Comparison of diagnostic tests in distinct well-defined diseases related to dry eye syndrome

Abstract

Purpose: The aim of this study was to describe and compare signs and symptoms of dry eye syndrome (DES) and ocular surface disorder in six well-defined and non-overlapping diseases.

Methods: A spontaneous and continuous sample of patients with Sjogren’s syndrome (SS) (n=27) , GVHD (n=30), Graves orbitopathy (n=28), facial palsy (n=8), diabetes (n=14) and under chronic glaucoma treatment (CGT) (n=20) were enrolled. Evaluation consisted of a comprehensive protocol encompassing: (1) structured questionnaire - Ocular Surface Disease Index (OSDI); (2) tear osmolarity (TearLab Osmolarity System-Ocusense); (3) tear film break-up time (TBUT); (4) fluoresceine and lissamine staining; (5) Schirmer test; (6) severity grading.

Results: One hundred twenty-seven patients (aged 48.8 years-old±14.1, male:female ratio=0.46) were enrolled in the study, along with 24 age and gender matched controls. In all six groups, significant diferences in the studied parameters were observed comparing individual patients and controls. OSDI was higher in SS, facial palsy and GVHD patients (all P < 0.05). Fluoresceine and lissamine staining was higher in SS and GVHD patients (P<0.05), who also presented the lowest TBUT and Schirmer test. Graves orbitopathy and patients under chronic glaucoma treatment presented tear instability (low TBUT) but staining and Schirmer test were close to normal. Tear osmolarity in mOsmos/L was consistently higher in diabetes (318.6±15.9), SS (316.0±23.1) and GHVD patients (310.7±18.3) compared to controls (295.3±7.8) (p<0.0001).

Conclusions: DES is a complex condition, in which no single test is a sole indicator. Herein, we have described a comprehensive set of diagnostic tools that could allow a more detailed evaluation of DES in several distinct conditions.

Keywords: 486 cornea: tears/tear film/dry eye