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A new treatment paradigm for ocular surface disease based on tear osmolarity
Session Title: Cornea Medical
Session Date/Time: Monday 07/10/2013 | 08:00-10:00
Paper Time: 08:24
Venue: Elicium 1 (First Floor)
First Author: : M.Jackson USA
Co Author(s): :
To examine the efficacy in diagnosing aqueous deficient dry eye from other forms of dry eye when presented with an ocular surface disease patient.
All patients were examined in an office setting as an outpatient with slit lamp evaluation, lipiview analysis, and tear osmolarity quantitative measurements.
A retrospective review of 100 eyes who presented with some form of ocular surface disease symptomatology (tearing, burning, blurred vision, vision fluctuation, itching, and/or dryness) were differentiated into categories of aqueous-deficient dry eye or evaporative dry eye based on slit lamp examination, tear breakup time (TBUT), corneal staining, conjunctival staining, lipiview interferometry (Tear Science device) analysis, and tear film osmolarity (Tear Lab device). TBUT < 5 seconds, any corneal or conjunctival staining, lipiview < 100 average, and osmolarity >300 mOsm/L or a difference between eyes > 8 mOsm/L were considered abnormal and categorized based on slit lamp evaluation of cornea, conjunctiva, and lid margin as well. Aqueous Deficiency (AD) was defined as abnormal osmolarity with presence of conjunctival and/or corneal staining but normal lipiview analysis and normal TBUT. Evaporative Dry (ED) eye due to meibomian gland dysfunction was defined as abnormal lipiview analysis with abnormal TBUT but normal osmolarity and presence or absence of conjunctival and/or corneal staining. A combination of both AD and ED was defined as abnormalities in tear osmolarity, lipiview analysis, TBUT, and presence of corneal and/or conjunctival staining.
Statistical significance revealed a clear distinction in prevalence of aqueous-deficient versus evaporative dry eye based on the appropriate diagnostic evaluation of dry eye. 24/100 eyes or 24% of eyes had clinical signs of AD only, 56/100 eye or 56% of eyes had clinical signs of ED only, and 20/100 or 20% eyes had clinical signs of both AD and ED.
Previous studies as published by Michael Lemp and Gary Foulkes in Cornea 2012 revealed that evaporative dry eye (ED) is the most common form of dry eye. The results of this study suggest the same conclusions. Current advanced diagnostic technology utilizing lipiview interferometry and tear film osmolarity with accepted slit lamp findings of TBUT and corneal/conjunctival staining based on the International Delphi panels dry eye workshop (DEWS) classification of dry eye as published in Cornea 2007 are critical in determining a correct dry diagnosis of aqueous deficiency versus evaporative meibomian gland dysfunction. Tear film osmolarity has become one of the more critical diagnostic aids in determining the correct diagnosis of dry eye so correct therapeutic options can be employed.
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