Prevalence of lid wiper epitheliopathy in subjects with dry eye signs and symptoms.

PURPOSE: The purpose of this study was to investigate the prevalence of lid wiper epitheliopathy (LWE) in patients diagnosed with dry eye disease (DED). METHODS: Patients were recruited for two groups. Inclusion criteria for the DED group (n = 50) was: a score greater than 10 with the Standard Patient Evaluation of Eye Dryness questionnaire, fluorescein break-up time 5 seconds or less, corneal and conjunctival staining with fluorescein, lissamine green Grade 1 or greater (scale 0-3), and Schirmer test with anesthesia 5 mm or less. For the asymptomatic group (n = 50), inclusion criteria were: no dry eye symptoms, fluorescein break-up time 10 seconds or greater, no corneal or conjunctival staining, and Schirmer test 10 mm or greater. Sequential instillations (n = 2, 5 minutes apart) of a mixture of 2% fluorescein and 1% lissamine green solution were used to stain the lid wipers of all patients. LWE was graded (scale 0-3) using the horizontal lid length and the average sagittal lid widths of the stained wiper. RESULTS: In symptomatic patients, 88% had LWE, of which 22% was Grade 1, 46% Grade 2, and 20% Grade 3. In asymptomatic patients, 16% had LWE, of which 14% was Grade 1, 2% was Grade 2, and 0% Grade 3. The difference in prevalence of lid wiper staining between groups was significant (P < 0.0001). CONCLUSIONS: The prevalence of LWE was six times greater for the DED group and the prevalence of LWE Grade 2 or greater was 16 times greater for the DED group than for the control group. These data further establish LWE as a diagnostic sign of dry eye disease.

The relationship between dry eye symptoms and lipid layer thickness.

PURPOSE: (1) To investigate the relationship between dry eye symptoms and lipid layer thickness (LLT) in patients presenting for routine eye examination and (2) to consider the practicality of interferometry in a clinical practice. METHODS: Patients presenting consecutively for routine eye examinations were recruited (n = 137, age range = 18-60 years, mean = 41.7 +/- 15.5 years, 102 females and 35 males). Patients were required to complete the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire after which their LLT was evaluated using a new interferometer (Ocular Surface Interferometer). Patients were assigned to 1 of 3 symptom categories: no symptoms (SPEED = 0), mild to moderate symptoms (SPEED = 1-9), and severe symptoms (SPEED > or = 10). Categorical analysis (contingency table) and linear regression were performed on the data. RESULTS: For patients with severe dry eye symptoms, 74% had an LLT < or =60 nm. Conversely, 72% of patients with no dry eye symptoms had an LLT of > or =75 nm (contingency table, chi = 12.63, df = 2, p = 0.0018). Furthermore, a linear regression of LLT and SPEED score reveal a significant linear relationship (as LLT increases, SPEED score decreases; p = 0.0014). CONCLUSIONS: (1) The data indicate that approximately 3 of 4 patients reporting severe symptoms have relatively thin lipid layers of 60 nm or less, whereas approximately 3 of 4 patients without symptoms have relatively thick lipid layers of 75 nm or more. Thus, the presence of dry eye symptoms significantly increases the likelihood of a relatively thin lipid layer. LLT seems to correlate better to symptoms, especially severe symptoms, than other reported correlations with objective clinical tests for dry eye disease. (2) Interferometry has the potential to be a practical and useful addition to clinical practice.

Comparison of the efficacy of two lipid emulsion eyedrops in increasing tear film lipid layer thickness.

PURPOSE: The lipid layer of the tear film is critical to maintaining the thickness of the multilayered tear film. This study was designed to determine whether a single drop of Refresh Dry Eye Therapy or Soothe, both lipid emulsion eyedrops, significantly increased the lipid layer thickness (LLT) of patients with self-reported dry eyes and thin lipid layers. METHODS: Lipid layer interference patterns were used to quantify the LLT of both eyes of eligible patients before and after test drop instillation. Patients (n=41) reporting dry eye symptoms and having baseline LLT of no more than 75 nm received 40 microL of Refresh Dry Eye Therapy in one eye and 40 microL of Soothe in the contralateral eye. After instillation, LLT was quantified at 1, 5, and 15 minutes. LLT after drop instillation was averaged for the three time points. RESULTS: The mean +/- standard error baseline LLT was 59.6 +/- 1.7 nm for eyes treated with Refresh Dry Eye Therapy and 61.5 +/- 1.6 nm for eyes treated with Soothe. These means were not significantly different (P>0.05). The overall mean LLT after drop instillation was 83.2 +/- 3.6 nm for Refresh Dry Eye Therapy (P<0.0001) and 121.5 +/- 3.8 nm for Soothe (P<0.0001). The mean LLT increase from Soothe (60.0 nm) was significantly greater than that from Refresh Dry Eye Therapy (23.6 nm) (P<0.0001). CONCLUSIONS: The application of a lipid emulsion eyedrop will increase LLT and benefit patients with deficient lipid layers who experience dry eye symptoms. Although both products are lipid emulsions, one drop of Soothe essentially doubled LLT and provided a mean increase in LLT that was 2.5 times greater than that of Refresh Dry Eye Therapy.

The effect of two novel lubricant eye drops on tear film lipid layer thickness in subjects with dry eye symptoms.

PURPOSE: Because the lipid layer of the tear film is recognized as a critical component in dry eye disease, this study was designed to determine if a single eye drop of either Soothe or Systane produces a significant increase in lipid layer thickness (LLT) for subjects reporting symptoms indicative of dry eyes. METHODS: A double-blind, internally paired study was performed. A custom-built lipid layer interferometer, enabling characterization of lipid layer interference patterns, was used to quantify baseline LLT (OU) of eligible subjects. Inclusion criteria included: 1) presence of dry eye symptoms and 2) baseline LLT < or =75 nm. Subjects (n = 40) received a single eye drop of Soothe in one eye and a single eye drop of Systane in the contralateral eye. After the instillation of each test drop, LLT was reanalyzed for all subjects. RESULTS: The mean +/- standard error baseline LLT pre-eye drop instillation was 60.0 +/- 1.8 nm for eyes treated with Soothe and 61.5 +/- 1.8 nm for eyes treated with Systane. These means were not significantly different (p > 0.5). The mean LLT for eyes treated with Soothe increased to 124.4 +/- 4.9 nm (p < 0.0001). The mean LLT for eyes treated with Systane increased to 71.3 +/- 2.6 nm (p < 0.0001). The LLT increase from Soothe was significantly greater than that from Systane (p < 0.0001). CONCLUSIONS: In subjects with symptoms indicative of dry eye states and LLT < or =75 nm, one eye drop of Soothe more than doubled LLT, a 107% mean increase, whereas Systane increased LLT by 16%.

Lid wiper epitheliopathy and dry eye symptoms.

OBJECTIVES: The lid wiper is defined as that portion of the marginal conjunctiva of the upper eyelid that wipes the ocular surface during blinking. The purpose of this study was to investigate whether lid wiper epitheliopathy occurred with patients who reported dry eye symptoms, yet had normal fluorescein breakup time (FBUT) and Schirmer test values and an absence of fluorescein corneal staining. METHODS: One hundred patients were divided into two groups based on the presence or absence of dry eye symptoms, as determined with the Standard Patient Evaluation of Eye Dryness questionnaire. Other criteria for admission to both groups were FBUT of 10 seconds or more, Schirmer test value of 10 mm or more, and absence of fluorescein corneal staining. After instillation of fluorescein and rose bengal dyes, the lid wipers of 50 asymptomatic and 50 symptomatic patients were graded for staining from grade 0 (absent) to grade 3 (severe). RESULTS: Of the symptomatic patients, 76% had staining of the lid wiper: 44%, grade 1; 22%, grade 2; and 10%, grade 3. Of the asymptomatic patients, 12% had staining; 8%, grade 1; 4%, grade 2; and 0%, grade 3. The difference in prevalence of lid wiper staining between the symptomatic and asymptomatic groups was significant (P<0.0001). CONCLUSIONS: Lid wiper epitheliopathy, diagnosed by staining with fluorescein and rose bengal dyes, is a frequent finding when symptoms of dry eye are experienced in the absence of routine clinical dry eye findings.