The relationship between clinical signs and dry eye symptoms.
OBJECTIVE
To evaluate (i) the relationship between traditional and new clinical tests (lid-wiper epitheliopathy (LWE), lid-parallel conjunctival folds (LIPCOF)) and dry eye symptoms in non-contact lens wearers, and (ii) that a combination of these tests can improve predictive ability for the development of dry eye symptoms.


METHODS
Tear meniscus height (TMH), non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test (PRTT), corneal and conjunctival staining, and LWE grades were observed in a cohort of 47 healthy, non-lens wearers (male=17, female=30, median age=35 years, range=19-70). Symptoms were assessed using the Ocular Surface Disease Index (OSDI).


RESULTS
LWE was significantly correlated to both temporal and nasal LIPCOF (0.537<r<0.607, P<0.05). LIPCOF and LWE were significantly correlated to NIBUT and PRTT (r > -0.248, P < 0.001). Significant correlations were found between NIBUT and TMH (r=0.461, P=0.001) and PRTT (r = 0.640, P < 0.001). OSDI scores were significant correlated to NIBUT, TMH, PRTT, LIPCOF, and LWE (r>∣0.31∣; P<0.05). Significant discriminators of OSDI+/- were NIBUT (area under the receiver operative characteristic curve (AUC)=0.895), TMH (0.715), PRTT (0.781), LIPCOF (temporal/nasal/Sum 0.748/0.828/0.816), and LWE (0.749). Best predictive ability was achieved by combining NIBUT with nasal LIPCOF (AUC=0.944).


CONCLUSIONS
The individual tests NIBUT, TMH, PRTT, LIPCOF, and LWE were significantly, but moderately, related to OSDI scores. The strongest relationship appeared by combining NIBUT with nasal LIPCOF.
Optometry and Vision Research, Weinheim, Germany. ovr@heiko-pult.de
H
H
Pult
C
C
Purslow
P J
PJ
Murphy
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003228:Conjunctiva / Q000473:pathology; D003315:Cornea / Q000473:pathology; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis; D007202:Indicators and Reagents; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013666:Tears / Q000502:physiology; D055815:Young Adult
D007202:Indicators and Reagents
Acta Ophthalmol Suppl. 1965;:SUPPL 81:1-134
14298285
Am J Ophthalmol. 2003 Mar;135(3):303-8
12614746
Ophthalmic Physiol Opt. 2008 Jan;28(1):13-20
18201331
Br J Ophthalmol. 2004 Mar;88(3):388-92
14977775
Am J Ophthalmol. 2007 Dec;144(6):930-937
17916317
J Am Optom Assoc. 1970 Mar;41(3):228-32
4193193
Ophthalmic Plast Reconstr Surg. 1986;2(1):25-8
3154534
Cornea. 2004 Apr;23(3):272-85
15084861
Arch Ophthalmol. 2010 Jan;128(1):94-101
20065224
Optom Vis Sci. 2009 Sep;86(9):E1042-50
19668016
Clin Exp Ophthalmol. 2005 Aug;33(4):351-5
16033344
Ocul Surf. 2009 Oct;7(4):199-211
19948103
Dev Ophthalmol. 2008;41:36-53
18453760
Nippon Ganka Gakkai Zasshi. 2003 Jul;107(7):363-8
12894742
Cornea. 2002 Oct;21(7):664-70
12352083
Cornea. 1997 Nov;16(6):649-61
9395875
Am J Ophthalmol. 2000 Mar;129(3):385-7
10704560
Cornea. 2000 Jul;19(4):483-6
10928763
Optom Vis Sci. 2009 Apr;86(4):e324-31
19225431
Am J Manag Care. 2008 Apr;14(3 Suppl):S102-6
18452369
Optom Vis Sci. 2006 Oct;83(10):731-9
17041318
Cornea. 2004 Nov;23(8):762-70
15502475
Ophthalmic Surg Lasers Imaging. 2006 Mar-Apr;37(2):112-8
16583632
Surv Ophthalmol. 2001 Mar;45 Suppl 2:S221-6
11587146
Optom Vis Sci. 2008 Oct;85(10):E930-8
18832968
Eye Contact Lens. 2008 Jan;34(1):35-8
18180681
Am J Ophthalmol. 2009 Jul;148(1):20-5.e1
19403112
Ophthalmic Physiol Opt. 2009 Sep;29(5):479-86
19689545
Surv Ophthalmol. 1998 Nov-Dec;43(3):225-32
9862310
Cornea. 2006 Aug;25(7):789-93
17068455
Eye Contact Lens. 2005 Jan;31(1):2-8
15665665
Cornea. 2004 May;23(4):365-71
15097131
CLAO J. 1983 Jul-Sep;9(3):281-9
6413088
Ophthalmologe. 1995 Dec;92(6):802-8
8563428
Zhonghua Yan Ke Za Zhi. 2004 Jan;40(1):37-9
14989959
Adv Exp Med Biol. 1998;438:853-8
9634978
Zhonghua Yan Ke Za Zhi. 2003 Jan;39(1):5-9
12760805
Eye Contact Lens. 2005 May;31(3):96-104
15894874
J Pediatr Ophthalmol. 1977 Nov-Dec;14(6):390-7
604447
Invest Ophthalmol Vis Sci. 1991 Feb;32(2):422-32
1993595
Cornea. 2004 Apr;23(3):294-8
15084864
Br J Ophthalmol. 2005 Mar;89(3):302-5
15722309
Ocul Surf. 2007 Apr;5(2):93-107
17508117
Adv Exp Med Biol. 2002;506(Pt B):1263-8
12614064
Arch Ophthalmol. 2000 May;118(5):615-21
10815152
Optom Vis Sci. 2000 Jul;77(7):357-63
10939313
Ophthalmic Physiol Opt. 2001 Jan;21(1):30-5
11220038
Optom Vis Sci. 2008 Oct;85(10):E924-9
18832967
Ophthalmic Physiol Opt. 1998 Nov;18(6):471-6
10070541
Arch Ophthalmol. 2000 Sep;118(9):1264-8
10980773
Invest Ophthalmol Vis Sci. 2010 Dec;51(12):6125-30
20631232
Curr Eye Res. 1985 Jan;4(1):1-7
3979089
CLAO J. 2002 Oct;28(4):211-6
12394549
Optom Vis Sci. 1992 Jul;69(7):570-3
1378957
Cornea. 2005 Nov;24(8 Suppl):S24-S31
16227820
Ophthalmic Physiol Opt. 2003 Nov;23(6):553-60
14622360
Adv Exp Med Biol. 1998;438:859-67
9634979
Eye (Lond). 2007 May;21(5):633-8
16518366
Cornea. 2007 May;26(4):403-6
17457186
Curr Eye Res. 1996 Jun;15(6):653-61
8670769