The eye as a window to oral and pain symptoms in Sjögren's disease

To investigate whether certain dry eye (DE) metrics relate to oral and pain manifestations of Sjögren's disease (SjD).

Secondary analysis of the Sjögren's International Collaborative Clinical Alliance dataset containing 1541 individuals with 2016 American College of Rheumatology/European League Against Rheumatism defined SjD. Binary logistic regression analyses examined which of 13 DE features related to various extraocular metrics.

The mean age of the population was 52±13.5 years; 45% identified as white and 94% as women. Heterogeneity in DE symptoms and signs was noted in individuals with SjD, with approximately one-third of individuals reporting significant spontaneous and/or evoked pain using various descriptors and indicating certain triggers, and approximately half having low tear production. Similarly, heterogeneity was noted with respect to oral and pain complaints, with extraocular pain symptoms found in approximately one-third of the population. Different ocular phenotypes aligned with different extraocular findings. Specifically, grittiness or scratchiness in the eyes (OR=1.6), blurred vision (OR=1.4) and low tear production (OR=1.8) most closely aligned with oral dryness ('Does your mouth feel dry?). On the other hand, burning or stinging in the eyes (OR=1.6), discomfort in low humidity (OR=1.2) and the absence of DE signs (normal tear production, OR=0.7; lack of ocular surface staining, OR=0.6) most closely aligned with pain outside the eye ('Do you experience persistent or frequent burning discomfort?').

Our findings suggest heterogeneity in SjD ocular presentations that predict extraocular features of disease and hint at mechanisms that underlie heterogeneity, namely divergent neurosensory processes.