Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation

Stephen C. Pflugfelder, Scheffer C G Tseng, Olga Sanabria, Hans Kell, Carlos G. Garcia, Carlos Felix, William J Feuer, Brenda L. Reis

Research output: Contribution to journalArticle

347 Citations (Scopus)

Abstract

Purpose. To determine which subjective assessments and objective tests have clinical utility as diagnostic tools in ocular irritation associated with Sjogren's syndrome-related aqueous tear deficiency (ATD), non-Sjogren ATD, inflammatory meibomian gland disease (MGD) associated with rosacea, and atrophic MGD. Methods. Forty adults with ocular irritation and 10 with normal ocular surfaces were enrolled in a nonrandomized, nonblinded clinical trial. Symptoms were evaluated. Tests included biomicroscopy; evaluation of tear- film integrity, production, and clearance; fluorescein and rose bengal staining; and serum autoantibody screening. Results. Symptoms were similar among groups and most severe in the Sjogren's group. Fluorescein tear break- up time was significantly faster in the ATD and MGD groups than that in controls. Schirmer scores were significantly lower in the ATD group than those in MGD and control groups. Tear clearance was delayed in the ATD and atrophic MGD groups. Xeroscope grid distortion was noted only with ATD. The Sjogren's group had greater loss of nasolacrimal reflex, slower fluorescein clearance, and greater ocular-surface fluorescein and rose bengal staining than did the others. More MGD subjects had meibomian gland orifice metaplasia and acinar dropout than did those with Sjogren-related ATD and controls. Schirmer scores correlated inversely with rose bengal staining, corneal fluorescein staining, and grid distortion. Rose bengal staining correlated with grid distortion and loss of nasal-lacrimal reflex, but not with MGD. Conclusion. Subjective assessments and objective diagnostic tests have clinical utility as diagnostic tools in tear-film disorders. ATD is correlated with ocular-surface disease. An algorithm summarizing the diagnostic utility of these tests is included.

Original languageEnglish (US)
Pages (from-to)38-56
Number of pages19
JournalCornea
Volume17
Issue number1
DOIs
StatePublished - Jan 1998

Fingerprint

Tears
Routine Diagnostic Tests
Meibomian Glands
Rose Bengal
Fluorescein
Staining and Labeling
Reflex
Rosacea
Control Groups
Eye Diseases
Sjogren's Syndrome
Metaplasia
Nose
Autoantibodies

Keywords

  • Aqueous tear deficiency
  • Meibomian gland disease
  • Ocular irritation
  • Ocular surface disease
  • Rosacea
  • Sjogren's syndrome
  • Tear break-up time
  • Tear-film disorder

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Pflugfelder, S. C., Tseng, S. C. G., Sanabria, O., Kell, H., Garcia, C. G., Felix, C., ... Reis, B. L. (1998). Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea, 17(1), 38-56. https://doi.org/10.1097/00003226-199801000-00007

Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. / Pflugfelder, Stephen C.; Tseng, Scheffer C G; Sanabria, Olga; Kell, Hans; Garcia, Carlos G.; Felix, Carlos; Feuer, William J; Reis, Brenda L.

In: Cornea, Vol. 17, No. 1, 01.1998, p. 38-56.

Research output: Contribution to journalArticle

Pflugfelder, SC, Tseng, SCG, Sanabria, O, Kell, H, Garcia, CG, Felix, C, Feuer, WJ & Reis, BL 1998, 'Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation', Cornea, vol. 17, no. 1, pp. 38-56. https://doi.org/10.1097/00003226-199801000-00007
Pflugfelder, Stephen C. ; Tseng, Scheffer C G ; Sanabria, Olga ; Kell, Hans ; Garcia, Carlos G. ; Felix, Carlos ; Feuer, William J ; Reis, Brenda L. / Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. In: Cornea. 1998 ; Vol. 17, No. 1. pp. 38-56.
@article{30824ac03c824f70a68de906e2417d0b,
title = "Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation",
abstract = "Purpose. To determine which subjective assessments and objective tests have clinical utility as diagnostic tools in ocular irritation associated with Sjogren's syndrome-related aqueous tear deficiency (ATD), non-Sjogren ATD, inflammatory meibomian gland disease (MGD) associated with rosacea, and atrophic MGD. Methods. Forty adults with ocular irritation and 10 with normal ocular surfaces were enrolled in a nonrandomized, nonblinded clinical trial. Symptoms were evaluated. Tests included biomicroscopy; evaluation of tear- film integrity, production, and clearance; fluorescein and rose bengal staining; and serum autoantibody screening. Results. Symptoms were similar among groups and most severe in the Sjogren's group. Fluorescein tear break- up time was significantly faster in the ATD and MGD groups than that in controls. Schirmer scores were significantly lower in the ATD group than those in MGD and control groups. Tear clearance was delayed in the ATD and atrophic MGD groups. Xeroscope grid distortion was noted only with ATD. The Sjogren's group had greater loss of nasolacrimal reflex, slower fluorescein clearance, and greater ocular-surface fluorescein and rose bengal staining than did the others. More MGD subjects had meibomian gland orifice metaplasia and acinar dropout than did those with Sjogren-related ATD and controls. Schirmer scores correlated inversely with rose bengal staining, corneal fluorescein staining, and grid distortion. Rose bengal staining correlated with grid distortion and loss of nasal-lacrimal reflex, but not with MGD. Conclusion. Subjective assessments and objective diagnostic tests have clinical utility as diagnostic tools in tear-film disorders. ATD is correlated with ocular-surface disease. An algorithm summarizing the diagnostic utility of these tests is included.",
keywords = "Aqueous tear deficiency, Meibomian gland disease, Ocular irritation, Ocular surface disease, Rosacea, Sjogren's syndrome, Tear break-up time, Tear-film disorder",
author = "Pflugfelder, {Stephen C.} and Tseng, {Scheffer C G} and Olga Sanabria and Hans Kell and Garcia, {Carlos G.} and Carlos Felix and Feuer, {William J} and Reis, {Brenda L.}",
year = "1998",
month = "1",
doi = "10.1097/00003226-199801000-00007",
language = "English (US)",
volume = "17",
pages = "38--56",
journal = "Cornea",
issn = "0277-3740",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation

AU - Pflugfelder, Stephen C.

AU - Tseng, Scheffer C G

AU - Sanabria, Olga

AU - Kell, Hans

AU - Garcia, Carlos G.

AU - Felix, Carlos

AU - Feuer, William J

AU - Reis, Brenda L.

PY - 1998/1

Y1 - 1998/1

N2 - Purpose. To determine which subjective assessments and objective tests have clinical utility as diagnostic tools in ocular irritation associated with Sjogren's syndrome-related aqueous tear deficiency (ATD), non-Sjogren ATD, inflammatory meibomian gland disease (MGD) associated with rosacea, and atrophic MGD. Methods. Forty adults with ocular irritation and 10 with normal ocular surfaces were enrolled in a nonrandomized, nonblinded clinical trial. Symptoms were evaluated. Tests included biomicroscopy; evaluation of tear- film integrity, production, and clearance; fluorescein and rose bengal staining; and serum autoantibody screening. Results. Symptoms were similar among groups and most severe in the Sjogren's group. Fluorescein tear break- up time was significantly faster in the ATD and MGD groups than that in controls. Schirmer scores were significantly lower in the ATD group than those in MGD and control groups. Tear clearance was delayed in the ATD and atrophic MGD groups. Xeroscope grid distortion was noted only with ATD. The Sjogren's group had greater loss of nasolacrimal reflex, slower fluorescein clearance, and greater ocular-surface fluorescein and rose bengal staining than did the others. More MGD subjects had meibomian gland orifice metaplasia and acinar dropout than did those with Sjogren-related ATD and controls. Schirmer scores correlated inversely with rose bengal staining, corneal fluorescein staining, and grid distortion. Rose bengal staining correlated with grid distortion and loss of nasal-lacrimal reflex, but not with MGD. Conclusion. Subjective assessments and objective diagnostic tests have clinical utility as diagnostic tools in tear-film disorders. ATD is correlated with ocular-surface disease. An algorithm summarizing the diagnostic utility of these tests is included.

AB - Purpose. To determine which subjective assessments and objective tests have clinical utility as diagnostic tools in ocular irritation associated with Sjogren's syndrome-related aqueous tear deficiency (ATD), non-Sjogren ATD, inflammatory meibomian gland disease (MGD) associated with rosacea, and atrophic MGD. Methods. Forty adults with ocular irritation and 10 with normal ocular surfaces were enrolled in a nonrandomized, nonblinded clinical trial. Symptoms were evaluated. Tests included biomicroscopy; evaluation of tear- film integrity, production, and clearance; fluorescein and rose bengal staining; and serum autoantibody screening. Results. Symptoms were similar among groups and most severe in the Sjogren's group. Fluorescein tear break- up time was significantly faster in the ATD and MGD groups than that in controls. Schirmer scores were significantly lower in the ATD group than those in MGD and control groups. Tear clearance was delayed in the ATD and atrophic MGD groups. Xeroscope grid distortion was noted only with ATD. The Sjogren's group had greater loss of nasolacrimal reflex, slower fluorescein clearance, and greater ocular-surface fluorescein and rose bengal staining than did the others. More MGD subjects had meibomian gland orifice metaplasia and acinar dropout than did those with Sjogren-related ATD and controls. Schirmer scores correlated inversely with rose bengal staining, corneal fluorescein staining, and grid distortion. Rose bengal staining correlated with grid distortion and loss of nasal-lacrimal reflex, but not with MGD. Conclusion. Subjective assessments and objective diagnostic tests have clinical utility as diagnostic tools in tear-film disorders. ATD is correlated with ocular-surface disease. An algorithm summarizing the diagnostic utility of these tests is included.

KW - Aqueous tear deficiency

KW - Meibomian gland disease

KW - Ocular irritation

KW - Ocular surface disease

KW - Rosacea

KW - Sjogren's syndrome

KW - Tear break-up time

KW - Tear-film disorder

UR - http://www.scopus.com/inward/record.url?scp=0031984088&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031984088&partnerID=8YFLogxK

U2 - 10.1097/00003226-199801000-00007

DO - 10.1097/00003226-199801000-00007

M3 - Article

VL - 17

SP - 38

EP - 56

JO - Cornea

JF - Cornea

SN - 0277-3740

IS - 1

ER -