Comparison of diagnostic tests in distinct well-defined conditions related to dry eye disease.
OBJECTIVE
This study compares signs, symptoms and predictive tools used to diagnose dry eye disease (DED) and ocular surface disorders in six systemic well-defined and non-overlapping diseases. It is well known that these tests are problematic because of a lack of agreement between them in identifying these conditions. Accordingly, we provide here a comparative clinical profile analysis of these different diseases.


METHODS
A spontaneous and continuous sample of patients with Sjögren's syndrome (SS) (n=27), graft-versus-host-disease (GVHD) (n=28), Graves orbitopathy (n=28), facial palsy (n=8), diabetes mellitus without proliferative retinopathy (n=14) and glaucoma who chronically received topical drugs preserved with benzalkonium chloride (n=20) were enrolled. Evaluation consisted of a comprehensive protocol encompassing: (1) structured questionnaire - Ocular Surface Disease Index (OSDI); (2) tear osmolarity (TearLab Osmolarity System - Ocusense); (3) tear film break-up time (TBUT); (4) fluorescein and lissamine green staining; (5) Schirmer test and (6) severity grading.


RESULTS
One hundred and twenty five patients (aged 48.8 years-old ± 14.1, male:female ratio=0.4) were enrolled in the study, along with 24 age and gender matched controls. Higher scores on DED tests were obtained in Sjögren Syndrome (P<0.05), except for tear film osmolarity that was higher in diabetics (P<0.001) and fluorescein staining, that was higher in facial palsy (P<0.001). TFBUT and OSDI correlated better with other tests. The best combination of diagnostic tests for DED was OSDI, TBUT and Schirmer test (sensitivity 100%, specificity 95% and accuracy 99.3%).


CONCLUSIONS
DED diagnostic test results present a broad range of variability among different conditions. Vital stainings and TBUT correlated best with one another whereas the best test combination to detect DED was: OSDI/TBUT/Schirmer.
Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil; Pontific Catholic University of Campinas, Campinas, SP, Brazil.
Monica
M
Alves
Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil.
Peter Sol
PS
Reinach
Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil.
Jayter Silva
JS
Paula
Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil.
Antonio Augusto
AA
Vellasco e Cruz
Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil.
Leticia
L
Bachette
Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil.
Jacqueline
J
Faustino
Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Francisco Penteado
FP
Aranha
Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Afonso
A
Vigorito
Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
Carmino Antonio
CA
de Souza
Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil.
Eduardo Melani
EM
Rocha
D003955:Diagnostic Tests, Routine / Q000379:methods*; D015352:Dry Eye Syndromes / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity