Abstract
Purpose :
Lid margin collarettes are debris at the base of eyelashes that are associated with Demodex and Staphylococcus, and there is uncertainty about the role of collarettes in ocular surface disease. A secondary analysis of data from the Dry Eye Assessment and Management (DREAM) study was performed to elucidate the impact of lid margin collarettes on dry eye disease (DED) severity.
Methods :
We performed a secondary analysis of data from the DREAM Study, a multicenter, double-blinded clinical trial evaluating the effects of omega-3 vs. placebo on patients with moderate-to-severe DED. At baseline, DED symptoms were evaluated using the Ocular Surface Disease Index (OSDI), and DED signs were assessed using conjunctival staining, corneal staining, tear break-up time (TBUT), Schirmer testing, and meibomian gland dysfunction (MGD). Patient baseline characteristics, DED symptoms, and signs were compared between patients with and without collarettes.
Results :
Of the 535 participants, 196 (36.6%) had collarettes in at least one eye at baseline, including 175 (32.7%) having collarettes in both eyes. 161 (30.1%) had 1-5 collarettes, 45 (8.4%) had 6-20 collarettes, and none had 21-40 or 40+ collarettes. Collarettes were more likely to be present in Whites (83.6% vs. 7.1% in “other races”, p<0.001) and non-Hispanics (92.9% vs 6.6%, p=0.003), and were associated with facial rosacea (26.2% vs. 17.3%, p=0.02) and eyelid margin erythema (24.0% vs. 11.9%, p<0.001). Collarettes were also associated with increased corneal staining, with an odds ratio of 1.07 (p=0.03). However, there were no significant differences in conjunctival staining, tear breakup time, Schirmer’s test, and tear osmolarity. No significant differences in symptoms (OSDI) were noted, though participants with collarettes noted less relief from DED treatment compared to those without collarettes (30.0% vs. 40.0%, p=0.050).
Conclusions :
Collarettes were common in patients with moderate-to-severe DED. The presence of collarettes was associated with eyelid margin erythema, consistent with findings in recent trials. Despite the association with corneal staining, no significant differences in DED symptoms and other signs were noted between the 2 groups. Patients with collarettes experienced less relief from DED treatment, highlighting the possible importance of novel treatments for collarettes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.