The following clinical tests and ocular investigations were performed for all participants: (1) immunological data as, anti-Scl-70 antibody, anti-SS-A anti-body, anti-SS-B anti-body, and ANA antibody were measured by indirect immunofluorescence assay; (2) evaluation of the patient's inflammatory status via C-reactive protein (CRP) level and erythrocyte sedimentation ratio (ESR) analyses; (3) assessment of the patient's mental state via HADS score; (4) OCTA; (5) ocular measurements, include IOP (Goldmann tonometry), VA (Snellen chart), spherical equivalent refractive error, the tear breakup time (BUT), Schirmer's test, tear meniscus height (TMH), and ocular staining score (OSS).
The protocol of BUT, Schirmer's test, TMH, and OSS were examined as we have previously described [16 (link)].
BUT: fluorescein sodium was applied evenly on the ocular surface, and the first tear point film rupture was observed under cobalt blue light, and the time for this to occur was recorded. Less than 10 s was considered positive.
Schirmer's test: after disinfecting the conjunctival sac, one end of a piece of filter paper measuring (5∗35 mm was folded into a right angle and inserted into the conjunctival sac. Length of the wet region of the paper after 5 minutes was observed, and < 5 mm was considered positive.
TMH: this was measured under infrared light after a blink using Keratograph 5M software.
OSS: a complete evaluation was performed using corneal fluorescein staining in conjunction with conjunctival lissamine green staining. The cornea, the nasal conjunctiva, and the temporal conjunctiva were the three areas of the ocular surface that were taken into consideration for each eye. A score was given to the nasal and temporal conjunctiva based on the amount of spotty conjunctivitis in the palpebral fissure. A positive OSS index was that the score higher than or equal 3.
The protocol of BUT, Schirmer's test, TMH, and OSS were examined as we have previously described [16 (link)].
BUT: fluorescein sodium was applied evenly on the ocular surface, and the first tear point film rupture was observed under cobalt blue light, and the time for this to occur was recorded. Less than 10 s was considered positive.
Schirmer's test: after disinfecting the conjunctival sac, one end of a piece of filter paper measuring (5∗35 mm was folded into a right angle and inserted into the conjunctival sac. Length of the wet region of the paper after 5 minutes was observed, and < 5 mm was considered positive.
TMH: this was measured under infrared light after a blink using Keratograph 5M software.
OSS: a complete evaluation was performed using corneal fluorescein staining in conjunction with conjunctival lissamine green staining. The cornea, the nasal conjunctiva, and the temporal conjunctiva were the three areas of the ocular surface that were taken into consideration for each eye. A score was given to the nasal and temporal conjunctiva based on the amount of spotty conjunctivitis in the palpebral fissure. A positive OSS index was that the score higher than or equal 3.
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