Fluorescence-based reagent and spectrum-based optical reader for lactoferrin detection in tears: differentiating Sjögren’s syndrome from non-Sjögren’s dry eye syndrome
Chia‐Ying TsaiChitsung HongMin‐Yen HsuTso‐Ting LaiChing-Wen HuangCheng-Yo LuWei‐Li ChenChao‐Min Cheng
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Abstract Identification of an early biomarker and effective testing device to differentiate dry eye disease secondary to autoimmune disease (Sjögren’s syndrome dry eye disease) from non-Sjögren’s dry eye disease are prerequisites for appropriate treatment. We aimed to demonstrate the capacity of a new photo-detection device to evaluate tear lactoferrin levels as a tool for differentiating systemic conditions associated with dry eye disease. Patients with non-Sjögren’s and Sjögren’s syndrome dry eye disease (n = 54 and n = 52, respectively) and controls (n = 11) were enrolled. All participants completed the Ocular Surface Disease Index questionnaire. Tear collection was performed with Schirmer test, and tear break-up time was examined using a slit lamp. Tear lactoferrin was evaluated using our newly developed photo-detection device. The average lactoferrin concentration was significantly lower in samples from patients with non-Sjögren’s dry eye disease (0.337 ± 0.227 mg/mL, n = 54) and Sjögren’s syndrome dry eye disease (0.087 ± 0.010 mg/mL, n = 52) than in control samples (1.272 ± 0.54 mg/mL, n = 11) (p < 0.0001). Further, lactoferrin levels were lower in patients with Sjögren’s syndrome dry eye disease than in those with non-Sjögren’s dry eye disease (p < 0.001). Our cost-effective, antibody-free, highly sensitive photo-detection device for evaluating tear lactoferrin levels can assist ophthalmologists in differentiating different types of dry eye diseases.Keywords:
Lactoferrin
Artificial tears
KERATOCONJUNCTIVITIS SICCA
Sjögren syndrome
Sjögren's Syndrome (SS) is a chronic systemic autoimmune disorder, characterized by the lymphocytic infiltration of lacrimal and salivary glands, giving rise to dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). Primary Sjögren's Syndrome commonly presents only with sicca manifestations; whereas, secondary Sjögren's syndrome occurs in connection with other autoimmune rheumatic diseases. Primary Sjögren's syndrome without ocular manifestation is rarely reported in the literature. Here we report a case of a 45-year-old female, who presented to us with complaints of dryness of mouth and dysphagia, without any ocular and systemic manifestations. On further evaluation she was diagnosed as a case of Primary Sjögren's syndrome. With this case report, we intend to emphasize the importance of an early diagnosis of this disorder, along with a brief review of various diagnostic criteria.
KERATOCONJUNCTIVITIS SICCA
Sjögren syndrome
Dry mouth
Sicca syndrome
Lymphocytic infiltration
Keratoconjunctivitis
Xerophthalmia
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KERATOCONJUNCTIVITIS SICCA
Artificial tears
Keratoconjunctivitis
Xerophthalmia
Schirmer test
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Purpose of review To document the changes in treatment paradigm for the management of dry eye. Restasis is 0.05% cyclosporine A and is the first immunomodulatory agent approved for treatment of dry eye. Recent findings Mounting evidence supports the inflammatory mechanism as explanation for the occurrence of dry eye disease. Immunomodulation has been shown to be effective in treating patients with moderate to severe dry eye disease caused by keratoconjunctivitis sicca. This addresses one of the two main forms of dry eye. There is a new report that immunomodulation using topical 0.05% cyclosporine A (Restasis) may also have a positive effect on meibomian gland dysfunction, the other main form of dry eye. Summary Dry eye disease is defined as an abnormality of tear film resulting in changes in the ocular surface. These changes may be seen on ocular examination with the use of fluorescein and supravital staining techniques. Classification of dry eye disease shows two main types: aqueous deficiency and evaporative loss. There is hope that both of these types of dry eye will respond to immunomodulation therapy. Restasis shows promise as the first of these agents to be approved as therapy to treat moderate to severe dry eye disease.
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Meibomian gland
Artificial tears
Keratoconjunctivitis
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1Toronto, Canada; 2Indiana University, School of Optometry, Bloomington, IN; Sjogren's Syndrome Research Group, Toronto Western Hospital; DREI Group,
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Sicca syndrome
Sjögren syndrome
Schirmer test
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Artificial tears
Schirmer test
Sjögren syndrome
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KERATOCONJUNCTIVITIS SICCA
Artificial tears
Sjögren syndrome
Keratoconjunctivitis
Sicca syndrome
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KERATOCONJUNCTIVITIS SICCA
Xerophthalmia
Dry mouth
Schirmer test
Sjögren syndrome
Keratoconjunctivitis
Lacrimal apparatus
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Twenty-two patients with rheumatoid arthritis and moderate to severe bilateral keratoconjunctivitis sicca were treated with artificial tears and a soluble slow-release artificial tear insert in a crossover trial. While using the inserts all but two patients reported an improvement in their symptoms. All the patients showed an improvement in the degree of conjunctival and corneal staining while using the inserts (p = 0.0001 and 0.00001 respectively). Nineteen patients (86%) found the inserts an acceptable form of therapy and 14 (64%) preferred them to other treatment regimens. Placement of the insert was not a problem despite all the patients having rheumatoid changes in their hands resulting in varying degrees of deformity. Two patients experienced initial difficulties with placement, but these were quickly resolved.
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KERATOCONJUNCTIVITIS SICCA
Artificial tears
Keratoconjunctivitis
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