Researchers in India recently assessed patients with primary and secondary Sjögren’s syndrome (SS) and determined that the risk factors for severe visual impairment (BCVA less than 20/200) include dryness, corneal scarring and ulceration, cataract and glaucoma. A diagnosis of secondary SS and scleritis was associated with an increased risk of developing corneal ulceration or perforation and warrants close monitoring.

Among the 919 study participants, 31% had primary and 69% had secondary SS. The most common cause of secondary SS was rheumatoid arthritis (98.1%), followed by systemic lupus erythematosus (0.79%), psoriasis (0.79%) and scleroderma (0.6%). When assessing the 1,838 eyes, the researchers noted severe visual impairment in 10% and corneal scarring or ulceration at presentation in 2.5%.

The study determined that the presence of corneal scarring (OR=3.00), corneal ulceration (OR=12.96), low Schirmer values (OR=0.93), cataract (OR=2.4), glaucoma (OR=4.09) and age at diagnosis (OR=1.02) were independent risk factors for developing severe visual impairment. Scleritis (OR=8.9) and secondary SS (OR=2.94) increased the risk of corneal complications.

The researchers concluded that patients with secondary SS who develop scleritis should be monitored closely for sight-threatening corneal complications.

Singh S, Das AV, Basu S. Ocular involvement in Sjogren’s syndrome: risk factors for severe visual impairment and vision-threatening corneal complications. Am J Ophthalmol. December 29, 2020. [Epub ahead of print].