title: Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation.
abstract: OBJECTIVE
  To determine which subjective assessments and objective tests have clinical utility as diagnostic tools in ocular irritation associated with Sjögren's syndrome-related aqueous tear deficiency (ATD), non-Sjögren ATD, inflammatory meibomian gland disease (MGD) associated with rosacea, and atrophic MGD.
  
  
  METHODS
  Forty adults with ocular irritation and 10 with normal ocular surfaces were enrolled in a nonrandomized, nonblinded clinical trial. Symptoms were evaluated. Tests included biomicroscopy; evaluation of tear-film integrity, production, and clearance; fluorescein and rose bengal staining; and serum autoantibody screening.
  
  
  RESULTS
  Symptoms were similar among groups and most severe in the Sjögren's group. Fluorescein tear break-up time was significantly faster in the ATD and MGD groups than that in controls. Schirmer scores were significantly lower in the ATD group than those in MGD and control groups. Tear clearance was delayed in the ATD and atrophic MGD groups. Xeroscope grid distortion was noted only with ATD. The Sjögren's group had greater loss of naso-lacrimal reflex, slower fluorescein clearance, and greater ocular-surface fluorescein and rose bengal staining than did the others. More MGD subjects had meibomian gland orifice metaplasia and acinar dropout than did those with Sjögren-related ATD and controls. Schirmer scores correlated inversely with rose bengal staining, corneal fluorescein staining, and grid distortion. Rose bengal staining correlated with grid distortion and loss of nasal-lacrimal reflex, but not with MGD.
  
  
  CONCLUSIONS
  Subjective assessments and objective diagnostic tests have clinical utility as diagnostic tools in tear-film disorders. ATD is correlated with ocular-surface disease. An algorithm summarizing the diagnostic utility of these tests is included.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida 33136, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Pflugfelder
authors.forename: S C
authors.initials: SC
authors.lastname: Tseng
authors.forename: O
authors.initials: O
authors.lastname: Sanabria
authors.forename: H
authors.initials: H
authors.lastname: Kell
authors.forename: C G
authors.initials: CG
authors.lastname: Garcia
authors.forename: C
authors.initials: C
authors.lastname: Felix
authors.forename: W
authors.initials: W
authors.lastname: Feuer
authors.forename: B L
authors.initials: BL
authors.lastname: Reis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005128:Eye Diseases / Q000209:etiology; D005141:Eyelid Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008537:Meibomian Glands / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D013666:Tears / Q000502:physiology*