The Course of Tear Function Parameters and Ocular Surface Morphology in Dry Eye Syndrome

Abstract

Abstract: : Purpose: To assess tear function parameters and ocular surface morphology in the clinical course of patients with dry eye syndrome under treatment in a period of 1 to 7 years. Method: In 88 patients (70 female, 18 male) with ocular discomfort, a clinical diagnosis of dry eye syndrome was made based on typical symptoms, tear film break-up time (BUT), Schirmer`s test without local anaesthesia (Schirmer I), rose bengal staining and impression cytology. Subsequent evaluations revealed a diagnosis of aqueous tear deficiency (ATD) in 9 patients, aqueous tear deficiency associated with Sjoegren`s syndrome (SS-ATD) in 20 patients, meibomian gland dysfunction (MGD) in 31 patients, and aqueous tear deficiency combined with meibomian gland dysfunction (ATD-MGD) in 28 cases. Follow-up assessments were performed 12 to 89 months (median: 39.5 months) after initial diagnosis. BUT, Schirmer I, rose bengal staining, impression cytology as well as subjective dry eye symptoms and frequency of tear substitute application were compared at baseline and at follow-up. Results: At baseline, Schirmer I scores were highly reduced in patients with ATD, SS-ATD, and ATD combined with MGD compared with those patients suffering from MGD. Break-up time and rose bengal staining were significantly pathologic in patients with SS-ATD. There was no statistically significant difference in ocular morphology as observed in impression cytology between groups. No differences in subjective symptoms and frequency of tear substitute application were found. Symptoms were similar among all patients examined but slightly more severe in the patients with Sjoegrens` syndrome. At follow-up, BUT was improved in the ATD, SS-ATD and MGD group, but remained unchanged in the ATD-MGD group. Schirmer I scores were higher in the ATD, SS-ATD and ATD-MGD group, but remained unchanged in the MGD group. Rose bengal staining remained unchanged in all patients. Ocular morphology as observed by impression cytology showed a tendency towards a more pathological picture, but the difference to baseline was not significant in all groups. Subjective symptoms and frequency of artificial tear application were reduced at follow-up. Conclusion: During the observation period of 1 to 7 years, the patients with dry eye syndrome showed no deterioration under appropriate treatment.

Keywords: 376 cornea: tears/tear film/dry eye • 365 conjunctiva • 452 lacrimal gland