Thirsty eyes: a look at dry eyes in autoimmune/inflammatory syndrome induced by adjuvants

Many patients with autoimmune/inflammatory syndrome induced by adjuvants due to breast implants (ASIA-BII) complain of dry eyes, which may be due to impaired tear production or increased tear evaporation. The clinical differences between ASIA-BII patients with dry eyes, compared to other rheumatic diseases (e.g. Sjögren's Disease (SjD)) are largely unknown. We aimed to better classify dry eye disease (DED) by determining if their symptoms stemmed from impaired tear production. We also explored whether common biomarkers present in SjD patients were detected in DED patients with ASIA-BII.

We utilised a cross-sectional design to enroll 78 consecutive patients with ASIA-BII, SjD (n=16), and healthy controls (HC) (n=17) from a single centre in our study. We assessed each participant using a Schirmer's test and the SjD Screening Questionnaire (SSSQ).

73.1% of ASIA-BII patients had impaired tear production (Schirmer test <15mm), with severe impairment of tear production (Schirmer's test <5mm) in 47.4%. Severely impaired tear production was similar in prevalence to the SjD patients (p=0.68). ASIA-BII and SjD patients had similar SSSQ scores and rates of abnormal SSSQ scores. Differences were, however, observed in the frequency of positive antinuclear antibodies, anti-Sjögren Syndrome-A (anti-SSA) and anti-Sjögren Syndrome-B (anti-SSB) antibodies between the two groups. When ASIA-BII patients with severely impaired tear production were compared to ASIA-BII patients with normal tear production, a reduction of circulating naive helper T cells (0.014) was observed suggesting a potential role for immune dysregulation in potentiating tear production in ASIA-BII patients.

ASIA-BII patients suffer from dry eyes due to impaired tear production. The SSSQ was unable to differentiate SjD patients from ASIA-BII patients, however, biomarkers such as autoantibodies differ between SjD and ASIA-BII patients. Further investigations are required to further characterise ASIA-BII patients with dry eyes.