Background/Purpose Fibromyalgia (FM) patients with ocular discomfort often describe symptoms characteristic of dry eye diseases, but frequently do not fulfill criteria diagnostic of Sjögrens syndrome. Thus, ophthalmologic subjective and objective testing were performed to (1) establish the association of FM with dry eye diseases and (2) attempt to identify the type(s) of dry eye diseases associated with FM.

Methods Consecutive patients (n=30) meeting American College of Rheumatology criteria for FM were evaluated as part of a comprehensive rheumatological examination. Subjective evaluation employed dry eye questionnaires, Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation of Eye Dryness (SPEED). Objective tests included determination of minimum tearfilm lipid layer thickness (LLT), tearfilm osmolarity (TOSM), tearfilm break-up time (TBUT), Schirmer tear test (STT), corneal fluorescein-staining, and meibomian gland assessment (MGA) scores.

Results Measurements were compared with widely accepted “Normal Values” (NV). OSDI 32.38±SD 20.7 (range, 2.27-79.16) 60% higher than NV(<13); SPEED 11.38±7.1 (range, 0-23.5) 47% higher than NV (≤6); LLT 49.72±17.2 nm (range, 28-90) 38% lower than NV (≤80nm); TOSM 312.2±14.1 mOsm/l (range, 290-341) higher than NV (300 mOsm); TBUT 5.01±3.1 sec (range, 1-15.24) 50% lower than ≥(10 sec); STT 6.02±3.9 nm (range, 0-11.5) 40% lower than NV (≥10 mm); and MGA scores 11.70±5.1 (range, 4-27) ­­lower than NV(>12).

Conclusion Fibromyalgia patients demonstrate evidence for both evaporative and aqueous-deficient dry eye diseases. FM patients should be routinely questioned for signs or symptoms of dry eye disease(s) and referred for a comprehensive evaluation to determine the type(s) of their dry eye disease(s) in order to recommend appropriate treatment(s).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaporative-dry-eye-disease-and-aqueous-deficient-dry-eye-disease-associated-with-fibromyalgia/