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Dry eye evaluation in the NHS ophthalmology clinic setting

Poster Details

First Author: N.Din UK

Co Author(s):    F. Harman   E. Ansari                 

Abstract Details


To evaluate the diagnostic criteria for dry eye disease (DED) from a general patient cohort at four NHS ophthalmology clinics.


Hillingdon Hospital, Middlesex, Great Western Hospital, Swindon, Wiltshire and St. Peter's Hospital, Chertsey, Surrey, Maidstone Hospital, Maidstone, United Kingdom.


This was a non-randomized multicenter study of 705 subjects. Tear osmolarity, corneal staining grade, tear break-up time (TBUT), meibomian gland function, and the ocular surface disease index (OSDI) were conducted on all patients. The consultant was masked to the tear osmolarity score and diagnosis of DED was assessed using the traditional tests. Consultant’s diagnosis and results from the various DED tests were compared across the different NHS clinics.


Age and gender of patients were not significantly different across site. DED determinations by consultant, OSDI, and osmolarity are not significantly different across sites while MGD, TBUT, and staining were significantly different (p<0.01). Staining had the most absolute variation amongst sites (41.3% vs 85.1%) while TBUT had the largest relative variation (22.4% vs 50.2%). Only 18% (128/705) of cases appear unequivocal, where all signs, symptoms, and the consultant’s diagnosis indicate no dry eye (64 cases) or dry eye (64 cases). 393/705 subjects had OSDI>15 suggestive of DED. 273/393 (69%) had hyperosmolarity, while only 222 (56%) were diagnosed with DED by the consultant.


OSDI scores and rates of tear hyperosmolarity were statistically constant between sites, indicating less inter-observer variability with these tests. Hyperosmolarity was far more common than the traditional signs in this cohort of subjects and in combination with subjective reporting of symptoms may lead to earlier diagnosis of DED and its management.

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