Subjective ocular dryness assessment may be unreliable

FORT LAUDERDALE, Fla. — Subjective assessment of aqueous tear production did not correlate with screening in patients undergoing refractive surgery, according to a study reported here.

Brian P. Vahjen, MD, and colleagues presented data in a poster at the Association for Research in Vision and Ophthalmology meeting.

Non-contact lens wearers were less likely than lens wearers to report symptoms of ocular dryness but were more likely to have objective signs of aqueous tear deficiency. Lens wearers were less likely to have objective signs of aqueous tear deficiency but were more likely to report symptoms, the authors said.

"Given these findings, an adequate aqueous tear production screening device should be considered prior to performing refractive surgery in all patients, as subjective reporting by the patient does not appear to correspond with more accurate, objective screening devices," they said.

The retrospective study included 104 eyes of 52 patients who presented for refractive surgery and underwent subjective and objective ocular surface assessments.

Investigators used Schirmer I testing to objectively assess ocular surface dryness. A patient questionnaire was administered to gather subjective complaints of ocular dryness. Thirty-four patients wore contact lenses and 18 patients were non-wearers.

Study data showed that, among contact lens wearers, five patients (15%) had at least one eye with a Schirmer I test score lower than 10, a sign of aqueous tear deficiency. Nine patients in that group (26%) subjectively reported symptoms of ocular dryness.

Six of 18 non-lens wearers (33%) had at least one eye with a Schirmer I score of less than 10, while one patient in that group (6%) reported symptoms of dryness, the authors reported.

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