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Comparative Utility of Tear Film and Ocular Surface Parameters in Differentiating Sjögren's Disease Dry Eye From Non-Sjögren's Dry Eye.

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Title: Comparative Utility of Tear Film and Ocular Surface Parameters in Differentiating Sjögren's Disease Dry Eye From Non-Sjögren's Dry Eye.
Authors: Haile M; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Lin MX; University of Maryland School of Medicine, Baltimore, MD, USA., Zeng J; Stritch School of Medicine, Loyola University, Chicago, IL, USA., Li G; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA., Cui D; The University of North Carolina, Chapel Hill, NC, USA., Hessen M; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Montecchi-Palmer M; Alcon Inc., Fort Worth, TX, USA., Akpek EK; The Foster Center for Ocular Immunology and Inflammation, Duke University School of Medicine, Durham, NC, USA.
Source: Translational vision science & technology [Transl Vis Sci Technol] 2026 Sep 01; Vol. 15 (9), pp. 17.
Publication Type: Journal Article; Comparative Study
Language: English
Journal Info: Publisher: Association for Research in Vision and Ophthalmology Country of Publication: United States NLM ID: 101595919 Publication Model: Print Cited Medium: Internet ISSN: 2164-2591 (Electronic) Linking ISSN: 21642591 NLM ISO Abbreviation: Transl Vis Sci Technol Subsets: MEDLINE
Imprint Name(s): Original Publication: Rockville, Md. : Association for Research in Vision and Ophthalmology
MeSH Terms: Tears*/metabolism , Tears*/physiology , Sjogren's Syndrome*/diagnosis , Sjogren's Syndrome*/metabolism , Dry Eye Syndromes*/diagnosis , Dry Eye Syndromes*/metabolism , Conjunctiva*/pathology , Conjunctiva*/metabolism , Cornea*/metabolism , Cornea*/pathology, Humans ; Female ; Cross-Sectional Studies ; Middle Aged ; Male ; ROC Curve ; Aged ; Adult ; Diagnosis, Differential
Abstract: Purpose: Tear production and ocular surface damage are equally weighted in the 2016 classification criteria for Sjögren's disease (SjD). We compared Schirmer testing versus ocular surface staining to distinguish SjD from non-SjD dry eye.
Methods: Patients with SjD dry eye (n = 20), non-SjD dry eye (n = 47), and controls (n = 29) were evaluated in this cross-sectional study. Schirmer testing assessed tear production; ocular surface staining was graded using the Sjögren's International Collaborative Clinical Alliance (SICCA) and National Eye Institute (NEI) systems. Analyses included age-stratified comparisons, receiver operating characteristic (ROC) analyses, and multivariable regression.
Results: Overall, mean Schirmer values did not differ between SjD and non-SjD dry eye but were lower in SjD among participants <60 years (8.78 ± 6.24 vs. 18.00 ± 10.04 mm, P = 0.018), not ≥60 years (15.27 ± 11.01 vs. 14.00 ± 8.28 mm, P = 0.699). Schirmer ≤5 mm threshold differentiated SjD only in the younger group (<60 years: 55.6% vs. 5.0%, P = 0.014; ≥60 years: 18.2% vs. 25.9%, P = 0.145), and Schirmer testing showed poor overall discrimination, particularly among older participants (area under the curve [AUC] = 0.602; <60 years 0.772; ≥60 years 0.453). By contrast, SICCA corneal staining demonstrated consistently stronger discrimination (overall AUC 0.803; <60 years 0.872; ≥60 years 0.754). In multivariable models, NEI conjunctival staining (odds ratio [OR] = 1.23, P = 0.008) and SICCA corneal staining (OR = 1.83, P = 0.046), but not Schirmer testing (OR = 1.01, P = 0.888), were associated with SjD.
Conclusions: Ocular surface staining was more strongly associated with classified SjD status in this cohort, whereas Schirmer testing showed age-dependent performance.
Translational Relevance: Ocular surface staining may be a more reliable marker of Sjögren's dry eye than Schirmer testing, with implications for clinical evaluation.
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Entry Date(s): Date Created: 20260925 Date Completed: 20260925 Latest Revision: 20261008
Update Code: 20261008
PubMed Central ID: PMC13641203
DOI: 10.1167/tvst.15.9.17
PMID: 42788775
Database: MEDLINE
Description
ISSN:2164-2591
DOI:10.1167/tvst.15.9.17