The Association Between Subjective and Objective Parameters for the Assessment of Dry-Eye Syndrome

Schmidl, Doreen; Witkowska, K.; Kaya, Semira; Baar, Carina; Faatz, Henrik; Nepp, Johannes; Unterhuber, Angelika; Werkmeister, René M.; Garhöfer, Gerhard; Schmetterer, Leopold

doi:10.1167/iovs.14-15814

Cited by 53 publications

(35 citation statements)

References 37 publications

(24 reference statements)

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“…The absence of clear associations between clinical signs and perceived symptoms among patients with DED is well known; thus, a substantial fraction of early/mild DE patients remain undiagnosed at the clinic, if the combination of non‐invasive assessments is not applied . Alternatively, signs in borderline patients, which are exposed to environmental and occupational risk factors, reverse in the absence of exposures, for example low RH or modified behavior.…”

Section: Resultsmentioning

confidence: 99%

External eye symptoms in indoor environments

Wolkoff

2016

Indoor Air

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Eye irritation, for example dry or irritated eyes, is generally among top three reported symptoms in office-like environments, in particular among workplaces with cognitive demanding visual display unit (VDU) work. The symptoms are especially among middle and advanced ages and particularly among women more than men. The symptoms are also among the most commonly reported complaints in the eye clinic. To be in a position to interpret the high prevalence of eye symptoms, a multidisciplinary and integrated approach is necessary that involves the external eye physiology (separate from internal eye effects), eye diseases (evaporative dry eye (DE), aqueous-deficient DE, and gland dysfunctions), and risk factors that aggravate the stability of precorneal tear film (PTF) resulting in hyperosmolarity and initiation of inflammatory reactions. Indoor environmental, occupational and personal risk factors may aggravate the PTF stability; factors such as age, contact lenses, cosmetics, diet, draft, gender, low humidity and high temperature, medication, outdoor and combustion pollutants, and VDU work.Psychological stressors may further influence the reporting behavior of eye symptoms.The impact of the risk factors may occur in a combined and exacerbating manner. The symptoms are also among the most commonly reported complaints in the eye clinic, 8 and dry eye disease (DED) is the most common cause of chronic eye irritation in patients over age of 50. 9,10 These external symptoms, as opposed to internal symptoms such as tired or strained eyes (asthenopia) as already described by Dante in 1304-1307, 11 are categorized as dry eye (DE)-like symptoms.12 The symptoms are especially among middle and advanced ages throughout the world and expected to increase due to visually highly demanding workplaces increase continuously and so does the average age of the workforce.Indoor air pollution and low relative humidity (RH) have been proposed to explain the external DE symptoms; furthermore, a number of occupational and personal risk factors have been suggested to exacerbate the symptom reporting. 13 For instance, high ozone concentrations, especially in aircraft, have been proposed to initiate both gas (homogeneous) and surface (heterogeneous) reactions with reactive substances to produce a complex host of gas-and particle-phase products, for example formaldehyde. 14-16 The key question in search of causality for DE symptoms in office workers is how important indoor air pollution is in comparison with occupational, environmental, and personal risk factors. For instance, reported DE symptoms among young and middle-aged Japanese office workers were significantly higher among those with clinically diagnosed DED (12%) than in those with probable (54%) or undiagnosed DED (34%);

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Section: Resultsmentioning

confidence: 99%

External eye symptoms in indoor environments

Wolkoff

2016

Indoor Air

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“…Beside the imaging anterior segment's morphology and vasculature, UHR-OCT was shown to be capable of resolving the pre-corneal tear film [18,35,36] and to provide tear film thickness maps [37] of the central cornea, which gives the technology a potential for diagnosis and treatment monitoring in dry eye diseases [38,39]. Furthermore, the assessment of the OCT reflectance provided super-resolved visualization of the tear film lipid layer [40].…”

Section: Introductionmentioning

confidence: 99%

Ultrahigh-resolution OCT imaging of the human cornea

Werkmeister¹,

Sapeta²,

Schmidl³

et al. 2017

Biomed. Opt. Express

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We present imaging of corneal pathologies using optical coherence tomography (OCT) with high resolution. To this end, an ultrahigh-resolution spectral domain OCT (UHR-OCT) system based on a broad bandwidth Ti:sapphire laser is employed. With a central wavelength of 800 nm, the imaging device allows to acquire OCT data at the central, paracentral and peripheral cornea as well as the limbal region with 1.2 µm x 20 µm (axial x lateral) resolution at a rate of 140 000 A-scans/s. Structures of the anterior segment of the eye, not accessible with commercial OCT systems, are visualized. These include corneal nerves, limbal palisades of Vogt as well as several corneal pathologies. Cases such as keratoconus and Fuchs's endothelial dystrophy as well as infectious changes caused by diseases like Acanthamoeba keratitis and scarring after herpetic keratitis are presented. We also demonstrate the applicability of our system to visualize epithelial erosion and intracorneal foreign body after corneal trauma as well as chemical burns. Finally, results after Descemet's membrane endothelial keratoplasty (DMEK) are imaged. These clinical cases show the potential of UHR-OCT to help in clinical decision-making and follow-up. Our results and experience indicate that UHR-OCT of the cornea is a promising technique for the use in clinical practice, but can also help to gain novel insight in the physiology and pathophysiology of the human cornea.

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“…In fact, several reports show a discrepancy between subjectively reported DE symptoms and objectively measured clinical signs. [8][9][10][11] What, in addition to tear stability, causes the provocation of DE symptoms in short-BUT DE?Rosenthal et al 12,13 described the concept of the corneal pain system in the context of neuropathic pain associated with DE disease. We hypothesized that DE symptoms might be provoked in cases featuring alteration of corneal sensitivity in addition to tear instability.…”

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confidence: 99%

Relationship of Corneal Pain Sensitivity With Dry Eye Symptoms in Dry Eye With Short Tear Break-Up Time

Kaido

Kawashima

Ishida

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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Citation: Kaido M, Kawashima M, Ishida R, Tsubota K. Relationship of corneal pain sensitivity with dry eye symptoms in dry eye with short tear break-up time. Invest Ophthalmol Vis Sci. 2016;57:914-919. DOI:10.1167/ iovs.15-18447 PURPOSE. The purpose of this prospective comparative study was to investigate corneal sensitivity in subjects with unstable tear film, with and without dry eye (DE) symptoms.METHODS. Forty-one eyes of 41 volunteers (mean age: 45.1 6 9.4 years; age range, 23-57 years), with normal tear function and ocular surface except for tear stability, were studied. The eyes were divided into two groups depending on the presence or absence of DE symptoms: 21 eyes with DE symptoms (symptomatic group); and 20 eyes without DE symptoms (asymptomatic group). Three types of corneal sensitivity values were measured using a Cochet-Bonnet esthesiometer: the sensitivity for perception of touch (S-touch), the sensitivity for blinking (S-blink), and the sensitivity for pain (S-pain).RESULTS. Mean S-blink and S-pain were significantly higher in the symptomatic group than in the asymptomatic group (P < 0.05), whereas there was no significant difference in mean Stouch between these groups (P > 0.05).CONCLUSIONS. Corneal sensitivity for blinking and pain evoked by increased stimuli was higher in the symptomatic group (subjects with short break-up time DE) compared with subjects who have no DE symptoms despite decreased tear stability. The presence of both tear instability and hyperesthesia, rather than tear instability alone, may contribute to DE pathogenesis.Keywords: corneal sensitivity, dry eye, hyperesthesia, tear break-up time, tear film T he tear film is an interface between the eye and the outside world, maintaining the health and function of the ocular surface. It protects the optical surface against dryness and maintains corneal smoothness under conditions of environmental stress. Blinking plays an important role in the wettability of the ocular surface.1 Disruption of the tear film between blinks results in reduced wettability and eventually causes dry eye (DE).Short tear break-up time (BUT) DE is characterized by tear film instability and the presence of DE symptoms. 2,3 Although short-BUT DE leads to severe DE symptoms similar to aqueous tear-deficient DE, 2,4 it is sometimes regarded as a mild or borderline case of DE because there is little or no corneal damage. This type of DE has shown high prevalence among office workers in recent decades, rising in parallel with the diffusion of electronic devices in our highly technological and information-oriented society. [5][6][7] On the other hand, we often encounter people who have a decreased BUT value but no DE symptoms, suggesting that a decreased BUT value alone is not sufficient to induce subjective DE symptoms. In fact, several reports show a discrepancy between subjectively reported DE symptoms and objectively measured clinical signs. [8][9][10][11] What, in addition to tear stability, causes the provocation of DE symptoms in short-BUT DE?Rosenthal ...

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The Association Between Subjective and Objective Parameters for the Assessment of Dry-Eye Syndrome

Cited by 53 publications

References 37 publications

External eye symptoms in indoor environments

External eye symptoms in indoor environments

Ultrahigh-resolution OCT imaging of the human cornea

Relationship of Corneal Pain Sensitivity With Dry Eye Symptoms in Dry Eye With Short Tear Break-Up Time

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