dry eye: evaluation of clinical features, diagnostic tests and management

ABSTRACT

Purpose The purpose of this study was to evaluate the clinical features, diagnostic tests and management of dry eye. Methods In this prospective study, 515 patients with different eye and systemic diseases thought to be associated with dry eye were divided into 12 clinical groups. After complete systemic and ophthalmologic examination, Schirmer-l test, tear break-up time [BUT], rose bengal staining 1%, determination of lactoferrin levels by ELISA, and lysozyme levels by spectrophotometer in tear samples, were carried out. Determination of serum vitamin A level, ocular ferming test and impression cytology were additionally performed for patients with liver cirrhosis. Sublabial salivary gland biopsy was done for suspected cases of Sj syndrome. Results The prevalence of dry eye among the studied groups was 47.2%. The most common symptom was foreign body sensation [33.3%], and the least common symptom was photosensitivity [5.1%]. The most common sign was meniscus floaters [23.7%], whilst the least common sign was the presence of mucus strands and filaments [13.1%]. The most sensitive test for detection of thy eye was the increase in lactoferrin level [63.4%], and the most specific test was rose bengal staining [100%]. The least sensitive test was Schirmer-l test [39%], and the least specific test was the decrease in lysozyme level [80%]. Therapy with artificial tears for at least one month gave subjective rather than objective improvement in 183 [75.3%] out of 243 patients. Sixty patients remained symptomatic and were additionally treated with punctal occlusion; 48 [80%] of whom showed improvement. The remaining 12 patients were treated with lateral tarsorrhaphy, eight [66.7%] of whom improved. The last remaining four patients refused further surgical intervention. Conclusions The most sensitive test in diagnosing dry eye was lactoferrin, although testing proved difficult and needed sophisticated techniques. For practical purposes, the most specific test was the rose bengal staining, followed by the Schirmer-I test and, lastly, the tear film breakup time [BUT]. The diagnosis of dry eye is confirmed when at least two of these three tests are abnormal