Do Unilateral Herpetic Stromal Keratitis and Neurotrophic Ulcers Cause Bilateral Dry Eye?
OBJECTIVE
To evaluate and compare the ocular surface condition in herpetic interstitial stromal keratitis and neurotrophic ulcer groups and their normal fellow eyes.


METHODS
In this observational, cross-sectional case-control study, 85 consecutive patients were included, including 56 cases of treated herpetic interstitial keratitis and 29 patients with neurotrophic ulcers. Fifty-six age- and sex-matched participants were also recruited from a normal population as the control group. We evaluated and scored the subjective and objective measures of dry eye for both eyes of all patients. Then, we compared the score of the groups with one another and also with the control group. The main outcome measures were the discomfort level, visual symptoms of dry eye, conjunctival injection, conjunctival staining, corneal staining, corneal tear signs of dry eye, meibomian gland dysfunction, tear break-up time, Schirmer test score with anesthesia, and tear osmolarity.


RESULTS
The normal fellow eye of the herpetic keratitis group had significantly higher discomfort levels (1.4 ± 0.9 vs. 1.3 ± 0.5, P = 0.003), visual symptoms (1.7 ± 0.8 vs. 1.3 ± 0.7, P = 0.002), tear break-up time (8.3 ± 3.2 vs. 12.1 ± 3.3 seconds, P = 0.003), Schirmer test scores (9.2 ± 3.9 vs. 12.9 ± 3 mm, P = 0.04), and tear osmolarity (9.2 ± 3.9 vs. 12.9 ± 3 mm, P = 0.003) in comparison with normal controls. The normal fellow eyes of the neurotrophic ulcer group had significantly worse values for discomfort level (1.9 ± 0.9 vs. 1.3 ± 0.5, P < 0.001), tear break-up time (7.9 ± 4 vs. 12.1 ± 3.3, P = 0.004), Schirmer test score (8.1 ± 3.9 vs. 12.9 ± 3, P = 0.005), and tear osmolarity (295 ± 9.2 vs. 292.7 ± 5.9, P = 0.02) compared with normal controls.


CONCLUSIONS
Both eyes of patients with neurotrophic ulcer and interstitial herpetic keratitis have a significantly poorer ocular surface condition compared with that of normal controls.
*Ophthalmology Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Farabi Eye Hospital, Tehran, Iran; and †Iran University of Medical Sciences, Tehran, Iran.
Mahmoud
M
Jabbarvand
Hesam
H
Hashemian
Mehdi
M
Khodaparast
Amin
A
Rafatnejad
Amirhooshang
A
Beheshtnejad
Amir
A
Salami
D000328:Adult; D016022:Case-Control Studies; D003315:Cornea / Q000294:innervation; D003319:Corneal Stroma / Q000821:virology*; D003320:Corneal Ulcer / Q000150:complications*; D003430:Cross-Sectional Studies; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000209:etiology*; D015828:Eye Infections, Viral / Q000150:complications*; D005260:Female; D006801:Humans; D016849:Keratitis, Herpetic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D013666:Tears / Q000737:chemistry; D020433:Trigeminal Nerve Diseases / Q000150:complications*