Henrich Claudia F, Ramulu Pradeep Y, Akpek Esen K
Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
Cornea. 2014 Aug;33(8):819-25. doi: 10.1097/ICO.0000000000000173.
The aim of this study was to review the frequency and types of inflammatory systemic diseases in a cohort of patients with dry eye, and identify clinical features suggesting the presence of these.
Consecutive new patients with a primary diagnosis of dry eye evaluated at a tertiary dry eye center between January 2010 and December 2011 were reviewed retrospectively. Standardized questionnaires were used to obtain data regarding systemic symptoms, previous medical diagnoses, and family history. Dry eye evaluations included Schirmer testing, tear film break-up time, corneal fluorescein staining, and bulbar conjunctival lissamine green staining. Clinically significant dry eye was defined as having a Schirmer test score without anesthesia of ≤10 mm or conjunctival lissamine green staining of ≥1 using the Oxford scale.
A total of 228 new patients were analyzed. Of these, 47.4% (108/228) presented with a known diagnosis of inflammatory disease. Based on a review of systems and ocular examination, 81 patients (81/228) underwent a further work-up that revealed 25 additional diagnoses that were not known on presentation. The most common newly identified conditions included occult thyroid eye disease (n = 20), primary Sjögren Syndrome (4), and Sjögren Syndrome suspect (1). Female gender, family history of autoimmune disease, self-reported joint pain or dry mouth, external signs of orbital inflammation, and conjunctival chemosis were more common in patients with inflammatory systemic disease as compared with that in patients with no identifiable condition (P < 0.05 for all).
Systemic inflammatory diseases are frequently associated with dry eye in patients evaluated at a tertiary academic center. Diagnostic evaluations may help uncover previously undiagnosed significant conditions in about one-third of tested patients.
本研究旨在回顾一组干眼患者中炎症性全身性疾病的发生率和类型，并确定提示这些疾病存在的临床特征。
回顾性分析2010年1月至2011年12月在三级干眼中心接受评估的初诊为干眼的连续新患者。使用标准化问卷获取有关全身症状、既往医学诊断和家族史的数据。干眼评估包括泪液分泌试验、泪膜破裂时间、角膜荧光素染色和球结膜丽丝胺绿染色。临床上显著的干眼定义为使用牛津量表时，无麻醉情况下泪液分泌试验评分≤10 mm或结膜丽丝胺绿染色≥1。
共分析了228例新患者。其中，47.4%（108/228）患有已知的炎症性疾病诊断。基于系统回顾和眼部检查，81例患者（81/228）接受了进一步检查，发现了另外25例就诊时未知的诊断。最常见的新发现疾病包括隐匿性甲状腺眼病（n = 20）、原发性干燥综合征（4例）和疑似干燥综合征（1例）。与无明确疾病的患者相比，炎症性全身性疾病患者中女性、自身免疫性疾病家族史、自我报告的关节疼痛或口干、眼眶炎症的外部体征和结膜水肿更为常见（所有P < 0.05）。
在三级学术中心评估的患者中，全身性炎症性疾病常与干眼相关联。诊断评估可能有助于在约三分之一的受检患者中发现先前未诊断出的重要疾病。
