ArticlePDF Available

Tear meniscus measurement in the diagnosis of dry eye

Authors:

Abstract

Assessment of the tear film meniscus is a quantitative, minimally invasive, direct measurement of tear film quantity. The aim of this study was to assess the efficacy of tear meniscus parameter measurement in the diagnosis of dry eye. Tear meniscus radius of curvature, height, width and cross-sectional area (TMC, TMH, TMW, XSA) were determined by photographing an optic section of the inferior tear meniscus (colored with a min volume of fluorescein) at 12 x magnification, and then scanning developed images into a computer analysis program. Fifteen dry eye subjects and 15 age-matched controls were assessed. Dry eye subjects satisfied the criteria of a rose bengal staining score >/= 1, and a mean phenol red thread 15s wetted length </= 10 mm. TMC, TMH and XSA were all reduced in magnitude in the dry eye group compared to the control group (mean +/- SD; TMC: 0.314 +/- 0.160 mm vs. 0.545 +/- 0.259 mm, TMH: 0.244 +/- 0.089 mm vs. 0.461 +/- 00.173 mm, XSA: 0.0082 +/- 0.0048 mm2 vs. 0.0176 +/- 0.0103 mm2, ANOVA, p < 0.05). Both TMC and TMH showed good diagnostic accuracy (166.7% and 160% respectively), with a dry eye referent value of </=0.35 mm for each parameter. TMC and TMH also showed strong correlations with the cotton thread test, non-invasive breakup time, and ocular surface staining scores (p < 0.01). TMH was the most powerful predictor of tear film insufficiency. This study has shown tear meniscus assessment to be a useful alternative to existing tests for dry eye.
... In humans, Mainstone et al. [28] determined that the mean range of TMH was 0.244 ± 0.089 mm in dry eyes and 0.46 ± 0.173 mm in normal eyes and suggested that the diagnostic sensitivity and specificity of the DET was 93.3% and 66.7%, respectively, when the cut-off level of dry eye diagnosis was below 0.35 mm in humans. In the present study, the TMH mean was 0.41 ± 0.21 mm and was consistent with the previous study in humans [28]. ...
... In humans, Mainstone et al. [28] determined that the mean range of TMH was 0.244 ± 0.089 mm in dry eyes and 0.46 ± 0.173 mm in normal eyes and suggested that the diagnostic sensitivity and specificity of the DET was 93.3% and 66.7%, respectively, when the cut-off level of dry eye diagnosis was below 0.35 mm in humans. In the present study, the TMH mean was 0.41 ± 0.21 mm and was consistent with the previous study in humans [28]. Therefore, it is also necessary to determine whether TMH is associated with quantitative KCS in dogs as it is in human patients with DED. ...
... In humans, Mainstone et al. [28] determined that the mean range of TMH was 0.244 ± 0.089 mm in dry eyes and 0.46 ± 0.173 mm in normal eyes and suggested that the diagnostic sensitivity and specificity of the DET was 93.3% and 66.7%, respectively, when the cut-off level of dry eye diagnosis was below 0.35 mm in humans. In the present study, the TMH mean was 0.41 ± 0.21 mm and was consistent with the previous study in humans [28]. ...
... In humans, Mainstone et al. [28] determined that the mean range of TMH was 0.244 ± 0.089 mm in dry eyes and 0.46 ± 0.173 mm in normal eyes and suggested that the diagnostic sensitivity and specificity of the DET was 93.3% and 66.7%, respectively, when the cut-off level of dry eye diagnosis was below 0.35 mm in humans. In the present study, the TMH mean was 0.41 ± 0.21 mm and was consistent with the previous study in humans [28]. Therefore, it is also necessary to determine whether TMH is associated with quantitative KCS in dogs as it is in human patients with DED. ...
Article
Background: Dry eye disease (DED) cannot be diagnosed by a single test because it is a multifactorial disorder of the ocular surface. Although studies on various dry eye tests (DETs) in dogs have been reported, standard criteria have not been established except for the Schirmer tear test 1 (STT-1). Objectives: To establish reference values for DETs in dogs with normal STT-1 values (≥ 15 mm/min) and to analyze the correlation between DETs. Methods: The STT-1 was performed in 10 healthy Beagle dogs (20 eyes). After 20 min, interferometry (IF) for estimating the lipid layer thickness (LLT) of the tear film, tear meniscus height (TMH), non-invasive tear breakup time (NIBUT), and meibomian gland loss rate of the upper eyelid (MGLRU) and lower eyelid (MGLRL), were measured using an ocular surface analyzer. Results: Mean values for STT-1, TMH, and NIBUT were as follows: 21.7 ± 3.4 mm/min, 0.41 ± 0.21 mm, and 19.1 ± 9.5 sec, respectively. The most frequent LLT range, measured by IF, was 30-80 nm (11 eyes), followed by 80 nm (5 eyes) and 80-140 nm (4 eyes). MGLRU ≤ 25% was measured in 11 eyes and 26%-50% in 9 eyes; MGLRL ≤ 25% in 8 eyes and 26%-50% in 12 eyes. Besides positive correlation between TMH and NIBUT (P = 0.038), there were no significant associations between DETs. Conclusions: Data obtained in this study provided normative references that could be useful for diagnosing DED and for further research into correlation between DETs in dogs with DED.
... In the TBUT test the presence of fluorescein in tears may stimulate reflex tearing and give a false resul overcome this limitation, we use non Tear meniscus is a thin strip of tear fluid with concave outer surface at the upper and lower margins. It contains more of exposed tear volume [23] . The absence of tear meniscus height is an indication of dry eye [8] . ...
Article
Full-text available
Background and objectives: The purpose of our study was to determine the effect and compare the changes between safety goggles and face shields on tear film parameters. Methods: The total sample size of our project was 60, which were between two groups of 30 subjects each, group 1 being safety goggles and group 2 of face shields. Baseline measurement of NITBUT and TMH using tearscope was taken and then subjects of group 1 were asked to wear safety goggles for 1 hour and group 2 subjects were asked to wear face shields for 1 hour and measurements of NITBUT and TMH were taken again. Results: TMH and NIBUT mean baseline for both eyes were found to be significantly decreased post use of Safety goggles and Face shield from baseline values (p <0.001).TMH and NIBUT parameters were more effected inthe safety goggle group. Conclusion: Both safety goggles and face shields have shown a significant decrease in values of tear film parameters. In comparison, safety goggles have a greater effect than face shields.
... Several studies have reported that acknowledged tear film volume examinations, including the Schirmer test (ST) without anesthesia, meniscometry, and strip meniscometry (SM), showed good diagnostic power and correlation with other DED parameters. [4][5][6][7][8][9][10][11] However, each inspection method has its own characteristics, so there is no consensus on which method to use as the standard. ...
Article
Full-text available
Purpose: To compare the diagnostic power of strip meniscometry (SM), Schirmer test (ST), and tear meniscus (TM) in mild dry eye disease (DED) and to evaluate the association with DED-related parameters. Methods: Forty left eyes with mild DED and 40 left eyes of control participants were investigated. All participants underwent a comprehensive ocular surface examination, including the Ocular Surface Disease Index (OSDI), fluorescein tear film break-up time (FTBUT), ocular surface staining grades, meiboscores, and tear film volume examinations, including SM, ST, tear meniscus height (TMH), and tear meniscus cross-sectional area (TMA) measurements, respectively, by optical coherence tomography (OCT) and Keratograph 5M (K5M). The correlation between these parameters was evaluated, and the receiver operating characteristic (ROC) curve was used to verify the diagnostic power by the area under the curve (AUC). Results: All tear film volume examinations significantly correlated with DED parameters. Among them, the most relevant factor to OSDI scores and FTBUT was SM. In addition, SM (AUC = 0.992), TMH-OCT (AUC = 0.978), and TMA-OCT (AUC = 0.960) showed better diagnostic power than ST (AUC = 0.650) in DED, in which the cutoff value of SM was 3.5 mm (sensitivity, 97.5%; specificity, 95.0%). Conclusions: Compared with ST, SM and TM parameters obtained by OCT were more relevant to ocular surface parameters and can provide a more valuable approach to discriminate mild DED from control participants. Translational relevance: This study made a comprehensive comparison of the existing tear volume detection methods and provided a basis for the clinical selection of appropriate detection methods and the diagnosis of mild DED.
... It has been reported that the tear meniscus contains 75-90% of the aqueous tear volume, which is positively correlated with the lacrimal secretory rate (36). The meniscus volume is also reported to be reduced in tear-deficient dry eye (37,38). Thus, the quantitative assessment of tear meniscus parameters may be useful in the diagnosis of dry eye disease. ...
Article
Full-text available
Dry eye-related ocular surface examination is very important in the diagnosis and treatment of dry eye disease. With the recent advances in science and technology, dry eye examination techniques have progressed rapidly, which has greatly improved dry eye diagnoses and treatment. However, clinically, confusion remains about which examination to choose, how to ensure the repeatability of the examination, and how to accurately interpret the examination results. In this review, we systematically evaluate previous examinations of dry eye, analyze the latest views and research hotspots, and provide a reference for the diagnosis and management of dry eye.
... Decreased tear meniscus is often a sign of dry eye. Normally, a patient with normal tear production has tear meniscus height of 0.2-0.5 mm; but in patient with dry eye, it is usually less than 0.25 mm or absent [4,14,15,20,21]. ...
Chapter
Full-text available
Dry eye disease (DED) is a multifactorial disease of tears and ocular surface that results in various symptoms with the potential damage to the ocular surface. It can range from mild to severe signs and symptoms and may affect patient’s quality of life. Various techniques and methods have been developed to evaluate DED for initial examination or regular follow up. The simple evaluations that can be performed in clinic include eyelid examination, tear break-up time, and ocular surface stainings; while the advanced ones may require certain devices or laboratory equipment. Careful and thorough examinations are important to guide the clinician to assess and evaluate dry eye.
Chapter
Sjogren’s syndrome (Sicca Syndrome) is mainly characterized by the presence of dry eye disease (DED). The diagnosis of DED in patients with Sjogren’s syndrome has been limited to tests such as the Schirmer test, tear breakup time (TBUT), and corneal stains; however, currently we can evaluate the functional unit in detail lacrimal, which is affected in patients with dry eye and Sjögren’s syndrome; thanks to technology that provides objective details for this difficult diagnostic. The newer evaluations that provide the greatest diagnostic value for Sjogren’s syndrome are: noninvasive keratograph tear rupture time (NIKBUT), tear meniscus height (TMH), Schirmer’s test, meibography, ocular surface disease index (OSDI), Vital stains of the ocular surface, Matrix Metalloproteinase 9 (MMP-9), Tear osmolarity (TearLab); all of these are important complements to the existing tests, which, although less objective, are not substitutable.
Article
Zusammenfassung Die komplexe, multifaktorielle Erkrankung „Trockenes Auge“ erfordert für die Diagnostik mehr als ein einziges Testverfahren inklusive einer subjektiven Fragebogenerhebung. Zudem kam es in den letzten Jahren zu einem Paradigmenwechsel im Verständnis dieser Erkrankung. Dieser erforderte Änderungen in Definition und diagnostischen Strategien und zog die Aktualisierung nationaler und internationaler Leitlinien (DOG/BVA und DEWS II) nach sich.
Article
Zusammenfassung Die komplexe, multifaktorielle Erkrankung „Trockenes Auge“ erfordert für die Diagnostik mehr als ein einziges Testverfahren inklusive einer subjektiven Fragebogenerhebung. Zudem kam es in den letzten Jahren zu einem Paradigmenwechsel im Verständnis dieser Erkrankung. Dieser erforderte Änderungen in Definition und diagnostischen Strategien und zog die Aktualisierung nationaler und internationaler Leitlinien (DOG/BVA und DEWS II) nach sich.
Chapter
Although important advances have been made in many branches of eye therapy over the past 100 years, we still have no fully satisfactory treatment method available to us today as regards keratoconjunctivitis sicca (KCS), generally known as dry eye. The words of the German surgeon August Gottlieb Richter in his Fundamental Background of the Art of Surgery (1790) still apply: “Chronic inflammations of the eye do not necessarily mean that there is a high risk of actually losing this organ, but rather that they are for the most part more difficult to heal than acute forms, as their causes are in most cases very involved, deeply rooted and difficult to discover.”
Article
A variety of tear function tests (rose bengal staining, marginal tear strip, break-up time, Schirmer's test and tear lysozyme) were performed on a group of patients with rheumatoid arthritis. The results obtained with each particular test were compared with present symptoms relating to dry eyes (spontaneous symptoms of: grittiness, dryness, epiphora, discharge and use of ocular medications). Correlations between different tests and symptoms are presented. It is suggested that the diagnosis of dry eyes should be made on the finding of a number of abnormalities of tear function tests rather than on the findings of one test alone.
Examination of the tear film by means of the slitlamp can reveal anomalies in the lipid layer. These variations may relate to contact lens wear and to ocular symptoms in patients not wearing contact lenses.
Article
To investigate the surface structure of precorneal tear film, a bio differential interference microscope for ophthalmological use was newly developed and the photographs of oily layer patterns of tear film was successfully taken. As clinical applications, the following observations were made: Dry spots in tear film. Corneal symptoms. Surfaces of contact lenses on the eye. By the present observations we can obtain many new informations, which can not be attained by the other testing methods.
Article
• In 50 normal subjects, results of kinetics studies of Schirmer's test demonstrated nonlinear wetting with an initial rapid phase of wetting followed by a progressive reduction in rate. This initial rapid phase of wetting indicated a reflex secretion of tears. In the majority of subjects, topical anesthesia with 0.5% proparacaine hydrochloride dampened the initial reflex secretion but could not completely suppress it. The data indicated that Schirmer's test with anesthesia was not capable of measuring a basic tear secretion independent of reflex components.