Ocular Microbiology and Immunology Group
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2016 OMIG Abstract 18

Signs of Sjögren's Syndrome and Symptoms of Dry Eye:
Which Predict Depression?
John Gonzales^1,2, Annie Chou³, Vatinee Bunya⁴, Caroline Shiboski³, Lindsey Criswell⁵, Jeremy Keenan^1,2, Jennifer Rose-Nussbaumer^1,2, Tom Lietman^1,2
1F.I. Proctor Foundation, ²Department of Ophthalmology, University of California San Francisco, ³Department of Orofacial Sciences, University of California San Francisco, ⁴Department of Ophthalmology, Hospital of the University of Pennsylvania, ⁵Department of Rheumatology, University of California San Francisco

Purpose: Our objective was to determine how ocular signs and symptoms in women with Sjögren’s syndrome (SS) keratoconjunctivitis sicca (KCS) predict depression in patients enrolled in the Sjögren’s International Collaborative Clinical Alliance (SICCA).

Methods: Retrospective review of the SICCA database registry. Depression was assessed with the Patient Health Questionnaire 9 (PHQ-9). We categorized patients into depressed (no to mild depression on PHQ-9) or not depressed (moderate to severe depression on PHQ-9) groups. We also categorized patients as being symptomatic (complaints of dry eyes, dry mouth, or both) or asymptomatic. Mixed effects logistic regression was performed to determine if clinical SS signs (using American College of Rheumatology diagnostic criteria) or patient-reported symptoms predicted depression.

Results: A total of 3,514 subjects were enrolled into the SICCA registry with 3,185  (90.6%) being women. There were 1,540 (43%) women with SS. Symptomatic (dry eyes, mouth, or both) women with SS had a 1.64-fold higher odds of depression compared to asymptomatic SS women (p < 0.001, 95% CI = 1.38-1.96). Similarly, symptomatic women without SS had a higher odds of depression compared to asymptomatic women without SS (1.37, p = 0.01, 95% CI 1.08-1.73). Symptomatic women with SS had no difference in depression compared to symptomatic women without SS. Subjects with specific ocular symptoms, including gritty sensation, light sensitivity, and burning sensation had statistically significant higher odds of having depression compared to subjects without such complaints. Therapies aimed at addressing dry eyes (artificial tears, cyclosporine, topical corticosteroids, and punctal plugs) were not associated with a reduced odds of depression.

Conclusions: The presence of ocular and/or oral symptoms predict depression in a cohort of SS women from the SICCA registry whereas SS signs do not. Symptoms in women without SS also predict depression. Therapies other than standard of care (artificial tears, topical cyclosporine, and punctal plugs) are needed that could have a beneficial impact on depression in patients with dry eye.

None of the authors have financial disclosures.

2016 Agenda and Abstracts | < Previous | Next >