was 0.76(95% CI, 0.54-0.90), and GA was 0.86 (95% CI, 0.74-0.92) for MGD. The combination of DI-TI-GA-SI showed an AUC = 0.82 (P < 0.001) for discriminating MGD from symptomatic subjects. The DI had a higher AUC in identifying early-stage MGD (grade 1-2), while TI and GA had higher AUCs in moderate and advanced stages (grade 3-5). Merging DI-TI-GA showed the highest AUCs in distinguish MGD severities. INTERPRETATION The MGs area ratio, diameter deformation, tortuosity and signal intensity could be considered promising biomarkers for MGD diagnosis and objective grading. FUNDING This work was supported by the Key-Area Research and Development Program of Guangdong Province (No. 2019B010152001), the National Natural Science Foundation of China under Grant (81901788) and Guangzhou Science and Technology Program (202002030412).
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Affiliation(s)
- Yuqing Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qian Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhongzhou Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Saiqun Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bowen Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lulu Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Peng Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
- Correspondence Author: Peng Xiao, PhD Zhongshan Ophthalmic Centre, Sun Yat-Sen University, 7 Jinsui Road, Tianhe District, Guangzhou, China, 510060, Tel.: (86)18826070428, Fax: (8620) 87331550
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
- Correspondence Author: Jin Yuan, MD, PhD Zhongshan Ophthalmic Centre, Sun Yat-Sen University,7 Jinsui Road, Tianhe District, Guangzhou, China, 510060, Tel.: (86)13825141659, Fax: (8620) 87331550
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Abstract
OBJECTIVES To investigate dry eye disease (DED) in patients affected by systemic lupus erythematosus (SLE). METHODS We conducted a systematic search of the literature on PubMed, EMBASE and the Cochrane Library databases from conception to 30 April 2020 for studies related to dry eye, secondary Sjögren's syndrome (sSS) and SLE. Original full-text articles with the number of patients diagnosed with SLE of over 15 were included. The risk of bias was evaluated with a validated critical appraisal tool which assessed study quality based on confounding factors, selection bias, bias related to measurement and bias related to data analysis. Data were extracted and pooled to evaluate the overall prevalence of DED with the random-effect model and sSS with the fixed effect model. RESULTS A total of 29 studies were included and 18 273 participants were involved. The pooled data showed that the overall prevalence of DED was 16% (95% CI 10% to 21%, p<0.001) in patients of SLE. Dry eye symptoms and abnormal Schirmer's test were found in 26% (95% CI 20% to 32%, p<0.001) and 24% (95% CI 14% to 34%, p<0.001) of patients with SLE, respectively. 12% (95% CI 9% to 15%, p<0.001) of patients also met the criteria of sSS. The OR of DED in patients with SLE was 4.26 (95% CI 3.47 to 5.05, p<0.001) compared with healthy controls. The meta-regression analysis showed that the sample size (p=0.004) and study location (p=0.022) could be the source of heterogeneity. CONCLUSIONS DED and sSS are both common in patients with SLE.
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Affiliation(s)
- Lixiang Wang
- Department of Ophthalmology, Sichuan University West China Hospital, Chengdu, Sichuan Province, China
| | - Yan Xie
- Department of Rheumatology and Immunology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yingping Deng
- Department of Ophthalmology, Sichuan University West China Hospital, Chengdu, Sichuan Province, China
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Ewurum A, Veligandla SR, Swindle JS, Clark JD, Borchman D. A spectroscopic approach to measuring meibum lipid composition and conformation in donors with Sjӧgren's syndrome. Exp Eye Res 2021; 210:108713. [PMID: 34363797 PMCID: PMC8429180 DOI: 10.1016/j.exer.2021.108713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/22/2021] [Accepted: 07/29/2021] [Indexed: 01/15/2023]
Abstract
Patients with Sjӧgren's syndrome (SS) have dry eye associated with meibomian gland dysfunction (MGD). The meibum from donors with dry eye due to MGD but without SS (MMGD) presents with lower levels of cholesteryl ester, less straight chains, and more ordered hydrocarbon chains compared with meibum from donors without MGD (Mn). The aim of the current study was to compare the composition and hydrocarbon chain conformation of meibum from donors with Sjögren's syndrome (Mss) to Mn and MMGD. Meibum was expressed from patients with SS using an ILUX instrument (Alcon Inc., Fort Worth TX). All of the nine meibum donors with SS were female. Meibum composition was characterized using 1H-NMR and meibum hydrocarbon chain conformation was measured using fourier transform infrared spectroscopy. Meibum from every donor with SS measured contained a significantly (P < 0.01) higher cholesteryl ester/wax ester ratio and more straight chains compared with donors without SS or dry eye. None of the nine phase transitional parameters were significantly different, P > 0.05, for Mss compared with Mn. Nor was the CH3/CH2 band height ratio used to estimate the number of hydrocarbon CH3 and CH2 moieties different, P = 0.22, for Mss compared with Mn. In conclusion, the compositional differences between Mss compared with Mn did not result in differences in any of the nine meibum lipid phase transitional parameters measured. The compositional differences observed between Mss and Mn could be markers for or contribute to SS as the differences could lead to tear film lipid packing differences other than conformational differences.
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Affiliation(s)
- Anthony Ewurum
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA
| | - Sravya R Veligandla
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA
| | - Jordan S Swindle
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA
| | - Jeremy D Clark
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA
| | - Douglas Borchman
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA.
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24
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Figueiredo FC, Baudouin C, Rolando M, Messmer EM, van Setten G, Garrigue JS, Garrigos G, Labetoulle M. The Enduring Experience in Dry Eye Diagnosis: A Non-Interventional Study Comparing the Experiences of Patients Living With and Without Sjögren's Syndrome. Ophthalmol Ther 2021; 10:321-335. [PMID: 33792865 PMCID: PMC8079601 DOI: 10.1007/s40123-021-00341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/12/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Previous studies have examined the patient experience regarding the diagnosis and management of dry eye disease (DED). The current study explored the ways in which the DED diagnostic pathway differs for those living with and without Sjögren's syndrome (SS), to identify aspects that influence the patient experience and associated quality of life (QoL). METHODS An observational/descriptive, non-interventional, retrospective, self-reported online survey was conducted among adults living in France, Spain and Italy who were diagnosed with DED (with/without SS), were using topical DED treatments (≥ 6 months), and were not contact lens users. Recruitment was via an online database for non-SS participants and through local patient advocacy groups for SS respondents. RESULTS The analysis included 827 respondents; 416 (50.3%) had SS and 82% were female. The mean age was 55 (SD 11; range 16-99) years. The mean age at diagnosis was 46 (SD 12; range 13-78) years and 50 (SD 10; range 21-73) years for SS and non-SS groups, respectively (p < 0.0001). The mean time to diagnosis was extended for SS participants [32 (SD 62) months] versus non-SS individuals [8.6 (SD 28) months (p < 0.0001)] and was associated with reduced QoL scores (r = 0.113; p = 0.0169). More SS participants (31%) consulted ≥ 4 healthcare professionals (HCPs) before DED diagnosis, versus non-SS individuals (6%) (p < 0.0001). Diagnosing clinician varied for SS respondents according to country, probably due to differences in healthcare systems/structures. More SS participants viewed their condition as a handicap than a discomfort, reporting greater QoL impact (p < 0.0001). CONCLUSIONS Patient experiences in DED diagnosis vary substantially when comparing SS and non-SS individuals. Time to diagnosis significantly impacts QoL for SS patients, who see more HCPs ahead of DED diagnosis. The number of HCPs consulted before diagnosis and perceptions of DED are important for both groups. Country-specific variations highlight opportunities to improve consistency and efficiency across DED diagnostic pathways. These data should be considered alongside existing evidence from high-quality sources (e.g. clinical records).
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Affiliation(s)
- Francisco C Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle University, Newcastle upon Tyne, UK.
- Bioscience Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 28 rue de Charenton, 75012, Paris, France
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Gysbert van Setten
- Department of Clinical Neurosciences, St Eriks Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Marc Labetoulle
- Bicêtre Hospital, APHP, South Paris University, Le Kremlin-Bicêtre, France
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), IDMIT Infrastructure, CEA, Université Paris-Saclay, Inserm U1184, 18 route du Panorama, Fontenay-aux-Roses, 92265, Cedex, France
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Abstract
ABSTRACT Sjögren syndrome (SS) is a chronic inflammatory autoimmune disease of the lacrimal and salivary glands. Salivary gland biopsy is still one of the most valuable and acceptable diagnostic tests for SS, which however, is an invasive test. Therefore, noninvasive diagnostic biomarkers with high specificity and sensitivity are required for the diagnosis and assessment of SS. Because ophthalmological testing constitutes to an important part for the diagnosis of SS. Tears harbor biomarkers with a high potential to be used for differential diagnosis and assessment of treatment in many systemic disorders, including SS. This review aims to summarize recent advances in the identification of tear biomarkers of SS, trying to identify reliable, sensitive, and specific biomarkers that can be used to guide treatment decisions.
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Affiliation(s)
- Cem Simsek
- Department of Ophthalmology (C.S.), Mugla Sitki Kocman University School of Medicine, Mugla, Turkey ; and Department of Ophthalmology (M.D.), Keio University School of Medicine, Tokyo, Japan
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Abstract
PURPOSE To evaluate the effect of obstructive sleep apnea-hypopnea syndrome (OSAHS) on the meibomian glands, ocular surface, and tear parameters. METHODS The study included 59 individuals (32 subjects with OSAHS, 27 control subjects) who underwent polysomnography in the Chest Diseases Clinic. The right eyes of all individuals were evaluated in the Ophthalmology Clinic. The first noninvasive tear break-up time (f-NTBUT) and the average noninvasive tear break-up time were measured, and Schirmer test was applied. Meibography was taken (Sirius; CSO, Florence, Italy), and meiboscore was used for indexing meibography. Finally, a sample was taken for conjunctival impression cytology. RESULTS In the study and control groups, the median of f-NTBUT was 2.1 seconds [interquartile range (IQR); 1.5-5.0] and 5.7 seconds (IQR; 2.9-8.8) and the median of average noninvasive tear break-up time was 5.6 seconds (IQR; 3.6-9.5) and 7.2 seconds (IQR; 4.2-10.7), respectively (P = 0.007 and P = 0.487, respectively). The mean Schirmer value was 16.3 ± 5.9 mm (range; 5-25) and 17.3 ± 6.6 mm (range; 5-30) in the study and control groups (P = 0.604). In upper eyelid meibography, the median of loss in the meibomian glands was 20.10% (IQR; 11.60%-40.80%) in the study group and 14.70% (IQR; 10.40%-21.30%) in the control group (P = 0.043). In lower eyelid meibography, the median of loss in the meibomian glands was 19.00% (IQR; 13.60%-35.30%) in the study group and 12.40% (IQR; 9.10%-16.40%) in the control group (P = 0.002). The median of the Nelson grade in conjunctival impression cytology was 1 (IQR; 0-1) in the study group and 1 (IQR; 0-1) in the control group (P = 0.445). CONCLUSIONS The loss in the meibomian glands together with the shortened f-NTBUT shows that there could be a predisposition in OSAHS for evaporative dry eye originating from meibomian gland damage.
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27
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Singh S, Sharma S, Basu S. Rabbit models of dry eye disease: Current understanding and unmet needs for translational research. Exp Eye Res 2021; 206:108538. [PMID: 33771517 DOI: 10.1016/j.exer.2021.108538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/17/2022]
Abstract
Dry eye disease (DED) is emerging as an eye health pandemic, affecting millions worldwide. The development of novel drugs, drug delivery systems, and targeted therapies for addressing the inflammation in DED necessitates progress in experimental models of DED. Animal models of DED have been created for simulating the two clinically described forms of DED: lacrimal insufficiency and the evaporative DED models. Although most DED models have relied upon rodents, the larger eye size and longer life span of rabbits and the closer resemblance to human lacrimal glands, render rabbits a promising near-ideal model for studying DED. Since the first rabbit DED model was described, numerous modifications including the use of topical epitheliotoxic drugs, neural abolition, activated lymphocytes injection, and surgical dacryoadenectomy have been introduced. The stability of these models, whether short-term or long-term, accordingly guides their experimental or therapeutic utility. A rabbit autoimmune dacryoadenitis model has successfully simulated DED signs and features of lacrimal gland inflammation, as observed in Sjogren's syndrome, that improved with mesenchymal stem cell therapy. This review summarizes the comparative microscopic anatomy of rabbit and human lacrimal glands, various existing rabbit DED models and their respective suitability for understanding pathogenetic mechanism of DED or for experimental drug testing. Also, the insights gained from animal models in dry eye management is described along with the future perspectives. There is still a pressing need of developing rabbit models for studying the pathogenesis of complex ocular surface changes in evaporative and aqueous deficiency DED other than autoimmune dacryoadenitis.
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Affiliation(s)
- Swati Singh
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India; Brien Holden Center for Eye Research (BHERC), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India; Brien Holden Center for Eye Research (BHERC), L V Prasad Eye Institute, Hyderabad, Telangana, India; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India.
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28
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Roszkowska AM, Oliverio GW, Aragona E, Inferrera L, Severo AA, Alessandrello F, Spinella R, Postorino EI, Aragona P. Ophthalmologic Manifestations of Primary Sjögren's Syndrome. Genes (Basel) 2021; 12:genes12030365. [PMID: 33806489 PMCID: PMC7998625 DOI: 10.3390/genes12030365] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
Sjögren’s syndrome (SS) is a chronic, progressive, inflammatory, autoimmune disease, characterized by the lymphocyte infiltration of exocrine glands, especially the lacrimal and salivary, with their consequent destruction. The onset of primary SS (pSS) may remain misunderstood for several years. It usually presents with different types of severity, e.g., dry eye and dry mouth symptoms, due to early involvement of the lacrimal and salivary glands, which may be associated with parotid enlargement and dry eye; keratoconjunctivitis sicca (KCS) is its most common ocular manifestation. It is still doubtful if the extent ocular surface manifestations are secondary to lacrimal or meibomian gland involvement or to the targeting of corneal and conjunctival autoantigens. SS is the most representative cause of aqueous deficient dry eye, and the primary role of the inflammatory process was evidenced. Recent scientific progress in understanding the numerous factors involved in the pathogenesis of pSS was registered, but the exact mechanisms involved still need to be clarified. The unquestionable role of both the innate and adaptive immune system, participating actively in the induction and evolution of the disease, was recognized. The ocular surface inflammation is a central mechanism in pSS leading to the decrease of lacrimal secretion and keratoconjunctival alterations. However, there are controversies about whether the ocular surface involvement is a direct autoimmune target or secondary to the inflammatory process in the lacrimal gland. In this review, we aimed to present actual knowledge relative to the pathogenesis of the pSS, considering the role of innate immunity, adaptive immunity, and genetics.
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Affiliation(s)
- Anna Maria Roszkowska
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
- Correspondence:
| | - Giovanni William Oliverio
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Emanuela Aragona
- IRCCS San Raffaele Scientific Institute, Ophthalmology Clinic, Vita Salute San Raffaele University, 20132 Milan, Italy;
| | - Leandro Inferrera
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Alice Antonella Severo
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Federica Alessandrello
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Rosaria Spinella
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Elisa Imelde Postorino
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Pasquale Aragona
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
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29
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Sutcliffe N, Recchioni A, Hilmi S, Rauz S, Tappuni AR. What's new in ocular and oral aspects of Sjögren's syndrome and do new treatments work? Rheumatology (Oxford) 2021; 60:1034-1041. [PMID: 33369647 DOI: 10.1093/rheumatology/keaa854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/01/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023] Open
Abstract
Primary SS (pSS) is a systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands leading to glandular dysfunction, resulting in dryness of the eyes, mouth and other mucosal surfaces. Systemic manifestations also occur in the majority of patients. There has been increasing interest in recent years, with a number of publications regarding the classification criteria, diagnostic tools, disease activity, damage, impact and potential treatments. This article reviews recent advances in the diagnosis and treatment of ocular and oral involvement in pSS. Recent stand-out developments include measurement of tear osmolarity as a marker in dry eye disease diagnosis, new devices measuring tear constituents and meibomian gland structure and treatment of its dysfunction. Lip biopsy is still valuable despite emerging evidence of non-invasive diagnostic techniques, notably salivary gland ultrasound.
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Affiliation(s)
| | - Alberto Recchioni
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, UK.,Birmingham & Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Shireen Hilmi
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - Saaeha Rauz
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, UK.,Birmingham & Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Anwar R Tappuni
- Institute of Dentistry, Queen Mary University of London, London, UK
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30
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Ashena Z, Dashputra R, Nanavaty MA. Autoimmune Dry Eye without Significant Ocular Surface Co-Morbidities and Mental Health. Vision (Basel) 2020; 4:vision4040043. [PMID: 33050472 PMCID: PMC7711510 DOI: 10.3390/vision4040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
Dry eye symptoms can negatively affect the psychological, physical, and social functioning, which can potentially impair the health-related quality of life. This review evaluated the association between autoimmune related dry eye in the absence of significant ocular surface co-morbidities and mental health. This review found a significantly higher prevalence of mental health disorders (such as depression and anxiety) in systemic lupus erythematous, rheumatoid arthritis, systemic sclerosis, Behcet’s disease, and primary Sjogren’s syndrome patients when compared to the general population. Moreover, patients with depression and anxiety interpret ocular sensations differently than healthy controls and the perception of dry eye symptoms can be influenced by their mood. Somatization is common in depression, and this could influence the perception of ocular discomfort. Anti-depressants and anxiolytics with their potential side effects on the tear film status may also contribute or aggravate the dry eye symptoms in these patients. Although ophthalmologists manage the dry eye disease, as per standardized algorithms, they should be mindful of different ocular sensation interpretation and coexistent mental health issues in a large number of this patient group and initiate a multidisciplinary management plan in certain cases. While rheumatologists look after their autoimmune condition, it may be worth liaising with GP and/or psychiatrist colleagues in order to address their neuropathic type pain and mental health co-morbidities.
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Affiliation(s)
- Zahra Ashena
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK; (Z.A.); (R.D.)
| | - Radhika Dashputra
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK; (Z.A.); (R.D.)
| | - Mayank A. Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK; (Z.A.); (R.D.)
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
- Correspondence: ; Tel.: +44-127-360-6126
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31
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Karakus S, Dai X, Zhu X, Gottsch JD. The role of lid margin structures in the meibomian gland function and ocular surface health. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1826309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sezen Karakus
- Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Xi Dai
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Xi Zhu
- Department of Biology and Public Health Studies, Johns Hopkins University, Baltimore, MD, USA
| | - John D Gottsch
- Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
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Hiraishi M, Masum MA, Namba T, Otani Y, Elewa YH, Ichii O, Kon Y. Histopathological changes in tear-secreting tissues and cornea in a mouse model of autoimmune disease. Exp Biol Med (Maywood) 2020; 245:999-1008. [PMID: 32438834 DOI: 10.1177/1535370220928275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPACT STATEMENT Cornea, an outermost layer of mammalian eye, is protected by tear film and abnormalities of tear film causes dry eye. Dry eye injures the cornea which results lower vision in patients. Several factors cause dry eye, including altered systemic conditions, environment, and immunological abnormality of the patient in autoimmune disease like Sjögren's syndrome (SS). However, the detailed pathology of autoimmune abnormality-mediated dry eye is unclear. Here we demonstrated that systemic autoimmune abnormality in BXSB-Yaa mice was associated with histological changes in the exocrine glands and cornea of the eyes. We also showed that BXSB-Yaa mice developed mild or early stage dry eye-like disease and explain the existence of a compensatory mechanism associated with the dysfunction of these tissues. Thus, BXSB-Yaa could be a model for SS-like disease-associated dry eye and these data would contribute to the understanding of the pathogenesis of autoimmune-related dry eye disease.
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Affiliation(s)
- Masaya Hiraishi
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0618, Japan
| | - Md Abdul Masum
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0618, Japan.,Department of Anatomy, Histology and Physiology, Faculty of Animal Science and Veterinary Medicine, Sher-e-Bangla Agricultural University, Dhaka 1207, Bangladesh
| | - Takashi Namba
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0618, Japan
| | - Yuki Otani
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0618, Japan
| | - Yaser Ha Elewa
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0618, Japan.,Department of Histology, Faculty of Veterinary Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Osamu Ichii
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0618, Japan.,Laboratory of Agrobiomedical Science, Faculty of Agriculture, Hokkaido University, Sapporo 060-8589, Japan
| | - Yasuhiro Kon
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0618, Japan
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Degirmenci C, Palamar M, Güven Yılmaz S, Ates H. Evaluation of ocular surface and meibomian glands in patients with uveitis related to oligoarticular juvenile idiopathic arthritis. Int Ophthalmol 2020; 40:1863-1867. [PMID: 32270334 DOI: 10.1007/s10792-020-01357-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/24/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate ocular surface changes and meibomian gland scores in patients with oligoarticular juvenile idiopathic arthritis. MATERIALS AND METHODS This prospective study was conducted at Ege University School of Medicine, Department of Ophthalmology. A total of 34 eyes of 17 patients with oligoarticular juvenile idiopathic arthritis and 30 right eyes of 30 age and gender-matched healthy subjects were included. Besides ophthalmic examination Schirmer 1 test, tear film break up time, Oxford staining scale and meibography were performed. RESULTS There was no statistically significant differences between groups in terms of age, mean intraocular pressure, mean Schirmer 1 test value, tear film break up time and Oxford staining score. The median upper and lower eyelid meiboscore were 1 ± 0.60 (IQR = 1), and 0 ± 0.34 (IQR = 0) in Group 1, and they were 1 ± 0.56 (IQR = 0), 1 ± 0.12 (IQR = 1) in Group 2. Also, mean upper and lower meiboscores were statistically similar (p values 0.068 and 0.545, respectively). However, the median total meiboscore was 1 ± 0.42 (IQR = 1) in Group 1 and 1 ± 0.66 (IQR = 1) in Group 2. The difference was statistically significant (p = 0.041). CONCLUSION Aqueous-deficient dry eye is a well-known condition in patients with rheumatologic diseases. However, evaporative dry eye and meibomian glands were not studied earlier. The current study demonstrated that total meiboscores of oligoarticular juvenile idiopathic arthritis patients are higher than normal subjects, which indicates a possible evaporative dry eye tendency in this entity.
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Affiliation(s)
- Cumali Degirmenci
- Department of Ophthalmology, School of Medicine, Ege University, Bornova, Turkey.
| | - Melis Palamar
- Department of Ophthalmology, School of Medicine, Ege University, Bornova, Turkey
| | - Suzan Güven Yılmaz
- Department of Ophthalmology, School of Medicine, Ege University, Bornova, Turkey
| | - Halil Ates
- Department of Ophthalmology, School of Medicine, Ege University, Bornova, Turkey
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Analysis of ocular surface damage and visual impact in patients with primary and secondary Sjögren syndrome. Rheumatol Int 2020; 40:1249-1257. [PMID: 32242261 DOI: 10.1007/s00296-020-04568-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
The objective of this study is to review the ocular surface changes and complications of patients with Sjögren syndrome and assess their visual impact. A retrospective, cross-sectional, observational, and descriptive study of patients with Sjögren syndrome diagnosed according to the American-European Consensus Group criteria was designed. Data including age, gender, the reason for consultation, associated systemic disease, visual acuity, and ocular complications were recorded. Dry eye tests including tear meniscus thickness; tear film break-up time; ocular surface staining (fluorescein and lissamine green); and Schirmer I test were performed. A total of 249 patients, 233 women (93.6%) and 16 men (6.4%) were studied. Meibomian gland dysfunction was found in 46% (n = 229 eyes) patients; shortened tear film break-up time in 44% (n = 220 eyes); decreased tear meniscus in 49% (n = 243 eyes); significant superficial punctate keratopathy in 49% (n = 242 eyes); a mean ocular surface staining score of 5.92 points; and a low score for Schirmer I test (mean = 5.4 mm). Eyes with a 4 + corneal fluorescein score showed the worst BCVA (mean = 0.63 ± 0.66 LogMAR, ≤ 20/80 Snellen eq., 95% CI 0.29-0.97), compared to 1 + to 3 + scores (mean = 0.211 ± 0.37 LogMAR, 20/32 Snellen eq., 95% CI 0.53-1.15). Ten eyes (4.0%) presented central corneal ulceration with a mean visual acuity of 20/500 (96% visual loss). Ocular surface alterations related to severe dry eye and complications from Sjögren syndrome may have a significant impact on visual acuity. Secondary Sjögren syndrome to rheumatoid arthritis had the worse dry eye prognosis, visual outcome, and ocular complications.
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Toward better outcomes in Sjögren's syndrome: The promise of a stratified medicine approach. Best Pract Res Clin Rheumatol 2020; 34:101475. [PMID: 32005417 DOI: 10.1016/j.berh.2019.101475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sjögren's syndrome is a systemic autoimmune disease defined by its targeted inflammation of the salivary and lacrimal glands, resulting in dry mouth and eyes in the majority and persistent or recurrent salivary gland enlargement in a minority of those affected. Involvement of major organs, an increased risk of lymphoma, and autoantibodies against ubiquitous cellular ribonucleoproteins define some of its systemic features. Those affected have a high symptom burden and the development of disease-modifying therapies is thus an urgent need. A stratified medicine approach offers promise as a means of targeting specific therapies to patients for whom the mechanism of action is most relevant. Implementation of this approach will require an understanding of the pathophysiological processes underlying different patient subsets, and then identifying or developing a drug that targets this pathway. Such therapies would be most effective if implemented early in the disease course before the advent of adverse outcomes or glandular damage. This review will provide a disease overview followed by an analysis of the feasibility of a stratified medicine approach, focusing on the disease heterogeneity, predictors of disease progression and adverse outcomes, and recent advances in the development of relevant outcome measures and new therapies.
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Robin M, Liang H, Rabut G, Augstburger E, Baudouin C, Labbé A. The Role of Meibography in the Diagnosis of Meibomian Gland Dysfunction in Ocular Surface Diseases. Transl Vis Sci Technol 2019; 8:6. [PMID: 31737430 PMCID: PMC6855297 DOI: 10.1167/tvst.8.6.6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/28/2019] [Indexed: 02/04/2023] Open
Abstract
Purpose To evaluate dysfunction in various ocular surface diseases (OSDs) including primary meibomian gland disease (MGD), perennial allergic conjunctivitis, and primary and secondary Sjögren syndromes. Methods A retrospective analysis of 146 patients (111 women and 35 men) with symptomatic OSDs was performed. Patients were divided into two groups: the non-MGD group (55 patients) and the MGD group (91 patients). All patients had an evaluation of ocular surface symptoms and clinical tests, including tear film breakup time (BUT), the first and the mean noninvasive breakup time (NIKBUTf and NIKBUTavg, respectively). The meibomian gland loss of the lower eyelid was quantified using meibography and the meiboscale. Results There was no significant difference regarding age or sex ratio between the two groups. The meiboscale in the MGD group was significantly higher than that in the non-MGD group (P = 0.003). The non-MGD patients were more symptomatic than those in the MGD group (P = 0.043). There were no significant differences between MGD and non-MGD groups regarding a Schirmer test (P = 0.195), BUT (P = 0.719), NIKBUTf (P = 0.96), or NIKBUTavg (P = 0.70). In the whole population, there was a negative correlation between meiboscale and NIKBUT (r = -0.21, P = 0.02), but no other correlations were found. Conclusions Meibomian gland dysfunction was observed among different OSDs. Meibomian gland loss evaluated by meibography might help identify MGD in patients suffering from OSD. Translation Relevance Meibography provides a better understanding of MGD in several OSD. It may be useful to integrate this objective analysis to improve treatments of OSD associated to MGD.
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Affiliation(s)
- Mathieu Robin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, Paris, France
| | - Hong Liang
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, Paris, France.,Sorbonne Universités, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Ghislaine Rabut
- CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, Paris, France
| | - Edouard Augstburger
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, Paris, France
| | - Christophe Baudouin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, Paris, France.,Sorbonne Universités, INSERM, CNRS, Institut de la Vision, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Antoine Labbé
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, Paris, France.,Sorbonne Universités, INSERM, CNRS, Institut de la Vision, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
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Bjordal O, Norheim KB, Rødahl E, Jonsson R, Omdal R. Primary Sjögren's syndrome and the eye. Surv Ophthalmol 2019; 65:119-132. [PMID: 31634487 DOI: 10.1016/j.survophthal.2019.10.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023]
Abstract
Primary Sjögren syndrome is an autoimmune disease that mainly affects exocrine glands such as the salivary and lacrimal glands. In addition, systemic involvement is common. Primary Sjögren syndrome is of particular interest to ophthalmologists as it constitutes an important differential diagnosis in conditions with dry eye disease. In addition, ocular tests for more precisely diagnosing and monitoring primary Sjögren syndrome have become increasingly important, and new therapeutics for local and systemic treatment evolve as a result of increased understanding of immunological mechanisms and molecular pathways in the pathogenesis of primary Sjögren syndrome. We provide an update of interest to ophthalmologists regarding pathogenesis, diagnosis, investigative procedures, and treatment options.
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Affiliation(s)
| | - Katrine Brække Norheim
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Eyvind Rødahl
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Roald Omdal
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.
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Choi W, Ha JY, Li Y, Choi JH, Ji YS, Yoon KC. Comparison of the meibomian gland dysfunction in patients with chronic ocular graft-versus-host disease and Sjögren's syndrome. Int J Ophthalmol 2019; 12:393-400. [PMID: 30918806 DOI: 10.18240/ijo.2019.03.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/12/2019] [Indexed: 01/16/2023] Open
Abstract
AIM To investigate the abnormalities in the meibomian gland in patients with dry eye disease (DED) associated with chronic ocular graft-versus-host disease (coGVHD) in comparison with Sjögren's syndrome (SS), a major form of aqueous deficient DED and meibomian gland dysfunction (MGD), a common cause of evaporative DED. METHODS A total 135 eyes of 135 subjects included in this study: patients with DED associated with coGVHD (n=30), patients with SS (n=35), patients with MGD (n=35), and normal controls (n=35). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire, ocular surface examination [Schirmer test, tear film breakup time (TFBUT), and ocular surface staining], and meibomian gland assessment [meiboscore (gland dropout detected on meibography using infrared camera of the Keratograph 5M), meibum expressibility score (MES), meibum quality score (MQS), lid margin abnormality]. In addition, correlations of meibomian gland characteristics with ocular surface parameters as well as disease severity score were investigated in coGVHD group. RESULTS The coGVHD group showed significantly higher meiboscore, MES, and MQS than the other 3 groups (all P<0.05). In the coGVHD group, parameters of meibomian gland showed a significant correlation each other and those of ocular surface. The correlation between meibomian gland parameters and severity score of coGVHD was also established (meiboscore, r=0.62; MES, r=0.47; MQS, r=0.47; lid margin abnormality score, r=0.55; all P<0.05). CONCLUSION Patients with DED associated with coGVHD show poorer gland morphology and worse gland function than other types of DED. In addition, meibomian gland damage is not only associated with ocular surface damage but also disease severity of coGVHD.
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Affiliation(s)
- Won Choi
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju 501-757, South Korea
| | - Jun Young Ha
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju 501-757, South Korea
| | - Ying Li
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju 501-757, South Korea
| | - Jung Han Choi
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju 501-757, South Korea
| | - Yong Sok Ji
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju 501-757, South Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju 501-757, South Korea
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Yoon HJ, Choi W, Yang JM, Ji YS, Lee SS, Yoon KC. Characteristics of dry eye in patients with pre-existing Sjögren's syndrome according to the revised 2016 ACR-EULAR classification criteria. Medicine (Baltimore) 2019; 98:e14641. [PMID: 30817584 PMCID: PMC6831189 DOI: 10.1097/md.0000000000014641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To compare the characteristics of dry eye (DE) patients who did and did not satisfy the 2016 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria for primary Sjögren's syndrome (SS) among patients with pre-existing SS diagnosed according to the 2012 ACR criteriaThis cross-sectional study evaluated 91 patients with pre-existing SS and 55 with non-SS DE. Patients with SS were divided into 2 groups according to whether they met the revised 2016 ACR-EULAR classification criteria for primary SS. Group 1 (n = 71) was comprised of patients who satisfied the revised 2016 criteria and group 2 (n = 20) was comprised of patients who did not satisfy the newly revised criteria. Group 3 consisted of 55 patients with non-SS DE. The ocular surface disease index (OSDI) score, tear break-up time (TBUT), Schirmer score, tear clearance rate (TCR), and corneal and conjunctival staining scores were evaluated and compared between the groups. Laboratory profiles, including antinuclear antibodies, rheumatoid factor levels, erythrocyte sedimentation rate, and C-reactive protein levels, and focus scores were analyzed.TBUT, Schirmer, and corneal/conjunctival staining scores were significantly worse in both groups of patients with SS (groups 1 and 2) than in those with non-SS DE (group 3). However, there were no significant differences between groups 1 and 2 in laboratory findings as well as in ocular surface findings, including OSDI, TBUT, Schirmer score, TCR, and corneal/conjunctival staining scores. The focus score, which shows the level of lymphocytic infiltration in the salivary glands, was higher in group 1 than in group.Of the patients with pre-existing SS who were diagnosed according to the 2012 ACR classification, patients who did not satisfy the 2016 ACR-EULAR classification criteria for primary SS showed similar ocular surface parameters and laboratory findings to patients who did meet the revised classification, except for focus score. There is no need to change the direction of treatment of DE in patients with pre-existing SS who did not meet the revised 2016 ACR-EULAR criteria.
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Affiliation(s)
- Hyeon Jeong Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju
| | - Won Choi
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju
| | - Jee Myung Yang
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon
| | - Yong Sok Ji
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju
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Evaluation of Dry Eye Disease in Children With Systemic Lupus Erythematosus and Healthy Controls. Cornea 2019; 38:581-586. [DOI: 10.1097/ico.0000000000001902] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Mandal A, Gote V, Pal D, Ogundele A, Mitra AK. Ocular Pharmacokinetics of a Topical Ophthalmic Nanomicellar Solution of Cyclosporine (Cequa®) for Dry Eye Disease. Pharm Res 2019; 36:36. [DOI: 10.1007/s11095-018-2556-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/05/2018] [Indexed: 01/22/2023]
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