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Morphologic Tests in the Diagnosis of Dry-eye
Módis M., Fodor M., Berta A.,
University of Debrecen, Medical and Health Science Center, Department of Ophthalmology (Debrecen)
Purpose: To introduce morphologic tests such as conjunctival impression cytology (CIC) and mucus fern test (MFT) in the diagnosis of dry eye.
Methods: Fifty eyes of 25 patients suffering from keratoconjunctivitis sicca (group KCS, mean age: 52±15 years) and fifty eyes of 25 patients suffering from Sjögrens syndrome (group SjS, mean age: 53±11 years) were evaluated with the conventional Copenhagen dry eye tests (Schirmer I test, break up time, corneal staining) and morphologic tests (CIC and MFT). Morphologic tests were evaluated according to standardized characteristics as described earlier (CIC: 0-3, MFT: 1-4).1,2 CIC grade 1-3 and MFT grade 3-4 was considered as pathologic. Forty-two eyes of 42 normal age-matched subjects (mean age: 58±12 years) served as control.
Results: The mean value of Schirmer I. test was 5.8±4.4 mm in the KCS group, 10±8.7 mm in the SjS group and 22.2±7.2 mm in the control group (p<0.0001). Tear film break up time was 3.9±2.7 sec, 4.4±3.2 sec and 15.4±5.1 sec in the KCS, SjS and control group, respectively (p<0.0001). Corneal staining was positive in 10 cases in the KCS and in 16 cases in the SjS patients. No corneal staining was present in the normal group. The mean MFT grade was 2.5±0.6 (KCS), 2.5±0.9 (SjS) and 2.1±0.8 (normal) (p=0.008 KCS and p=0.025 SjS). The mean CIC grade was 1.2±0.8 (KCS), 1.5±0.7 (SjS) and 0.2±0.5 (normal) (p<0.0001). Moreover, CIC disclosed correlation with corneal staining (r=0.43, p=0.007) in the KCS patient group and MFT correlated inversely with the Schirmer test (r=-0.3, p=0.03) and break up time (r=-0.49, p=0.01) in the SjS group.
Conclusions: Both morphologic methods provide additional objective information on the complex tear film and the ocular surface. The application of these techniques should be considered in the diagnostic procedures of dry eyes.
References: 1. Nelson JD, Havener VR, Cameron JD: Cellulose acetate impressions of the ocular surface. Arch Ophthalmol 1983;101:1869-1872.; 2. Tabbara KF, Okumoto M.: Ocular ferning test. A qualitative test for mucus deficiency. Ophthalmology 1982; 89:712-714.