Journal List > J Korean Ophthalmol Soc > v.58(6) > 1010781

Yun, Yim, Kim, and Na: Clinical Significance of Tear Film Osmolarity for Non-Sjögren Dry Eye Diagnosis

Abstract

Purpose

To evaluate the diagnostic value of tear film osmolarity for non-Sjogren dry eye syndrome through measuring the correlation between tear osmolarity and several conventional dry eye parameters.

Methods

In this observational cross-sectional study, 274 patients (274 eyes) with non-Sjogren dry eye syndrome were examined using tear film osmolarity and the following conventional dry eye parameters: Schirmer's test, tear film break-up time, ocular surface disease index (OSDI), and corneal staining score. The correlations between tear film osmolarity and each conventional dry eye parameter were assessed using Spearman's correlation coefficients.

Results

The mean tear film osmolarity of the study population was 296.34 ± 21.08 mOsm/L. The tear film osmolarity was significantly negatively correlated with the Schirmer's test value (r = -0.431, p < 0.001) and tear break-up time (r = -0.131, p = 0.031), while it was significantly positively correlated with the OSDI scores (r = 0.191, p = 0.001) and corneal staining scores (r = 0.150, p = 0.013).

Conclusions

Tear film instability was significantly correlated with other conventional dry eye parameters. However, additional studies are required to determine its feasibility as a stand-alone diagnostic tool.

Figures and Tables

Figure 1

Association between tear osmolarity and the Schirmer's test, tear break-up time, Ocular Surface Disease Index (OSDI) score and Corneal staining score. The tear osmolarity was significantly negatively correlated with the Schirmer's test value (A), and tear break-up time (B). The tear osmolarity was significantly positively correlated with OSDI scores (C), and the corneal staining scores (D). Data were analyzed using Spearman correlation.

jkos-58-640-g001
Table 1

Clinical characteristics of study population

jkos-58-640-i001

Values are presented as mean ± SD (range) or n (%) unless otherwise indicated.

TBUT = tear film break-up time; OSDI = Ocular Surface Disease Index (values were not calculated by using OSDI formula).

Table 2

Comparison of clinical measurements between different severity groups

jkos-58-640-i002

Values are presented as mean ± SD unless otherwise indicated.

DEWS = International Dry Eye Workshop; OSDI = Ocular Surface Disease Index (values were not calculated by using OSDI formula); TBUT = tear film break-up time.

*Mann-Whitney test.

Table 3

International Dry eye Workshop (DEWS) Classification of dry eye disease severity*

jkos-58-640-i003

OSDI = Ocular Surface Disease Index (values were not calculated by using OSDI formula); TBUT = tear film break-up time.

*Developed by Suzuki et al.14

References

1. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007; 5:75–92.
2. Kim WJ, Kim HS, Kim MS. Current trends in the recognition and treatment of dry eye: a survey of ophthalmologists. J Korean Ophthalmol Soc. 2007; 48:1614–1622.
3. Bron AJ. Diagnosis of dry eye. Surv Ophthalmol. 2001; 45:Suppl 2. S221–S226.
4. Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007; 5:108–152.
5. Mishima S, Kubota Z, Farris RL. The tear flow dynamics in normal and in keratoconjunctivitis sicca cases. Excerpta Medica Int Congr Ser. 1970; 222:1801–1805.
6. Schargus M, Wolf F, Tony HP, et al. Correlation between tear film osmolarity, dry eye disease, and rheumatoid arthritis. Cornea. 2014; 33:1257–1261.
7. Amparo F, Jin Y, Hamrah P, et al. What is the value of incorporating tear osmolarity measurement in assessing patient response to therapy in dry eye disease? Am J Ophthalmol. 2014; 157:69–77.e2.
8. Bunya VY, Langelier N, Chen S, et al. Tear osmolarity in Sjögren syndrome. Cornea. 2013; 32:922–927.
9. Na KS, Yoo YS, Hwang KY, et al. Tear osmolarity and ocular surface parameters as diagnostic markers of ocular Graft-Versus-Host Disease. Am J Ophthalmol. 2015; 160:143–149.e1.
10. Gilbard JP. Tear film osmolarity and keratoconjunctivitis sicca. CLAO J. 1985; 11:243–250.
11. Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea. 2003; 22:640–650.
12. Tomlinson A, Khanal S. Assessment of tear film dynamics: quantification approach. Ocul Surf. 2005; 3:81–95.
13. Bron AJ, Tiffany JM, Yokoi N, Gouveia SM. Using osmolarity to diagnose dry eye: a compartmental hypothesis and review of our assumptions. Adv Exp Med Biol. 2002; 506(Pt B):1087–1095.
14. Suzuki M, Massingale ML, Ye F, et al. Tear osmolarity as a biomarker for dry eye disease severity. Invest Ophthalmol Vis Sci. 2010; 51:4557–4561.
15. Lemp MA, Bron AJ, Baudouin C, et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol. 2011; 151:792–798.e1.
16. Tomlinson A, Khanal S, Ramaesh K, et al. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci. 2006; 47:4309–4315.
17. Versura P, Profazio V, Campos EC. Performance of tear osmolarity compared to previous diagnostic tests for dry eye diseases. Curr Eye Res. 2010; 35:553–564.
TOOLS
Similar articles