Managing dry eye disease in primary Sjögren's syndrome using the chronic care model: a single-group pre-post study

Dry eye is the most prevalent ocular complaint among patients with primary Sjögren's syndrome, manifesting as pronounced eye discomfort and frequently complicated by mental disorders including anxiety and depression. Prior research has demonstrated that the chronic care model improves both clinical indicators and psychological status. This study compared changes in clinical parameters and psychological status in patients with primary Sjögren's syndrome following a 24-week chronic disease management intervention.

This single-group pre-post study was conducted at a tertiary hospital in China between April 2022 and October 2023. A total of 34 patients diagnosed with primary Sjögren's syndrome were recruited into this study. Questionnaires including the Ocular Surface Disease Index questionnaire, treatment compliance, the Knowledge-Attitude-Practice questionnaire, and the Depression Anxiety Stress Scales-21, were administered to patients at different follow-up time points. Patients also received objective ocular examinations consisting of Schirmer's test values, Tear Break-Up Time, corneal staining assessed with the NEI scale, and conjunctival staining assessed with the Sicca OSS scale. Data were analyzed using SPSS version 27.0, with descriptive statistics, paired t-tests, repeated-measures analysis of variance (with Bonferroni correction), Spearman's rank correlation analysis, and McNemar tests. Statistical significance was set at p < 0.05.

A total of 34 patients were enrolled (mean age 56.62 ± 12.16 years; 94.12% female). The primary outcome, Ocular Surface Disease Index score, improved significantly at 12 weeks compared with baseline. Significant changes were also detected in all secondary outcomes: Tear Break-Up Time increased significantly at both 12 and 24 weeks; Schirmer's test results and conjunctival staining grade shifted significantly from moderate to severe to mild or normal at 12 weeks; compliance with all treatment approaches was markedly elevated; the knowledge and practice domains of the Knowledge-Attitude-Practice questionnaire improved greatly; and depression, anxiety, and stress scores declined significantly. All of the above comparisons were statistically significant (p < 0.05).

Intervention with the chronic care model management program can enhance treatment compliance, elevate patients' Knowledge-Attitude-Practice levels and psychological status, and potentially relieve dry eye-related symptoms among patients with primary Sjögren's syndrome.

Retrospectively registered with the Chinese Clinical Trial Registry ( https://www.chrictr.org.cn/ ) on March 26, 2025, ChiCTR2500099615.