The gut-eye-lacrimal gland-microbiome axis in Sjögren Syndrome

The bacterial communities that collectively inhabit our body are called the microbiome. Virtually all body surface harbors bacteria. Recent advances in next-generation sequencing that have provided insight into the diversity, composition of bacterial communities, and their interaction are discussed in this review, as well as the current knowledge of how the microbiome promotes ocular health. The ocular surface is a site of low bacterial load. Sjögren Syndrome is an autoimmune disease that affects the exocrine glands, causing dry mouth and dry eye. Systemic antibiotic treatment and germ-free mice have demonstrated that commensal bacteria have a protective role for the ocular surface and lacrimal gland. The existence of a gut-eye-lacrimal gland axis-microbiome is discussed.     

Comparison of Meibomian Gland Imaging Findings and Lipid Layer Thickness between Primary Sjögren Syndrome and Non-Sjögren Syndrome Dry Eyes

ABSTRACT

Purpose: To compare meibomian gland (MG) imaging findings and lipid layer thickness (LLT) between patients with primary Sjögren syndrome (SS) dry eyes (DE) and non-SS DE.

Methods: A total of 60 patients—30 with SS DE and 30 with non-SS DE were evaluated. Infrared image findings of MGs and LLT were assessed using the LipiView II interferometer.

Results: The maximum LLT was significantly lower in the SS DE group. SS DE exhibited significantly higher MG dropout compared to the non-SS DE. Average and maximal LLT showed significant negative correlations with MG dropout in both groups (p<0.05). Conjunctival staining scores showed significant correlations with average and maximum LLT and MG dropout values in the SS DE group (p<0.05).

Conclusion: These findings suggest that the new interferometer will be useful in understanding the pathophysiology of SS DE.     

Condition Judgement of Dry Eye in Sicca Syndrome

In this paper, we presented 32 dry eyes of 16 random patients with primary Sicca Syndrome graded with rose bengal(rb), Break up time of tear film (BUT) and Schirmer 1 test (S1T). Of them, the lip biopsy and tear β2-M level were examined and overall studied. The results showed that the grade of dry eye was closely related with both the degree of lymphocyte infiltration of lip glands and level of tear β2-M, and indicated that our grading methed for dry eye based on rb, BUT and SIT is dependable, and the l...     

The effect of artificial tears on corneal surface regularity in patients with Sjögren syndrome

PURPOSE: To evaluate the effect of artificial tears on the topographic parameters associated with corneal surface regularity in patients with Sj?gren syndrome. METHODS: A total of 38 eyes of 20 patients with Sj?gren syndrome were evaluated prospectively. The mean age of the patients was 50.5 +/- 15.3 years (range, 28-76). Corneal topography with the Topographic Modeling System (TMS-2, Tomey) was performed before and after the instillation of artificial tears. The surface regularity index (SRI), surface asymmetry index (SAI), potential visual acuity (PVA) and mean astigmatism were compared in dry eyes before and after the instillation of artificial tears. RESULTS: Before the instillation of artificial tears SAI, SRI, PVA and mean antigmatism values were found to be 1.37 +/- 1.47, 0.74 +/- 0.42, 20/30.92 +/- 20/8.12 and 1.53 +/- 1.47 D, respectively. In corneal topography performed after the instillation of artificial tears SAI, SRI, PVA and mean astigmatism values were 0.71 +/- 0.82, 0.43 +/- 0.36, 20/25.92 +/- 20/5.55 and 1.08 +/- 1.18, respectively. When compared statistically, the SRI, SAI, and mean astigmatism all decreased significantly and the PVA improved (p = 0.0001). CONCLUSION: Irregular corneal surface in dry eye patients affects optical quality. The statistically significant improvement observed in SRI and SAI values after the instillation of artificial tears also improves the PVA that is especially related to SRI.     

Tear evaporation rates in Sjögren syndrome and non-Sjögren dry eye patients

PURPOSE: To reinvestigate tear evaporation rates in Sj?gren syndrome (SS) and non-Sj?gren (non-SS) dry eye patients with a recently reported ventilated chamber evaporimeter system. DESIGN: Prospective case-control study. METHODS: A ventilated chamber evaporimeter system was used to measure tear evaporation rates. A DR-1 camera (Kowa, Nagoya, Japan) was used for tear lipid layer interference image acquisition. The Yokoi severity grading system was used for DR-1 image evaluation. Twenty-four aqueous tear deficiency (ATD) eyes of 21 consecutive patients with SS were studied (SS ATD group). Twenty-one ATD eyes of 12 non-SS patients (non-SS ATD group) were examined as control subjects. RESULTS: Tear evaporation rates of the SS ATD group (5.9 +/- 3.5 [10(-7) g/cm(2) per second]) were significantly higher than those of the non-SS ATD group (2.9 +/- 1.8 [10(-7) g/cm(2) per second]; P = .0009). The severity grading of DR-1 tear interference images of the SS ATD group was significantly higher (P = .03), along with significantly worse meibomian gland expressibility and vital staining scores, compared with those of the non-SS ATD group. CONCLUSIONS: Tear evaporation rates were higher in eyes of the SS ATD group compared with the non-SS ATD group. Tear evaporation assessed in conjunction with tear lipid layer findings and meibomian gland expressibility provides an increased understanding in the differential diagnosis of dry eye states.     

Efficacy and retention rate of two types of silicone punctal plugs in patients with and without Sjögren syndrome

OBJECTIVE: To compare the efficacy, retention rates, and complications of two types of silicone lacrimal punctal plugs in patients with or without Sj?gren syndrome. METHODS: We studied 36 patients with keratoconjunctivitis sicca (KCS) including 17 cases with Sj?gren syndrome (SS) and 19 without SS. The fluorescein and rose bengal staining scores and the Schirmer values with and without nasal stimulation were evaluated before and after insertion of the Eagle Plugs and the punctal plugs (FCI Punctal Plugs). The retention rates and complications of these plugs were also investigated. RESULTS: The staining scores were significantly improved after the insertion of the plugs, but the Schirmer values did not increase significantly in either SS or non-SS patients. A spontaneous loss of the plugs was observed in 29% of all plugs within 1 month after insertion. The Eagle Plugs were lost more frequently, and plugs in the upper punctum were lost more often for the Eagle Plugs. There was one case of granulomatous proliferation and two cases of punctal infection with the FCI Punctal Plugs. CONCLUSIONS: Both types of punctal plugs led to an improvement of the fluorescein and rose bengal staining scores in eyes with KCS. The difference in the retention rate and complications between the two types of plugs was probably caused by the differences in the material and the design of the plugs. Close monitoring is necessary to check for loss of plugs and to prevent complications.     

Chemokine tear levels in primary Sjögren’s syndrome and their relationship with symptoms

International Ophthalmology - To evaluate CCL2, CXCL8, and CXCL10 in the tears of patients with Primary Sjögren’s syndrome (PSS) and correlate them with ocular symptoms/discomfort and...     

Bilateral Internuclear Ophthalmoplegia as a Presenting Manifestation of Primary Sjögren’s Syndrome

Bilateral internuclear ophthalmoplegia has been linked with various pathological conditions of the central nervous system (CNS), such as multiple sclerosis, stroke, tumours, and brainstem inflammatory processes. Herein the authors report a case of a 45-year-old female patient who presented with diplopia due to bilateral internuclear ophthalmoplegia, with no evidence of brainstem lesion in brain magnetic resonance imaging (MRI) and was diagnosed with primary Sjögren’s syndrome.     

Noninvasive interference tear meniscometry in dry eye patients with Sjögren syndrome

PURPOSE: To compare noninvasive tear meniscus height (NI-TMH) using a tear interference device in normal subjects and dry eye patients with Sj?gren syndrome (SS), and to investigate the applicability of this new method before and after the punctal occlusion procedure. DESIGN: Prospective case control study. METHODS: Tear meniscus was visualized noninvasively using a tear interference device (Tearscope plus, Keeler, Windsor, United Kingdom). Tear interference image was captured with digital video camera (SP-321, JFC Sales Plan Co, Tokyo, Japan) attached to the slit-lamp. Lower lid margin NI-TMH was measured using image analysis software. NI-TMH of 28 eyes from 17 normal subjects and 46 eyes from 27 aqueous tear deficiency (ATD) dry eye patients with SS were compared. The change of NI-TMH three weeks after the successful punctal occlusion was examined in 11 eyes of eight dry eye subjects. RESULTS: Tear meniscus was well visualized with the tear interference device in all cases. Lower lid margin NI-TMH was 0.22 +/- 0.065 mm in normal subjects, and 0.13 +/- 0.042 mm in SS subjects, respectively (P < .0001). After the punctal occlusion, lower lid margin NI-TMH increased significantly from 0.12 +/- 0.026 mm to 0.42 +/- 0.21 mm (P = .001). CONCLUSIONS: NI-TMH was substantially lower in SS subjects and also significantly improved after punctal occlusion. This method is expected to be helpful in the diagnosis and in the evaluation of the efficacy of punctal occlusion in ATD dry eyes such as SS.