Research Article

Association between Clinical Signs and Subjective Symptoms of Dry Eye Disease in Patients with and without Primary Sjögren’s Syndrome

Abstract

Purpose: To compare objective clinical signs and subjective symptoms of dry eye disease in patients with and without primary Sjögren's syndrome (SS).
Methods: This study included patients diagnosed with dry eye disease (DED) due to primary Sjögren’s syndrome and patients with DED without SS (non-SS DED), all meeting the inclusion criteria at Helal Hospital (Tehran, Iran). Objective clinical assessments—including tear film breakup time (TBUT), Oxford corneal staining, tear osmolarity, and Schirmer's test I—were conducted in both groups. Subjective symptoms were assessed with the Ocular Surface Disease Index (OSDI) questionnaire. Correlation coefficients were calculated using linear regression analysis.
Results: This study was conducted from January 2023 to February 2024. Forty patients were included: 20 with SS DED and 20 with non-SS DED. The non-SS DED group had a significantly higher OSDI score (41.66 ± 7.50) than the SS DED group (37.29 ± 6.04; p = 0.05). Tear secretion measured by Schirmer I was significantly higher in the non-SS DED group (p = 0.00), while corneal staining scores were higher in the SS DED group (p = 0.00). The association between OSDI scores and objective clinical test results was weak in both groups. Among SS DED patients, OSDI scores showed a significant moderate correlation with disease duration (r = −0.529, p = 0.017). Additionally, within this group, higher tear osmolarity showed a very weak correlation with lower OSDI scores (r = −0.383, p = 0.096).
Conclusion: There is a weak and inconsistent association between subjective symptoms (OSDI scores) and objective clinical signs of DED in both patients with and without primary SS. Patients with SS may underreport their discomfort despite having more severe clinical signs of DED. 

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Keywords
Clinical signs; Subjective symptoms; Dry eye, Sjögren’s syndrome
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1.
Mohammadpour M, Ramin S, Abbasi A, Khorrami-Nejad M. Association between Clinical Signs and Subjective Symptoms of Dry Eye Disease in Patients with and without Primary Sjögren’s Syndrome. jmr. 2025;(-).