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Incidence of Dry Eye in Patients Presenting with Symptoms sug

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Incidence of Dry Eye in Patients Presenting with Symptoms sug Powered By Docstoc
					324                                       AIOC 2009 PROCEEDINGS




                    AUTHORS’S PROFILE:
                    DR. REJI KOSHY THOMAS: M.B.B.S. (’86) & M.S. (’92), St. John’s Medical College;
                    F.I.A.C.L.E. (International) (’96). Recipient of Best Paper–Karnataka Ophthal. Society
                    Conference, 1991, Runner-up, Col. Rangachiari Award, AIOC Cochin. Presently, Professor, St.
                    John’s Medical College Hospital.
                    Contact: (080)25537700, E-mail: rejiann@dataone.in



 Incidence of Dry Eye in Patients Presenting with Symptoms sug-
           gestive of Dry Eye in An Urban Population
 Dr. Reji Koshy Thomas, Dr. Yogesh D, Dr. Suneetha N, Dr. Manjoo C. S., Dr. Myna T.


T
                                  (Presenting Author: Dr. Yogesh D)
    he international dry eye workshop (2007)             Stevens-Johnson Syndrome. Additional, factors
    defined dry eye as a multifactorial disease of       such as contact lens wear, dry or windy
the tears and ocular surface that results in             environment or visual tasking can exacerbate this
symptoms of discomfort1,2 and visual
                                                         disease. With the number of patients presenting
disturbance,3-4 with potential damage to the
ocular surface . It can be caused by reduced tear        with dry eye on the rise, a better understanding
production, poor tear quality, or excessive tear         of the presentation of dry eye will facilitate rapid
evaporation and is associated with symptoms              and early diagnosis, with more efficient
such as irritation, foreign body sensation or            treatment and consequently long term patient
redness .                                                satisfaction. The objective of this study was to
Dry eye can also be associated with systemic             determine the incidence of dry eye in patients
diseases such as Sjogrens syndrome, Lupus and            presenting with symptoms suggestive of dry eye.
                                      LACRIMAL SESSION                                                    325


Materials and Methods                                  Results
This study was conducted on patients who               150 consecutive patients presenting with
reported to the Department of Ophthalmology,           symptoms of dry eye were included in the study.
St. John’s Medical college Hospital during the         All the patients were subjected to the 8 diagnostic
period August 2005 to July 2007.                       tests. Using the diagnostic index evolved for the
This was a prospective observational study in          study, patients who tested positive for 2-5 of the
which patients fulfilling the selection criteria       tests were considered to have mild to moderate
were included in the study after taking consent .      dry eye, while patients who tested positive for 6
                                                       or more of the tests were considered to have
Inclusion criteria                                     severe dry eye. Patients who tested positive for
Patients who reported with symptoms of                 none or 1 of the tests were considered to have no
grittiness, itchiness, burning, redness, excessive     dry eye.
tearing, sensitivity to light, dryness, ocular
                                                       Using the above criteria, the incidence of dry eye
fatigue, visual disturbances, eye strain, watery
                                                       in patients who presented with symptoms of dry
feel in the eyes, excessive mucous secretions,
                                                       eye was 50.66% i.e.76 of the 150 patients. Of these,
heaviness of the lids, tight eyelids, poor tearing ,
                                                       43(56.57%) had mild to moderate forms of dry
matting or crusting of lids , intolerance to fan and
                                                       eye while 33(43.42%) had severe dry eye. The
air conditioning were included in this study
                                                       most common symptom was burning (60.7%)
Exclusion criteria                                     followed by gritty sensation (52%) foreign body
1. Patients suffering from acute ocular                sensation (50%) and watering (48.7%).
   infections, extensive corneal or conjunctival       Photophobia (p<0.001), inability to produce tears
   pathology,                                          (p=0.006) and gritty sensation (p=0.02) showed
2.   Chronic dacrocystitis                             statistically significant correlation with the
                                                       diagnostic index for dry eye.
3.    Patients who had undergone ocular surgery
     in the last six months                            Discussion
4. Patients who were on topical lubricants for         Past studies of Hikichi T et al6 Farrell J et al7 and
   the last six months                                 Albietz et al 8 suggested that dry eye prevalence
A detailed history regarding symptoms,                 ranges from 10.8% to 57.1%. In our study the
occupation, drug intake and local and systemic         incidence of dry eye was 50.66% among patients
associations was taken. The ocular surface             presenting to us with symptoms of dry eye. This
disease index (OSDI) questionnaire was applied         seems to fall in the middle of this range. The
to all patients. The OSDI score was then               most common symptom was burning (60.7%)
calculated.                                            followed by gritty sensation (52%) foreign body
                                                       sensation (50%) and watering (48.7%).
The following diagnostic tests were carried out
on all patients;                                       The population in our study had ages ranging
                                                       between 24 to 88 years, with a preponderance of
1. blink rate,
                                                       patients in the fifth decade. The mean age was
2. tear meniscus height,                               49.25 (+/- 13.78) years. The mean age in Khurana
3. tear film break up time,                            et al9 study was 49.19 years. In the 76 cases
4. rose Bengal staining,                               diagnosed to have dry eye in our study, there
5. flourescein staining of the cornea,                 was a slight female preponderance, 41 (53.95%)
                                                       and 35 (46.05%) were males. These findings are
6. meibomian gland dysfunction,
                                                       consistent the studies done by Moses et al10 and
7. Schirmer’s test.                                    Mc Carty et al.11
                                                References
1. Lemp MA. Report of the National Eye                    relationship between habitual patient reported
   Institute/Industry Workshop on clinical Trials in      symptoms and clinical signs among patients with
   Dry Eye. CLAO J 1995;21:221-32.                        dry eye of varying severity. Invest Ophthalmol Vis Sci
2. Begley CG, Chalmers RL, Ab Etz L, et al. The           2003;44:4753-61.
326                                              AIOC 2009 PROCEEDINGS


3.    Rieger G. The importance of the precorneal tear                time with schirmers tear test. Acta Ophthalmol
     film for the quality of optical imaging. Br J                   (Copenh) 1992;70:357-60.
     Ophthalmol 1992;76:157-8.                                 8.    Albietz JM. Prevalence of dry eye subtypes in
4.   Liu Z, Pflugfelder SC. Corneal surface irregularity             clinical optometry practice. Optometry Vis Sci
     and the effect of artificial tears in aqueous tear              2000;77:357-63.
     deficiency. Ophthalmology 1999;106:936-43.                9.    Khurana AK, Choudhary R, Ahluwalia BK et al.
5.   Goto E, Yogi Y, Matsumoto Y et al. Impaired                     Hospital epidemiology of dry eye. Indian J
     functional visual acuity of dry eye patients. Am J              Ophthalmol 1991;39:255-58.
     Ophthalmol 2002;133:181-6.                                10.   Moses et al. Incidence of dry eye in an older
6.   Hikichi T, Yoshida A, Fukui Y et al. Prevalence of              population. Arch Ophthalmol 2004;122:319-326
     dry eye in Japanese eye centres.                          11.   McCarty CA, Bansal AK, Livingstone PM et al. The
7.   Farrell J, Grierson DJ, Patel S et al. A classification         epidemiology of dry eye in Melbourne, Australia.
     for dry eyes following comparison of tear thinning              Ophthalmology 1998;105:1114-9.

				
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