Rose Bengal Staining of the Temporal Conjunctiva Differentiates Sjögren's Syndrome from Keratoconjunctivitis Sicca

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Abstract
Purpose. To compare the clinical presentation of 231 patients with primary Sjögren's syndrome (pSS) with 89 patients with aqueous-deficient dry eye (keratoconjunctivitis sicca; KCS), to determine those procedures that best differentiate these groups in the eye care clinic. Methods. The records of all patients seen at the University Health Network Sjögren's Syndrome Clinic from October 1992 to July 2006 were reviewed and documented. The diagnosis of pSS was based on the AECC (American European Consensus Criteria) of 2002. KCS control subjects were non-SS patients with symptoms of dry eye and Schirmer scores of ≤10 mm in 5 minutes in at least one eye. There were 90 variables used in the analysis of the total database. Recursive partitioning was used to generate tree diagrams that demonstrated which characteristics best distinguished pSS from KCS. Results. Recursive partitioning of the full database demonstrated that the serum immunoglobulin Ro and the status of the salivary gland biopsy were most important in distinguishing pSS and KCS. The presence of rose bengal staining of the temporal conjunctiva was the most important noninvasive ocular variable that separated the groups. Total rose bengal staining also improved sensitivity. When only noninvasive techniques were used, staining of the temporal conjunctiva and severity of dry mouth symptoms were the major factors in distinguishing pSS from KCS. Conclusions. Rose bengal staining of the ocular surface is an important observation in the detection of SS and the differentiation of pSS and KCS.