Correlations between commonly used objective signs and symptoms for the diagnosis of dry eye disease: clinical implications

Abstract

. Purpose: To evaluate the relationship between signs and symptoms of dry eye disease (DED) in a clinic‐based population. Methods: In a retrospective analysis, clinical signs and symptoms were evaluated for 344 subjects (n = 82, normal; n = 263, dry eye), across 11 sites from the EU and United States. Pearson correlations between signs and symptoms (r2) and an independent components analysis (ICA) mixing matrix were derived from the data set. Similar analysis was performed on an independent data set from 200 subjects in a previous study in Munich, Germany. Results: No correlations above r2 = 0.17 were found between any signs and symptoms, except for corneal and conjunctival staining, which reported an r2 = 0.36. In the multisite study, the average r2 for osmolarity (0.07), tear breakup time (0.12), Schirmer test (0.09), corneal (0.16) and conjunctival staining (0.17), meibomian grading (0.11) and Ocular Surface Disease Index® (0.11) were consistently low. Among patients who showed evidence of DED by consensus of clinical signs, only 57% reported symptoms consistent with a diagnosis of DED. Similar results were observed in the Munich‐based study data set. Each component of the ICA mixing matrix exhibited minimal residual information. Conclusions: No consistent relationship was found between common signs and symptoms of DED. Each type of measurement provides distinct information about the condition of the ocular surface. These results also demonstrate that symptoms alone are insufficient for the diagnosis and management of DED and argue for a consensus of clinical signs that better reflect all aspects of the disease.

Human tear-production rate from closed-eye Schirmer-strip capillary dynamics

“…The proposed procedure is simple and time efficient. Clinical evaluation is necessary to establish its accuracy and usefulness, especially for distinguishing between evaporative dry eye and aqueous-deficient dry eye [28][29][30].…”

“…To provide clinicians with insight into what is actually measured [18][19][20][21][22][23][24][25][26][27][28][29][30], it is essential to understand the physical foundations of STT. Elucidation of the wetting kinetics in a Schirmer strip is particularly important when attempting to obtain quantitative lacrimal-production rates.…”

In vivo detection of clinically non-apparent ocular surface inflammation in patients with meibomian gland dysfunction-associated refractory dry eye symptoms: a pilot study

“…[11][12][13][14][15] Herein, we report for the first time, to our Palpebral conjunctival epithelial immune cell (EIC), palpebral conjunctival stromal immune cell (SIC), and central corneal dendritic cell (DC) densities were measured by two masked observers for both controls (n = 11) and patients (n = 5). Both observers had low bias and high correlation between their measurements for EIC, SIC, and DC.…”

“…Symptom-sign disparity is a well-recognized challenge in the management of DED, as the symptoms remain unexplained by the lack of proportional findings on clinical examination and vice versa. [11][12][13][14][15] To date, the management and treatment of inflammation in MGD have been addressed in the context of clinically apparent inflammation. Here, we employed high-magnification, laser-scanning in vivo confocal microscopy (IVCM) to examine the palpebral conjunctivae and corneas in a series of five such patients with MGD that showed clear improvement on clinical examination following mechanical gland expression, yet had refractory symptoms of ocular discomfort.…”

Effect of chronic anti-glaucoma medications and trabeculectomy on tear osmolarity

“…The lab-on-a-chip system of the instrument consists of a one-time-use test card, which collects 50 Zl of tear sample and analyses it immediately to provide an osmolarity reading. 29 In accordance to the recommendation of the manufacturer and a previous report, 30 three measurements per eye were taken and averaged for analysis. However, only the eye eligible for the study was evaluated.…”