More Than Meets the Eye: The Relationship Between Dry Eye Disease and Multisystem Exocrinopathy

INTRODUCTION: Sjögren's Syndrome, commonly known to be the disease of "dry eyes and dry mouth", is an autoimmune disease that targets the lacrimal and salivary glands. Sjögren's Syndrome primarily affects women with an estimated prevalence of 1.4% in the United States. Its diagnosis is confirmed via presence of anti-Ro/anti-La antibodies, demonstration of reduced salivary and tear production, and a positive lip biopsy. Patients with Sjögren's Syndrome commonly manifest symptoms of a multisystem exocrinopathy. Currently, over 16 million American adults suffer from dry eye disease and do not meet the diagnostic criteria for Sjögren's Syndrome. For many of these patients, current treatment strategies are not sufficient to eradicate or reduce the chronic symptoms of dry eye, thus decreasing overall quality of life. The objective of this study is to establish whether patients with non-Sjögren's dry eye disease also exhibit symptoms of a multisystem exocrinopathy. METHODS: This was a retrospective chart review of 199 randomly chosen patients who were seen between January 2015 and April 2017 in the Department of Ophthalmology at the Aston Ambulatory Care Center. All patients reviewed had a diagnosis of dry eye disease in their medical chart. Using a validated exocrine dysfunction questionnaire as a template, comprehensive data was collected for ophthalmic findings, patient demographics, oral and topical medications, serology, a review of symptoms for all body systems (such as allergies, congestion, and reflux), and all known diagnoses. A univariate analysis was performed to test for differences between dry eye subtypes. A multivariate analysis is currently underway. Results: 31.2% of patients presented with a diagnosis of evaporative dry eye, 57.5% were aqueous-deficient non-Sjögren's dry eye, and 11.3% were aqueous-deficient Sjögren's dry eye. Analysis of the non-Sjögren's cohorts revealed over 25 symptoms consistent with a multisystem exocrinopathy. 35% of dry eye patients had a diagnosis for rheumatoid arthritis. Exocrine manifestations were significantly different among dry eye subtypes for sinusitis (p=0.0283), diarrhea (p=.0059), and hypothyroidism (p=.0291). DISCUSSION: This study is the first to indicate a multisystem exocrinopathy disorder in patients with non-Sjögren's dry eye disease. While results from the multivariate analysis are still pending, the identification of specific exocrine symptoms in patients with distinct subtypes of dry eye may lead to the establishment of new, tailored treatment regimens that will enhance patient response to therapy and improve overall quality of life.