Background When Henrik Sjögren described Sjögren’s syndrome (SS) for the first time in 1933, patients reported that their eyes stayed dry during crying, although they knew for sure that they were able to cry with tears before . In the years thereafter, Sjögren’s syndrome has been firmly established as a disease, but only few studies mentioned problems with crying in this group, and not one study examined crying in patients with ocular dryness.
Objectives To investigate the dimensions of crying and its relations to ocular dryness in patients with Sjögren’s syndrome, and to compare crying ability between patients and demographically-matched people from the general population.
Methods Questionnaires were completed by 300 patients with SS and 100 demographically- matched people from the general population (93% female, mean age 56 years). Crying was investigated with the newly developed Sicca Crying Inventory (SCI), measuring multiple aspects of crying. Ocular dryness was measured with a 100mm Visual analogue scale (VAS). Principal axis factoring with oblimin rotation was used to derive the dimensions of the SCI, analyses of variance with posthoc Bonferonni comparisons were used to examine group differences, and partial correlation coefficients (corrected for age and gender) were used to examine correlations between the domains of crying dimensions and ocular dryness.
Results The Sicca Crying Inventory consisted of four dimensions that were named crying ability (the capability to cry with tears, 7 items, α=0.93), frustration (suffering from the reduced ability to cry, 4 items, α=0.80), physical consequences (bodily symptoms like a burning sensation in the eyes, 4 items, α=0.77), and suppression (restrain tears or emotions, 2 items, α=0.85). Problems with crying ability were reported by 74% of the SS patients and by 46% of the control subjects. Scores of SS patients were lower on crying ability (p<0.001, d= -0.64) and higher on frustration (p<0.001, d=0.33) and physical consequences (p<0.05, d= -0.27) than scores of control subjects. The groups did not significantly differ in suppression. In SS, ocular dryness was correlated with a lower crying ability (r= -0.26, p<0.001) and more frustration (r=0.19, p=0.001) and physical consequences (r=0.22, p=0.001), but not significantly with suppression.
Conclusions A large number of patients with Sjögren’s syndrome, but also relatively many people in the general population, reported crying problems, such as a reduced ability to cry with tears, frustration of the reduced ability to cry with tears, and physical consequences of crying. Crying problems correlated to some extent with ocular dryness. Apparently, inflammation of the tear glands is only one of many risk factors for crying problems. Crying is believed to be a strong form of human emotional expression. Patients who cannot use tears to process and express emotions may experience adjustment problems in tear-inducing situations. This study is a first step towards a better understanding of the observation of Henrik Sjögren eighty years ago.
Supported by the Dutch Arthritis Association.
Sjögren H. Zur kenntnis der keratoconjunctivitis sicca: Keratitis filiformis bei hypofunktion der tränendrüsen. Acta Ophthalmol Suppl. 1933;2:1-151.
Disclosure of Interest None Declared