New research suggests lacrimal gland color Doppler ultrasonography (LGCDUS) may offer ophthalmologists a practical window into early primary Sjögren’s Syndrome (pSS), potentially identifying lacrimal gland involvement before more obvious structural changes appear.
In this Scientific Reports article, investigators from Xiangya Hospital compared 24 patients with early-stage pSS with 26 healthy controls, asking whether color Doppler could capture both morphologic and hemodynamic changes in the gland. Because the lacrimal gland may be affected earlier than other exocrine glands in pSS, the concept is compelling: a non-invasive, clinic-friendly imaging test targeted at one of the first organs involved.
The strongest signal was vascular rather than structural. After correction for multiple comparisons, early-stage pSS eyes showed significantly higher end-diastolic velocity (EDV) in the lacrimal artery and a lower resistance index (RI), indicating increased perfusion and reduced vascular resistance. Peak systolic velocity and minor-axis enlargement also trended upward, but did not retain significance after Bonferroni correction. On ultrasound examples used in the study, most glands still appeared relatively subtle on grayscale imaging, with only isolated cases of hypoechoic areas, inhomogeneity, or hyperechoic bands. That pattern supports the authors’ argument that hemodynamic disturbance may precede overt morphologic change in early disease.
That matters clinically because current pSS work-ups remain imperfect. The 2016 ACR/EULAR pathway relies heavily on serology, labial salivary gland biopsy, and gland-function testing, each with limitations in invasiveness, specificity, or real-world variability. In this cohort, lacrimal Doppler changes also appeared to reflect disease biology. The strongest association to survive stringent correction was a positive correlation between lacrimal gland sagittal diameter and C-reactive protein, visualized by a heatmap in the study. Several other links – to Schirmer results, ocular staining, ESSDAI/ESSPRI, ESR, and disease duration – were suggestive, though they did not remain statistically robust after correction.
From a diagnostic standpoint, EDV emerged as the standout metric. In multivariable analysis it was the only independent predictor of disease status, outperforming the other single LGCDUS parameters with an AUC of 0.764, sensitivity of 62.8%, and specificity of 80.8%. Just as importantly for a technique that could move into wider use, inter-observer agreement was good to excellent across all measured parameters, with ICC values above 0.75 and particularly strong reproducibility for PSV and EDV.
This is not yet a practice-changing paper. The study is small, retrospective, and limited to early-stage disease; patients with systemic comorbidities or immunosuppressive therapy were excluded, and the authors could not correlate imaging with lacrimal histopathology. Still, for ophthalmologists managing dry eye, ocular surface disease, and systemic inflammatory overlap, the message is intriguing. LGCDUS may offer a fast, non-invasive way to detect early gland involvement, quantify inflammatory vascular change, and potentially complement – not replace – current Sjögren’s diagnostics. Larger comparative studies against salivary gland ultrasound and established classification tools will determine whether it can move from promising signal to routine screening adjunct.
