Ocular surface characteristics and dry eye symptoms in primary biliary cholangitis patients complicated with seasonal allergic conjunctivitis

To evaluate ocular surface characteristics and dry eye symptoms in primary biliary cholangitis (PBC) patients with seasonal allergic conjunctivitis (SAC).

This retrospective case-control study included 73 PBC patients: 38 with SAC (PBC+SAC group, 38 eyes) and 35 controls (35 eyes). All the participants underwent comprehensive ocular surface assessment and ocular surface disease index (OSDI) scoring. The severity of ocular allergy in PBC+SAC group was indicated by total ocular symptom score (TOSS), and correlation analysis was carried out between TOSS and ocular parameters.

Age (59.60±10.69y vs 58.72±11.13y, P=0.629) and gender distribution (34 vs 32 females, P=0.713) did not differ significantly between groups. Compared to controls, the PBC+SAC group had higher dry eye prevalence (65.79% vs 28.57%, P=0.002), higher OSDI score [median: 34.3 (interquartile range, IQR: 26.05, 43.6) vs 21.2 (IQR: 15.15, 31.2), P<0.001], shorter non-invasive tear film breakup time [NIBUT, median: 4.16s (IQR: 2.52, 6.48) vs 6.88s (IQR: 4.81, 9.28), P<0.001], more severe upper meibomian gland loss (P<0.001), higher corneal fluorescein staining score [median: 1 (IQR: 0, 1) vs 0 (IQR: 0, 0.25), P<0.001], and higher rates of meibomian gland duct thinning (60.53% vs 31.43%, P=0.004) and distortion (73.68% vs 25.71%, P=0.001). TOSS was positively correlated with OSDI score (r=0.484, P<0.001) in PBC+SAC group but not with other ocular parameters (all P>0.05).

PBC patients with SAC have higher dry eye prevalence and more severe dry eye symptoms, mainly evaporative dry eye with obvious upper meibomian gland morphological abnormalities. Allergic symptom severity is positively correlated with dry eye discomfort, suggesting allergic inflammation may exacerbate ocular surface burden in PBC patients.