title: Application of a new grading scale for tear ferning in non-dry eye and dry eye subjects.
abstract: OBJECTIVE
  To apply the Masmali tear ferning (TF) grading scale on non-dry eye (NDE) and dry eye (DE) subjects to test the validity of the grading scale in practice, and to describe the grading scale range for NDE and DE.
  
  
  METHODS
  Forty NDE subjects (20 males, 20 females) and 40 DE subjects (23 males, 17 females) ranging in age from 19 to 53 years (mean±SD: 25.3±5.5) with no other ocular disease, no contact lens wear, and not pregnant or breastfeeding were recruited. McMonnies scores were used for subject grouping. Phenol red thread (PRT) and slit-lamp test were used. A tear sample was collected from right eye, which was then dried to produce a ferning pattern, that was observed using a digital microscope, and graded.
  
  
  RESULTS
  Mean McMonnies, PRT and TF grade in NDE subjects were 7.1±3.8, 27.4±4.3 mm and 0.78±0.40, respectively. Median McMonnies, PRT and TF grade in DE subjects were 16.5±3.0, 9.0±2.0 mm and 2.3±1.48, respectively. In NDE subjects, grades 0.0-1.8 were observed (82.5% Grade 0.0-1.00). Grades 2.0-4.0 were observed in DE subjects (72.5% Grades 2.0-3.0). For all subjects, there were large correlations between TF grade and PRT (r=-0.79), PRT and McMonnies (r=-0.60), and TF and McMonnies (r=0.73).
  
  
  CONCLUSIONS
  The Masmali TF grading scale showed good validity in describing the TF patterns. Grades ≥2 can be classified as abnormal patterns. The TF test has the potential to be used in the clinic.
authors.affiliation: Cornea Research Chair (CRC), Department of Optometry, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia. Electronic address: amasmali@ksu.edu.sa.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Masmali
authors.affiliation: Cornea Research Chair (CRC), Department of Optometry, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia.
authors.forename: Sultan
authors.initials: S
authors.lastname: Al-Qhtani
authors.affiliation: Cornea Research Chair (CRC), Department of Optometry, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia.
authors.forename: Talha M
authors.initials: TM
authors.lastname: Al-Gasham
authors.affiliation: Cornea Research Chair (CRC), Department of Optometry, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia.
authors.forename: Gamal A
authors.initials: GA
authors.lastname: El-Hiti
authors.affiliation: School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Purslow
authors.affiliation: School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Murphy
mesh_terms: D000328:Adult; D003261:Contact Lenses / Q000009:adverse effects; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013666:Tears / Q000737:chemistry* / Q000378:metabolism; D055815:Young Adult
keywords: Dry eye disease; Masmali grading scale; Phenol red thread test; Tear ferning