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[Clinical characteristics of patients with dry eye syndrome]
Abstract
To learn the clinical characteristics of patients with dry eye syndrome.
The following items were recorded in 115 patients (229 eyes) with dry eye, including symptoms, causation, systematic diseases, slit-lamp examination, tear break-up time, basal and reflex Schirmer's test, vital staining (fluorescent and rose bangle) and meibomian gland dysfunction examination. Rheumatoid factor and auto-antibody detection were performed in Sjögren's syndrome suspected patients.
Aqueous tear deficiency (ATD, 48.7%) ranked the most common type, followed by over-evaporation dry eye (34.8%), mixed type (13.9%) and conjunctivochalasis (3.5%). In all the causes of the dry eye, about 11.3% had Sjögren syndrome (SS). Females suffering from dry eye were more than males, especially SS. Dryness was the most common symptom (84.0%), especially in ATD patients, then followed by ocular fatigue (72.0%), foreign body sensation (64.0%) and impairment of vision (56.0%). The ocular irritation was more severe in meibomain gland dysfunction (MGD) patients than in ATD patients. Among the results of tear break-up time (BUT), rose bangle (Rb) staining and fluorescent (Fl) staining in all types of dry eye, significant relationship was found among them, especially between Rb and Fl score (r = 0.612, P = 0.000). SS patients had much more severe abnormality in all the four signs than non-SS aqueous tear deficiency (NSTD) and MGD patients. However, in the comparisons of BUT, Rb and Fl between NSTD and MGD patients, there were no significant differences.
Symptoms combined with examinations of BUT, Schirmer's test, Fl and Rb staining and meibomian gland function are the necessary means to diagnose most of the dry eye patients.
... Esta prueba se realiza midiendo la cantidad de humedad de un papel filtro (Whatman N°1) de 5 mm de ancho y 35 mm de longitud, previa instilación de una gota de tetracaína al 5% para bloquear el lagrimeo reflejo. 10,14 Se estima que el resultado normal es ≥10 mm con anestesia. Entre 5 mm y 10 mm, representa un resultado limítrofe; menor de 5 mm sugiere la existencia de una alteración en la secreción lagrimal. ...
... Algunos autores sugieren que el punto de corte entre lo normal y lo anormal es de 6 mm. 7,14,15 Tamaño del menisco lagrimal: Es un signo básico que orienta a sospechar la patología de ojo seco. El menisco lagrimal debe ser uniforme y abundante, siendo en condiciones normales de aproximadamente 1 mm de alto. ...
... 7,15 Este parámetro clínico siempre se encuentra alterado en pacientes con QCS. 14,17 Medición de la integridad de la película lagrimal: La tinción con verde de lisamina o rosa de Bengala es la prueba más sensible para indicar gravedad de la QCS. Estas tinciones tienen especial afinidad por las células muertas o desvitalizadas, así como áreas de la superficie ocular desprovistas de mucina. ...
... Esta prueba se realiza midiendo la cantidad de humedad de un papel filtro (Whatman N°1) de 5 mm de ancho y 35 mm de longitud, previa instilación de una gota de tetracaína al 5% para bloquear el lagrimeo reflejo. 10,14 Se estima que el resultado normal es ≥10 mm con anestesia. Entre 5 mm y 10 mm, representa un resultado limítrofe; menor de 5 mm sugiere la existencia de una alteración en la secreción lagrimal. ...
... Algunos autores sugieren que el punto de corte entre lo normal y lo anormal es de 6 mm. 7,14,15 Tamaño del menisco lagrimal: Es un signo básico que orienta a sospechar la patología de ojo seco. El menisco lagrimal debe ser uniforme y abundante, siendo en condiciones normales de aproximadamente 1 mm de alto. ...
... 7,15 Este parámetro clínico siempre se encuentra alterado en pacientes con QCS. 14,17 Medición de la integridad de la película lagrimal: La tinción con verde de lisamina o rosa de Bengala es la prueba más sensible para indicar gravedad de la QCS. Estas tinciones tienen especial afinidad por las células muertas o desvitalizadas, así como áreas de la superficie ocular desprovistas de mucina. ...
Introducción: El síndrome de Sjögren (SS) es una enferme-dad multisistémica, caracteri-zada por queratoconjuntivitis sicca (QCS). Los grados de sequedad ocular no se corre-lacionan con el curso clínico de la enfermedad, por lo que resulta necesario conocer si existen factores que se rela-cionen con el grado de seve-ridad. Método: Se incluyeron 80 pacientes con SS, seguidos durante ≥ tres meses con exa-men oftalmológico completo y serologías, clasificados en QCS severa y no severa. Se compararon los resultados ◗ Abstract Objective: Sjögren syndrome (SS) is a multisystemic di-sease characterized by kera-toconjunctivitis sicca (KCS). There is no correlation bet-ween dry eye severity and the clinical course of the di-sease. It is relevant to know if there are factors that con-tribute to the severity to the disease. Method: A total of 80 pa-tients with SS, follow up at 3 months with complete eye examinations and labora-tory test were included. We classified KCS as severe and non severe. During this re-search we compared clinical Correspondencia: Dr. Alejandro Rodríguez-García. Río San Juan no. 103 (1er piso) Col. Miravalle, Monterrey, N.L. 64660. Teléfonos: (81) 8356 1878 y 1884, Fax. (81) 8356 1799. Correo electrónico: arodri@itesm.mx
... [10][11][12][13][14][15] In clinic based studies and likewise using different definitions, MGD prevalence estimates range from 32% to 78% (Table 2). [16][17][18][19][20][21][22][23][24] Risk factors for MG have also been described in the above studies and include older age, male gender, high diastolic blood pressure, and certain medications (angiotensin II receptor blockers, isotretinoin). 5 Despite this, there are still many gaps in the literature regarding the epidemiology of MGD. ...
... We found that MGD is a frequent finding in an elderly, predominantly male population. Our frequency of 59% is within the range reported in other clinic based studies [15][16][17][18][19] (Table 2). Differences in MGD definition, however, make comparisons between studies difficult. ...
Purpose:
To study the epidemiology of meibomian gland (MG) dysfunction in an elderly, predominantly male population.
Methods:
Prospective study of 233 subjects seen in the Miami Veterans Affairs eye clinic. Patients underwent a complete ocular surface examination, including dry eye questionnaires and tear assessments (osmolarity, tear breakup time, corneal staining, Schirmer test). The main outcome measures were correlations between MG parameters and demographics, dry eye symptoms, and tear parameters. The studied MG parameters were eyelid vascularity and meibum quality; a score ≥2 for either parameter was considered abnormal.
Results:
Mean age of the 233 subjects was 63 years (SD = 11); 91% were male and 59% had at least 1 abnormal MG parameter (abnormal quality 55%; vascularity 17%). Demographically, patients with abnormal MG parameters were significantly older than their counterparts without these findings. Whites were more likely to have abnormal eyelid vascularity compared with blacks [n = 36 (31%) vs. n = 1 (1%), P < 0.0005] but no differences were noted between races with respect to meibum quality. Abnormal meibum quality, but not abnormal vascularity, was significantly associated with more severe dry eye symptoms. Similarly, abnormal meibum quality, but not eyelid vascularity, was significantly associated with worse dry eye signs, including decreased tear breakup time and increased corneal staining (P < 0.05 for all).
Conclusions:
MG dysfunction is a frequent finding in an elderly, predominantly male population with racial differences noted in the frequency of abnormal eyelid vascularity but not in MG quality. Abnormal meibum quality was significantly associated with more severe dry eye symptoms and signs.
... Meibomian gland dysfunction is one of the most common and complex causes for dry eye symptoms and signs [1][2][3][4][5][6][7][8][9][10][11][12]. Normal Meibomian gland secretion has been postulated through integration of both continuous secretion and the action of lid muscles surrounding gland orifices at the lid margins [13,14]. ...
Purpose:
To estimate the prevalence of Meibomian gland dysfunction (MGD) and determine the associated factors in the general population in Iran.
Methods:
This cross-sectional study is based on the data from the second phase of the Shahroud Eye Cohort Study conducted in 2014. Of the 4737 participants of the second phase, data was available for 4700 people; their mean age was 55.9±6.2 years and 2768 (58.9%) were women. Diagnosis of MGD was made based on the classification of the International Workshop on MGD as judged by the examining ophthalmologist. The prevalence of MGD was summarized as percentage and 95% confidence intervals (CI), and related factors were studied through simple and multiple logistic regressions.
Results:
The diagnosis of MGD in at least one eye was recorded for 1235 (26.3%) participants; the prevalence of unilateral and bilateral MGD was 26.3% (95% CI: 24.5-28.1) and 26.1% (95% CI: 24.3-27.9), respectively. In the multiple logistic regression analyses, MGD significantly correlated with pinguecula [odds ratio (OR)=1.3, 95% CI: 1.12-1.50], hypertension (OR=1.34, 95% CI: 1.11-1.61), high-density lipoprotein (HDL) level (OR=0.0992, 95% CI: 0.986-0.999), diabetes mellitus (OR=0.83, 95% CI: 0.71-0.97), and years of education (OR=0.98, 95% CI: 0.96-0.99).
Conclusions:
MGD prevalence in this study was lower than the rates reported in other studies on Asian populations. Besides HDL level, MGD is associated with another ocular surface disorder, namely pinguecula, as well as certain systemic diseases such as hypertension and diabetes mellitus. These associations should be taken into consideration when diagnosing MGD.
Purpose. Although comfort is important for contact lens wearers, common clinical tests can fail to predict patients' symptoms. Lid wiper epithehopathy (LWE) and lid parallel conjunctival folds (LIPCOF) are related to dry eye symptoms in lens wearers. This study investigates the predictive value of EWE and LIPCOF as objective measures of discomfort, and their relation to the ocular surface in soft contact lens wearers. Methods. Subjects were classified as symptomatic or asymptomatic, using the Contact Lens Dry Eye Questionnaire (CLDEQ). Pre-lens tear break-Up time (PLBUT), limbal and bulbar hyperaemia, corneal staining, EWE and LIPCOF were assessed in the right eyes of 61 (23 M, 38 F; mean age 32.1 years; range - 18 to 55) experienced contact lens wearers. Differences between groups, and relationships between LWE, LIPCOF (nasal, temporal and sum) and objective signs were examined using non-parametric analyses. The positive and negative predictive values for symptoms of each objective measure were calculated. Results. Thirty eight subjects were classified as asymptomatic, 23 symptomatic. LWE and LIPCOF severity scores were significantly increased in symptomatic patients (U-lest, p < 0.03), while no significant differences were found between groups for PLBUT, corneal staining or hyperaemia (0.29 < p < 0.88). Significant positive correlations were found between LWE and LIPCOF scores (temporal r = 0.67, p < 0.001; nasal r = 0.39, p < 0.001), and between I-WE and hyperaemia (bulbar, r = 0.28, p < 0.001; limbal r - 0.36, p < 0.001). Age and gender were different in the two groups (p < 0.05). The predictive value of temporal LIPCOF was positive = 56.9%, negative = 77.1% with a Cutoff value of >= 2 (PPV/NPV/cutoff value), of nasal LIPCOF 70.7%/75.0%/>= 1, of LIPCOF Sum 79.8%/86.5%/>= 2, and of LWE 53.1%/81.1%/>= 1 Conclusions. Contact lens wearers with dryness symptoms exhibit significantly more EWE and LIPCOF, but 1101 increased corneal staining, bulbar hyperaemia or decreased PLBUT. LWE and LIPCOF are significantly correlated: this may reflect their common frictional origin. LIPCOF Sum severity scores appear to be most predictive for symptoms. (Optom Vis Sci 2008;85:924-929)
Objective: To study both qualitative identification and localization of sex hormone receptors in meibomian glands and Zeis glands in healthy human. Methods: By means of immunohistochemical technique and the method stained by DAB, a qualitative identification and localization of estrogen receptors (ER), progesterone receptors (PR) and androgen receptors (AR) were performed to reveal the expression in epithelial cell of meibomian glands and Zeis glands. Results: Meibomian glands and Zeis glands in fetus of 4 months were positive in ER, PR, AR; Meibomian glands and Zeis glands from children to adult were positive in ER and AR. Each of receptor was located on cell membrane, and in plasma and nuclear. Analyses of fisher test showed no statistically significant different in ER expression between the age groups (P > 0.05). It has statistically significant difference in PR expression between the age groups studied (P < 0.05) and no statistically significant difference in AR expression of meibomian glands between the age groups (P > 0.05), AR expression in Zeis glands between the age groups studied(P < 0.05). ER, PR, AR expression in sex groups of the fetus and in ER, AR expression in sex groups from children to adult(P > 0.05). Conclusion: Meibomian glands and Zeis glands in fetus of 4 months expressed in ER, PR, AR; ER and AR are expressed from children to adult, mainly in ER. All of receptors are located on membrane, in plasma and nuclear as well.
AIM: To evaluate the relationship between clinical tests (traditional and new) [lid-wiper epitheliopathy (LWE), lid-parallel conjunctival folds (LIPCOF)] and dry eye symptoms after 3mo of phacoemulsification. The combination of these tests can improve predictive ability for the development of dry eye symptoms. METHEDS: Tear film was monitored in 43 patients (43 eyes) afterphacoemulsification. A new clinical test was used to evaluate the dry eye symptoms after surgery. Tear meniscus height (TMH), LIPCOF, phenol red thread test (PRTT), corneal and conjunctival staining and LWE grades were observed. The results were analyzed by using SPSS 19.0. Symptoms were assessed by using the ocular surface disease index (OSDI). RESULTS: LWE was significantly correlated to nasal nasal and temporal side LIPCOF (P<0.05). LIPCOF and LWE were significantly correlated to NIBUT and PRTT (P<0.01). Significant correlations were found between TMH and PRTT (P<0.01). OSDI scores were significantly correlated to TMH, PRTT, LIPCOF and LWE (P<0.05). Significant discriminators of OSDI+/- were nasal LIPCOF [area under the receiver operating characteristic curve (AUC) (0.803), TMH (0.706), PRTT (0.755), LIPCOF (temporal/sum, 0.725/0.763) and LWE (0.727), etc]. Best predictive ability was achieved by nasal LIPCOF. CONCLUSION: The individual tests TMH, PRTT, LIPCOF and LWE were significantly but moderately related to OSDI scores.
• AIM: To investigate the quality of life (QL) of dry eye patients with sjögren syndrome (SS). • METHODS: A total of 42 SS patients with dry eye were surveyed by using SF-36 and SQOL-DVI. • RESULTS: For SS dry eye patients, total QL related to health decreased, especially on role limitation due to physical problem (RP), role limitation due to emotional problem (RE), general health (GH) and social functioning (SF) of SF-36. So did in SQOL-DVI. • CONCLUSION: Compared to other types of dry eye, QL of SS dry eye reduced obviously. Clinical physicians should pay much attention to the social psychology conditions of SS dry eye patients and the related treatments, treat individually according to the cause, then provide the basis for evaluating the effects of different treatments on QL of patients with SS dry eye.
Objective
To explore a proper acupuncture treatment protocol for dry eye syndrome (DES), by comparing the therapeutic effects between ordinary acupuncture and electroacupuncture (EA).
Methods
Forty-seven eligible subjects with DES were randomized into an acupuncture group (n=23) and an EA group (n=24). With the same acupoint formula, the acupuncture group was treated with ordinary acupuncture, and the EA group was treated with ordinary acupuncture plus electrical stimulation. After a treatment course, eye symptom score, Schirmer I test (SIT), Break-up Time (BUT) of tear film, Corneal Fluorescein Staining (CFS), and Visual Analogue Scale (VAS) were adopted in evaluation and comparison of the two groups.
Results
The total effective rate was 79.2% in the EA group versus 56.5% in the acupuncture group, and the difference was statistically significant (P<0.05). After treatment, both groups had marked improvements in eye symptom score, SIT, BUT, CFS, and VAS values (P<0.001); the EA group was better than acupuncture group in improving eye symptom score and SIT value (both P<0.05); the differences were insignificant in comparing VAS, BUT and CFS results between the two groups (P>0.05).
Conclusion
Both EA and ordinary acupuncture are effective in treating DES, but EA is better than ordinary acupuncture in improving eye symptom and SIT score.
Purpose:
To investigate the expression of mucin and inflammatory factors in the conjunctival epithelium of subjects with dry eye and determine a correlation between clinical laboratory tests and subjective symptoms.
Methods:
The ocular surface disease index questionnaire, corneal fluorescein staining, tear film breakup time, and Schirmer I tests were administered in 66 subjects. According to questionnaire scores, the subjects were divided into mild, moderate, and severe symptom groups. Then, the subjects were divided based on the clinical tests into negative and positive groups. Impression cytology specimens from all patients were immunolabeled with antibodies directed against human mucin 5AC (MUC5AC) and interleukin-6 (IL-6) and the staining density was measured.
Results:
MUC5AC was lower in the severe symptom group compared with the mild and moderate symptom groups (P < 0.001, respectively). IL-6 was higher in the severe symptom group compared with the mild and moderate symptom groups (P < 0.001, respectively), and also in the moderate symptom group compared with the mild symptom group (P < 0.001). A decrease of MUC5AC was found in the positive group compared with the negative group (P < 0.001). IL-6 was higher in the positive group compared with the negative group (P = 0.029). MUC5AC was negatively correlated with the ocular surface disease index scores (r = -0.697, P < 0.001), whereas IL-6 positively correlated the scores (r = 0.895, P < 0.001). There were weak correlations for MUC5AC and IL-6 with tear film breakup time (r = 0.158 and r = -0.195, respectively; P = 0.038 and P = 0.041, respectively), and no correlations with other clinical tests.
Conclusions:
Dry eye disease is associated with decreased levels of mucin and an overexpression of IL-6, which correlate to the symptomatic severity of disease.
Scientists have been interested in studying the secretions of the meibomian glands for many years, 1– 8 and diseases associated with the meibomian glands (e.g., cancers, posterior blepharitis) have been noted in the medical literature since at least the early part of the 20th Century. 9 –13 However, the term “meibomian gland dysfunction” (MGD) was only introduced by Korb and Henriquez in 1980. 14 The terminology “meibomian gland disease” was later introduced by Bron et al. 15 as an umbrella term to indicate any disease affecting the meibomian glands (see Definition and Classification). Although the etiology of MGD may differ from that of aqueous-deficient dry eye disease (which is due to insufficient lacrimal gland production), the two conditions share many clinical features, including symptoms of ocular surface irritation and visual fluctuation, altered tear film stability, and potential ocular surface compromise. When MGD is of sufficient degree, it may give rise to the second major subtype of dry eye disease, evaporative dry eye. 16 These subtypes are not mutually exclusive, as has been acknowledged. 16
To evaluate (i) the relationship between traditional and new clinical tests (lid-wiper epitheliopathy (LWE), lid-parallel conjunctival folds (LIPCOF)) and dry eye symptoms in non-contact lens wearers, and (ii) that a combination of these tests can improve predictive ability for the development of dry eye symptoms.
Tear meniscus height (TMH), non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test (PRTT), corneal and conjunctival staining, and LWE grades were observed in a cohort of 47 healthy, non-lens wearers (male=17, female=30, median age=35 years, range=19-70). Symptoms were assessed using the Ocular Surface Disease Index (OSDI).
LWE was significantly correlated to both temporal and nasal LIPCOF (0.537<r<0.607, P<0.05). LIPCOF and LWE were significantly correlated to NIBUT and PRTT (r > -0.248, P < 0.001). Significant correlations were found between NIBUT and TMH (r=0.461, P=0.001) and PRTT (r = 0.640, P < 0.001). OSDI scores were significant correlated to NIBUT, TMH, PRTT, LIPCOF, and LWE (r>∣0.31∣; P<0.05). Significant discriminators of OSDI+/- were NIBUT (area under the receiver operative characteristic curve (AUC)=0.895), TMH (0.715), PRTT (0.781), LIPCOF (temporal/nasal/Sum 0.748/0.828/0.816), and LWE (0.749). Best predictive ability was achieved by combining NIBUT with nasal LIPCOF (AUC=0.944).
The individual tests NIBUT, TMH, PRTT, LIPCOF, and LWE were significantly, but moderately, related to OSDI scores. The strongest relationship appeared by combining NIBUT with nasal LIPCOF.
Although comfort is important for contact lens wearers, common clinical tests can fail to predict patients' symptoms. Lid wiper epitheliopathy (LWE) and lid parallel conjunctival folds (LIPCOF) are related to dry eye symptoms in lens wearers. This study investigates the predictive value of LWE and LIPCOF as objective measures of discomfort, and their relation to the ocular surface in soft contact lens wearers.
Subjects were classified as symptomatic or asymptomatic, using the Contact Lens Dry Eye Questionnaire (CLDEQ). Pre-lens tear break-up time (PLBUT), limbal and bulbar hyperaemia, corneal staining, LWE and LIPCOF were assessed in the right eyes of 61 (23 M, 38 F; mean age 32.1 years; range = 18 to 55) experienced contact lens wearers. Differences between groups, and relationships between LWE, LIPCOF (nasal, temporal and sum) and objective signs were examined using non-parametric analyses. The positive and negative predictive values for symptoms of each objective measure were calculated.
Thirty eight subjects were classified as asymptomatic, 23 symptomatic. LWE and LIPCOF severity scores were significantly increased in symptomatic patients (U-test, p < 0.03), while no significant differences were found between groups for PLBUT, corneal staining or hyperaemia (0.29 < p < 0.88). Significant positive correlations were found between LWE and LIPCOF scores (temporal r = 0.67, p < 0.001; nasal r = 0.39, p < 0.001), and between LWE and hyperaemia (bulbar, r = 0.28, p < 0.001; limbal r = 0.36, p < 0.001). Age and gender were different in the two groups (p < 0.05). The predictive value of temporal LIPCOF was positive = 56.9%, negative = 77.1% with a cutoff value of > or =2 (PPV/NPV/cutoff value), of nasal LIPCOF 70.7%/75.0%/> or =1, of LIPCOF Sum 79.8%/86.5%/> or =2, and of LWE 53.1%/81.1%/> or =1.
Contact lens wearers with dryness symptoms exhibit significantly more LWE and LIPCOF, but not increased corneal staining, bulbar hyperaemia or decreased PLBUT. LWE and LIPCOF are significantly correlated: this may reflect their common frictional origin. LIPCOF Sum severity scores appear to be most predictive for symptoms.
To compare the prevalence and severity of dry eye in patients with rheumatoid arthritis (RA) with that in age- and sex-matched controls in the Indian population.
A cross-sectional study was performed on 84 randomly selected eyes of 84 adult patients with well-documented rheumatoid arthritis and 84 eyes of 84 age- and sex-matched controls in the Department of Ophthalmology, Seth G.S. Medical College and K.E.M. Hospital. McMonnie's dry eye questionnaire was used to classify the patients on the basis of their symptoms. Dry eye was diagnosed if the wetting on Schirmer filter paper test was < or =5 mm at 5 minutes and the tear film breakup time was < 10 seconds on slit-lamp examination after fluorescein staining.
Twenty three patients (27.3%) with rheumatoid arthritis had dry eyes based on the Schirmer test as compared to 10 (12%) age- and sex-matched controls; 19 (22.62%) patients with RA had a tear film breakup time of < 10 sec. on slit-lamp examination, compared to 8 (9.52%) patients without RA. The difference in the mean wetting (p = 0.003) and mean tear film breakup time (p < 0.001) between RA and non-RA patients was statistically significant. Ocular symptoms had a limited correlation with the results of these tests.
Patients with RA in the Indian population have a significantly higher prevalence and severity of dry eye when compared to age- and sex-matched controls.
The tear film lipid layer is the major barrier to evaporation from the ocular surface. A decrease in its thickness or functional integrity may cause evaporative dry eye (EDE). Obstructive meibomian gland dysfunction (MGD) is the most common cause of EDE and occurs as a primary disorder or secondary to acne rosacea, seborrheic or atopic dermatitis, and with cicatrizing conjunctival disorders, such as trachoma, erythema multiforme, and cicatricial pemphigoid. MGD may be an incidental finding in asymptomatic eyes, or it may be responsible for irritative lid symptoms in the absence of dry eye. MGD-dependent EDE is diagnosed on the basis of a defined degree of MGD in a symptomatic patient showing typical ocular surface damage in the absence of an aqueous tear deficiency. When MGD occurs in a background of aqueous tear deficiency (ATD), then an additional evaporative component may assumed, depending on the extent of meibomian obstruction. However, definitive criteria are not yet established. The clinical severity of dry eye is greatest when ATD and EDE occur together, particularly in Sjogren syndrome. A hypothesis is proposed to explain the steps leading to primary, simple MGD and subsequent EDE.
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