Evaporative dry eye is more common in patients with scleroderma than patients without the chronic connective tissue disease, a new study in Cornea suggests. Systemic sclerosis, also known as scleroderma, is classified as one of the autoimmune rheumatic diseases, and can affect many different organs, including the eyes. Although data on the ocular manifestations is lacking, research suggests most involve eyelid skin and dry eye, with incidences of dry eye varying between 37% and 79%, according to the research team.  

To better understand the ocular surface and meibomian glands of patients with scleroderma, the researchers assessed ocular surface parameters of 64 eyes of 32 scleroderma patients (48.34±9.73 years old) and 62 eyes of 31 healthy controls (45.84±4.42 years old). The mean duration of systemic sclerosis, or scleroderma, in the study group was 9.78±7.40 years.

A team conducted Schirmer’s testing, tear break-up time, tear osmolarity, ocular surface staining (Oxford score), Ocular Surface Disease Index (OSDI) score, meibomian gland dysfunction evaluation and meibography.

They found shorter mean tear break-up times (6.73±1.90 seconds vs. 9.26±2.93 seconds) and higher Oxford scores (0.95±0.54 vs. 0.26±0.44) in the study group compared with the controls. They noted that upper meiboscores of grade one and higher were also more common in the study group compared with controls, as was the presence of foamy tears (21.9% vs. 3.2%) and telangiectasia of the eyelids (56.3% vs. 29.0%). They discovered no statistical differences for osmolarity, OSDI score and Schirmer’s testing between groups.

The investigators added that OSDI score was the only factor found to significantly correlate with disease duration.

Based on these findings, the study authors recommend clinicians prescribe not only artificial tears, but also eyelid hygiene to help maintain ocular surface hemostasis in patients with dry eye related to scleroderma.

Adiguzel S, Palamar M, Yargucu F, et al. Evaluation of ocular surface and meibomian glands in patients with scleroderma. Cornea. October 19, 2020. [Epub ahead of print].