Keratoconjunctivitis sicca in rheumatoid arthritis.

The prevalence of keratoconjunctivitis sicca (KCS) was studied in a randomly selected group of 104 patients with rheumatoid arthritis (RA). Symptoms of KCS were noted in 33 patients (31.7%) and they were studied further. After rose bengal staining, 22 of these patients were found to have KCS which was diagnosed by the presence of corneal or conjunctival desiccation. The overall prevalence of KCS was 21.2%. Although an abnormal Schirmer's test was noted in 21 of the 22 patients with KCS, only 8 patients had values of 5 mm or less while the remainder had a mild abnormality ranging from 6 to 15 mm. A reduced marginal tear film was noted in 15 patients (68.2%) with KCS and 13 patients (59%) had a reduced tear break-up time. The Schirmer's test alone is inadequate to make a definite diagnosis of KCS and it is essential to perform slit lamp examination to detect epithelial staining with rose bengal.