July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Lid laxity and Concurrent Signs of Ocular Surface Disease
Author Affiliations & Notes
  • Tracy Doll
    Pacific University College of Optometry, Forest Grove, Oregon, United States
  • Jennifer S Harthan
    Illinois College of Optometry, Chicago, Illinois, United States
  • Scott Schwartz
    Private Practice, Sterling Heights, Michigan, United States
  • Clare Halleran
    Private Practice, Clarenville, Newfoundland, Canada
  • Milton M Hom
    Private Practice, Azusa, California, United States
  • Footnotes
    Commercial Relationships   Tracy Doll, Allergan (C), Shire (C); Jennifer Harthan, Allergan Inc (C), Metro (P), Metro (C), Shire (C), Tangible Science (R); Scott Schwartz, AGN (C), AGN (F), Bausch and Lomb (C), Kala (F), Shire (C), Shire (F), Sun (C); Clare Halleran, Allergan Inc (C), Shire (C); Milton Hom, AGN (C), AGN (F), Bausch and Lomb (C), Kala (F), Shire (C), Shire (F), Sun (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 923. doi:
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    • Get Citation

      Tracy Doll, Jennifer S Harthan, Scott Schwartz, Clare Halleran, Milton M Hom; Lid laxity and Concurrent Signs of Ocular Surface Disease. Invest. Ophthalmol. Vis. Sci. 2018;59(9):923.

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

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Purpose : Lower lid laxity can lead to ocular exposure and subsequent dry eye symptomatology. This study looks at the association between a positive lid snap test for lower eyelid/orbicularis oculi laxity with other signs of concurrent ocular surface disease, including cylindrical dandruff indicative of the presence of Demodex follicularis.

Methods : The lid snap test (LST) for lower eyelid/ orbicularis oculi laxity and the medial canthal laxity test (MCT) were performed on 66 subjects in this multi-center study. The InflammaDry Test for MMP-9 (by Quidel) was conducted on the right eye only all 66, with 33 eyes in the same cohort. All four eyelids of each subject underwent infrared meibography imaging and were examined for the presence of cylindrical dandruff. All subjects were asked to respond to three dry eye symptoms questionnaires, Ocular Surface Index (OSDI), Dry Eye Questionnaire-5 (DEQ-5), as well as one questionnaire for allergic conjunctivitis, the Total Ocular Symptom Score (TOSS).

Results : The Pearson coefficient for the following were found to demonstrate a mild positive relationship: cylindrical dandruff and positive InflammaDry MMP-9 ( r=0.4180, p=0.0005), lid snap and the severity of cylindrical dandruff (r= 0.4120, p=0.0002), lid snap and DEQ-5 (r=0.3100, p=0.0049), and lid snap and TOSS (r=0.4390, p=0.00004).
The Pearson coefficient for the following were found to demonstrate a moderate positive relationship: lid snap and MCT (r=0.5420, p=0.0000004), lid snap and SPEED (r=0.6070, p=0.000000002), lid snap and OSDI (r=0.54753301640, p=0.0000001), lid snap and meibomian gland dropout of upper (r=0.534, p=0.000002) and lower lids (r=0.504, p=0.000006), and lid snap and age (0.6311014032, p=0.0000000007).

Conclusions : The correlation between lid laxity, symptoms, and other signs of dry eye helps to emphasize the importance of investigating these patients for ocular surface disease. Lid laxity may become a helpful tool in the diagnosis of dry eye, and is an important test for patients with dry eye symptoms.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.


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