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Morning dry eye may be caused by incomplete lid seal
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CHICAGO – Patients with dry eye should be asked about symptoms upon waking and evaluated for incomplete lid seal, according to research presented in a poster here at the American Academy of Optometry meeting.
Christen Kenrick, OD, FAAO, and colleagues set out to determine the prevalence of incomplete lid seal in a group of patients as well as the prevalence of dryness symptoms upon waking in those with incomplete seal, according to the study abstract.
In this prospective, cross-sectional pilot study, the researchers enrolled 93 women and 44 men with a mean age of 49.6 years and evaluated them for incomplete lid seal using the Korb-Blackie Light Test.
Kenrick told Primary Care Optometry News that the light test is conducted in a darkened exam room. A fully illuminated transilluminator is placed against the relaxed, closed upper eyelid at the superior junction of the tarsal plate with minimal pressure, just enough to maintain contact.
“The amount of light emanating between the upper and lower lid margins is graded by an examiner,” Kenrick said.
The study subjects also filled out a questionnaire and were asked if they experienced dryness upon waking.
The researchers found incomplete lid seal in 37.2% of all eyelids: in 20.2% of patients 21 to 40 years old, in 42.0% of patients 41 to 60 years old, and in 50.0% of patients 61 to 80 years old, according to the abstract.
A total of 39.4% reported dryness symptoms upon waking – 39.8% of women and 38.6% of men. Of this group, incomplete lid seal was found in 53.7%: in 32.4% of the youngest group, in 52.6% of those 41 to 60 years old and in 75.0% of the oldest group, according to the study.
Researchers recommended in the poster: “Any patient who reports dry eye symptoms should be specifically questioned for symptoms of dryness upon awakening and be evaluated for incomplete lid seal. This screening is especially important for patients after the fourth decade of life.”
Kenrick told PCON: “Even if a patient’s eyes appear closed, they may not be completely sealed.
If a patient is found to have incomplete lid seal in the presence of symptoms of dryness upon awakening or clinical signs of dry eye, then I advocate nighttime protection with ophthalmic ointment at bedtime or sleep goggles.
“It is important to note, though, that the goal of these interventions is not to correct the incomplete lid seal, but rather to protect the ocular surface from chronic nighttime exposure to desiccating stress,” she added – by Nancy Hemphill, ELS, FAAO
References:
Blackie CA, Korb DR. Eye Contact Lens. 2015;doi:10.1097/ICL.0000000000000072.
Kenrick C, et al. Prevalence of incomplete lid seal and dry eye symptoms upon awakening in a clinical population. Presented at: American Academy of Optometry meeting; Oct. 14-17, 2017; Chicago.
Disclosure: Kenrick reports no relevant financial disclosures.