The Effects of Lower Lid Laxity to the Response of Dry Eye Treatments

Jae Wook Han; Hye Bin Yim; Na Young Lee

doi:10.3341/jkos.2014.55.9.1307

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Han, Yim, and Lee: The Effects of Lower Lid Laxity to the Response of Dry Eye Treatments

Original Article

J Korean Ophthalmol Soc 2014;55(9):1307-1312.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.9.1307

The Effects of Lower Lid Laxity to the Response of Dry Eye Treatments

Jae Wook Han, MD, Hye Bin Yim, MD, PhD, Na Young Lee, MD, PhD

Department of Ophthalmology, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to Na Young Lee, MD, PhD, Department of Ophthalmology, The Catholic University of Korea, Incheon St. Mary's Hospital, #56 Dongsu-ro, Bupyeong-gu, Incheon 403-720, Korea, Tel: 82-32-280-5110, Fax: 82-32-280-5118, E-mail: nyny5555@naver.com

Received 7 December 2013 Revised 31 March 2014 Accepted 29 August 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the response of dry eye treatment in patients divided by the degree of lower lid laxity.

Methods

Thirty patients were classified into three groups - normal, moderate and severe, according to the degree of lower lid laxity. Tear break-up time (TBUT), Schirmer test (ST), ocular surface disease index (OSDI) scores and changes in OSDI score in each group were compared before and at 3 months after the treatment.

Results

TBUT, ST and OSDI scores were not different among the three groups at baseline. TBUT improved to 6.60 ± 1.43, 6.0 ± 2.54 and 6.0 ± 1.45 sec in normal, moderate and severe lower lid laxity group, respectively at 3 months after the treatment and no difference among the groups was found. ST scores did not increase after the treatment, while OSDI scores improved to 12.20 ± 1.40, 16.10 ± 4.63 and 20.80 ± 4.52 in each group, respectively and they were significantly different (p = 0.029, 0.029, <0.001, respectively). The response to the dry eye treatment as assessed by changes in OSDI scores was poorer in patients in the severe lower lid laxity group (p = 0.019 vs. moderate laxity group, <0.01 vs. normal group).

Conclusions

As the degree of lower lid laxity increases, the response to dry eye treatment becomes poorer even when TBUT increases.

Keywords: Dry eye, Lower lid laxity, OSDI, Schirmer test, Snap-back test

References

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Figure 1.

Changes in tear break-up time (TBUT), before and at 3 months after the treatment in eyes grouped by the degree of lower lid laxity.

Figure 2.

Changes in Schirmer test (ST) before and at 3 months after the treatment in eyes grouped by the degree of lower lid laxity.

Figure 3.

Changes in ocular surface disease index (OSDI) scores before and at 3 months after the treatment in eyes grouped by the degree of lower lid laxity. ^*Mann Whitney test (significance level is p < 0.05).

Figure 4.

Comparison of changes in ocular surface disease index (OSDI) scores between pretreatment and at 3 months after the treatment in eyes grouped by the degree of low er lid laxity. ^*Mann Whitney test (significance lev el is p < 0.05).

Table 1.

Demographics and changes in tear break-up time (TBUT), Schirmer test (ST) and ocular surface diseases index (OSDI) scores before and at 3 months after the treatment in eyes grouped by the degree of lower lid laxity

Parameters	Groups			p-value
Parameters	I (n = 10)	II (n = 10)	III (n = 10)	I & II	II & III	I & III
Age (years)	55.00 ± 5.29	56.70 ± 5.36	56.10 ±4.80	0.436	0.912	0.631
Sex (M:F)	0:10	1:9	2:8	1.000	1.000	0.474
Treatments (%)
0.1% Fluorometholon	50	60	60	1.000	1.000	1.000
0.05% Cyclosporine A	10	20	10	1.000	1.000	1.000
Tetracyclin oint + Blephasol^®	0	20	40	0.474	0.628	0.087
MGD	1.20 ± 0.42	1.90 ± 0.74	2.00 ± 0.00	0.043†	0.739	0.002†
TBUT (sec)
Baseline	4.00 ± 0.94	3.70 ± 1.34	4.50 ± 1.08	0.739	0.218	0.315
3 months	6.60 ± 1.43	6.00 ± 2.54	6.00 ± 1.45	0.631	0.684	0.436
p-value	0.004^*	0.011^*	0.010^*
ΔTBUT	2.60 ± 0.84	2.30 ± 1.57	1.50 ± 1.20	0.739	0.218	0.051
ST (mm)
Baseline	8.60 ± 2.46	7.30 ± 4.79	7.80 ± 2.66	0.105	0.247	0.529
3 months	8.40 ± 2.55	7.80 ± 4.39	7.50 ± 2.07	0.353	0.631	0.481
p-value	0.557	0.496	0.457
ΔST	−0.20 ± 2.15	0.50 ± 2.32	−0.30 ± 1.83	0.631	0.579	0.853
OSDI
Baseline	27.80 ± 4.44	30.30 ± 7.99	30.00 ± 4.85	0.796	1.000	0.579
3 months	12.20 ± 1.40	16.10 ± 4.63	20.80 ± 4.52	0.029^†	0.029^†	<0.001^†
p-value	0.005^*	0.005^*	0.005^*
ΔOSDI	15.6 ± 3.31	14.2 ± 5.33	9.2 ± 2.62	0.529	0.019^†	<0.001^†

Values are presented as mean ± SD unless otherwise indicated.

MGD = meibomian gland dysfunction.

^* Wilcoxon signed rank test (significance level is p < 0.05);

^† For the comparison of age, MGD, TBUT, ST and OSDI among 3 groups, Mann Whitney test was used (significance level is p < 0.05), for the comparison of sex and treatments among 3 groups, Fisher's exact test was used (significance level is p < 0.05).

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