Journal List > J Korean Ophthalmol Soc > v.50(8) > 1008328

Seung, Hyo, and Kyung: Tear Film and Ocular Surface Changes in Chronic Renal Failure Patients Undergoing Hemodialysis

Abstract

Purpose:

To evaluate the changes of tear film and ocular surface in patients with chronic renal failure (CRF) undergoing hemodialysis.

Methods:

In 50 eyes of 25 CRF patients undergoing hemodialysis and 30 eyes of 15 control subjects, tear break-up time (BUT), basal tear secretion (BST), corneal sensation, tear clearance rate (TCR), keratoepitheliopathy and impression cytology findings were compared. Correlation between the above parameters and local or systemic factors was analyzed.

Results:

Tear BUT, BST, TCR, conjunctival squamous metaplasia and conjunctival goblet cell density in the patient and control groups were 7.7±3.8 and 11.1±2.9 sec, 7.0±3.1 and 14.0±6.2 mm, 3.5±1.2 and 4.5±0.7, 1.5±0.6 and 0.3±0.5, 6.5±1.7 and 24.3±21.4 cells/mm2. Osmolarity in serum and tears of the patient group was higher than that of the control group. Serum and tear osmolarity correlated with BST, corneal sensation and conjunctival goblet cell density, and serum creatine level correlated with conjunctival goblet cell density (p<0.05).

Conclusions:

Patients with CRF undergoing hemodialysis have an increased risk of dry eye and thus, serum and tear osmolarity in dry eye patients should be closely monitored.

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Figure 1.
Impression cytologic findings. (A) Specimen from a patient with chronic renal failure undergoing hemodialysis shows a loss of goblet cells and large, polygonal epithelial cells. (B) Specimen from a normal subject shows many periodic acid-Schiff positive goblet cells and small, round epithelial cells.
jkos-50-1167f1.tif
Figure 2.
Correlation between corneoconjunctival calcification (grade) and serum calcium (mEq/L) in chronic renal failure patients undergoing hemodialysis.
jkos-50-1167f2.tif
Table 1.
Comparison of serum BUN, Cr, Ca, P and osmolarity between the chronic renal failure-hemodialysis and control groups
  CRF group (mean±SD) Control group (mean±SD) p value
Serum BUN (mg/dL) 61.19±25.68 15.73±5.86 <0.01
Serum Cr (mg/dL) 8.94±3.08 0.79±0.32 <0.01
Serum Ca (mEq/L) 4.42±0.55 4.43±0.33 0.73
Serum P (mg/dL) 5.02±1.50 3.63±0.56 0.07
Serum osmolarity (mOsm/kg) 307.36±12.41 287.75±6.70 0.01

CRF=chronic renal failure.

Table 2.
Comparison of serum BUN, Cr between the DM patients and the other patients in the chronic rena failure-hemodialysis group
  CRF with DM (mean±SD) CRF without DM (mean±SD) p value
Serum BUN (mg/dL) 62.99±23.68 59.98±21.22 0.15
Serum Cr (mg/dL) 7.24±2.90 9.11±2.55 0.09

CRF=chronic renal failure.

Table 3.
Comparison of tear film and ocular surface parameters between the chronic renal faliure-hemodialysis and control groups
  CRF group (mean±SD) Control group (mean±SD) p value
BUT (sec) 7.65±3.82 11.08±2.87 0.01
BST (mm) 6.95±3.06 14.00±6.22 <0.01
CST§ (mm) 58.61±2.30 59.50±1.58 0.28
TCR (Log2)-1 3.45±1.19 4.54±0.66 0.01
Keratoepitheliopathy 1.00±1.56 0.95±0.10 0.31
Squamous metaplasia (grade) 1.50±0.58 0.33±0.52 0.04
GCD (cells/mm2) 6.5±1.73 24.33±21.44 0.01
Tear osmolarity (mOsm/kg) 322.80±10.76 295.75±6.75 0.014

CRF=chronic renal failure

BUT=tear break-up time

BST=basal tear secretion

§ CST=corneal sensation

TCR=tear clearance rate

GCD=goblet cell density.

Table 4.
Comparison of tear film and ocular surface parameters between the DM patients and the other patients in the chronic renal failure-hemodialysis group
  CRF with DM (mean±SD) CRF without DM (mean±SD) p value
BUT (sec) 7.12±3.44 7.98±3.87 0.22
BST (mm) 7.21±2.97 6.57±3.82 0.14
CST§ (mm) 59.22±1.97 58.32±1.46 0.75
TCR (Log2)-1 3.31±1.10 3.67±1.22 0.35
Keratoepitheliopathy 1.10±1.42 0.97±1.27 0.41
Squamous metaplasia (grade) 1.48±0.53 1.52±0.60 0.52
GCD (cells/mm2) 6.9±1.28 5.95±1.99 0.15
Tear osmolarity (mOsm/kg) 319.76±11.89 326.33±9.74 0.55

CRF=chronic renal failure

BUT=tear break-up time

BST=basal tear secretion

§ CST=corneal sensation

TCR=tear clearance rate

GCD=goblet cell density.

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