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E. Castillanos, J. Torres, I. Fernandez, H. Martinez-Osorio, J. M. Herreras, M. E. Stern, M. Calonge; Preponderance of Evaporative Over Aqueous Deficient-Type Dry Eye Syndrome in Patients With Chronic Dry Eye-Related Symptoms. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2371. doi: https://doi.org/.
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Dry eye (DE)-related symptoms are highly prevalent in adults and often lead to a diagnosis of Dry Eye Syndrome (DES). If DES is not further classified into preferentially evaporative (pEV-DES) or aqueous-deficient (pAD-DES), the assumed diagnosis is usually pAD-DES. This may lead to a misdiagnosis resulting in the wrong treatment. The 1st therapeutic option for pAD-DES, artificial tears, usually fails in the most frequent cause of pEV-DES, meibomian gland disfunction (MGD). In this study, we reviewed the diagnosis of a consecutive series of patients referred with undiagnosed chronic DE-related symptoms.
A retrospective analysis of patients referred with chronic DE-related symptoms was performed. Retrieved data included demographics, elapsed time between onset of symptoms and our final diagnosis (T S-D), the 3 most frequent reported symptoms, chief complaint, meniscus height (MH) , break-up time (BUT), vital dye stainings, Schirmer test (ST), tear lysozyme level (TLL), and conjunctival impression cytology (CIC). When DES was diagnosed, it was subsequently classified into pEV-DES (either due to MGD or other causes) or pAD-DES.
A total of 271 patients (60 males, 211 females) with a mean age of 52.1 (SD 14.5; range, 16-86) years were retrieved. Most patients (84.1%) had no diagnosis at referral; the remaining had a previous diagnosis of possible DES, blepharitis, and/or allergy. T S-D was 56.9 (SD 86.6; range, 6-516) months, and over 12 months in 68.3% of patients. The 3 most frequently reported symptoms were burning, foreign body sensation (FBS), and redness; chief complaint was FBS, regardless of the final diagnosis. Redness-dryness, and eyelid itching-pain were the 2nd-3rd most frequent symptoms in pEV-DES and pAD-DES, respectively. All patients had a final diagnosis of DES: 82.7% pEV-DES (all MGD) and 17.3% pAD-DES (29.8% Sjögren and 70.2% non Sjögren). Allergy, rosacea and rheumatoid arthritis were the most frequently associated diseases. Low TLL was preferentially found in pAD-DES (61.7% vs 15.4%) and was positively correlated with MH, BUT, ST, and normal CIC.
Patients with undiagnosed chronic DE-symptoms were more likely to have a final diagnosis of blepharitis (MGD). The assumption that DE-related symptoms usually correspond to pAD-DES may not be correct. This may also help explain the failure of artificial tears in some patients with DE-related symptoms.
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