EVALUATION OF SUBJECTIVE ASSESSMENTS AND OBJECTIVE DIAGNOSTIC-TESTS FOR DIAGNOSING TEAR-FILM DISORDERS KNOWN TO CAUSE OCULAR IRRITATION

Purpose. To determine which subjective assessments and objective tests have clinical utility as diagnostic tools in ocular irritation associ ated with Sjogren's syndrome-related aqueous tear deficiency (ATD), no n-Sjogren ATD, inflammatory meibomian gland disease (MGD) associated w ith rosacea, and atrophic MGD. Methods. Forty adults with ocular irrit ation and 10 with normal ocular surfaces were enrolled in a nonrandomi zed, nonblinded clinical trial. Symptoms were evaluated. Tests include d biomicroscopy; evaluation of tear-film integrity, production, and cl earance; fluorescein and rose bengal staining; and serum autoantibody screening. Results. Symptoms were similar among groups and most severe in the Sjogren's group. Fluorescein tear break-up time was significan tly faster in the ATD and MGD groups than that in controls. Schirmer s cores were significantly lower in the ATD group than those in MGD and control groups. Tear clearance was delayed in the ATD and atrophic MGD groups. Xeroscope grid distortion was noted only with ATD. The Sjogre n's group had greater loss of nasolacrimal reflex, slower fluorescein clearance, and greater ocular-surface fluorescein and rose bengal stai ning than did the others. More MGD subjects had meibomian gland orific e metaplasia and acinar dropout than did those with Sjogren-related AT D and controls. Schirmer scores correlated inversely with rose bengal staining, corneal fluorescein staining, and grid distortion. Rose beng al staining correlated with grid distortion and loss of nasal-lacrimal reflex, but not with MGD. Conclusion. Subjective assessments and obje ctive diagnostic tests have clinical utility as diagnostic tools in te ar-film disorders. ATD is correlated with ocular-surface disease. An a lgorithm summarizing the diagnostic utility of these tests is included .