IgG4-ROD Instigates Myriad Dry Eye Disease Signs

Patients with immunoglobulin G4-related ophthalmic disease (IgG4-ROD) demonstrate numerous features of both aqueous tear deficiency and evaporative dry eye disease, according to research published in the American Journal of Ophthalmology. The analysis reveals lower lid meibomian gland (MG) dropout in 48% of participants with IgG4-ROD, and lacrimal gland involvement in up to 90%.

In fact, 64 eyes of 64 patients with IgG4-ROD also showed significantly higher upper MG dropout, compared with 64 healthy, sex- and age-matched control participants (P =.001), as well as corneal fluorescein staining score (P =.0187). Specific characteristics included differences such as MG plugging, expressibility, and worse meibum quality (all P =.0001).

Lipid layer thickness (r=-0.0982; P =.476), and upper lid MG dropout (r=0.336; P =.0140) positively correlated with age at onset. Noninvasive tear film break-up time (TBUT) negatively correlated with onset age. Also, case eyes presenting enlarged lacrimal glands were likely to display lower TBUT — 10 seconds, compared with 18 seconds for those unaffected.

Additionally, significant differences between eyes in the case and control groups included lid margin telangiectasia, papillae, and lid-parallel conjunctival folds. Participants with IgG4-ROD had tear meniscus height of 0.4 mm compared with healthy individuals’ 0.3 mm (P <.05).

Ocular Surface Disease Index (OSDI) scores and LLT proved similar among groups. “We postulate that the comparable LLT could be due to the mixed pattern of evaporative dry eye disease and aqueous tear deficiency in IgG4-ROD patients, which would result in a relatively increased thickness of the lipid layer,” according to the investigators.

Previous studies demonstrate individuals with IgG4-ROD may experience worse OSDI, elevated corneal fluorescein staining, lower TBUT and Schirmer results. Notably, it is also reported patients with lacrimal gland impairment have improved with immunosuppressive therapy.

Investigators enrolled patients at participating hospitals in Hong Kong, diagnosed between 2005 to 2022, and recruited control individuals visiting an academic eye center from July 2022 to December 2022. Limitations of this study comprised a cross-sectional design lacking follow-up information, and different DED management strategies at various centers.