Dry eye disease in systemic lupus erythematosus: a cross sectional study.

Aim: To explore ocular surface manifestations of dry eye disease (DED) and its influencing factors in systemic lupus erythematosus (SLE) patients.

Methods: Ophthalmological examinations were conducted in SLE patients (=43) and controls (=41), including Ocular Surface Disease Index (OSDI), objective scatter index (OSI), tear meniscus height (TMH), lipid layer thickness (LLT), non-invasive Keratograph tear breakup time (NIKBUT), corneal fluorescein score (CFS), Schirmer I test. DED was diagnosed according to the Tear Film and Ocular Surface Society Dry Eye Workshop II Criteria. SLE patients were further divided into DED group and non-DED group, the disease activity, clinical manifestations and laboratory investigations were compared between the two groups. The disease activity was evaluated by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Receiver operative characteristic (ROC) curve and multiple-factor binary logistic regression were performed.

Results: SLE patients showed higher OSDI [9.1 (2.8-15.9) 6.3 (2.2-7.5), =0.035], higher OSI [1.67 (1.09-2.60) 0.96 (0.87-1.60), =0.001], higher CFS [1 (0-2) 0 (0-1), =0.001], lower LLT [65 (42-100) 100 (79.5-100), =0.010], and lower NIKBUT [8.03 (4.02-9.73) 9.67 (5.26-12.71), =0.030] than controls. The 32.6% of SLE patients had DED, which was higher than 12.2% of healthy controls. DED group showed higher SLEDAI-2K score [9.7±6.1 5.4±3.4, =0.025], higher anti-cardiolipin antibody (ACL) [8.7 (3.5-13.2) 3.6 (2.0-6.9), =0.035], and higher proportion of patients with cutaneous eruption [42.9% 6.9%, =0.015] than non-DED group. According to multiple-factor binary logistic regression analysis, the SLEDAI-2K score (OR=1.194, =0.041) and cutaneous eruption (OR=7.094, =0.045) could be consider as risk factors for DED in SLE patients. The ROC curve of the combined factors including age, disease duration, SLEDAI-2K score, ACL, and cutaneous eruption was analyzed, with a sensitivity of 0.786, a specificity of 0.793, and an area under curve of 0.820.

Conclusion: Ocular surface affection is frequent in SLE patients, and patients with high disease activity and cutaneous eruption show increased risk of DED.