Patient symptoms influence grading of dry eye more than clinical signs

Patient complaints may influence physicians’ diagnosis and grading of dry eye more than actual clinical signs, according to researchers at Indiana University.

Carolyn G. Begley and colleagues conducted a multicenter, cross-sectional study of 122 people between the ages of 35 and 65 years. Among the 122 enrolled, 28 served as controls, 73 had non-Sjögren’s keratoconjunctivitis sicca and 21 had Sjögren’s syndrome. Subjects both with and without Sjögren’s syndrome reported discomfort and dryness most frequently. They also reported most frequently that symptoms worsened over the day and were bothersome.

Regarding clinical testing, the groups were significantly different in corneal fluorescein staining, conjunctival lissamine green staining, Schirmer 1 tear test and tear breakup time. Correlations were found between the frequency and evening intensity of dryness and discomfort and tear breakup time. Correlations were also found between Schirmer’s tear test, overall corneal fluorescein staining and temporal lissamine green conjunctival staining and the patient’s reports of frequency and evening intensity of dryness and discomfort.

The dry eye symptoms were moderately to highly correlated with the clinical grading of severity and were highly correlated to the patient’s self-assessment of severity (r = 0.46-0.86; P < .0001). The clinical signs, however, showed a lower correlation (r = 0.22-0.46; P < .0001).

The study is published in the November issue of Investigative Ophthalmology & Visual Science.