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A Population-Based Assessment

Oliver D. Schein, MD, MPH; Marc C. Hochberg, MD, MPH; Beatriz Muñoz, MS; James M. Tielsch, PhD; Karen Bandeen-Roche, PhD; Thomas Provost, MD; Grant J. Anhalt, MD; Sheila West, PhD

Arch Intern Med. 1999;159:1359-1363.

Background  Symptoms of dry eye and dry mouth are common in the elderly and are often debilitating. Previous research on small populations has been inconsistent regarding the contribution to sicca symptoms of autoimmune markers, medication use, and other factors. The objective of this study was to determine the population prevalence of symptoms of dry eye and dry mouth and to evaluate possible risk factors.

Methods  This is a population-based study of 2481 individuals, aged 65 to 84 years, residing in Salisbury, Md, and identified by the Health Care Financing Medicare database. The main outcome measures included information on sicca symptoms, medical history, medication use, and joint examination results collected in a standardized manner. Autoimmune status was assessed in 1200 individuals by measuring antinuclear antibody, rheumatoid factor, and autoantibodies to the soluble nuclear antigens Ro/SS-A and La/SS-B by double immunodiffusion.

Results  Approximately 27% of the population reported dry eye or dry mouth symptoms to be present often or all the time and 4.4% reported both. The prevalence of dry mouth (but not dry eye) symptoms increased with age, female sex, and white race. No association of sicca symptoms was found with rheumatoid arthritis, smoking, alcohol consumption, reproductive hormonal status, or the presence of autoantibodies. A strong, dose-response relationship was observed between sicca symptoms and the use of certain medication classes. The proportion of the population prevalence of sicca symptoms attributable to the use of drying medications was estimated at 62% for dry eye and dry mouth and 38% for dry eye or dry mouth symptoms.

Conclusions  Sicca symptoms are common in the elderly, and medication side effects appear to be a major underlying factor. Our results do not indicate an association between autoimmune status and sicca symptoms and do not support immunologic testing in persons with sicca symptoms in the absence of other important systemic features.

From the Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University, Baltimore, Md (Drs Schein, Tielsch, and West and Ms Muñoz); Division of Rheumatology and Clinical Immunology, Departments of Medicine and Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore (Dr Hochberg); and the Departments of International Health (Dr Tielsch), Biostatistics (Dr Bandeen-Roche), and Dermatology (Drs Provost and Anhalt), Johns Hopkins University.

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