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RAMYA RAVINDRAN, Kalpana Suresh, Varshini Varadaraj; Prevalence of asymptomatic dry eye in patients with Collagen Vascular Diseases in South India. Invest. Ophthalmol. Vis. Sci. 2013;54(15):934.
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Dry Eye Syndrome (DES) is common in patients with collagen vascular disorders. The purpose of this study was to identify asymptomatic DES in patients with collagen vascular disorders in South India. In our part of the world, awareness regarding the implications of late diagnosis is still lacking. The objectives were to identify DES, classify it's severity based on the ocular surface integrity and to delineate the sub set that had not undergone a prior ophthalmic evaluation.
A prospective, cross sectional, non interventional, observational study was conducted in a university hospital. 75 patients diagnosed with various collagen vascular disorders with no ocular complaints from the departments of General medicine, Pediatrics and Rheumatology formed the study group. 75 age and sex matched controls were used for comparison. Patients with local and systemic conditions that contribute to DES were excluded. Schirmer's test, TBUT and rose bengal (RB) staining were performed and scored according to the Van Bijsterveld scoring system. History of their last ophthalmic visit was noted. The Mann Whitney U test was used for statistical analysis.
In our study we noticed a female preponderance (64%). Post diagnosis with collagen vascular disorders, 76% of the patients had not undergone an ophthalmic examination. 30.66% of the patients in the study group had an abnormal Schirmers test compared to 12% of the controls (p<0.001). 81.33% of the study group had an abnormal TBUT which was the commonest deranged test in our study versus 8% of the controls(p<0.0001). A RB staining score of > 3 was seen in 52.67% of the study group and 6% of the controls (p<0.0001) .Severe DES as identified by a RB staining score of 7-9 was seen only in the study group (11.33%). Overall dry eye was present in 84% of the study group versus 20% of the controls (p<0.0001).
We noticed a statistically significant difference between the study and the control group, proving that the presence of DES was considerably higher than presumed in these patients. We also noticed that a visit to an Ophthalmologist was a rarity in these patients as they had no ocular symptoms. This large referral gap between the primary care physician and the Ophthalmologist is yet to be bridged. It is of utmost significance for the primary care physician to be aware of asymptomatic DES for timely referral to prevent possible complications.
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