Keratoconjunctivitis sicca in patients with primary Sjögren's syndrome. A longitudinal study of ocular parameters

Thirty-four patients, all fulfilling the Copenhagen criteria for Primary Sjögren's Syndrome, were examined retrospectively in order to evaluate possible longitudinal alterations in Schirmer-1-test results, Rose-bengal score, break-up time and level of ocular score. Twenty-three of the patients were characterized as Bromhexine responders according to their initially positive response to systemic treatment (16 mg x 3 daily) and 11 patients were Bromhexine non-responders. All patients were treated with tear substitutes during the entire observation period of 27 to 76 months (mean 53 months), and all eye examinations were carried out by the same ophthalmologist. The responder group had, both in the start as well as at the end of the observation period, a better ocular status compared to the non-responder group. The latter group had a significantly (P less than 0.02) lower Schirmer-1-test at the start and at the end of the period, and a significantly (P less than 0.02) higher Rose-bengal score at the end of the period. Moreover, the responder group improved in Rose-bengal score (P less than 0.001), whereas the non-responder group improved both in break-up time (P less than 0.05) and Rose-bengal score (P less than 0.05). The use of a score combining results from all three tests, i.e. the ocular score, seems to be a useful tool when evaluating longitudinal variations i dry eye states. Considerable variation was seen between successive results of each ocular test, also in the periods without systemic treatment.