Oral and ocular manifestations in Sjögren's syndrome.
OBJECTIVE
Little is known about the relationship between lachrymal and salivary gland involvement in Sjögren's syndrome (SS). It is also of interest to know which eye test contributes most to the diagnosis of SS. We investigated the performance of different tear tests and how these tests relate to common serologic and salivary tests in SS.


METHODS
In patients suspected of SS, the tear breakup time and the tear mucus score were evaluated in addition to the routine tests. Eighty consecutive patients were included, categorized into primary SS (pSS), secondary SS (sSS), and negative for SS.


RESULTS
The tear breakup time and mucus score both performed insufficiently in diagnosing SS, in contrast to the Rose Bengal score. In pSS and sSS patients, a clear correlation was noted between tear and saliva quality and secretion rate, and between the Rose Bengal score and parotid sialography. Increased Rose Bengal scores also correlated significantly with hyperglobulinemia and presence of SSB antibodies in serum, with duration of subjective eye dryness, and with decreased tear gland function.


CONCLUSIONS
The Rose Bengal score remains the eye test of choice having the highest specificity for SS. Hyperglobulinemia and especially positive SSB serology may warrant close monitoring of the eyes, since these serum findings appear to relate to the severity of ocular surface damage. Theoretically, a positive evaluation of either the ocular or oral component, in addition to positive serology or histopathology, could be sufficient to diagnose the syndrome for clinical purposes.
Kalk
Wouter W I
WW
Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands. w.w.i.kalk@kchir.azg.nl
Mansour
Khaled
K
Vissink
Arjan
A
Spijkervet
Fred K L
FK
Bootsma
Hendrika
H
Kallenberg
Cees G M
CG
Roodenburg
Jan L N
JL
Nieuw Amerongen
Arie V
AV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000097:blood; D018450:Disease Progression; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007781:Lactoferrin / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009093:Mucus; D012395:Rose Bengal; D012466:Salivary Gland Diseases / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D012680:Sensitivity and Specificity; D012859:Sjogren's Syndrome / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D013666:Tears / Q000737:chemistry
D000974:Antibodies, Antinuclear; D005456:Fluorescent Dyes; C035357:SS-B antibodies; D012395:Rose Bengal; D007781:Lactoferrin