K. Tsubota et al., DECREASED REFLEX TEARING IS ASSOCIATED WITH LYMPHOCYTIC INFILTRATION IN LACRIMAL GLANDS, Journal of rheumatology, 23(2), 1996, pp. 313-320
Objective. To investigate whether reflex tearing measured by the Schir
mer test with nasal stimulation is better correlated with lymphocytic
infiltration of the lacrimal gland and is thus a more appropriate test
for Sjogren's syndrome (SS). Methods. 272 patients with dry eye (age
55.5 +/- 13.5 years) with regular Schirmer test results <10 mm were re
cruited for the study. They were divided into 2 groups depending on th
e results of the Schirmer test with nasal stimulation. 24 age and sex
matched patients from each group were selected for lacrimal gland biop
sy and 10 patients for salivary gland biopsy, acid the levels of syste
mic autoantibodies and degrees of ocular surface staining and lymphocy
tic infiltration of the lacrimal and salivary glands were compared. Re
sults. Of the 272 patients, 187 (68.8%) had good reflex tearing (GT) a
nd 85 (31.2%) had poor reflex tearing (PT). There were no significant
differences in the age or sex of the 2 groups. Lymphocytic infiltratio
n of the lacrimal gland was observed in 7 GT cases and 22 PT cases out
of 24 cases. Lymphocytic infiltration of the salivary gland was also
higher in the PT (6 of 10) than the GT group (2 of 10). Conclusion. Ev
aluation of reflex tearing by the Schirmer test with nasal stimulation
identifies 2 groups of patients with dry eye. Those with poor reflex
tearing were more likely to have autoantibodies and lymphocytic infilt
ration of the exocrine glands consistent with SS.