September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Allergic Conjunctivitis and Total Ocular Symptom Score
Author Affiliations & Notes
  • Scott Schachter
    Southern California College of Optometry, Pismo Beach, California, United States
    Private Practice, Pismo Beach, California, United States
  • Aubrey Schachter
    Private Practice, Pismo Beach, California, United States
  • Emily James
    Marshall B. Ketchum University, Fullerton, California, United States
  • Milton M Hom
    Private Practice, Azusa, California, United States
  • Footnotes
    Commercial Relationships   Scott Schachter, Allergan (C), Biotissue (C); Aubrey Schachter, None; Emily James, None; Milton Hom, Allergan (F), AMO (F), Bausch and Lomb (F), OptoVue (R), Shire (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 5702. doi:
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      Scott Schachter, Aubrey Schachter, Emily James, Milton M Hom; Allergic Conjunctivitis and Total Ocular Symptom Score. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5702.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Ocular allergy and Meibomian Gland Dysfunction (MGD) have been shown in past studies to be related, and objective signs such as changes in meibomian gland morphology and inflammation have been reported with allergic conjunctivitis (AC). The relationship between subjective AC symptoms and meibomian gland morphology has not been explored. This study explores the correlation between a questionnaire used to evaluate AC, Total Ocular Symptom Score (TOSS), and meibomian gland atrophy.

Methods : 53 consecutive patients ages 7-85 (mean=42, 17 males) were evaluated in a private optometry practice in October and November 2015. Patients completed a TOSS questionnaire and images of their meibomian glands were captured using an Oculus Keratograph. Meibomian gland atrophy was graded using the Pult scale Area of Loss (0: 0% loss, 1: <26% loss, 2: 26-50% loss, 3: 51-75% loss, 4: >75% loss). The correlation between TOSS score and average Pult score was determined using a Pearson correlation.

Results : Our findings indicated that TOSS is correlated with meibomian gland atrophy in patients age 40 and over (r=0.46, p=0.01). For patients under 40 years of age, TOSS had no significant relationship with gland atrophy (r=-0.19, p=0.39). These two correlations were also significantly different (p=0.02). Average TOSS scores between these two groups did not significantly vary (p=0.23), but average grade of atrophy was significantly different (1.16 versus 1.86 in the respective groups, p=0.03).

Conclusions : This data indicates that AC precedes atrophy. We propose that AC causes inflammation and obstruction, and that over time this obstruction leads to atrophy. This delay would explain why TOSS does not correlate with atrophy in younger patients. Although more research must be done to evaluate this pathway, the data does clearly indicate that TOSS can be used as a simple screening tool for meibomian gland atrophy only in patients 40 years of age and older. Other tools must be used to screen for atrophy in patients younger than 40.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.



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