Tear Meniscus and Corneal Sub-basal Nerve Plexus Assessment in Primary Sjögren Syndrome and Sicca Syndrome Patients

Abstract

Purpose: To evaluate lower tear meniscus and corneal sub-basal nerve plexus in primary Sjögren's syndrome (pSS) and Sicca syndrome patients. Methods: Cross-sectional study of 116 patients with Sicca syndrome associated with pSS and not associated with Sjögren's syndrome (non-SS Sicca) and 20 normal control subjects. Tear meniscus height and area were measured using anterior segment optical coherence tomography; corneal sub-basal nerve plexus density, length, and tortuosity were evaluated using in vivo confocal microscopy. Data analysis was performed using IBM-SPSS Statistics 24.0. Results: Corneal sub-basal nerve plexus density and length were significantly lower, and tortuosity was significantly higher in pSS and non-SS Sicca groups than in normal control subjects (P < 0.001; P = 0.018, respectively). Corneal sub-basal nerve plexus presented a strong association with Schirmer test I and tear breakup time. Cutoff values of sub-basal nerve plexus density (36.5 nerve/mm2) and length (12.5 mm/mm2) presented 80.2% to 81.9% sensitivity and 85% specificity for detecting Sicca syndrome patients. No significant differences were found between the 3 groups regarding tear meniscus height and area. Conclusions: Corneal sub-basal nerve plexus in vivo confocal microscopy may be a useful tool in the assessment of dry eye disease in Sicca syndrome, complementing the information provided by the conventional modalities used in dry eye disease evaluation.

Quantification of Increased Corneal Subbasal Nerve Tortuosity in Dry Eye Disease and Its Correlation With Clinical Parameters

“…Notably, short-TBUT-type DED is more prevalent than other DED types in Asia, and many of these patients tend to have a normal Schirmer I test value. 42,43 In addition, both Cardigos et al 11 and we observed no correlation between tortuosity and CFS scores. The reason could be that disruption of tight junctions, accountable for positive CFS, occurred in the epithelium on the superior surface of the cornea, but not in the subbasal layer, where nerve trunks are located.…”

“…33 Reports of subbasal nerve tortuosity have more consistently revealed an increase in DED. 11,12,[32][33][34] However, most of these studies used subjective grading systems, not quantifying tortuosity, thereby decreasing the reproducibility and clinical significance of their results. Therefore, in this study, we quantified corneal subbasal nerve tortuosity in DED using Tagg, an objective and aggregated measure of tortuosity, and evaluated its correlation with clinical parameters of DED.…”

“…Several studies have reported increased corneal subbasal nerve tortuosity in primary Sjögren syndrome-related DED, non-Sjögren syndrome-related DED, and symptomatic contact lens-related DED. [11][12][13] However, research on tortuosity of corneal nerves is challenging due to its vague definition. Current methods to assess corneal nerve tortuosity were mostly subjective with poor reproducibility across studies.…”

Corneal nerve structure in patients with primary Sjögren’s syndrome in China

“…In vivo confocal microscopy (IVCM), as a noninvasive technique, has been widely utilized to evaluate the ocular surface in dry eye disease at the cellular level, including corneal and conjunctival epithelial cell density, conjunctival squamous metaplasia, and corneal nerve morphology [ 8 – 11 ]. In terms of corneal subbasal nerve morphology, controversial results have been demonstrated in several studies among different DED types [ 12 – 15 ]. Previous study investigated the corneal nerve morphology of SSDE concluded that SSDE has more corneal nerve density and number than non-Sjögren dry eye disease (NSDE) in China, which is contrary to studies in western populations [ 13 , 15 ].…”

“…In terms of corneal subbasal nerve morphology, controversial results have been demonstrated in several studies among different DED types [ 12 – 15 ]. Previous study investigated the corneal nerve morphology of SSDE concluded that SSDE has more corneal nerve density and number than non-Sjögren dry eye disease (NSDE) in China, which is contrary to studies in western populations [ 13 , 15 ]. The purpose of this study was therefore to investigate the morphology of corneal subbasal nerves and its relationship with clinical parameters in patients with primary SSDE and NSDE based on a Chinese population.…”