title: Effect of Lid Debridement-Scaling in Sjögren Syndrome Dry Eye.
abstract: OBJECTIVE
  To evaluate the effect of lid debridement-scaling (LDS) on dry eye signs and symptoms in subjects with Sjögren syndrome (SS).
  
  
  METHODS
  This prospective randomized controlled study enrolled 14 female subjects with SS. Seven subjects were randomized into the treatment group where they were selected to receive LDS; the remainder did not receive LDS and served as control subjects. Lid debridement-scaling was conducted using a stainless steel golf club spud (Hilco Wilson Ophthalmics, Plainville, MA) on both the upper and lower eyelids of both eyes. Outcome variables were assessed before LDS and again 1 month later. The outcome variables were the Ocular Surface Disease Index (OSDI), Symptom Assessment iN Dry Eye (SANDE) visual analog scores, ocular staining (SICCA OSS [Sjögren's International Collaborative Clinical Alliance Ocular Staining Score]), fluorescein tear breakup time (FLBUT), meibomian gland score (MGS), meibomian gland yielding liquid secretions (MGYLS) score, and line of Marx's (LOM) position.
  
  
  RESULTS
  Thirteen subjects completed the study. Data from only the right eye were analyzed. For the control group (n = 6; mean [± SD] age, 62.3 [± 11.6] years), the pre-LDS, post-LDS, and significance level (pre-LDS mean [± SD] vs. post-LDS mean [± SD]; p value) were as follows: OSDI (58.3 [± 22.1] vs. 48.3 [± 29.0]; p = 0.051), SANDE (77.4 [± 22.1] vs. 89.6 [± 32.6]; p = 0.20), SICCA OSS (7.0 [± 4.5] vs. 8.2 [± 3.5]; p = 0.25), MGS (1.3 [± 1.5] vs. 1.0 [± 0.9]; p = 0.75), MGYLS (0.3 [± 0.5] vs. 0.0 [± 0.0]; p = 0.50), FLBUT (2.99 [± 1.54] vs. 2.85 [± 1.79]; p = 0.63), and LOM (2.0 [± 0.0] vs. 2.0 [± 0.0]; p = n/a). For the treatment group (n = 7; mean [± SD] age, 58.0 [± 8.1] years), the pre-LDS, post-LDS, and significance level were as follows: OSDI (63.2 [± 13.3] vs. 46.9 [± 19.4]; p = 0.04), SANDE (72.6 [± 17.1] vs. 77.0 [± 28.0]; p = 0.54), SICCA OSS (6.6 [± 2.9] vs. 5.0 [± 3.9]; p = 0.02), MGS (1.0 [± 1.2] vs. 3.1 [± 1.7]; p = 0.01), MGYLS (0.0 [± 0.0] vs. 0.6 [± 1.0]; p = 0.50), FLBUT (3.13 [± 0.81] vs. 3.45 [± 1.03]; p = 0.53), and LOM (0.9 [± 0.9] vs. 1.0 [± 1.0]; p = 1.00).
  
  
  CONCLUSIONS
  This pilot study showed that LDS improved symptoms, ocular staining, and meibomian gland function for the group that received LDS. This indicates that LDS can aid in the management of SS dry eye.
authors.affiliation: *OD, BSc, FAAO †OD, PhD, FAAO ‡PhD, BSOptom, FAAO §PhD, FCOptom, FAAO Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada (WN, SS, LWJ); and Toronto Eye Care, Toronto, Ontario, Canada (BC).
authors.forename: William
authors.initials: W
authors.lastname: Ngo
authors.forename: Barbara
authors.initials: B
authors.lastname: Caffery
authors.forename: Sruthi
authors.initials: S
authors.lastname: Srinivasan
authors.forename: Lyndon W
authors.initials: LW
authors.lastname: Jones
mesh_terms: D000368:Aged; D003646:Debridement / Q000379:methods*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D019793:Fluorescein; D006801:Humans; D008537:Meibomian Glands / Q000503:physiopathology; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012859:Sjogren's Syndrome / Q000503:physiopathology / Q000601:surgery*; D013194:Staining and Labeling; D013666:Tears / Q000502:physiology
chemical_list: D019793:Fluorescein