We thank Dr Kotaniemi and associates for their comprehensive review¹ of this important topic. Among all the ophthalmic measures studied, screening for dry eye by Schirmer’s test and interview alone aroused our interest.

Unlike other well known causes for Sjögren’s syndrome, such as systemic lupus erythematosus or rheumatoid arthritis, juvenile idiopathic arthritis is not commonly associated with dry eye or keratoconjunctivitis sicca. Carvounis et al have shown the prevalence to be as low as 2.3%.² Surprisingly, Kotaniemi et al reported that a discordantly high 40% of patients with uveitis and 26% of non-uveitis patients had dry eye symptoms or signs.¹ This obvious disparity may be attributed to multiple uncontrolled confounding factors in this study, including the intrinsically low reproducibility of the Schirmer score and poor correlation between conventional dry eye tests and …