Medical Treatment Improves Symptoms but Not Clinical Signs in Patients Suffering Dry Eye Disease (DED)

Abstract

Purpose: : To describe changes in symptoms and signs after therapy in systemically healthy patients referred for dry eye symptoms in which a final diagnosis of dry eye disease (DED) was confirmed.

Methods: : A series of 21 consecutive patients referred with dry eye-related symptoms and not previously treated were recruited. Exclusion criteria were: previous positive ocular history, contact lens wear, systemic disease, and systemic or ocular therapies. Symptoms were assessed by the SODQ and SANDE (Version 2) questionnaires. Clinical signs measured were: bulbar (BH) and limbal hyperemia (LH), tear meniscus height (TMH), phenol red thread test (PRTT), break up time (BUT), corneal fluorescein (FS) and conjunctival rose Bengal (RB) staining, tear lysozyme concentration (TLC), Schirmer test (ST), and lid margin changes. Subjects were re-evaluated after a 2 month-course of aggressive lid hygiene, non-preserved artificial tears, topical unpreserved steroids, and oral doxycicline. Complete improvement was considered when symptoms had improved and no further therapy was required, partial improvement when symptoms decreased but additional therapy was recommended and no improvement when symptoms persisted unhanged.

Results: : SODQ score (12.19±5.43 vs 9.14±4.89) and mean change in SANDE decreased significantly. At firts visit, all tests except BUT (OD 4.19±3.12; OS 3.95±2.64) and lid changes were within normal limits: FS was <1 (scale, 0-5) and RS was<1.5 (scale, 0-5) in all cases. After treatment, lid margin changes and quality of Meibomian gland secretion improved significantly. Although BUT improved (OD 4.86±2.78; OS 4.67±2.56; no significance), it remained abnormal. BH decreased significantly (1.57±0.60 vs 0.71±1.00) although its value at first visit was considered not relevant. After treatment, complete improvement, partial improvement or no improvement was accomplished by 2, 16, and 3 patients, respectively.

Conclusions: : If patients referred for dry-eye like complains with no other ocular or systemic disease are recruited, it is most likely to have symptomatic subjects with normal evaluation tests. Subsequently, efficacy of therapies is difficult to demonstrate other than by symptom improvement. A partial or complete symptomatic improvement was accomplished in 85.7% of these patients.

Keywords: cornea: tears/tear film/dry eye • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • quality of life