Tear Meniscus Dimensions in Tear Dysfunction and Their Correlation With Clinical Parameters

PURPOSE: To evaluate relationships between tear meniscus dimensions and parameters of ocular surface disease in a variety of tear dysfunction conditions. DESIGN: Single-institution prospective observational study. METHODS: This study from the Baylor College of Medicine included 128 eyes of 64 subjects. Cross-sectional lower tear meniscus height and tear meniscus area were measured using optical coherence tomography and were compared with tear break-up time (TBUT), corneal staining, conjunctival staining, and an irritation symptom questionnaire (Ocular Surface Disease Index). Study groups included meibomian gland disease (MGD), aqueous tear deficiency (ATD), Sjogren syndrome, non Sjogren syndrome ATD, and control subjects. Statistical analyses were performed using the Pearson correlation and Student's t test. RESULTS: When compared with mean tear meniscus height in controls (345 mu m), mean tear meniscus height was lower in all tear dysfunction (234 mu m; P = .0057), ATD (210 mu m; P = .0016), and Sjogren syndrome groups (171 mu m; P =.0054). For tear meniscus height <= 210 mu m, relative risk ratio for developing corneal staining >= 10 was 4.65. Tear meniscus height correlated with corneal staining for all subjects (R = -0.32; P =.0008), MGD (R = + 0.40; P = .059), and ATD (R = -0.36; P = .04). Tear meniscus area showed similar trends in MGD (R = + 0.55; P = .006) and ATD (R = - 0.40; P = .018). Tear meniscus height correlated with TBUT for all subjects (R = + 0.39; P <.0001) and ATD (R = + 0.37; P = .018). CONCLUSIONS: In tear dysfunction conditions, lower tear volume correlates with worse corneal epithelial disease in ATD and Sjogren syndrome, conditions with lacrimal gland dysfunction. In contrast, higher tear volume is associated with corneal epithelial disease in MGD. These findings may improve the ability to identify patients at risk for corneal epithelial disease. (C) 2014 by Elsevier Inc. All rights reserved.