Decrease in Corneal Sensitivity and Change in Tear Function in Dry Eye

Xu, Ke Ping; Yagi, Yukiko; Tsubota, Kazuo

doi:10.1097/00003226-199605000-00002

Cited by 181 publications

(149 citation statements)

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“…Results from the present study demonstrated a reduction of both these parameters in the SS-I patients with statistically significant differences vs the two other groups. In the SS-I patients, the chronic presence of inflammation caused by the lymphocytic infiltration of the lachrymal gland reduces tear secretion and corneal sensitivity, 31 as also found by others 32 and supported by morphological findings. 33 A reduced tear secretion, consequent to reduced corneal sensitivity, could also be in relation with an impairment in the parasympathetic control of lachrymal gland, as demonstrated in other exocrine gland, 34,35 as a consequence of the presence of anti M3 muscarinic receptors 36 independently from the concurrent presence of anti-SSA and anti-SSB, 37 as it has been demonstrated in an animal model.…”

Section: Eyesupporting

confidence: 73%

Diagnostic performance of tear function tests in Sjogren's syndrome patients

Versura

Frigato

Cellini

et al. 2006

Eye

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Objective To evaluate the diagnostic performance of the tests included in primary Sjogren's syndrome (SS-I) diagnostic criteria (Schirmer I, break-up time, vital dye staining) and to compare them with other examinations related to the ocular surface status. Methods Clinical and cytological data were collected from 177 patients (62 SS-1, 56 non-SS autoimmune diseases, 59 Sicca syndrome). Tear tests included: a validated questionnaire on symptoms, Schirmer I, Jones test, Ferning test, BUT, corneal aesthesiometry, tear clearance test, lissamine green staining, impression conjunctival cytology. Data were statistically evaluated and sensitivity, specificity, likelihood ratio (LR þ ), receiveroperating characteristics (ROC) curves were calculated for each test. Results Data showed a poor diagnostic performance of Schirmer test I (sensitivity 0.42; specificity 0.76; LR þ 1.75) and BUT (sensitivity 0.92; specificity 0.17; LR þ 1.11) (area under the curve in ROC analysis o0.58). Validated subjective symptoms questionnaire (sensitivity 0.89; specificity 0.72; LR þ 3.18), Jones test (sensitivity 0.60; specificity 0.88; LR þ 5), corneal aesthesiometry (sensitivity 0.80; specificity 0.67; LR þ 2.42), and tear clearance test (sensitivity 0.63; specificity 0.84; LR þ 3.93), all exhibited a high diagnostic performance (area under the curve in the ROC analysis always 40.70). Lissamine green staining exhibited the best performance (sensitivity 0.63; specificity 0.89; LR þ 5.72) but the result could be distorted by an incorporation bias. Conclusions Our data suggest to implement the items for ocular signs and symptoms contained in many SS-I diagnostic criteria with the use of a validated questionnaire, performance of Jones test, corneal aesthesiometry measurement, and tear clearance rate evaluation.

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Section: Eyesupporting

confidence: 73%

Diagnostic performance of tear function tests in Sjogren's syndrome patients

Versura

Frigato

Cellini

et al. 2006

Eye

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“…11 Xe-Ping Xu and associates demonstrated decreased corneal sensitivity in dry eye patients. 5 They thought that decreased corneal sensitivity is related to disturbance of the ocular surface integrity. In this study, increased staining was correlated with decreased corneal sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, increased staining was correlated with decreased corneal sensitivity. 5 Sensory nerves may adapt to a irritation by decreasing the frequency and intensity of action potentials. Prolonged irritation of the cornea may elevate the pain threshold, and stronger stimuli is needed to evoke corneal sensation.…”

Section: Discussionmentioning

confidence: 99%

“…The filament is applied perpendicularly to the central cornea. 5 Corneal sensitivity was measured before the Schirmer and dye tests.…”

Section: Measurement Of Corneal Sensitivitymentioning

confidence: 99%

“…5 However, whether corneal hypoaesthesia is associated with morphological changes of corneal nerves in dry eye patients is not known.…”

Section: Introductionmentioning

confidence: 99%

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Morphology of corneal nerves and corneal sensation in dry eye: a preliminary study

Hoşal

Örnek

Zílelíoğlu

et al. 2004

Eye

113

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Purpose To evaluate the corneal sensitivity and nerve morphology in dry eyes. Methods A total of 32 eyes of 16 patients (10 Sjogren's syndrome and six non-Sjogren's syndrome) and 19 eyes of 10 age-matched controls were studied. Sensitivity of the central cornea was measured by the Cochet-Bonnet aesthesiometer. The morphology of corneal nerves was studied by in vivo confocal microscopy (ConfoScan 2.0, Fortune Technologies Srl, Vigonza (PD), Italy). Sub-basal epithelial nerve plexus, subepithelial nerve plexus, and stromal nerves were localized and evaluated for the number of nerves, thickness, reflectivity, and tortuosity for each frame. Results The mean corneal sensitivity of dry eye patients (5.6 mm/grs/S) was found significantly lower than that of the control (5.0 mm/grs/S) group (Po0.01). Although the subepithelial nerves were thicker in dry eyes (mean: 6.3871.18 lm) than control eyes (mean: 5.7271.27 lm), this difference was not significant (P40.05). Conclusion Decreased corneal sensitivity is not associated with morphological changes of corneal nerves in dry eyes.

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Correlation of the Schirmer 1 and Fluorescein Clearance Tests With the Severity of Corneal Epithelial and Eyelid Disease

Macrı́¹

2000

Arch Ophthalmol

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Objective: To evaluate the correlations of the fluorescein clearance test (FCT) and the Schirmer 1 test with the severity of corneal epithelial and eyelid disease in normal patients and patients with tear film disorders due to meibomian gland disease (MGD) and/or aqueous tear deficiency (ATD).Methods: Nineteen normal control subjects, 16 patients with MGD associated with rosacea, 21 patients with noninflammatory atrophic MGD, and 43 patients with ATD were enrolled. There was a similar age and sex distribution in each group. Each patient completed a symptom severity questionnaire that consisted of 11 questions and then underwent a panel of diagnostic tests in the following order: assessment of corneal and conjunctiva sensation with the Cochet-Bonnet esthesiometer, FCT, assessment of corneal fluorescein staining, Schirmer 1 test (5 minutes without anesthesia), and biomicroscopic examination of the eyelid margins and meibomian glands. The FCT was performed with a fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus. By studying the best area under the receiver operating characteristic curves, we developed a formula that combined the FCT and Schirmer test results, which we termed the FCT corrected by Schirmer test. Results:The FCT showed stronger correlation with ocular irritation symptoms (r=0.35, P Ͻ.001), corneal fluorescein staining (r=0.54, PϽ.001), and meibomian gland and eyelid pathologic signs than the Schirmer 1 test. A correction factor that was based on the best area under the receiver operating characteristic curves, added to the FCT score, improved its correlation with ocular irritation symptoms, eyelid margin and meibomian gland pathologic signs, and ocular surface sensitivity scores.Conclusions: Corneal epithelial disease is correlated with decreased aqueous tear production and delayed tear clearance, whereas eyelid and MGD are correlated with delayed tear clearance. The FCT corrected by Schirmer 1 test improves the correlations of the FCT with ocular irritation symptoms, corneal epithelial and eyelid pathologic signs, and corneal and conjunctival sensitivity for patients with MGD and ATD.

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Decrease in Corneal Sensitivity and Change in Tear Function in Dry Eye

Cited by 181 publications

References 0 publications

Diagnostic performance of tear function tests in Sjogren's syndrome patients

Diagnostic performance of tear function tests in Sjogren's syndrome patients

Morphology of corneal nerves and corneal sensation in dry eye: a preliminary study

Correlation of the Schirmer 1 and Fluorescein Clearance Tests With the Severity of Corneal Epithelial and Eyelid Disease

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