Potential blindness from nutritional xerophthalmia in autistic patients.

BACKGROUND: Vitamin A is vital to retinal rod function and epithelial cell differentiation. Although uncommon in the developed world, vitamin A deficiency (VAD) secondary to poor diets or gastrointestinal disease has been reported and can lead to xerophthalmia, which is characterized by night blindness and a spectrum of ocular surface changes. Patients with autism spectrum disorder have been shown to have restrictive diets secondary to sensory issues leading to rejection of foods except for those of certain color or texture. METHODS: We present a case series of 6 pediatric patients with autism who developed varying degrees of xerophthalmia due to VAD, which resulted from restrictive eating. RESULTS: All patients presented with a history of eye irritation that was not relieved by antibiotic or allergy eye drops. Further questioning revealed they had restrictive diets consisting of only or mostly white and tan foods, and serum vitamin A testing confirmed severe VAD. Most stages of xerophthalmia were completely reversed with vitamin A supplementation, but in 2 patients more advanced xerophthalmia resulted in irreversible blindness and ocular damage. CONCLUSIONS: Both pediatricians and pediatric eye care providers must be vigilant for VAD as an etiology of eye irritation, photophobia, or new-onset visual impairment in autistic children. A review of the child's diet must be implemented as a standard part of routine history taken in this vulnerable population. Early identification and vitamin A supplementation can prevent irreversible ocular compromise and vision loss.

Recognizing vitamin A deficiency: special considerations in low-prevalence areas.

PURPOSE OF REVIEW: Although vitamin A deficiency (VAD) is rare in well resourced countries, there is a growing trend of VAD in at-risk pediatric populations. Early diagnosis is critically important to prevent its associated morbidity and mortality. This review highlights key lessons for evaluation, diagnosis, and management of children with xerophthalmia in the United States. It synthesizes the latest findings from the literature on the pathophysiology, epidemiology, risk factors, evaluation, and management of VAD in low-prevalence areas. RECENT FINDINGS: Vitamin A is crucial for maintaining the functional integrity of the eye, immune system, skin, and mucous membranes. Despite the scarcity of VAD in developed countries, there are increasing reports of VAD in at-risk children, including those with autism spectrum disorder and gastrointestinal conditions. There is a broad range of manifestations of VAD, posing a diagnostic challenge. Familiarity with the variable presentations of VAD and having a high index of suspicion in at-risk populations can aid in its early diagnosis. Systemic vitamin A supplementation and a multidisciplinary approach are important components of the management of VAD. SUMMARY: Even in well resourced countries, VAD should remain on the differential in patients with risk factors who present with relevant signs and symptoms. Early diagnosis and appropriate involvement of a multidisciplinary care team can help prevent morbidity and mortality associated with VAD.

Astenopia em docentes universitários durante a pandemia da COVID-19 / Asthenopia in college lecturers during the COVID-19 pandemic

RESUMO Objetivo: Avaliar sintomas astenópicos e fatores sociodemográficos, hábitos comportamentais e clínicos nos docentes universitários durante a pandemia da COVID-19. Métodos: Trata-se de estudo transversal que avaliou a ocorrência de astenopia em 104 docentes. Questionários de sintomatologia visual validados foram adaptados para a coleta de dados. Houve comparação dos docentes quanto à ocorrência ou não de sintomas astenópicos, bem como foi aplicada regressão logística binária, para aferir a associação com variáveis independentes (p<0,05). Resultados: Houve maior aparecimento de sintomas astenópicos durante o período pandêmico, em que o tempo de exposição a telas parece ter sido o fator mais determinante. Além disso, os indivíduos com tempo de tela superior a 5 horas diárias, que faziam uso de telas para o lazer e usavam colírio/lubrificantes apresentaram significativamente maior chance de estar no grupo com sintomas astenópicos. Conclusão: Foi identificada associação significativa entre a ocorrência de sintomas astenópicos e o uso de telas durante o período pandêmico, principalmente nos grupos com maior duração do tempo de tela. O estudo chama atenção para a saúde ocular de docentes universitários em ensino remoto, além de suscitar novos estudos para investigação desse quadro em distintos ambientes escolares.

ABSTRACT Objective: To assess asthenopic symptoms and sociodemographic factors, behavioral and clinical aspects in college lecturers during the COVID-19 pandemic. Methods: This is a cross-sectional study evaluating asthenopia in 104 lecturers. Some validated visual symptom questionnaires were adapted for data collection. Lecturers were compared regarding the occurrence or not of asthenopic symptoms, and binary logistic regression was applied to measure the association with independent variables (p<0.05). Results: Asthenopic symptoms occurred more often during the pandemic, when exposure to screens was a determinant factor. The individuals with screen time longer than five hours a day, who used screens for leisure, and who used eye drops/lubricants were significantly more likely to be in the group with asthenopic symptoms. Conclusion: A significant association was identified in occurrence of asthenopic symptoms and screen use during the pandemic period, especially in groups with longer screen time. The study draws attention to the eye health of college lecturers in distance learning, and the need for further research on this situation in different school environments.

The clinical effects of sodium hyaluronate, polyethylene glycol, and dextran-70 eye drops in relieving dry eye after phacoemulsification.

ABSTRACT: To compare the clinical efficacy of sodium hyaluronate eye drops, polyethylene glycol eye drops, and compound dextran eye drops in the treatment of dry eye after phacoemulsification of cataract.A total of 99 patients with dry eye after cataract phacoemulsification combined with intraocular lens implantation were treated in our hospital. Patients were divided into group A (sodium hyaluronate eye drops), group B (polyethylene glycol eye drops), and group C (dextran-70 eye drops). The clinical effect, tear film breakup time, basic tear secretion, corneal staining score, dry eye symptom score, and the incidence of ocular irritation were assessed.On the 3rd, 15th, 30th, and 60th day after operation, the tear film breakup time, corneal staining score, Schirmer I test, and dry eye symptom score in group A and group B were better than those in group C (P < .05). In addition, there were no significant differences in tear breakdown time, corneal staining score, Schirmer I test, and dry eye symptom score between group A and group B (P > .05). At 3 days to 60 days after operation, the incidence of dry eye in group A (12.12%) and group B (18.18%) was lower than that in group C (39.39%), and the incidence of dry eye in group A was significantly lower than that in group B (P < .05).The effect of sodium hyaluronate eye drops elicited a greater beneficial impact as compared to polyethylene glycol eye drops and dextran-70 eye drops.

Long-term results of the treatment of primary hyperhidrosis with oxybutynin: follow-up of 1,658 cases.

BACKGROUND: Hyperhidrosis (HH) is characterized by exaggerated sweating in a specific region due to hyperfunction of the sweat glands. In the late 2000s, we started treating patients with an anticholinergic, oxybutynin, that was not being used until then. OBJECTIVES: To present, after 12 years of utilizing this medication in our service, the substantial experience obtained with the use of oxybutynin as an initial treatment of HH in a large series of 1,658 patients. METHODS: We analyzed 1,658 patients treated with oxybutynin for HH from May 2006 to June 2018. The patients were divided into four groups according to the main site of HH: the plantar group, the axillary group, the facial group, and the palmar group. To measure the degree of satisfaction, a quality of life (QoL) questionnaire was used. RESULTS: Pre-treatment QoL was poor or very poor in more than 94% of the cases, and the palmar group had the worst quality of life. After treatment, we observed an improvement in the quality of life in 77% of patients. More than 70% of the patients in all groups present moderate or optimal subjective clinical improvement in sweating after treatment. The group with the best result was the facial group. Intense dry mouth was reported in 24.9% of all patients in all groups. CONCLUSIONS: This study included a large number of patients followed for a long period and demonstrated the good effectiveness of treatment with oxybutynin for hyperhidrosis in the main sites of sweating.

Dry Eye Disease: Prevalence, Assessment, and Management.

Dry eye disease is a chronic condition of the corneal surface marked by persistent symptoms of irritation or burning that can cause inflammatory damage to the cornea and conjunctiva if untreated. Common risk factors for this syndrome include advancing age, female sex, low humidity environments, systemic medications, and autoimmune disorders. Treatments to relieve symptoms include tear replacement, humidification, improved nutrition, and anti-inflammatory ocular agents. Home healthcare nurses can identify signs and symptoms of dry eye syndrome and initiate strategies that range from warm compresses to physician referrals for more aggressive treatment. Consistent management of this condition improves quality of life and minimizes damage to the ocular surface.

Relation of accommodative microfluctuation with dry eye symptoms in short tear break-up time dry eye.

PURPOSE: To investigate accommodative microfluctuations (AMFs) and visual function in short tear break-up time (BUT)-type dry eye (DE) and non-DE subjects. METHODS: This prospective comparative study included 48 volunteers with DE symptoms (mean age 34.8 ± 5.5 years, age range 25-42 years) and 73 without DE symptoms (mean age 30.6 ± 4.7 years, age range 25-42 years). The eyes were divided into two groups: (1) DE group with DE symptoms and BUT ≤ 5 s and (2) non-DE group without DE symptoms and BUT > 5 s. We excluded eyes with Schirmer score ≤ 5 mm and positive keratoconjunctival epithelial damage. Tear evaluation, AMF, and functional visual acuity (VA) examinations were performed. AMF parameters included total high-frequency component (HFC), HFC with low accommodation for the task of staring into the distance (HFC1), and HFC with high accommodation for deskwork (HFC2). Functional VA parameters included starting VA, functional VA, visual maintenance ratio, and blink frequency. RESULTS: A total of 33 and 34 eyes were categorized in the DE and non-DE groups, respectively. Mean blink frequency and HFC1 values were significantly higher in the DE group than they were in the non-DE group. CONCLUSIONS: DEs with symptoms showed abnormal AMF and visual function, which may be associated with DE symptoms.

Prevalencia de síntomas de enfermedad de la superficie ocular en pacientes que acuden a consulta oftalmológica.

OBJECTIVE: To determine the prevalence of symptoms of ocular surface disease (OSDI) surface disease and its relationship with associated risk factors in patients of ophthalmic practices using OSDI questionnaire. METHOD: A cross-sectional survey was conducted Between September and December 2014 to assess the prevalence and risk factors for OSDI. RESULTS: The OSDI average value was 40.46 ± 23.62 points, with 86.4% of patients (1967) having a OSDI score higher than 12 points. Women had OSDI symptoms more frequently than men (odds ratio: 1.17; 95% confidence interval: 1.08-1.28) and higher OSDI score (42.12 ± 24.03 vs. 38.01 ± 22.81 points). Patients without disease were younger than the patients with severe disease (45.30 ± 18.32 vs. 50.62 ± 18.86). CONCLUSIONS: Ophthalmological patients have a prevalence of 80.4% of OSDI. Female and older age was associated with ocular surface disease.

Subjective and Objective Measures of Dryness Symptoms in Primary Sjögren's Syndrome: Capturing the Discrepancy.

OBJECTIVE: To develop a novel method for capturing the discrepancy between objective tests and subjective dryness symptoms (a sensitivity scale) and to explore predictors of dryness sensitivity. METHODS: Archive data from the UK Primary Sjögren's Syndrome Registry (n = 688) were used. Patients were classified on a scale from -5 (stoical) to +5 (sensitive) depending on the degree of discrepancy between their objective and subjective symptoms classes. Sensitivity scores were correlated with demographic variables, disease-related factors, and symptoms of pain, fatigue, anxiety, and depression. RESULTS: Patients were on average relatively stoical for both types of dryness symptoms (mean ± SD ocular dryness -0.42 ± 2.2 and -1.24 ± 1.6 oral dryness). Twenty-seven percent of patients were classified as sensitive to ocular dryness and 9% to oral dryness. Hierarchical regression analyses identified the strongest predictor of ocular dryness sensitivity to be self-reported pain and that of oral dryness sensitivity to be self-reported fatigue. CONCLUSION: Ocular and oral dryness sensitivity can be classified on a continuous scale. The 2 symptom types are predicted by different variables. A large number of factors remain to be explored that may impact symptom sensitivity in primary Sjögren's syndrome, and the proposed method could be used to identify relatively sensitive and stoical patients for future studies.

Vitamin A deficiency and xerophthalmia in children of a developed country.

AIM: We aim (i) to characterise the clinical features of vitamin A deficiency (VAD) in a small cohort of Australian children; (ii) to determine the effects of VAD; and (iii) to quantify the prevalence of ophthalmic review in this group. METHODS: Data collected from the charts incorporated patient demographics, laboratory results, past medical history, ophthalmic symptoms and dietary history. Outcome measures were (i) occurrence of VAD in our study population; (ii) presence of associated systemic effects and ocular manifestations in those diagnosed with VAD; and (iii) determination of whether children with VAD had an ophthalmology review. RESULTS: Fifty-two of the 146 children had VAD; their average age was 8.4 years (range 11 days to 18 years old). In this Australian cohort, the most common pre-existing medical conditions in those children whose vitamin A status was investigated were cystic fibrosis, gastro-oesophageal reflux disease, micronutrient deficiency and short gut syndrome. The most common medical conditions affecting children with measured VAD in this cohort include autism, coeliac disease and cystic fibrosis. A significant association was found between VAD and anaemia and serum iron levels. Of the 146 children, 28 had ophthalmology review, of whom 13 had VAD. The most common reason for ophthalmology review was retinopathy of prematurity; there was only one referral for review for xerophthalmia. There was one case of xerophthalmia referred due to microbial keratitis. CONCLUSION: Vitamin A deficiency and xerophthalmia do exist in children of developed country. The potential for xerophthalmia should be considered, and there should be a consideration of an ophthalmology review.

The relationship between dry eye and migraine.

Presently, migraine and dry eye are both thought to have an inflammatory pathogenesis. We aimed to investigate dry eye findings and any relationship with headache characteristics in migraine patients with and without aura. In total, 58 migraineurs and 41 age- and gender-matched controls were enrolled in this prospective clinical study. The migraine diagnosis was made according to the International Classification of Headache Disorders II diagnostic criteria. All patients underwent a complete ophthalmologic examination including tear meniscus measurements, meibography, tear breakup time, Schirmer test and the Ocular Surface Disease Index questionnaire. The presence of dry eye was higher in migraineurs as compared to the control group, but this did not reach statistical significance (p = 0.282). Among the headache characteristics, the presence of aura was significantly higher, and disease and attack durations were significantly longer in migraineurs with dry eye than in those without dry eye (p = 0.009, p = 0.010, and p = 0.003, respectively). In multiple logistic regression model, attack duration was found to be independently associated with the presence of dry eye in migraine patients (OR; 95 % CI; p = 0.029). The results show that dry eye may present in migraine patients with greater presence of auras and longer disease and attack durations.

Meibomian gland dysfunction determines the severity of the dry eye conditions in visual display terminal workers.

OBJECTIVE: To explore meibomian gland dysfunction (MGD) may determine the severity of dry eye conditions in visual display terminal (VDT) workers. METHODOLOGY: Prospective, case-control study carried out in China.106 eyes of 53 patients (VDT work time >4 hour per day) were recruited as the Long time VDT group; 80 eyes of 40 control subjects (VDT work time ≤ 4 hour per day) served as the Short time VDT group. A questionnaire of Ocular Surface Disease Index (OSDI) and multiple tests were performed. Three dry eye tests: tear film breakup time (BUT), corneal fluorescein staining, Schirmer I test; and three MGD parameters: lid margin abnormality score, meibum expression assessment (meibum score), and meibomian gland dropout degree (meiboscore) using Keratograph 5 M. PRINCIPAL FINDINGS: OSDI and corneal fluorescein score were significantly higher while BUT was dramatically shorter in the long time VDT group than the short time VDT group. However, the average of Schirmer tear volumes was in normal ranges in both groups. Interestingly, the three MGD parameters were significantly higher in the long time VDT group than the short time one (P<0.0001). When 52 eyes with Schirmer <10 mm and 54 eyes with Schirmer ≥ 10 mm were separated from the long time VDT workers, no significant differences were found between the two subgroups in OSDI, fluorescein staining and BUT, as well as the three MGD parameters. All three MGD parameters were positively correlated with VDT working time (P<0.0001) and fluorescein scores (P<0.0001), inversely correlated with BUT (P<0.05), but not correlated with Schirmer tear volumes in the VDT workers. CONCLUSIONS: Our findings suggest that a malfunction of meibomian glands is associated with dry eye patients in long term VDT workers with higher OSDI scores whereas some of those patients presenting a normal tear volume.

Psychological distress, job dissatisfaction, and somatic symptoms in office workers in 6 non-problem buildings in the Midwest.

BACKGROUND: Researchers examined office worker characteristics and reports of non-specific somatic symptoms in 6 non-problem buildings in the Midwestern United States. METHODS: We assessed office workers for demographic characteristics and somatic symptoms that occurred in the workplace. Sampling was conducted over a 1-week period in each building over 4 seasons. Our team administered the Medical Outcome Survey questionnaire, the Brief Symptom Inventory, and the Job Content Questionnaire to individuals at each site, comparing office workers reporting no symptoms to those reporting ≥4 symptoms. RESULTS: Self-reported nonspecific somatic symptoms were frequent in office workers in non-problem buildings. High symptom levels were associated with younger age, female sex, psychological distress, impaired quality of life, and poor job satisfaction. CONCLUSIONS: The findings suggest that office workers frequently report somatic symptoms they believe are related to the workplace even in buildings considered non-problematic. People with high symptom levels perceived as related to the workplace are psychologically distressed, have impaired quality of life, and feel dissatisfied and powerless in the workplace.

Prevalence and determinants of xerophthalmia in rural children of Uttarpradesh, India.

INTRODUCTION: Vitamin A deficiency (VAD) is recognized as a major cause of blindness among children in India. OBJECTIVE: To find out the prevalence of VAD in rural children of Uttar Pradesh, India. MATERIALS AND METHODS: This cross-sectional study was undertaken amongst children (0-15 years) in a rural area of Bareilly (Uttar Pradesh) where the study population was selected by simple random sampling out of villages under a Primary Health Centre. Out of 844 children, 802 participated in the study. The WHO classification of xerophthalmia was used. RESULTS: Overall, the prevalence of xerophthalmia was 5.4 %. The prevalence of Bitot's spots was 0.9 % in children under six years of age and 3.3 % in children above six years. The prevalence of xerophthalmia was significantly more in older children. Overall, the prevalence of anemia was found to be 11.8 % in the study population. A significantly high prevalence of xerophthalmia (OR= 5.7; 95 % CI = 2.8 - 11.5) was observed in children suffering from anemia. CONCLUSION: The presence of a milder manifestation of xerophthalmia and a 0.9 % prevalence of Bitot's spot in children under six years of age in the present study shows a declining trend of VAD although it is still a public health problem. The higher prevalence in children above six years of age shows that apart from strengthening of Vitamin A prophylaxis programs, health education is needed for dietary diversification to include vegetables and fruits in the diet for long-term sustainability in improving the vitamin A status of children of all age groups.

Vitamin A deficiency control measures: importance of vitamin A supplementation as a public health policy in the Indian context.

Recently prominent nutrition scientists across the world have opposed continuation of vitamin A supplementation (VAS) programmes and recommended gradual phasing out VAS for pre-school children. A few eminent nutrition scientists in India have echoed this view, arguing that vitamin deficiency (VAD) is no longer a public health problem in India. We review the evidence, highlighting the high rates of VAD among pre-school children in India, (clinical, subclinical, and dietary deficiency) and argue that in India VAD remains an immensely important public health problem and it is crucial to strengthen and continue the existing VAS programme in India, and in other developing countries until such time as their children's dietary consumption of vitamin A is improved adequately and blood vitamin A levels reach optimal levels.

The frequency of sicca symptoms and Sjögren's syndrome in patients with systemic sclerosis.

OBJECTIVE: The objectives are to detect the frequency of sicca symptoms and Sjögren's syndrome (SS) in patients with systemic sclerosis (SSc) based on the diagnostic criteria of the American-European Consensus Group (AECG) and to evaluate demographic, clinical and serologic characteristics. PATIENTS AND METHOD: One hundred and eighteen SSc patients referred to our hospital were included in this study. All SSc patients were questioned with respect to sicca symptoms. Levels of rheumatoid factor (RF), anti-nuclear antibodies (ANA), anti-Ro and anti-La antibodies were measured; non-stimulated saliva amounts were recorded and Schirmer test and break-up time were applied to all patients. Minor salivary gland biopsy samples were obtained from those patients giving ≥ 3 positive answers to sicca symptom questions, patients with positive xerostomia/xerophthalmia test results, and patients with at least one antibody being positive. Patients presenting with grade 3 and/or grade 4 sialoadenitis based on Chisholm criteria were considered pathological. RESULTS: Sicca symptoms were present in 84 of 118 patients with SSc (71.2%). Minor salivary gland biopsy samples were obtained from 74 patients. Grade 3 and/or grade 4 sialoadenitis was detected in 40 (33.9%) patients and they were diagnosed with SS. Compared to patients diagnosed with SSc alone, systemic sclerosis patients diagnosed with SS had lower pulmonary hypertension and less diffuse lung involvement. Statistically significant difference was detected in terms of sclerodactylia and telangiectasia between SSc-SS and SSc patient groups (P = 0.045 and P = 0.011, respectively). Serological assessments revealed that in the SSc-SS group, 13 patients were anti-Ro antibody positive, six were anti-La antibody positive and 37 were anti-topoisomerase 1 antibody positive. RF, ANA and anti-centromere antibody levels were higher in the SSc-SS group. CONCLUSION: In the present study, highly frequent sicca symptoms and Sjögren's syndrome based on AECG criteria were noted in patients with systemic sclerosis. The SSc-SS patient group had less severe clinical course and lung involvement.

Prevalence of xerophthalmia among malnourished children in rural Ethiopia.

To assess the prevalence of eye disease among malnourished children in a rural Ethiopian health center and evaluate correlations between xerophthalmia and grades of malnutrition. A retrospective, cross-sectional survey. An institution-based cross-sectional prospective study was performed at Bushulo Health Center in rural south Ethiopia and included all children age 6 months to 14 years receiving care for malnourishment from June 1st to July 30th, 2008. Data collection involved a combination of interviews with caretakers, ocular examination by a pediatric ophthalmologist and anthropometric measurements. One hundred and seventy-three children (average age at examination 2.9 ± 0.2 years) were treated for malnutrition (97 female, 76 male). One hundred and forty-nine patients had moderate malnutrition (86.03 %) and 24 had severe malnutrition (13.9 %). The following eye diseases were diagnosed--trachoma (12.1 %), blepharitis (13.3 %) and xerophthalmia (20.8 %). Severely malnourished children were more likely to suffer from xerophthalmia than moderately malnourished children (p < 0.0001). When comparing anthropometric measurements to the diagnosis of xerophthalmia, only weight percentile showed significance (p = 0.008). Xerophthalmia is a common global cause of pediatric blindness and is highly correlated with severe malnutrition. Continued efforts are necessary to improve nutrition and outcomes in these patients.

Prevalence of vitamin A deficiency in South Asia: causes, outcomes, and possible remedies.

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot's spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stem efforts are needed to address this issue of public-health significance at local and international level in lower- and middle-income countries of South Asia.

Autoimmune rheumatic disease associated symptoms in fibromyalgia patients and their influence on anxiety, depression and somatisation: a comparative study.

OBJECTIVES: In this study we evaluated the frequency of autoimmune rheumatic disease associated major symptoms in fibromyalgia (FM) patients, and the association between their presence and anxiety, depression and somatisation. METHODS: Two hundred and thirty-two FM, 78 systemic lupus erythematosus (SLE) patients and 70 healthy controls were included. All subjects were questioned face-to-face for the presence of autoimmune rheumatic disease-associated symptoms and antinuclear antibody (ANA) was determined. All FM patients were questioned for the severity of pain and symptoms of FM by using a visual analogue scale. In addition, all subjects were interrogated for anxiety, depression, somatic symptoms and neuropathic pain by using different validated questionnaires. RESULTS: FM patients had significantly higher frequency of photosensitivity (27.6% vs. 11.4%) and Raynaud phenomenon (22% vs. 10%) when compared to controls (p-values, 0.005 and 0.026). FM patients had significantly lower frequencies of photosensitivity, oral ulcers, xerostomia, and xerophthalmia than SLE patients (all p-values <0.001). ANA positivity was 11.8% in FM patients and 7.1% in healthy controls. ANA-positive and negative FM patients had similar frequencies of autoimmune rheumatic disease symptoms. FM patients with photosensitivity had higher anxiety (p=0.002), somatic symptoms (p=0.015) and neuropathic pain (p=0.03) scores than others. FM patients with Raynaud had higher anxiety (p=0.004), depression (p=0.001), somatic symptom (p<0.001) and neuropathic pain scores than others. CONCLUSIONS: The presence of which findings in FM seems to be associated with anxiety, depression, and somatization rather than ANA positivity and disease severity.