<p>Dry Eye Syndrome and Sicca Complex are Commonly Found in Patients with Postural Orthostatic Tachycardia Syndrome</p>

Abstract

Purpose: Patients with postural orthostatic tachycardia syndrome (POTS) present to outpatient dysautonomia clinics endorsing a wide range of symptoms. Dry eyes and mouth, or sicca complex are frequently reported. This retrospective study investigates the incidence and quantifies the severity of dry eye syndrome (DES) in patients with POTS. Patients and Methods: This retrospective study compiles survey results, and dry eye clinical data from twenty-three POTS patients (22 females, average age 34.9 and st dev 14.0 years) surveyed during their initial or follow-up appointments. Patient's medication lists were documented to account for anticholinergics, antihistamines, and anticholinesterase use. Patients endorsing dry eye symptoms were tested with Schirmer's test strips to identify clinically dry eyes and stratified for severity. Results: Sixty-five percent of patients endorsed dry eye symptoms (15/23). Seventy-four percent of patients endorsed dry mouth symptoms (17/23). Among patients endorsing dry eyes, 81% of eyes had decreased tear production with Schirmer's strip wetting less than 10 mm/5 min (13/16). Conclusion: DES is an additional and significant disease burden for the POTS patient population. Dry eye and exocrine gland function should be evaluated as part of the dysautonomia work up with referral to ophthalmology as appropriate. Patients with clinically dry eyes who report additional autonomic dysfunction should be further evaluated for widespread autonomic dysfunction.

Ehlers-Danlos syndromes and their manifestations in the visual system

“…Dry eye is a frequently reported symptom in patients with hEDS. Ghabriya et al demonstrated that hEDS patients had more reports of dry eye symptoms than controls and that the severity of symptoms correlated with Schirmer test findings (42) (43) explored the relationship between postural orthostatic tachycardia syndrome (POTS) and dry eye syndrome. Notably, they found a higher prevalence of sicca complex in EDS patients with POTS dysautonomia relative to the general public (43).…”

“…Ghabriya et al demonstrated that hEDS patients had more reports of dry eye symptoms than controls and that the severity of symptoms correlated with Schirmer test findings (42) (43) explored the relationship between postural orthostatic tachycardia syndrome (POTS) and dry eye syndrome. Notably, they found a higher prevalence of sicca complex in EDS patients with POTS dysautonomia relative to the general public (43). Although the exact mechanism is not well delineated in the current literature, one hypothesis is that an underlying autonomic dysfunction which is classically associated with EDS may manifest as impaired tear film production secondary to diminished exocrine gland function.…”

“…Similarly, Gauthier et al conducted a study on 12 patients with hEDS and found dry eye symptoms present in 83% of patients with 46% of them exhibiting objective findings including punctate epithelial erosions or decreased tear break up time. Ho et al ( 43 ) explored the relationship between postural orthostatic tachycardia syndrome (POTS) and dry eye syndrome. Notably, they found a higher prevalence of sicca complex in EDS patients with POTS dysautonomia relative to the general public ( 43 ).…”

“…Although the exact mechanism is not well delineated in the current literature, one hypothesis is that an underlying autonomic dysfunction which is classically associated with EDS may manifest as impaired tear film production secondary to diminished exocrine gland function. It was proposed that tear secretion may be impaired due to abnormal extracellular matrix production in the lacrimal gland ( 43 ).…”