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Donald R Korb, Caroline A Blackie, Amy C. Nau; Prevalence of Compromised Lid Seal in Symptomatic Refractory Dry Eye Patients and Asymptomatic Patients. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2696.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Lid seal compromise, which may result in a failure to adequately protect the ocular surface from desiccation during sleep, was first reported in 2015. To assess the prevalence of lid seal compromise, a retrospective, observational study was performed on two populations. 1. Patients with symptomatic refractory dry eye (symptomatic), and 2. Asymptomatic patients (asymptomatic).
Methods: A retrospective analysis of lid seal compromise was performed at a single clinical center on de-identified data from eligible, fully consented, symptomatic refractory dry eye patients (15 males, 31 females, n = 46) and asymptomatic patients (12 males, 38 females, n = 50). Inclusion criteria for both groups: age over 18, normal appearing lids, no lagophthalmos and no history of ocular surgery within past 6 months. Lid seal compromise was assessed using the Korb–Blackie (KB) Light Test and graded on a scale from 0 to 3 where 0 = no visible lid seal compromise and grade 3 = severe lid seal compromise.
Results: There was no significant differences in age or demographic characteristic between the two groups (p >0.5 for all comparisons): symptomatic group 50.9 ± 16.5 years (range = 18 – 80 years), (15 males, 31 females, n = 46; asymptomatic group 51.9 ± 14.3 years (range = 23 –77 years), (12 males, 38 females, n = 50). In the symptomatic group: 20% had grade 0 lid seal compromise, 18% grade 1, 36% grade 2, and 25% grade 3. Over all 61% had moderate to severe compromise. In the asymptomatic group 80% had grade 0 lid seal compromise, 6% grade 1, 6% grade 2, and 8% grade 3. Overall, 14% had moderate to severe compromise. The prevalence of compromised lid seal, grade 1 or higher, was significantly greater in the symptomatic refractory dry eye vs. the asymptomatic group. (Contingency analysis, Chi-square = 72.2, df = 3, alpha <0.05, p < 0.0001)
Conclusions: The prevalence of lid seal compromise in the symptomatic refractory dry eye group was 4 fold greater than for the asymptomatic group. This is the first report of the prevalence of lid seal compromise in a refractory dry eye population. The newly reported condition known as lid seal compromise should be further investigated as a possible primary noxious factor in the etiology of dry eye: chronic exposure to desiccating stress during sleep.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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