Test and symptoms in keratoconjunctivitis sicca and their correlation

Results of dry eye tests and ocular symptoms were compared and correlated in patients with primary Sjögren's syndrome (1 degree SS), in patients with connective tissue disease differing from 1 degree SS, and in normal controls. Patients with 1 degree SS had many and pronounced ocular complaints, however, non-diagnostic for the disease. Break-up time and Schirmer-1 test results below 10 mm/5 min both had high sensitivity but low specificity, whereas the reverse was true for Rose-Bengal score and Schirmer-1 test below 5 mm/5 min. Presence of snake-like chromatin in conjunctival imprints and the lactotest on tear fluid did not qualify as alternative tests since they had very low specificity and were less sensitive than the Schirmer-1 test and break-up time. Cornea sensitivity was not found to be an appropriate test at all. In 21% of eyes the presence of keratoconjunctivitis sicca changed from one consultation to the next in patients with 1 degree SS. Examination for keratoconjunctivitis sicca should therefore be repeated in test negative cases where symptoms indicate 1 degree SS.