{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T11:19:50Z","timestamp":1769167190904,"version":"3.49.0"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T00:00:00Z","timestamp":1639699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007880","name":"Johns Hopkins University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007880","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>To assess the long-term treatment outcomes of dry eye in patients with and without underlying primary Sj\u00f6gren\u2019s syndrome (SS).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design<\/jats:title>\n<jats:p>Retrospective longitudinal cohort.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>SS and non-SS dry eye patients with clinic visits for a minimum of 5 consecutive years at a tertiary, dedicated dry eye clinic were included. Electronic health records were reviewed to collect data regarding demographics, objective dry eye parameters, treatments utilized at baseline and final visit, and corneal complications observed during follow-up.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Two hundred and two patients (101 SS and 101 randomly selected non-SS), with a mean follow-up of 7.1 years were included. At baseline, mean conjunctival lissamine green staining score was 2.9 and mean corneal fluorescein staining score was 2.0. At last visit, notable improvement in staining score for cornea (\u20131.1, P &lt; .001) and conjunctiva (\u20131.8, P &lt; .001) was seen equally in both dry eye groups. Most patients (88.1%) had an escalation of treatment by the final visit, with similar rates in both groups (P = .51). Half (48.9%) of the patients had no conjunctival staining, and a third (34.4%) had no corneal staining at their last visit. Twenty (9.9%) patients experienced a vision-threatening corneal complication, including ulcers and melt, with no difference in occurrences between the groups (P = .64).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The majority of patients in this longitudinal, tertiary clinic-based sample demonstrated improvement in their ocular surface staining score by the final visit with escalation in treatment. Treatments used, improvement achieved, and corneal complication rates leading to loss of vision were similar in both SS and non-SS dry eye groups.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0261241","type":"journal-article","created":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T18:39:10Z","timestamp":1639766350000},"page":"e0261241","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Outcomes of Sj\u00f6gren\u2019s versus non-Sj\u00f6gren\u2019s related dry eye in a longitudinal, tertiary clinic-based sample"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6101-5164","authenticated-orcid":true,"given":"David","family":"Cui","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priya","family":"Mathews","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gavin","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shanna","family":"VanCourt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esen","family":"Akpek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,12,17]]},"reference":[{"issue":"11S","key":"pone.0261241.ref001","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1016\/j.ophtha.2017.07.010","article-title":"The pathophysiology of dry eye disease: What we know and future directions for research","volume":"124","author":"S Pflugfelder","year":"2017","journal-title":"Ophthalmology"},{"issue":"3","key":"pone.0261241.ref002","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jtos.2017.05.008","article-title":"TFOS DEWS II definition and classification report.","volume":"15","author":"JP Craig","year":"2017","journal-title":"Ocul Surf"},{"issue":"1","key":"pone.0261241.ref003","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1038\/s41598-020-59078-0","article-title":"Patients with non-Sj\u00f6gren\u2019s sicca report poorer general and oral health-related quality of life than patients with Sj\u00f6gren\u2019s syndrome: a cross-section study.","volume":"10","author":"B Tashbayev","year":"2020","journal-title":"Sci Rep"},{"issue":"12","key":"pone.0261241.ref004","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1097\/OPX.0000000000001303","article-title":"Impact of dry eye on prolonged reading","volume":"95","author":"S Karakus","year":"2018","journal-title":"Optom Vis Sci"},{"key":"pone.0261241.ref005","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ajo.2020.05.043","article-title":"Ocular manifestations and burden related to Sj\u00f6gren\u2019s syndrome: Results of a patient survey","volume":"219","author":"IJ Saldanha","year":"2020","journal-title":"Am J Ophthalmol"},{"issue":"2","key":"pone.0261241.ref006","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s40135-013-0009-1","article-title":"Dry eye disease: Impact on quality of life and vision","volume":"1","author":"M Uchino","year":"2013","journal-title":"Curr Ophthalmol Rep"},{"issue":"3","key":"pone.0261241.ref007","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jtos.2017.05.003","article-title":"TFOS DEWS II epidemiology report.","volume":"15","author":"F Stapleton","year":"2017","journal-title":"Ocul Surf"},{"key":"pone.0261241.ref008","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1007\/978-1-4615-5359-5_111","article-title":"Epidemiology and classification of dry eye","volume":"438","author":"MA Lemp","year":"1998","journal-title":"Adv Exp Med Biol"},{"issue":"1","key":"pone.0261241.ref009","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1186\/s12886-017-0646-5","article-title":"Study design and baseline findings from the progression of ocular findings (PROOF) natural history study of dry eye","volume":"17","author":"PJ McDonnell","year":"2017","journal-title":"BMC Ophthalmol"},{"issue":"4","key":"pone.0261241.ref010","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/ICO.0b013e3181f7f363","article-title":"The economic burden of dry eye disease in the United States: a decision tree analysis","volume":"30","author":"J Yu","year":"2011","journal-title":"Cornea"},{"issue":"10","key":"pone.0261241.ref011","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/j.ophtha.2020.04.037","article-title":"Ophthalmic medication expenditures and out-of-pocket spending: an analysis of United States prescriptions from 2007 through 2016","volume":"127","author":"EM Chen","year":"2020","journal-title":"Ophthalmology"},{"key":"pone.0261241.ref012","first-page":"1447","article-title":"Managing Sj\u00f6gren\u2019s syndrome and non-Sj\u00f6gren syndrome dry eye with anti-inflammatory therapy","volume":"8","author":"TG Coursey","year":"2014","journal-title":"Clin Ophthalmol"},{"issue":"2","key":"pone.0261241.ref013","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.ophtha.2013.09.015","article-title":"Lifitegrast ophthalmic solution 5.0% for treatment of dry eye disease: results of the OPUS-1 phase 3 study","volume":"121","author":"JD Sheppard","year":"2014","journal-title":"Ophthalmology"},{"issue":"4","key":"pone.0261241.ref014","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/S0161-6420(99)00176-1","article-title":"Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3","volume":"107","author":"K Sall","year":"2000","journal-title":"Study Group. Ophthalmology"},{"issue":"2","key":"pone.0261241.ref015","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.ophtha.2015.10.011","article-title":"Long-term natural history of dry eye disease from the patient\u2019s perspective","volume":"123","author":"JP Lienert","year":"2016","journal-title":"Ophthalmology"},{"issue":"11","key":"pone.0261241.ref016","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1136\/bjophthalmol-2015-306930","article-title":"Long-term outcome after topical ciclosporin in severe dry eye disease with a 10-year follow-up","volume":"100","author":"M Straub","year":"2016","journal-title":"Br J Ophthalmol"},{"issue":"1","key":"pone.0261241.ref017","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.ophtha.2006.05.077","article-title":"Long-term resolution of chronic dry eye symptoms and signs after topical cyclosporine treatment","volume":"114","author":"SE Wilson","year":"2007","journal-title":"Ophthalmology"},{"issue":"1","key":"pone.0261241.ref018","doi-asserted-by":"crossref","first-page":"P286","DOI":"10.1016\/j.ophtha.2018.10.023","article-title":"Dry eye syndrome preferred practice pattern\u00ae","volume":"126","author":"EK Akpek","year":"2019","journal-title":"Ophthalmology"},{"issue":"5","key":"pone.0261241.ref019","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1097\/ICO.0b013e31818d3846","article-title":"Evaluation of patients with dry eye for presence of underlying Sj\u00f6gren syndrome","volume":"28","author":"EK Akpek","year":"2009","journal-title":"Cornea"},{"issue":"8","key":"pone.0261241.ref020","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1097\/ICO.0000000000000173","article-title":"Association of dry eye and inflammatory systemic diseases in a tertiary care-based sample","volume":"33","author":"CF Henrich","year":"2014","journal-title":"Cornea"},{"issue":"1","key":"pone.0261241.ref021","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ophtha.2014.07.026","article-title":"Ocular and systemic morbidity in a longitudinal cohort of Sj\u00f6gren\u2019s syndrome","volume":"122","author":"EK Akpek","year":"2015","journal-title":"Ophthalmology"},{"issue":"4","key":"pone.0261241.ref022","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/00005792-200207000-00003","article-title":"Primary Sj\u00f6gren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients","volume":"81","author":"M Garc\u00eda-Carrasco","year":"2002","journal-title":"Medicine (Baltimore)."},{"issue":"8","key":"pone.0261241.ref023","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1097\/ICO.0000000000002299","article-title":"Differential diagnosis of Sj\u00f6gren versus non-Sj\u00f6gren dry eye through tear film biomarkers","volume":"39","author":"EK Akpek","year":"2020","journal-title":"Cornea"},{"issue":"2","key":"pone.0261241.ref024","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.ajo.2013.04.003","article-title":"Analysis of tear cytokines and clinical correlations in Sj\u00f6gren syndrome dry eye patients and non-Sj\u00f6gren syndrome dry eye patients","volume":"156","author":"SY Lee","year":"2013","journal-title":"Am J Ophthalmol"},{"issue":"3","key":"pone.0261241.ref025","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.ajo.2009.09.013","article-title":"A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sj\u00f6gren\u2019s Syndrome International Registry","volume":"149","author":"JP Whitcher","year":"2010","journal-title":"Am J Ophthalmol"},{"issue":"3","key":"pone.0261241.ref026","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.jtos.2017.05.006","article-title":"TFOS DEWS II management and therapy report","volume":"15","author":"L Jones","year":"2017","journal-title":"Ocul Surf"},{"issue":"4","key":"pone.0261241.ref027","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1002\/acr.21591","article-title":"American College of Rheumatology classification criteria for Sj\u00f6gren\u2019s syndrome: a data-driven, expert consensus approach in the Sj\u00f6gren\u2019s International Collaborative Clinical Alliance cohort","volume":"64","author":"SC Shiboski","year":"2012","journal-title":"Arthritis Care Res (Hoboken)."},{"issue":"9","key":"pone.0261241.ref028","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1097\/ICO.0b013e318242fd60","article-title":"Clinical utility of objective tests for dry eye disease: variability over time and implications for clinical trials and disease management","volume":"31","author":"BD Sullivan","year":"2012","journal-title":"Cornea"},{"issue":"8","key":"pone.0261241.ref029","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1097\/ICO.0000000000002311","article-title":"Ocular clinical signs and diagnostic tests most compatible with keratoconjunctivitis sicca: a latent class approach","volume":"39","author":"JA Gonzales","year":"2020","journal-title":"Cornea"},{"issue":"6","key":"pone.0261241.ref030","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1001\/jamaophthalmol.2015.0429","article-title":"Variability of tear osmolarity in patients with dry eye","volume":"133","author":"VY Bunya","year":"2015","journal-title":"JAMA Ophthalmol"},{"issue":"9","key":"pone.0261241.ref031","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1016\/S0161-6420(97)30125-0","article-title":"Relation between signs and symptoms of dry eye in the elderly. A population-based perspective","volume":"104","author":"OD Schein","year":"1997","journal-title":"Ophthalmology"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261241","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T18:39:39Z","timestamp":1639766379000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261241"}},"subtitle":[],"editor":[{"given":"Michael","family":"Mimouni","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,12,17]]},"references-count":31,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0261241","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,17]]}}}