In patients with Sjögren’s syndrome, increased activity of matrix metalloproteinases on the ocular surface can lead to damage of the lacrimal ducts and gland and ultimately increase the risk for corneal ulcers. Photo: Ben Gaddie, OD. Click image to enlarge.

It’s been shown that severe dry eye disease (DED) can predispose a patient to corneal ulceration, which can then lead to loss of vision—even when treated appropriately. In a recent study, researchers sought to understand the demographic factors and ocular surface disease associated with corneal ulcers. The team’s paper on the work was recently published in Ophthalmology.

A total of 1,910,340 Medicare beneficiaries were included. Corneal ulcers were associated with female sex, white race, dry eye with concurrent cicatrizing conjunctivitis or Sjögren’s syndrome and open-angle glaucoma among others.

White subjects had 1.5 to two times the odds of having corneal ulcers compared to Black and Hispanic individuals, although the authors noted in their paper on the work that prior studies found the opposite relationship and their findings may have undercounted non-white subjects.

Women had slightly higher odds (1.1) of developing a corneal ulcer compared to men, especially those older than age 75, possibly due to autoimmune diseases. According to the authors, autoimmune diseases are more common in women and can exacerbate DED, which may partially explain their higher risk of ulcers, as well as the impact of estrogen on the ocular surface.

Overall, patients with DED had 5.38 times higher odds of developing corneal ulcers than those without the condition. “Evaluation of ocular surface and tear film parameters and appropriate escalation of therapy are essential,” the authors wrote.

As mentioned earlier, Sjögren’s syndrome and cicatrizing conjunctivitis are both significantly associated with corneal ulcers. “The increased risk for corneal ulcers could be explained by the increased activity of matrix metalloproteinases on the ocular surface, which can lead to damage of the lacrimal ducts and gland,” the authors wrote.

To the authors’ knowledge, this is the first study to reveal significant racial differences in corneal ulcer prevalence and the potential role of underlying Sjogren’s syndrome in compounding the risk of developing corneal ulcers among individuals with DED. While these results are valid, further studies are needed to evaluate the severity of corneal ulcers based on these risk factors and identify possible pathogenic mechanisms that increase the risk.