Diagnostic value of three simple and rapid dry eye tests: Lid parallel conjunctival folds, tear meniscus height and tear ferning

Abstract

Introduction/Objective. The objective of this paper was to assess the diagnostic value of three simple dry eye (DE) tests: lid parallel conjunctival folds (LIPCOF), tear meniscus height (TMH), and tear ferning (TF). Methods. Diagnostic DE tests LIPCOF, TMH and TF tests were performed in 100 patients. Eighty of them were referred to us by rheumatologists and general practitioners either during evaluation for Sj?gren?s syndrome, or because of DE symptoms. Control group was made of 20 patients, with no DE relating symptoms. Ocular Surface Disease Index (OSDI) questionnaire was used for DE symptoms? evaluation. Results of LIPCOF, TMH and TF tests were compared with results of Copenhagen criteria (CC) DE tests i.e., tear fluorescein break up time, Schirmer I and Rose Bengal tests. Ability of tests to recognize DE in various grades according to Dry Eye Work Shop (DEWS) report score system was assessed. Results. Compared to CC, sensitivity of LIPCOF and TMH was high: 92.8% and 83.5%, while specificity was low: 34.4% and 49.2%, respectively. TF had low sensitivity of 59.1% but high specificity of 82.7%. Mean values of both LIPCOF and TMH differed significantly (F = 7.222, p < 0.001 and F = 11.802, p < 0.001) between control group and all DEWS DE grades, but not among different grades of DE. Conclusions. Diagnostic tests TMH and LIPCOF showed high sensitivity which makes them excellent screening DE tests. Low sensitivity of TF suggests that it is not truly a good screening test on its own, but its high specificity is of definite value.