Background/Purpose: Dry eye symptoms and signs have been frequently reported in fibromyalgia patients (1,2). However, no study so far has addressed the concordance between subjective symptoms and objective findings in this population. Aim of this study was to assess the concordance between subjective symptoms of dry eye and objective findings in fibromyalgia.
Method: 52 patients were studied, 23 with fibromyalgia (FM: 20 F, 3 M, mean age 41.57 years, range 20-57) and 29 control subjects affected by miscellaneous rheumatic diseases (Controls: 26 F, 3 M, mean age 42.17 years, range 18-59). All patients completed the questionnaire used in the diagnosis of Sjögren's syndrome (3), and the McMonnies dry eye questionnaire, a 14-item validated questionnaire (4). In all patients Schirmer's I test (ST) was performed, and a result < 5 mm after 5 minutes was defined as positive. The impact of FM was assessed by the Widespread Pain Index (WPI), and by the Symptom Severity score (SS) (5). Statistical methods included chi-square statistic, and non-parametric ANOVA. The relatioship of selected variables on dry eye symptoms was assessed by binary logistic regression.
Results: Antinuclear antibodies (ANA) were positive in 15/52 (28.8%) patients (1 FM, 14 Controls). Schirmer's test was positive in 7/52 (13.5%) patients (FM 2/23 (8.7%); Controls 5/29 (17.2%) ). 30/52 (57.7%) patients answered affirmatively to at least one of the three questions related to dry eye of the Sjögren's questionnaire (FM 18/23 (78.3%); Controls 12/29 (41.4%)), including 28 (53.8%) patients with negative ST (FM 16/21 (76.2%); Controls 12/24 (50.0%) ) (fig 1). By McMonnies questionnaire, 32/52 (61.5%) patients (FM: 18/23 (78.3%); Controls 14/29 (48.3%)) were classified as having dry eye, including 27 with negative ST (FM 16/21 (76.2%); Controls 11/24 (45.8%)). Logistic regression results showed that for both the Sjogren's questionnaire and the McMonnies questionnaire, dry eye symptoms were correlated to age (p = 0.003) and to the presence of FM (p = 0.004 and p = 0.040 respectively), but not to age, to actual ST result, nor to ANA-positivity. Among FM patients, dry eye symptoms were correlated to higher SS scores (fig 2).
Conclusion: To our knowledge, this is the first study addressing the concordance between subjective symptoms and objective findings in the assessment of dry eye in fibromyalgia. Our results show that in this population, dry eye symptoms are extremely frequent, but are related to the severity of FM symptoms rather than to the results of Schirmer's test.
1) Dinerman H,et al. J Rheumatol. 1986;13:368-73.
2) Gallar J, et al. Invest Ophthalmol Vis Sci. 2009;50:4129–4134.
3) Vitali C, et al. Ann Rheum Dis 2002;61:554–558.
4) Nichols KK, et al. Cornea 2004;23:365–371.
5) Wolfe F, et al. Arthritis Care Res. 2010;62:600-10.
Disclosure: M. Antivalle, None; M. Battellino, None; A. Batticciotto, None; M. C. Ditto, None; A. Mutti, None; G. Santalena, None; V. Varisco, None; P. Sarzi-Puttini, None.