Photorefractive keratectomy for patients with preoperative low Schirmer test value

Purpose

To compare dry eye signs and symptoms between patients with preoperative low and normal Schirmer test after Photorefractive keratectomy (PRK).

Methods

In this prospective, nonrandomized, comparative case series, 76 eyes of 76 patients were preoperatively categorized into two groups according to selected criteria for characterization of tear film status: the low Schirmer test value (STV) group and the normal STV group. For the tear function assessment, we performed a Schirmer test with and without anesthesia, tear break-up time (TBUT) test, and measurement dry eye symptoms using the Farsi translation of Ocular Surface Disease Index (OSDI) questionnaire pre- and 3 months post-operation.

Results

Postoperatively, the Schirmer and TBUT values were significantly lower in both groups than preoperatively (all p < 0.05). Deterioration in tear secretion was significantly greater in the low STV group (p = 0.012), but tear stability was more compromised in the normal STV group (p = 0.021). The changes in OSDI score were not significant between the two groups.

Conclusion

These results demonstrated that tear function deteriorates after PRK. Therefore, patients with low preoperative Schirmer test values should be thoroughly assessed for dry eye before proceeding with refractive surgery to eliminate postoperative complication.

Reduced ocular surface disease index (OSDI) scores in patients with isotretinoin treatment

To evaluate the changes in ocular surface and functions of tear-film in patients treated with systemic isotretinoin, to assess diagnostic performance of ocular surface disease index (OSDI) test in the dry eye conditions in association with the use of isotretinoin, and to determine the correlation between all tear-film function tests, OSDI and the dose and duration of isotretinoin administration. One hundred and twenty eyes of 60 subjects treated with oral isotretinoin were enrolled. All patients underwent ophthalmic examination at the baseline and another examination during the course of treatment. Biomicroscopic ophthalmic examination of the meibomian glands, non-anesthetized Schirmer test, and tear film break-up time (BUT) were performed. Subjective ocular complaints were scored with an OSDI questionnaire. Average Schirmer scores were not significantly changed by isotretinoin treatment. There were significant differences in the average OSDI score, the average meibomian gland disease (MGD) grade and average BUT value of both eyes during the treatment compared with baseline values (p < 0.01). There was a statistically significant inverse correlation between MGD grade and BUT value. There was no significant correlation between BUT value, OSDI score, Schirmer score, MGD grade, the total and divided dose of isotretinoin and the duration of treatment. The follow-up time was 4.01 ± 1.3 months (range 1.5-6 months). Systemic isotretinoin treatment can cause alterations in the tear film and dry eye symptoms. The OSDI test can be used as a diagnostic test for patients receiving systemic isotretinoin treatment.

Lower Lid Laxity is Negatively Correlated with Improvement of the Ocular Surface Disease Index in Dry Eye Treatment

PURPOSE

To compare the responses to dry eye treatment of patients sorted by the degree of lower lid laxity.

METHODS

Sixty patients were grouped into three groups according to the degree of lower lid laxity. Tear break-up time (TBUT), Schirmer test (ST) scores, ocular surface disease index (OSDI) scores, and changes in OSDI score in each group were compared, before and at 3 months after treatment.

RESULTS

TBUT, ST, and OSDI scores were not different among the three groups at baseline. TBUT improved in each group at 3 months after treatment, and no differences between groups were found. ST scores were not increased after treatment, while OSDI were improved to 22.57 ± 5.243, 31.16 ± 11.353, and 37.85 ± 13.342 in the no, moderate, and high laxity groups, respectively; these improvements were statistically significant (p = 0.003, <0.001, <0.001, respectively). Patients with greater than moderate lower lid laxity saw the smallest improvement in response to dry eye treatment, as assessed by change in OSDI score (p = 0.005 versus moderate laxity group, p = 0.005 versus no laxity group).

CONCLUSIONS

Lower lid laxity is one of the factors contributing to the responses to dry eye treatment assessed by change in OSDI score, independent of TBUT and ST scores.

Validity of subjective assessment as screening tool for dry eye disease and its association with clinical tests

AIM

To determine the role of subjective assessment using McMonnies dry eye questionnaire in diagnosing dry eye disease and its association with clinical tests.

METHODS

There were 500 patients screened for dry eye using McMonnies dry eye questionnaire between May to October 2013 at the outpatient Department of Ophthalmology of a medical college hospital. All 500 patients were subjected to clinical tests. Dry eye was defined as having one or more symptoms often or all the time. Positive signs were if one or both eyes revealed tear film breakup time (TBUT) of ≤10s, a Schirmer test score of ≤10 mm, a Rose Bengal staining score of ≥1, a Lissamine green staining score of ≥1 or existence of meibomian gland disease (≥grade 1). Statistical analysis was performed to describe the distribution of symptoms and signs, to assess the correlations between McMonnies score (MS) and variable clinical signs of dry eye, and to explore the association between dry eye symptoms and variable clinical signs. Analysis was performed using software package Epi info. A Probability (P) value using Chi-square test of <0.005 was taken as significant.

RESULTS

Dry eye prevalence with symptoms (questionnaire), Schirmer test, TBUT, Rose Bengal staining and Lissamine green staining was 25.6%, 15.20%, 20.80%, 23.60%, and 22.60% respectively. Among those with severe symptoms (MS>20), 75.86% had a low TBUT (<10s), 58.62% had a low Schirmer's I test (≤10 mm), 86.20% had Rose Bengal staining score of ≥1, 79.31% had Lissamine green staining score of ≥1. We found statistically significant associations between positive Schirmer test and arthritis (P<0.002), dryness elsewhere (P<0.001), contact lens use (P<0.002), systemic medication (P<0.0001), sleeping with eyes partly open (P<0.002), history of dry eyes treatment (P<0.0001), environmental factors (P<0.001), swimming (P<0.001).

CONCLUSION

Subjective assessment plays an important role in diagnosing dry eye disease. There is strong correlation between MS and Schirmer test, TBUT, Rose Bengal staining and Lissamine green staining in normal as well as marginal and pathological dry eye.

Tear function in patients with chronic renal failure undergoing hemodialysis

OBJECTIVES

To evaluate dry eye symptoms and clinical tear film alterations in patients with chronic renal failure (CRF).

MATERIALS AND METHODS

Thirty-five non-diabetic CRF patients undergoing hemodialysis, and 31 healthy individuals were enrolled. An ocular surface disease index questionnaire (OSDI) was administered, and after a complete ocular examination, Schirmer and tear break-up time (TBUT) tests were performed.

RESULTS

OSDI scores were significantly higher (p<0.01) and TBUT tests were significantly lower (p=0.01) in CRF patients than in the control group. Schirmer test results were also lower in the CRF patients group, but lacked statistical significance (p=0.20).

CONCLUSION

Patients with CRF should be advised to obtain an ophthalmic examination, especially for dry eye.

Ocular surface changes following botulinum toxin injection for strabismus

CONTEXT

Botulinum toxin injection is widely used for many purposes, including neuromuscular diseases, movement disorders and strabismus.

OBJECTIVE

To evaluate and report the impact of botulinum toxin injection on ocular surface parameters in patients with strabismus.

PARTICIPANTS

Twenty-six consecutive patients who underwent botulinum toxin A injection for ocular misalignment were recruited for this prospective study.

MATERIALS AND METHODS

Testing of ocular surface parameters including tear break-up time (BUT), lissamine green (LG) staining and Schirmer test (under topical anesthesia) was performed, and Ocular Surface Disease Index (OSDI) questionnaire scores were recorded before and at certain time points after injection (one week, two weeks, one month, three months and six months after botulinum toxin A injection). Two-way analysis of variance (ANOVA) with repeated measures, Friedman's test and Wilcoxon test were used for statistical analysis.

RESULTS

Twenty six patients (15 eso- and 11 exo-deviations) with a mean age of 32.46 ± 14.41 (17-65) years were recruited for the study. All injections were performed in one eye. The mean amount of deviation at near and distance reduced after injection. The change of BUT, LG staining and OSDI scores was found to be significant during follow-up in treated eyes (p = 0.001, p = 0.007 and p = 0.009, respectively) whereas the change was insignificant for the Schirmer test results (p = 0.266).

CONCLUSIONS

The ocular surface parameters appear to be altered by botulinum toxin injection in strabismic patients. Even though these effects seemed to be temporary, the findings of the present study support the notion of botulinum toxin effects on ocular surface parameters.

A field test of Web-based screening for dry eye disease to enhance awareness of eye problems among general Internet users: a latent strategy to promote health

Background

A Web-based self-check system including a brief questionnaire would seem to be a suitable tool for rapid disease screening.

Objective

The purpose of this preliminary study was to test a Web-based self-screening questionnaire for drawing attention to dry eye disease among general Internet users and identifying those with a higher risk of developing the condition.

Methods

A survey website was launched and used to recruit participants from general Internet users. In the first phase, volunteers were asked to complete a Web-based self-screening questionnaire containing 12 questions on dry eye symptoms. The second phase focused on the respondents who reported five or more dry eye symptoms and expressed their intention to seek medical attention. These participants performed the Schirmer test, for evaluating tear production, and completed a paper-based lifestyle questionnaire to provide relevant background data.

Results

Of the 1689 visitors to the website, 980 (58.0%) volunteers completed the Web-based self-screening questionnaire. Among these, 355 (36.2%) respondents reported five or more dry eye symptoms. Then, 99 (27.9%) of the symptomatic participants performed the Schirmer test and completed the paper-based lifestyle questionnaire. Out of these, 32 (32.2%) had abnormal tear production (≤5 mm).

Conclusions

The proposed Web-based self-screening questionnaire seems to be a promising tool for raising awareness of dry eye disease among general Internet users and identifying those with a higher risk of developing the condition, although further research is needed to validate its effectiveness.

An evaluation of dry eye symptoms and signs in a cohort of children with juvenile idiopathic arthritis

OBJECTIVE

To determine the prevalence of dry eye symptoms and signs in children with juvenile idiopathic arthritis (JIA).

PATIENTS AND METHODS

A total of 192 children with JIA: 48 oligo-, 39 extended oligo-, 79 polyarthritis, and 26 with other types of arthritis (eight juvenile spondyloarthritis, five juvenile psoriatic arthritis, three mixed connective tissue diseases, two systemic onset arthritis, and eight undetermined arthritis) were interviewed for dry eye symptoms and tested with Schirmer test with anesthetic. Two thirds of the patients were female and the mean age of the patients was 13.1 years (range 10-16) and the mean duration of arthritis was six years (SD 4, 4). Thirty-one percent of the patients had a history of uveitis. Dry eye was defined as Schirmer test score </= 5 mm in five minutes. The type of arthritis, a history of uveitis, and the ocular and systemic medication used were evaluated for their correlation with dry eye symptoms and signs by using chi-square tests and the Mann-Whitney Monte Carlo analysis.

RESULTS

Altogether 17% of this cohort had decreased basal tear secretion. The most common symptoms of dry eye were discharge secretion, itching, and watering. The intensity of symptoms and signs did not correlate. The type of arthritis, a history or presence of uveitis, and the medication used did not correlate with the occurrence of dry eyes.

CONCLUSION

Dry eye symptoms and signs are common in JIA, and Schirmer test with anesthetic is a useful tool in evaluating these patients.

Quantitative assessment of tear production: A review of methods and utility in dry eye drug discovery

The successful development of a therapeutic agent targeting treatment of dry eye syndrome necessitates the demonstration of drug efficacy for both sign and symptom endpoints. As numerous therapeutic strategies incorporate a secretagogue function into their overall mechanism of action, the quantitative assessment of tear production serves as a logical endpoint to anchor "sign" efficacy. Although several methods including the Schirmer, the phenol red thread and tear clearance tests exist, their utility in clinical evaluations of novel therapeutics is unclear. The purpose of this review is to summarize findings and conclusions describing the performance of each of these tests so as to gain insight into which, if any, is most applicable for use in discovering new dry eye therapeutics.