Evaluation of Maximum Blink Interval for the detection of Dry Eye Cases with Discrepancy between Subjective symptoms and Corneal Findings

Abstract

Purpose : Purpose: Dry eye cases sometimes present with a notable discrepancy between subjective symptoms and corneal findings, which can often be a diagnostic dilemma. Maximum blink interval (MBI), which encapsulates both one’s subjective sensation and corneal physiology, may help aid in dry eye diagnosis with aforementioned atypical presentations. This retrospective observational study aims to elucidate the characteristics of dry eye cases with such symptom and exam finding discrepancies by MBI.

Methods : Methods: Patients who visited Juntendo University Hospital from October 2017 to August 2022 without a history of cataract surgery were included. Positive dry eye symptoms (DES) was defined as Japanese version of the Ocular Surface Disease Index (J-OSDI, 0–100 points) total score ≥ 13 points. Similarly, positive corneal epithelial damage (CED) was defined as corneal fluorescein staining (CFS, 0-9 points) score ≥ 3 points. Patients were divided into two groups with four subgroups: DES(+)CED(-) and DES(-)CED(+) constituted the discrepancy group, while DES(-)CED(-) and DES(+)CED(+) constituted the non-discrepancy group. The characteristics of each group were compared. Logistic regression analysis was performed to assess the relationship between the discrepancy and factors such as age, gender, tear film breakup time (BUT), tear secretion volume (Schirmer’s test), and MBI.

Results : Results: Of 364 patients (mean age 56.2 ± 16.0 years, 313 female [86.0%]), 136 had DES(+)CED(-) discrepancy and 42 had DES(-)CED(+) discrepancy. Compared to the DES(-)CED(-) group, the DES(+)CED(-) group had a significantly shorter MBI (14.6 ± 8.2 s vs. 10.9 ± 6.8 s; P = 0.003). Compared to the DES(+)CED(+) group, the DES(-)CED(+) group showed a significantly longer MBI (9.6 ± 5.8 s vs. 12.2 ± 9.6 s; P = 0.011). No significant differences were observed in BUT and tear secretion volume. A significant association between MBI and symptom/finding discrepancy was seen on logistic regression analysis comparing DES(-)CED(-) and DES(+)CED(-) groups (odds ratio [95% CI]; 0.858 [0.802-0.918], P < 0.001), as well as the DES(+)CED(+) and DES(-)CED(+) groups (0.919 [0.861-0.981], P = 0.011).

Conclusions : Conclusions: MBI may be a useful clinical tool in dry eye diagnosis, particularly for atypical presentations of dry eye with a high discrepancy between observed clinical findings and subjective symptoms.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.