Evaluation of patients with dry eye for presence of underlying sjögren syndrome

Esen Karamursel Akpek, Alena Klimava, Jennifer E. Thorne, Don Martin, Kaevalin Lekhanont, Ann Ostrovsky

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


PURPOSE: To evaluate the rate of Sjögren syndrome (SS) in a cohort of patients with dry eye syndrome. METHODS: Medical records of patients with a primary diagnosis of dry eye syndrome (International Classification of Diseases [ICD] code 375.15 or 370.33) were reviewed retrospectively. Patients who had 2 or more visits to a single dry eye center during a 2-year period (January 2004 to January 2006) were considered. RESULTS: Two hundred twenty patients with dry eye syndrome were identified. A total of 57 patients (25.9%) had an underlying rheumatic condition: 25 patients (11.4%) had rheumatoid arthritis and 24 (10.9%) had primary Sjögren syndrome (PSS). Majority of the patients with rheumatoid arthritis (96%) carried the diagnosis at the time of presentation. Of all patients with PSS, only 33.3% (8/24) carried the diagnosis at the time of presentation. Fifty percent (12/24) were diagnosed as a result of the initial evaluation. Among those, only 66.6% (8/12) tested SSA (anti-Ro antibodies) or SSB (anti-La antibodies) positive. One third of patients (4/12) tested only antinuclear antibody positive at a titer of <1/320 and required minor salivary gland biopsy for definitive diagnosis. Additional 16.7% (4/24), who were initially serologically negative, eventually underwent minor salivary gland biopsy and became diagnosed with SS. CONCLUSIONS: PSS seems to be underdiagnosed in patients with dry eye syndrome and should be the focus of diagnostic evaluations. A minor salivary gland biopsy might be required for a definitive diagnosis in a significant proportion of the patients with SS.

Original languageEnglish (US)
Pages (from-to)493-497
Number of pages5
Issue number5
StatePublished - Jun 2009


  • Dry eye
  • Laboratory work-up
  • Sjogren syndrome

ASJC Scopus subject areas

  • Ophthalmology


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