Comparison of Schirmer's test and tear film breakup time test to detect tear film abnormalities in patients with pterygium.

OBJECTIVE: To compare tear film breakup time test with Schirmer's test in patients with pterygium. METHODS: The case-control study, involving 86 patients with unilateral primary pterygium aged between 30 and 70 years, was conducted at the Department of Ophthalmology, Karachi Medical and Dental College, Abbasi Shaheed Hospital, from May 2009 to December 2010. The eye with pterygium was taken as the case, and was compared with the other eye without pterygium which was taken as the control in these patients. All patients underwent routine ophthalmic examination. Tear film tests such as Schirmer's test and tear film breakup time test were performed on all these eyes. Results of tear function test between the eyes with pterygium (cases) and the eye without pterygium (control) were compared. SPSS 17 was used for statistical analysis. Chi square test was used for comparing the results of the cases and the controls. RESULTS: Of the 86 patients, 63 (73.3%) were men, while 23 (26.7%) were women. The median age was 41 years. There were 62 (72.1%) patients with pterygium in the right eye, while 24 (27.9%) had it in the left. Among the involved eyes, decreased tear breakup time (<10 seconds) was observed in 65 (75.6%) eyes, while 21 (24.4%) eyes did not show decreased tear breakup time i.e.>10 seconds. On the other hand, 8 (9.3 %) eyes with pterygium had Schirmer's test positive and 78 (90.7 %) eyes had it negative. CONCLUSION: Tear film breakup time test has better diagnostic value compared to Schirmer's test in detecting tear film abnormality in patients with pterygium.

Recurrence rate of pterygium following surgical excision with intraoperative versus postoperative mitomycin-C.

OBJECTIVE: To compare the rate of recurrence and complications of pterygium following surgical excision by applying 0.02% mitomycin-C intraoperatively or using topical 0.02 % mitomycin-C drops postoperatively. STUDY DESIGN: Randomized clinical trial. PLACE AND DURATION OF STUDY: Baqai Medical University Hospital, Department of Ophthalmology, from January 2001 to July 2005. METHODOLOGY: Eighty-four eyes of 65 patients, aged between 20-70 years, with primary pterygium were randomly allocated into two groups using random tables. Patients with bilateral disease were treated with an interval of 10-14 days and randomized separately. In group-I, 0.02 % mitomycin-C was applied intraoperatively for 3 minutes after pterygium excision. Group-II received mitomycin-C 0.02 % eye drops twice a day for 2 weeks after pterygium excision. Patients were followed-up for pterygium recurrence for one year. Variables were compared for significance, using Pearson chi-square test. RESULTS: In Group I, recurrence of pterygium was seen in 4 (10.0%) eyes and superficial punctate keratitis in 4 (9.5%) eyes, while 8 (19.0%) eyes developed avascularization of sclera at the pterygium excision site. In group II, 8 (20.51%) eyes had pterygium recurrence (p=0.38), 13 (31.0%) eyes had superficial punctate keratitis and tenon cyst was seen in one (2.4%) eye. One (2.4%) eye in each group developed scleral thinning. CONCLUSION: There was no significant difference in pterygium recurrence rate intraoperatively or postoperative application of 0.02% mitomycin-C. Complications were comparatively less following application of intraoperative 0.02% mitomycin-C for 3 minutes.

Diagnostic value of tear films tests in type 2 diabetes.

OBJECTIVE: To compare the diagnostic value of Schirmer's tests, Rose Bengal test, and Tear Film Breakup Time test in patients with type 2 Diabetes. METHODS: Two hundred eyes of 100 patients were seen at the department of ophthalmology, Baqai Medical University Hospital who presented with complaints of redness and burning sensation and were aged between 45 to 75 years. Any history of systemic illness was recorded such as diabetes mellitus and hypertension. All subjects underwent routine ophthalmic examination and tear film tests such as Schirmer's test, Rose Bengal test and tear film break up time test. RESULT: Total numbers of eyes subjected to Tear Film Tests were 200, of which 92 (46.0%) belonged to patients with type 2 Diabetes. Schirmer's test was positive in 56 (60.86%) eyes of Rose Bengal test was positive in 80 (86.95%) eyes and Tear film break up time test was positive in 50 (54.34%) eyes. Among non diabetics Schirmer's test was positive in 30 (68.18%) eyes, Rose Bengal test was positive in 10 (22.72%) eyes and tear film break up time test was positive in 24 (54.54%) eyes. CONCLUSION: Keratoconjunctivitis sicca is another manifestation of Diabetes Mellitus. The ocular surface disease could be confirmed by performing multiple tear film tests. Among these tests Schirmer's test and Rose Bengal test have more diagnostic value in patients with type 2 diabetes as compared to Tear Film Break-up time test.