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Moon, Kim, Seo, Kim, and Lee: The Relationship between Subjective Ocular Discomfort and Blepharitis Severity in Dry Eye Patients
Original Article

J Korean Ophthalmol Soc 2016;57(10):1507-1513.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.10.1507

The Relationship between Subjective Ocular Discomfort and Blepharitis Severity in Dry Eye Patients

In Hee Moon, MD1, Tae Im Kim, MD, PhD1, 2, Kyoung Yul Seo, MD, PhD1, 2, Eung Kweon Kim, MD, PhD1, 2, Hyung Keun Lee, MD, PhD1, 2

1The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

2Institute of Corneal Dystrophy Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Hyung Keun Lee, MD, PhD Department of Ophthalmology, Gangnam Severance Hospital, #211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea Tel: 82-2-2019-3440, Fax: 82-2-3463-1049 E-mail: shadik@yuhs.ac

Received 14 April 2016       Accepted 20 September 2020

Copyright © 2016 Korean Ophthalmological Society

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

Although a number of clinical parameters are well known to affect dry eye (DE) disease, it is unknown which factor mostly affects the discomfort of DE. Blepharitis is recognized as one of the leading causes of evaporative-type DE disease, but there have been no large-scale study to investigate the effect of blepharitis on DE symptoms. The purpose of this study was to evaluate the factors influencing subjective ocular discomfort in DE patients with blepharitis and to determine which parameter is most highly related to severity of blepharitis.

Methods

This investigation was a cross-sectional, clinical study. The test population consisted of DE patients suffering from moderate blepharitis. Seventy-three subjects aged 22 to 81 years (mean age 56.36) were enrolled, 49 of whom completed the investigation on a total of 49 eyes. A detailed assessment was conducted, including history taking, visual analog scale (VAS) pain scoring, ocular surface disease index (OSDI) questionnaire, blepharitis severity grading (score 0–4), conjunctival, corneal fluorescein staining (score 0–4), and tear break up time (TBUT) assessment.

Results

The results revealed significant correlations between subjective symptoms and blepharitis severity. Significant increases in overall VAS score, OSDI score (p = 0.031, p = 0.006) were recorded in DE patients with severe blepharitis. Conjunctival erosion was significantly related to VAS score (p = 0.016). Other parameters were not significantly related with VAS and OSDI scores. Additionally, conjunctival erosion was related with blepharitis severity (p < 0.0001), and corneal erosion was not correlated with blepharitis severity. TBUT also did not show any statistical correlation with blepharitis.

Conclusions

Our results showed that blepharitis severity is the main factor influencing subjective pain and discomfort in DE patients, although blepharitis severity was not related with the known clinical parameters of DE such as corneal erosion and TBUT. This study indicates that targeting treatment for blepharitis can significantly improve quality of life for patients suffering from DE disease.

Keywords: Blepharitis, Dry eye disease, Meibomian gland dysfunction, Subjective symptoms, Visual analog scale (VAS) score

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Figure 1.
Blepharitis– Obstructive meibomian gland dysfunction Grading. This is slit lamp photographs of clinical scale for blepharitis grading (especially temporal side). (A) Grade 1 blepharitis: 0–20% few capped meibomian glands. (B) Grade 2 blepahritis: 20–30% several blocked glands, and the secretions appeared thick. (C) Grade 3 blepharitis: approximately half the glands were blocked or stenosed. (D) Grade 4 blepharitis. more than half the glands were blocked/stenosed in combination with viscous secretions, tears. Black arrowheads mean the meibomian gland orifice.
jkos-57-1507f1.tif
Figure 2.
Linear regression analysis of visual analogue scale (VAS) pain scoring and dry eye related ocular surface parameters. (A) Blepharitis grading was correlated with VAS score (r = 0.309, p = 0.031). (B) Conjunctival erosion grading was also related to VAS score (r = 0.342, p = 0.016). (C) Corneal erosion grading was not significantly related to VAS score (p = 0.357). (D) Fluorescein tear breakup time (BUT) showed no statistical correlation with VAS score (p = 0.520). * p-value < 0.05.
jkos-57-1507f2.tif
Figure 3.
Linear regression analysis of ocular surface disease index questionnaire score (OSDI) and dry eye related ocular surface parameters and other parameters. (A) Blepharitis grading was correlated with OSDI score (r = 0.389, p = 0.006). (B) Conjunctival erosion grading was not related to OSDI score (p = 0.085). (C) Corneal erosion grading was not significantly related to OSDI score (p = 0.276). (D) Fluorescein tear breakup time (BUT) showed no statistical correlation with OSDI score (p = 0.735). * p-value < 0.05.
jkos-57-1507f3.tif
Table 1.
Demographic data and clinical results
  Blepharitis Grading 0–2 Blepharitis Grading 3–4 p-value
Eyes (N) 33 16  
Male/Female 5/28 (33) 5/11 (16) <0.0001†
Age (years) 52.15 ± 1.76 60.88 ± 1.52 0.0026†
VAS score (0–10) 4.30 ± 0.45 5.87 ± 0.53 0.0418*
OSDI (0–100) 33.54 ± 3.91 50.31 ± 6.39 0.0233*
Conjunctival erosion (0–4) 1.55 ± 0.15 2.25 ± 0.21 0.0103*
Corneal erosion (0–4) 1.38 ± 0.20 1.43 ± 0.26 0.8533
FTBUT (sec) 2.13 ± 0.24 1.90 ± 0.38 0.6197

Values are presented as mean ± SD unless otherwise indicated.

VAS = visual analogue scale; OSDI= ocular surface disease index questionnaire; FTBUT = fluorescein tear breakup time.

* p-value < 0.05

† p-value < 0.01.

Table 2.
Pearson's correlation anlaysis of VAS, OSDI and dry eye related ocular surface parameters
  VAS p-value OSDI p-value
Blepharitis 0.309 0.031* 0.389 0.006†
Conjunctival erosion 0.342 0.016* 0.249 0.085
Corneal erosion 0.136 0.357 0.161 0.276
FTBUT –0.114 0.520 0.060 0.735

VAS = visual analogue scale; OSDI = ocular surface disease index questionnaire; FTBUT = fluorescein tear breakup time.

* p-value < 0.05

† p-value < 0.01.

Table 3.
Pearson's correlation anlaysis among dry eye related ocular surface parameters
  Blepharitis p-value Conjunctival erosion p-value Corneal erosion p-value FTBUT p-value
Blepharitis     0.486 0.000* 0.036 0.809 0.095 0.593
Corneal erosion 0.036 0.809 0.239 0.101     –0.155 0.381
Conjunctival erosion 0.486 0.000*     0.239 0.101 –0.078 0.661
FTBUT 0.095 0.593 –0.078 0.661 –0.155 0.381    

FTBUT = fluorescein tear breakup time.

* p-value < 0.01.

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