Dry eye symptoms align more closely to non-ocular conditions than to tear film parameters

Galor, Anat; Felix, Elizabeth R.; Feuer, William J.; Shalabi, Nabeel; Martin, Eden R.; Margolis, Todd P.; Sarantopoulos, Constantine; Levitt, Roy C.

doi:10.1136/bjophthalmol-2014-306481

Cited by 84 publications

(97 citation statements)

References 24 publications

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“…Mental health abnormalities are often comorbid with chronic pain conditions,21 therefore their association with DE symptoms and discordance is not surprising. Strong correlations between DE symptoms, depression, anxiety and PTSD versus only weak correlations seen between symptoms and tear film measures22 imply DE symptoms are more strongly connected to mental health metrics than ocular surface findings.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of discordance between symptoms and signs of dry eye

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Epidemiology of discordance between symptoms and signs of dry eye

et al. 2017

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“…Based on our prior data, 24 features suggestive of NOP were assessed using four questions: (1) presence of spontaneous burning ocular pain, presence of evoked pain, including ocular pain caused or increased by (2) wind, (3) light and (4) air temperature (air conditioned/warm weather), with all responses rated on a scale from 0 to 10. Using a two-step cluster analysis based on burning, sensitivity to light, wind and temperature, the patient population was divided into two groups that were significantly different from each other regarding these NOP complaints and were subsequently termed 'high NOP' and 'low NOP' groups.…”

Section: Nop Complaintsmentioning

confidence: 99%

“…23 We previously demonstrated that DE symptom severity correlated with severity of pain elsewhere in the body (non-ocular), depression and post-traumatic stress disease (PTSD) more strongly than it did with ocular surface parameters. 24 Taking this idea a step further, in this paper, we test our hypothesis by classifying patients with DE symptoms into groups based on complaints suggestive of NOP. We then compared features of CSS ( pain ratings, comorbid pain conditions and mental health indices) between these groups.…”

Section: Introductionmentioning

confidence: 99%

Patients with more severe symptoms of neuropathic ocular pain report more frequent and severe chronic overlapping pain conditions and psychiatric disease

et al. 2016

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Objective To study chronic pain and mental health profiles in patients with dry eye (DE) symptoms, comparing those with high and low levels of neuropathic ocular pain (NOP) complaints. Design Cross-sectional study of 181 patients with DE symptoms (dry eye questionnaire score ≥6) seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding DE symptoms, NOP complaints (burning, sensitivity to wind, light and cold/hot temperatures) and pain elsewhere in the body (non-ocular). This was followed by a comprehensive ocular surface examination. The patients’ comorbidities, medications, mental health (depression and post-traumatic stress disorder) and quality-of-life indices were also obtained. Patients were classified using cluster analysis into either the ‘high NOP’ or ‘low NOP’ group. Subsequent analyses were performed to examine differences in ocular and non-ocular parameters between these two groups. Results Despite similar ocular surface findings, patients in the high NOP group had very different systemic (non-ocular) profiles with higher overall pain intensity ratings, higher frequency of comorbid chronic centralised pain conditions, lower quality-of-life indices and more abnormal mental health scores than those in the low NOP group. Conclusions Consistent with a chronic overlapping pain condition, patients with DE disease with more severe NOP symptoms report more frequent and severe non-ocular functional comorbid pain disorders.

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“…In another study on normal subjects, rates of ocular surface cooling was found to be positively correlated to fluorescein tear thinning and break-up [42][43][44][45]. Simultaneous imaging of OST and fluorescein adopted in these studies [46][47][48] indicated some improvements in methodology to study OST and tear film behaviour at the same time. Pattmöller et al [43], on the other hand, reported no correlation between corneal temperatures with other ocular parameters such as corneal thickness, endothelial cell density and anterior chamber depth in normal subjects.…”

Section: Correlation Between T4 Metrics and Signs And Symptoms For Drmentioning

confidence: 99%

“…Indeed, it was reported that up to 40% of patients had symptom and clinical sign discordance [46]. A more recent study has shown that dry eye symptoms aligned more closely to non-ocular pain, depression and post-traumatic stress disorder than tear film parameters [48].…”

Section: Correlation Between T4 Metrics and Signs And Symptoms For Drmentioning

confidence: 99%

Diagnostic Ability of Conventional Dry Eye Tests and their Correlation with Ocular Surface Temperature

Tan¹,

Morgan²

2016

J Clin Exp Ophthalmol

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Objective: To study the diagnostic ability of conventional dry eye tests and their correlation with ocular surface temperature (OST) and derive the best combined objective tests for dry eye. Methods:This was a single visit study included a few conventional dry eye tests on 62 dry eye and 82 control subjects: symptom evaluation, fluorescein break-up time (FBUT), corneal epithelial staining (CES), non-invasive break-up time (NIBUT) and tear meniscus height (TMH). OST was recorded using NEC TH9260 thermo tracer and six temperature metrics of the extreme nasal conjunctiva was studied including the temperature 10 seconds after eye opening (T4-10). Diagnostic ability was assessed by calculating sensitivity and specificity and area under the receiver operating characteristics curve (AUC). Results:No correlation (Pearson's coefficient, -0.203 to 0.209; p>0.05) was found between Mscore, Scount, FBUT and CES with any of the temperature metrics. However, CES correlated significantly with TMH (r=0.276; p=0.030) and inversely correlated significantly with FBUT (r=-0.258; p=0.043). Values of Mscore at 8 were found to give sensitivity of 87.1% (95% CI: 76.2 to 94.3%) and specificity of 92.7% (84.8 to 97.3%). Values of Scount at 1 were found to give sensitivity of 93.6% (84.3 to 98.2%) and specificity of 65.9% (54.6 to 76.0%). Values of FBUT at 2 s were found to give sensitivity of 58.1% (44.9 to 70.5%) and specificity of 87.8% (78.7 to 94.0%). Values of CES at grade 2 were found to give sensitivity of 71% (58.1 to 81.8%) and specificity of 59.8% (48.3 to 70.4%). Combining CES with T4-10 (series) had increased the AUC to 78% with sensitivity and specificity of 92.3% and 42.7% respectively. Conclusion:This work validated the ability of Mscore, Scount, FBUT and CES in diagnosing dry eye and further confirmed the discordance between its signs and symptoms. Combining CES with T4-10 (series) can be future objective tests for dry eye.

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Dry eye symptoms align more closely to non-ocular conditions than to tear film parameters

Abstract: Dry eye symptoms more closely align to non-ocular pain, depression and PTSD than to tear film parameters.

Cited by 84 publications

References 24 publications

Epidemiology of discordance between symptoms and signs of dry eye

Epidemiology of discordance between symptoms and signs of dry eye

Patients with more severe symptoms of neuropathic ocular pain report more frequent and severe chronic overlapping pain conditions and psychiatric disease

Diagnostic Ability of Conventional Dry Eye Tests and their Correlation with Ocular Surface Temperature

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