title: Association of Dry Eye Tests With Extraocular Signs Among 3514 Participants in the Sjögren's Syndrome International Registry.
abstract: OBJECTIVE
  To identify a screening strategy for dry eye patients with a high likelihood of having Sjogren syndrome (SS) through the evaluation of the association of ocular surface tests with the extraocular signs used for the diagnosis of SS.
  
  
  METHODS
  Multicenter cross-sectional study.
  
  
  METHODS
  The Sjogren's International Clinical Collaborative Alliance (SICCA) registry enrolled 3514 participants with SS or possible SS from 9 international academic sites. Ocular surface evaluation included Schirmer I testing, tear breakup time (TBUT), and staining of the cornea (0-6 points) and conjunctiva (0-6 points). Multivariate logistic regression analysis was performed to identify predictive factors for (1) histopathologic changes on labial salivary gland (LSG) biopsies (positive = focus score of ≥1 focus/4 mm2) and (2) positive anti-SSA/B serology.
  
  
  RESULTS
  The adjusted odds of having a positive LSG biopsy were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.26, 95% CI 1.05-1.51, P = .014) and positive conjunctival staining (for each additional unit of staining 1.46; 95% CI 1.39-1.53, P < .001) or corneal staining (for each additional unit of staining 1.14; 95% CI 1.08-1.21, P < .001). The odds of having a positive serology were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.3; 95% CI 1.09-1.54, P = .004) and conjunctival staining (adjusted OR = 1.51; 95% CI 1.43-1.58, P < .001).
  
  
  CONCLUSIONS
  In addition to corneal staining, which was associated with a higher likelihood of having a positive LSG biopsy, conjunctival staining and abnormal Schirmer I testing are of critical importance to include when screening dry eye patients for possible SS, as they were associated with a higher likelihood of having a positive LSG biopsy and serology.
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: vatinee.bunya@uphs.upenn.edu.
authors.forename: Vatinee Y
authors.initials: VY
authors.lastname: Bunya
authors.affiliation: Department of Ophthalmology and F. I. Proctor Foundation, University of California San Francisco, San Francisco, California.
authors.forename: Satasuk Joy
authors.initials: SJ
authors.lastname: Bhosai
authors.affiliation: Department of Ophthalmology, German Hospital and University of Buenos Aires, Argentina.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Heidenreich
authors.affiliation: Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Kazuko
authors.initials: K
authors.lastname: Kitagawa
authors.affiliation: Department of Ophthalmology, King's College Hospital, London, London, United Kingdom.
authors.forename: Genevieve B
authors.initials: GB
authors.lastname: Larkin
authors.affiliation: Department of Ophthalmology and F. I. Proctor Foundation, University of California San Francisco, San Francisco, California.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
authors.affiliation: Department of Ophthalmology and F. I. Proctor Foundation, University of California San Francisco, San Francisco, California.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Gaynor
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Esen K
authors.initials: EK
authors.lastname: Akpek
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mina
authors.initials: M
authors.lastname: Massaro-Giordano
authors.affiliation: Aravind Eye Hospital, Madurai, Tamil Nadu, India.
authors.forename: M
authors.initials: M
authors.lastname: Srinivasan
authors.affiliation: Department of Ophthalmology and F. I. Proctor Foundation, University of California San Francisco, San Francisco, California.
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.affiliation: Department of Ophthalmology and F. I. Proctor Foundation, University of California San Francisco, San Francisco, California.
authors.forename: John P
authors.initials: JP
authors.lastname: Whitcher
authors.affiliation: Division of Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Shiboski
authors.affiliation: Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, Departments of Medicine and Orofacial Sciences, University of California San Francisco, San Francisco, California.
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Criswell
authors.affiliation: Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California.
authors.forename: Caroline H
authors.initials: CH
authors.lastname: Shiboski
mesh_terms: D003430:Cross-Sectional Studies; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D012042:Registries; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000150:complications*; D013666:Tears / Q000737:chemistry*; D055815:Young Adult