Clinical Signs Fail to Reveal Health and Vision-Related Quality of Life in DED

Patients with primary Sjögren syndrome report poorer quality of life, which correlates with dry eye disease severity.

Patients with primary Sjögren syndrome perceive a lower quality of life (QOL), which is associated with the severity of dry eye disease (DED) symptoms, according to research published in Eye. However, these subjectively reported DED symptoms may not correlate with objectively measured clinical signs, according to the report. 

Investigators included 34 individuals with primary Sjögren syndrome (mean age, 61.3 years; 28 women) in the analysis and performed tear breakup time (TBUT), ocular surface staining, Schirmer 1 testing, and visual acuity measurements. Study participants completed 4 questionnaires, which included the Ocular Surface Disease Index (OSDI), National Eye Institute Visual Function (NEI VFQ-25), Short form-36 (SF-36), and EULAR Sjögren Syndrome Patient Reposted Index (ESSPRI) to report DED severity and QOL changes.

Among the cohort, 44.1% used immunosuppressive drugs, 100% used ocular lubricants (mean, 6.9 times per day), TBUT was 3.1 seconds, Schirmer 1 score was 2.2 mm, and all participants had a best-corrected visual acuity (BCVA) of 0.3 logarithm of the minimum angle of resolution (logMAR) or better.

Participants’ OSDI scores indicated mild DED in 11.8% of participants, moderate DED in 17.6% of patients, and severe DED in 55.9% of study individuals.

When managing pSS clinicians should be aware and considerate of the potential mental and physical weight of DED.

The SF-36 assessment revealed lower perceived health-related QOL scores among the cohort compared with normative data (mean difference [MD], 9.91; P =.001). Stratified by age and sex, subscores for energy and vitality, role limitations due to physical function or emotional health, general health, physical and social function, bodily pain, and mental health were all lower among individuals with primary Sjögren syndrome  compared with normative data.

Moderate correlations were observed between frequency of lubricant usage and OSDI function (r, 0.61; P =.004) and total (r, 0.55; P =.011) and symptom scores (r, 0.52; P =.018). The team also noted associations between BCVA and OSDI function (r, 0.43; P =.011) and overall scores (r, 0.38; P =.026), and a correlation between Schirmer I test and OSDI function score (r, 0.36; P =.028).

Lubricant usage was associated with vision-specific role difficulties (r, -0.55; P =.013) and mental health (r, -0.46; P =.040). Schirmer test results demonstrated a correlation with vision-specific role difficulties (r, -0.43; P =.012). Participants’ OSDI symptoms were associated with vision-specific mental health (r, -0.47; P =.005), social functioning (r, -0.45; P =.007), and dependency (r, -0.35; P =.041), according to the report.

NEI VFQ-25 outcomes correlated with OSDI symptoms, specifically for general vision (r, -0.40; P =.021), distance activities (r, -0.37; P =.032), and ocular pain (r, -0.34; P =.047).

“The symptoms of DED have a significant degrading effect on patient health- and vision-related quality of life in [primary Sjögren syndrome],” according to the researchers. “When managing [primary Sjögren syndrome] clinicians should be aware and considerate of the potential mental and physical weight of DED. Furthermore, clinicians should rely more on patient reported outcomes and visual acuity and focus beyond simply assessing traditional clinical signs like TBUT and ocular surface staining.”

Study limitations include a small sample size and the lack of a control group.


Greenan E, Pilson Q, Gabhann-Dromgoole JN, Murphy CC. Relationship between clinical parameters and quality of life in primary Sjögren’s syndrome: a prospective study. Eye. Published online January 19, 2023. doi:10.1038/s41433-023-02386-2