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Norihiko Yokoi, Shigeru Kinoshita, Rieko Sakai, Georgi A. Georgiev, Anthony J. Bron, John M. Tiffany; A Comparative Study between Short Breakup Time Dry Eye and Other Disorders Giving Rise to a Short Breakup. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3854. doi: https://doi.org/.
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Short breakup time dry eye (SBUTDE) is a disorder which is characterized by a short fluorescein breakup time (FBUT) and severe ocular symptoms. SBUTDE does not generally accompany tear deficiency and produces minimal ocular surface damage. In this study, various ocular-surface examinations were performed on SBUTDE and eyes with a reduced FBUT (≤5 sec.) due to other causes (abnormal BUT - ABUT).
Thirteen eyes from 13 SBUTDE subjects [age: 51.3±12.8 (mean±SD) yrs.] and 33 eyes from 33 ABUT subjects (age: 52.9±13.8 yrs.) were compared. All enrolled subjects had no meibomian gland dysfunction. Examinations were performed on study eyes in the order of least to most invasive as follows: 1) measurement of the radius (R) of the lower, central tear meniscus by meniscometry, 2) measurement of the initial velocity of the tear film lipid layer (TFLL) spread [H’(0), mm/sec.] using a cross-correlation method and the rheological Voigt model, 3) measurement of the non-invasive BUT (NIBUT), in seconds with a video-interferometer (DR-1TM; Kowa Co. Ltd., Japan), 4) measurement of the FBUT, 5) evaluation of epithelial damage by summing the scores for punctate fluorescein staining on the cornea and conjunctiva [OSED score; scores: from 0 (none) to 9 (most severe)], and 6) the Schirmer 1 test (ST1). The results from both groups were then compared and discriminant analysis was performed using logistic regression.
Examined values (SBUTDE; ABUT) were R (0.23±0.08; 0.21±0.09), H’(0) (6.5±2.8; 3.3±3.1), NIBUT (4.4±2.0; 4.7±3.7), FBUT(1.5±1.2; 2.1±1.5), OSED score (0.92±1.2; 3.8±3.3), and ST1 (19.5±13.3; 7.9±8.7). Significant differences were found between the two groups in H’(0), OSED score, and ST1 (p<.005). Discriminant analysis showed that error rate for discrimination was 4.3% (proportion of right answers: 95.7%) [Linear discriminant function: 1.3x(NIBUT)-0.86xH’(0)+0.98xOSED score-3.2].
SBUTDE may be differentially diagnosed from ABUT based on examinations including H’(0), NIBUT, and OSED score. In SBUTDE, H’(0) is greater and OSED score is lesser than those in ABUT
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