The relationship between clinical signs and dry eye symptoms

Purpose To evaluate (i) the relationship between traditional and new clinical tests (lid-wiper epitheliopathy (LWE), lid-parallel conjunctival folds (LIPCOF)) and dry eye symptoms in non-contact lens wearers, and (ii) that a combination of these tests can improve predictive ability for the development of dry eye symptoms. Methods Tear meniscus height (TMH), non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test (PRTT), corneal and conjunctival staining, and LWE grades were observed in a cohort of 47 healthy, non-lens wearers (male 17, female 30, median age 35 years, range 19-70). Symptoms were assessed using the Ocular Surface Disease Index (OSDI). Results LWE was significantly correlated to both temporal and nasal LIPCOF (0.537 < r < 0.607, P < 0.05). LIPCOF and LWE were significantly correlated to NIBUT and PRTT (r > -0.248, P < 0.001). Significant correlations were found between NIBUTand TMH (r = 0.461, P = 0.001) and PRTT (r = 0.640, P < 0.001). OSDI scores were significant correlated to NIBUT, TMH, PRTT, LIPCOF, and LWE (r > vertical bar 0.31 vertical bar; P < 0.05). Significant discriminators of OSDI+/- were NIBUT (area under the receiver operative characteristic curve (AUC) = 0.895), TMH (0.715), PRTT (0.781), LIPCOF (temporal/nasal/Sum 0.748/0.828/0.816), and LWE (0.749). Best predictive ability was achieved by combining NIBUT with nasal LIPCOF (AUC = 0.944). Conclusions The individual tests NIBUT, TMH, PRTT, LIPCOF, and LWE were significantly, but moderately, related to OSDI scores. The strongest relationship appeared by combining NIBUT with nasal LIPCOF. Eye (2011) 25, 502-510; doi:10.1038/eye.2010.228; published online 21 January 2011