Síndrome do olho seco / Dry eye syndrome

A Síndrome do Olho Seco é uma condição ocular crônica, de origem multifatorial, caracterizada pelo círculo vicioso de instabilidade do filme lacrimal e sua hiperosmolaridade, que causam inflamação da superfície ocular e anormalidades neurossensoriais (NELSON et al., 2017; TSUBOTA et al., 2017; ZEMANOVÁ, 2021). A doença é classificada em dois subtipos, sendo: deficiência aquosa, quando há produção lacrimal reduzida ou hiperevaporativo, em que o filme lacrimal se evapora de forma excessiva em decorrência de alteração na produção de algum dos componentes da lágrima por disfunção da glândula meibomiana (MGD). Cerca de 10% dos indivíduos apresentam deficiência aquosa e mais de 80% a hiperevaporação. No entanto, também pode ocorrer uma combinação de ambos (MESSMER, 2015)

Dry Eye Syndrome is a chronic eye condition, of multifactorial origin, characterized by the vicious circle of tear film instability and its hyperosmolarity, which cause ocular surface inflammation and neurosensory abnormalities (NELSON et al., 2017; TSUBOTA et al., 2017; ZEMANOVÁ, 2021). The disease is classified into two subtypes, namely: water deficiency, when there is reduced tear production, or hyperevaporative, in which the tear film evaporates from excessive form due to alteration in the production of some of the tear components due to meibomian gland dysfunction (MGD). About 10% of individuals have water deficiency and more than 80% have hyperevaporation. However, a combination of both can also occur (MESSMER, 2015)

Dry eye, its clinical subtypes and associated factors in healthy pregnancy: A cross-sectional study.

The study determined the frequency of dry eye, its clinical subtypes and risk factors among pregnant women. This study was a hospital-based cross-sectional study of pregnant women visiting the antenatal clinic of the University of Cape Coast hospital. Clinical dry eye tests were performed along with the administration of a symptom questionnaire. Frequencies, chi-square analysis and logistic regression analyses were conducted to determine the frequency of dry eye disease, its clinical subtypes and associated factors. The prevalence of dry eye disease among the cohort of pregnant women was 82/201 (40.8% 95% confidence interval 34.3%-47.3%). Among the 82 pregnant women with dry eye disease, the frequencies of the clinical subtypes of dry eye were: evaporative dry eye [15/82(18.3%; 95% CI, 12.2%-25.2%)], aqueous deficient dry eye [10/82(12.2.%; 95% CI, 7.3%-18.3)], mixed dry eye [6/82(7.3%; 95% CI, 3.7%-11.0%)], and unclassified dry eye [51/82(62.2%; 95% CI, 52.4%-72.0%)]. Binary logistic regression analysis showed that the following factors were not significantly associated with dry eye: age, BMI, lipid profile, prolactin level, testosterone level, ocular protection index and blink rate. Only gestational age was significantly associated with dry eye disease in pregnancy. In conclusion, the current study showed that dry eye disease occurs frequently in pregnant women ranging from the first to the third trimester and it is associated with increasing gestational age. The evaporative dry eye was more common compared to the aqueous deficient dry eye, but most dry eye could not be classified.

Updated definition and classification of dry eye disease: Renewed proposals using the nominal group and Delphi techniques.

The aim of our research was to obtain expert consensus for updated definition and classification of dry eye disease using formal methodology. The nominal group technique (NGT) involved a steering committee of four ophthalmologists began with collection of ideas followed by group discussion. The ideas were collated, refined, and voted upon. The main characteristics considered, each with different degrees of severity in types I, II, and III, were the ability or not of the ocular surface to re-equilibrate itself, frequency of symptoms, presence of inflammation, epithelial alterations, and possible alterations in the quality of vision. This was followed by three rounds of a "mini-Delphi" involving an expert panel of 13 ophthalmologists, with the last round including all 17 ophthalmologists. Consensus in the final round of voting (⩾75% of votes) was reached on the definition of dry eye disease and on criteria for its classification in three forms. Type I is a transient and reversible form with subclinical inflammation, possible epithelial alterations, and occasional alterations in vision. Type II is a recurrent form characterized by a reduced ability to re-equilibrate the ocular surface, frequent symptoms and alterations in vision with clinically-evident inflammation, and clear evidence of epithelial alterations. Type III is a chronic form with inability to re-equilibrate the ocular surface and accompanied by clinically-evident and chronic inflammation, persistent epithelial alterations, and frequent alterations in quality of vision. The vast majority of patients with dry eye disease can be easily classified into one of these three forms. Dry eye disease definition was updated accordingly.

A New Perspective on Dry Eye Classification: Proposal by the Asia Dry Eye Society.

The 2017 consensus report of the Asia Dry Eye Society (ADES) on the definition and diagnosis of dry eyes described dry eye disease as "Dry eye is a multifactorial disease characterized by unstable tear film causing a variety of symptoms and/or visual impairment, potentially accompanied by ocular surface damage." The report emphasized the instability of tear film and the importance of visual dysfunction in association with dry eyes, highlighting the importance of the evaluation of tear film stability. This report also discussed the concept of tear film-oriented therapy, which stemmed from the definition, and which is centered on provision of insufficient components in each tear film layer and ocular surface epithelium. The current ADES report proposes a simple classification of dry eyes based on the concept of tear film-oriented diagnosis and suggests that there are three types of dry eye: aqueous-deficient, decreased wettability, and increased evaporation. It is suggested that these three types respectively coincide with the problems of each layer: aqueous, membrane-associated mucins, and lipid/secretory mucin. Although each component cannot be quantitatively evaluated with the current technology, a practical diagnosis based on the patterns of fluorescein breakup is recommended. The Asia Dry Eye Society classification report suggests that for a practical use of the definition, diagnostic criteria and classification system should be integrated and be simple to use. The classification system proposed by ADES is a straightforward tool and simple to use, only through use of fluorescein, which is available even to non-dry eye specialists, and which is believed to contribute to an effective diagnosis and treatment of dry eyes.

Characteristics of dry eye in patients with pre-existing Sjögren's syndrome according to the revised 2016 ACR-EULAR classification criteria.

To compare the characteristics of dry eye (DE) patients who did and did not satisfy the 2016 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria for primary Sjögren's syndrome (SS) among patients with pre-existing SS diagnosed according to the 2012 ACR criteriaThis cross-sectional study evaluated 91 patients with pre-existing SS and 55 with non-SS DE. Patients with SS were divided into 2 groups according to whether they met the revised 2016 ACR-EULAR classification criteria for primary SS. Group 1 (n = 71) was comprised of patients who satisfied the revised 2016 criteria and group 2 (n = 20) was comprised of patients who did not satisfy the newly revised criteria. Group 3 consisted of 55 patients with non-SS DE. The ocular surface disease index (OSDI) score, tear break-up time (TBUT), Schirmer score, tear clearance rate (TCR), and corneal and conjunctival staining scores were evaluated and compared between the groups. Laboratory profiles, including antinuclear antibodies, rheumatoid factor levels, erythrocyte sedimentation rate, and C-reactive protein levels, and focus scores were analyzed.TBUT, Schirmer, and corneal/conjunctival staining scores were significantly worse in both groups of patients with SS (groups 1 and 2) than in those with non-SS DE (group 3). However, there were no significant differences between groups 1 and 2 in laboratory findings as well as in ocular surface findings, including OSDI, TBUT, Schirmer score, TCR, and corneal/conjunctival staining scores. The focus score, which shows the level of lymphocytic infiltration in the salivary glands, was higher in group 1 than in group.Of the patients with pre-existing SS who were diagnosed according to the 2012 ACR classification, patients who did not satisfy the 2016 ACR-EULAR classification criteria for primary SS showed similar ocular surface parameters and laboratory findings to patients who did meet the revised classification, except for focus score. There is no need to change the direction of treatment of DE in patients with pre-existing SS who did not meet the revised 2016 ACR-EULAR criteria.

Estimated Prevalence and Incidence of Dry Eye Disease Based on Coding Analysis of a Large, All-age United States Health Care System.

PURPOSE: To assess overall prevalence, annual prevalence, and incidence of dry eye disease (DED) in a large, representative population in the United States. DESIGN: Prevalence and incidence study. METHODS: Retrospective analysis using the Department of Defense (DOD) Military Health System (MHS) data on beneficiary medical claims from United States DOD military and civilian facilities, January 1, 2003 through March 31, 2015. PATIENT POPULATION: Using an algorithm, medical diagnostic codes indicative of DED and prescriptions for cyclosporine ophthalmic emulsion identified a DED population from 9.7 million MHS beneficiaries (DOD service members, retirees, and dependents, aged 2-80+ years). MAIN OUTCOME MEASURES: DED overall prevalence (2003-2015), annual prevalence (2005-2012), and annual incidence (2008-2012) stratified by sex, age group, and International Statistical Classification of Diseases and Related Health Problems, Ninth Revision diagnosis code grouping. RESULTS: DED prevalence was 5.28% overall, 7.78% among female beneficiaries, 2.96% among male beneficiaries and increased with age from 0.20% for ages 2-17 years, to 11.66% for individuals aged 50+ years. Annual prevalence increased from 0.8% to 3.0% overall, from 1.4% to 4.5% in female beneficiaries, and from 0.3% to 1.6% in male beneficiaries. Annual prevalence increased across age groups starting at age 18-39, 0.1%-0.6%, to age 50+, 1.8%-6.0%. Annual incidence increased from 0.6% to 0.9% overall, from 0.8% to 1.2% in female beneficiaries, and from 0.3% to 0.6% in male beneficiaries. Across age groups, annual incidence increased starting at age 18-39 (0.2%-0.3%), to age 50+ (1.0%-1.6%). CONCLUSIONS: DED overall prevalence, annual prevalence, and incidence were found to increase over time for all demographics. These findings highlight the continued importance of research and therapeutic development for this common condition.

Classifying signs and symptoms of dry eye disease according to underlying mechanism via the Delphi method: the DIDACTIC study.

BACKGROUND/AIMS: Dry eye disease (DED) is categorised by pathophysiology as aqueous deficient dry eye (ADDE), evaporative dry eye (EDE) or mixed. Treatment should be tailored to DED pathophysiology, but this is challenging to determine. This Delphi consultation aimed to categorise and weight signs and symptoms to help identify the evaporative or aqueous deficient DED origin. METHODS: A panel of French DED experts created an initial list of 77 DED signs and symptoms. In a Delphi consultation, experts categorised items by DED pathophysiology. Likert scoring was used to indicate whether items were strongly or moderately indicative of ADDE or EDE. Items could also be judged non-applicable to DED, with the opportunity to suggest alternative diagnoses. RESULTS: Experts attributed 19 items (of which 11 were strongly indicative) to a pathophysiology of EDE and 12 items (of which four were strongly indicative) to ADDE. Items scored strongly indicative with agreement >90% for EDE were previous chalazia, rosacea/rhinophyma, telangiectasias of eyelid margin and thick non-expressible meibomian gland secretions, and for ADDE were Sjögren syndrome or associated disease, and Schirmer <5 mm after 5 min (without anaesthesia). Seventeen items indicated neither pathophysiology and 18 items were found to be suggestive of alternative diagnoses. CONCLUSIONS: This Delphi consultation categorised signs and symptoms, using an innovative weighting system to identify DED pathophysiology. An algorithm integrating the weighting of each sign and symptom of an individual patient would be valuable to help general ophthalmologists to classify the DED subtype and tailor treatment to DED underlying mechanism.

Clinical subtypes of dry eye in youthful clinical sample in Ghana.

PURPOSE: To evaluate in a cohort of patients with dry eye disease (DED) the distribution of patients with asymptomatic and symptomatic dry eye involving aqueous deficient or the evaporative subtype of DED. METHODS: This was a clinic-based cross-sectional study of consecutive patients visiting the University of Cape Coast eye clinic for a comprehensive eye examination. Eligible participants completed the Ocular Surface Disease Index (OSDI), ocular surface staining and tear break up time. Subjects with dry eye (symptomatic or asymptomatic) underwent clinical examination comprising lid margin assessments, meibomian gland expressibility and quality assessments, and Schirmer 1 test. RESULTS: A total of 172 patients were included in the study. The mean age of the eligible participants was 22.7 (±3.7) years, with a range of 17-35 years. There were 83 males and 89 females in the sample. There was an association between the form of the dry eye whether symptomatic or asymptomatic and sex, (X2 = 6.51 df = 1 p = 0.011). The frequency of symptomatic aqueous-deficient dry eye was 9(5.2%) whiles that of the symptomatic evaporative dry eye was 20(11.6%). The frequencies of the asymptomatic aqueous-deficient dry eye and asymptomatic evaporative dry eye were 9(5.2%) and 12(7.0%) respectively. The frequency of symptomatic mixed dry eye was 30(17.4%) and the asymptomatic mixed dry eye was 8(4.7%). The distribution of unclassifiable dry eye among the symptomatic dry eye group was 41(23.8%) and 43(25%) among the asymptomatic dry eye group. CONCLUSION: The number of patients exhibiting signs of the evaporative dry eye resulting from meibomian gland dysfunction far outnumbers those of aqueous deficient dry eye but there remains a high unclassifiable group with an unknown etiology. Further, studies are needed to explore the other etiology or etiologies of dry eye apart from meibomian gland dysfunction and reduced aqueous production.

Lid-parallel conjunctival fold (LIPCOF) morphology imaged by optical coherence tomography and its relationship to LIPCOF grade.

PURPOSE: Lid-parallel conjunctival folds (LIPCOF) are a well-accepted clinical sign in dry eye diagnosis. Commonly, LIPCOF is classified by grading the number of folds observed by slit-lamp microscope. This study investigated the relationship between subjective grading scale and LIPCOF morphology imaged by optical coherence tomography (OCT). METHODS: Temporal and nasal LIPCOF of 42 subjects (mean age 27.3 ± 8.4 (SD) years; 13 M, 29 F) were observed and classified by an experienced optometrist using the Pult LIPCOF grading scale (0: no permanent, lid-parallel conjunctival fold; 1: one fold; 2: two folds, 3: three or more folds). Additionally, LIPCOF cross-sectional area (LIPCOF-A) and fold count (LIPCOF-C), as imaged by OCT (Cirrus HD; Carl Zeiss Meditec, Jena, Germany), were analysed with ImageJ 1.50 (http://rsbweb.nih.gov/ij). Correlations between subjective grading and LIPCOF-A and LIPCOF-C were analysed by Spearman correlation, differences between subjective grading and LIPCOF-C were analysed by Wilcoxon test. RESULTS: For temporal and nasal sectors, mean subjective LIPCOF grade was 1.43 ± 0.86 grade units and 0.57 ± 0.80 grade units, mean LIPCOF-C was 1.67 ± 0.82 folds and 0.69 ± 0.78 folds, and mean LIPCOF-A was 0.0676 ± 0.0236mm2 and 0.0389 ± 0.0352 mm2, respectively. Subjective temporal and nasal LIPCOF grade was significantly correlated to LIPCOF-C (r = 0.610, p < 0.001 and r = 0.645, p < 0.001, respectively), and to LIPCOF-A (r = 0.612, p < 0.001 and r = 0.583, p < 0.001, respectively). LIPCOF-C was not statistical different to subjective LIPCOF grade (p = 0.07 and p = 0.239; temporal and nasal sectors, respectively). CONCLUSIONS: OCT allows for better imaging of finer details of LIPCOF morphology, and especially of LIPCOF area. OCT evaluation of LIPCOF area correlated well with subjective grading and appears to be a promising objective method for LIPCOF classification.

Is Sjögren's syndrome dry eye similar to dry eye caused by other etiologies? Discriminating different diseases by dry eye tests.

PURPOSE: Dry Eye Disease (DED) is part of several conditions, including Sjögren's syndrome (SS) and no single test to diagnosis DED. The present study intends to evaluate whether a set of signs and symptoms of DED can distinguish: a) SS from other non-overlapping systemic diseases related to DED; b) primary and secondary SS. METHODS: 182 consecutive patients with DED were evaluated under five groups: SS, graft-versus-host disease (GVHD), Graves' orbitopathy (GO), diabetes mellitus (DM), glaucoma under treatment with benzalkonium chloride medications (BAK). Twenty-four healthy subjects were included as control group (CG). The evaluation consisted of Ocular Surface Disease Index (OSDI), Schirmer test (ST), corneal fluorescein staining (CFS) and tear film break up time (TFBUT). Indeed, a subset of DED patients (n = 130), classified as SS1, SS2 and nonSS (NSS) by the American-European Criteria were compared. Quadratic discriminant analysis (QDA) classified the individuals based on variables collected. The area under Receiver Operating Characteristics (ROC) curve evaluated the classification performance in both comparisons. RESULTS: Comparing SS with other diseases, QDA showed that the most important variable for classification was OSDI, followed by TFBUT and CFS. Combined, these variables were able to correctly classify 62.6% of subjects in their actual group. At the discretion of the area under the ROC curve, the group with better classification was the control (97.2%), followed by DM (95.5%) and SS (92.5%). DED tests were different among the NSS, SS1 and SS2 groups. The analysis revealed that the combined tests correctly classified 54.6% of the patients in their groups. The area under the ROC curve better classified NSS (79.5%), followed by SS2 (74.4%) and SS1 (69.4%). CONCLUSIONS: Diseases that causes DED, and also SS1, SS2 and NSS are distinguishable conditions, however a single ocular tools was not able to detect the differences among the respective groups.

Assessment of Dry Eye Symptoms: Current Trends and Issues of Dry Eye Questionnaires in Japan.

Dry eye disease (DED) is one of the most common disease in the ophthalmic clinic, and the reasons DED patients visit ophthalmic clinics are symptoms such as stinging, burning, or scratchy sensations. The symptoms and visual disturbances of DED have a negative impact on the daily routines and social lives of the patients (i.e., their quality of life [QOL]). The presence of symptoms was required in the definition of DED by the National Eye Institute/Industry Workshop in 1995; therefore, disease-specific questionnaires were essential for monitoring and managing patients with DED. Thereafter, many questionnaires have been developed to evaluate the specific symptoms of dry eyes. Although many questionnaires are available to assess the dry eye symptoms, it is essential that they provide valid answers and are easy to use to assess the effects of DED on the QOL. The Asia Dry Eye Society and Japan Dry Eye Society have proposed a new definition of DED that is a combination of symptoms and an unstable tear film, and information on these two factors is sufficient to make a definitive diagnosis of DED. Therefore, the assessments of the symptoms are fundamental in the diagnosis of DED.

Quality of life measures and health utility values among dry eye subgroups.

BACKGROUND: To determine whether quality of life (QOL) and health utility are affected to the same extent among dry eye (DE) patients with short tear film break-up time dry eye (TBUT-DE) with minimal clinical signs were as severe as aqueous-deficient dry eye (ADDE). METHODS: A multicenter cross-sectional study was conducted among DE patients who visited one of 10 eye clinics in Japan. Among the 463 registered patients, this study involved 449 patients with DE who were aged 20 years or older. Ophthalmic examination findings were assessed, including tear film break-up time (TBUT), Schirmer I value, and keratoconjunctival staining score. QOL was evaluated with the Dry Eye-Related Quality-of-Life Score (DEQS; 0 [best], 100 [worst]) and health utility (1 [total health], 0 [worst]) with the Health Utilities Index Mark 3 (HUI-3); scores were stratified by DE subgroup. RESULTS: Median (interquartile range) of DEQS and HUI-3 scores across all participants were 21.7 (10.0-40.0) and 0.82 (0.69-0.91), respectively. Median (interquartile range) DEQS and HUI-3 scores in the ADDE group were 23.3 (10.0-40.0) and 0.79 (0.69-0.88), respectively; those in the short TBUT-DE group were 23.3 (13.3-38.3) and 0.82 (0.74-0.92), respectively. There were no significant between-group differences in questionnaire scores. Among the ophthalmic examination findings, a weak significant correlation between TBUT, corneal staining score and keratoconjunctival staining score to DEQS; TBUT and Schirmer test values to HUI-3, were seen. CONCLUSIONS: The burden of short TBUT-DE on QOL as assessed by the DEQS and HUI-3 was as severe as that in ADDE. Our findings suggest that clinicians should be aware of the impact of short TBUT-DE on patients QOL and utility values. TRIAL REGISTRATION: University Hospital Medical Information Network (registration no. UMIN 000015890). Registered 10th December 2014, retrospectively registered.

[New international consensus statement about the definition, classification, ethiology, diagnostics and therapy of dry eye (TFOS DEWS II)]. / Új nemzetközi konszenzusnyilatkozat a száraz szem definíciójáról, felosztásáról, etiológiájáról, diagnosztikájáról és terápiájáról.

Ten years have passed since the publication of the DEWS Report that summarized the information based on scientific literature concerning dry eye disease. Hundreds of papers have been published since then and time has come for a new summary. Organized by the Tear Film & Ocular Surface Society, 12 working groups summerized former and recent data. The DEWS II Report was created. The authors of the present publication summarize the most important changes in definition, classification, diagnostics, and therapy concerning dry eye disease. They also disclose the relevant changes on which the non-ophthalmologist specialists have to be informed. The DEWS II Report published by TFOS consists of 11 chapters. Completely new chapters deal with the role of sensation/pain and iatrogenic dry eyes. Orv Hetil. 2018; 159(20): 775-785.

Development and Evaluation of Semiautomated Quantification of Lissamine Green Staining of the Bulbar Conjunctiva From Digital Images.

Importance: Lissamine green (LG) staining of the conjunctiva is a key biomarker in evaluating ocular surface disease. The disease currently is assessed using relatively coarse subjective scales. Objective assessment would standardize comparisons over time and between clinicians. Objective: To develop a semiautomated, quantitative system to assess lissamine green staining of the bulbar conjunctiva on digital images. Design, Setting, and Participants: Using a standard photography protocol, 35 digital images of the conjunctiva of 11 patients with a diagnosis of dry eye disease based on characteristic signs and symptoms were obtained after topical administration of preservative-free LG, 1%, solution. Images were scored independently by 2 masked ophthalmologists in an academic medical center using the van Bijsterveld and National Eye Institute (NEI) scales. The region of interest was identified by manually marking 7 anatomic landmarks on the images. An objective measure was developed by segmenting the images, forming a vector of key attributes, and then performing a random forest regression. Subjective scores were correlated with the output from a computer algorithm using a cross-validation technique. The ranking of images from least to most staining was compared between the algorithm and the ophthalmologists. The study was conducted from April 26, 2012, through June 2, 2016. Main Outcomes and Measures: Correlation and level of agreement among computerized algorithm scores, van Bijsterveld scale clinical scores, and NEI scale clinical scores. Results: The scores from the automated algorithm correlated well with the mean scores obtained from the gradings of 2 ophthalmologists for the 35 images using the van Bijsterveld scale (Spearman correlation coefficient, rs = 0.79), and moderately with the NEI scale (rs = 0.61) scores. For qualitative ranking of staining, the correlation between the automated algorithm and the 2 ophthalmologists was rs = 0.78 and rs = 0.83. Conclusions and Relevance: The algorithm performed well when evaluating LG staining of the conjunctiva, as evidenced by good correlation with subjective gradings using 2 different grading scales. Future longitudinal studies are needed to assess the responsiveness of the algorithm to change of conjunctival staining over time.

Development and validation of the Chinese version of dry eye related quality of life scale.

BACKGROUND: To develop the Chinese version of quality of life scale for dry eye patients based on the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire and to assess the reliability and validity of the developed scale. METHODS: The original IDEEL was adapted cross-culturally to Chinese language and further developed following standard procedures. A total of 100 Chinese patients diagnosed with dry eye syndrome were included to investigate the psychometric properties of the Chinese version of scale. Psychometric tests included internal consistency (Cronbach's ɑ coefficients), construct validity (exploratory factor analysis), and known-groups validity (the analysis of variance). RESULTS: The Chinese version of Dry Eye Related Quality of Life (CDERQOL) Scale contains 45 items classified into 5 domains. Good to excellent internal consistency reliability was demonstrated for all 5 domains (Cronbach's ɑ coefficients range from 0.716 to 0.913). Construct validity assessment indicated a consistent factorial structure of the CDERQOL scale with hypothesized construct, with the exception of "Dry Eye Symptom-Bother" domain. All domain scores were detected with significant difference across three severity groups of dry eye patients (P < 0.05) except for "Satisfaction with Treatment" domain, indicating good known-groups validity. CONCLUSIONS: The results indicated that the CDERQOL scale is a reliable and valid instrument for patients with dry eye syndrome among Chinese population, and could be used as a supplementary diagnostic and treatment-effectiveness measure.

Validation of International Chronic Ocular Graft-Versus-Host Disease (GVHD) Group Diagnostic Criteria as a Chronic Ocular GVHD-Specific Metric.

PURPOSE: To validate the International Chronic Ocular GVHD Consensus Group (ICCGVHD) diagnostic criteria for chronic ocular chronic graft-versus-host disease (GVHD), by comparing results with comprehensive ophthalmic evaluation after allogeneic hematopoietic stem cell transplantation. METHODS: A single-institution retrospective chart review was conducted on patients who underwent hematopoietic stem cell transplantation at Vanderbilt University Medical Center in Nashville, TN, from January 1, 2002, through April 17, 2014. A total of 344 patients were eligible for the study. Data collected include the Schirmer test score, corneal fluorescein staining, Ocular Surface Disease Index, conjunctival injection, and presence or absence of systemic GVHD. The diagnosis of chronic ocular GVHD in each participant and determination of the overall severity score were determined based on the newly proposed ICCGVHD diagnostic criteria and compared with the best clinical practice (BCP) score. RESULTS: Chronic ocular GVHD was diagnosed in 141/344 (41%) participants, of these, 86 (61%) had complete charts. Based on the BCP score, 1.2% had none, 38.4% mild, 47.7% moderate, and 12.8% had severe chronic ocular GVHD. Based on the ICCGVHD, 34.8% had none, 59.3% mild/moderate, and 5.8% had severe chronic ocular GVHD. The clinical diagnostic stages of chronic ocular GVHD by BCP and ICCGVHD criteria had slight agreement (kappa statistic 0.187, with 95% confidence interval 0.049-0.321), with a higher correlation seen in those with severe chronic ocular GVHD. CONCLUSIONS: The newly proposed ICCGVHD diagnostic criteria can be used reproducibly for the diagnosis and determination of severity of chronic ocular GVHD. However, larger prospective studies are needed to further validate it.

The Prevalence of Dry Eye and Sjögren Syndrome in Patients with Migraine.

PURPOSE: To evaluate the presence of dry eye and primary Sjögren syndrome (SS) in patients with migraine. METHODS: In total, 46 eyes of 46 patients with migraine (group 1) and 50 eyes of 50 healthy subjects (group 2) were included in this study. Detailed ophthalmologic, neurologic and rheumatologic examination were performed on all participants. Ocular surface disease index questionnaire, tear function tests, visual analog scale for pain, serologic analysis were also performed. RESULTS: Dry eye symptoms and findings were significantly higher and more severe in group 1 when compared with group 2. Primary SS was not found in any of the participants. The migraine lifetime duration was negatively correlated with the tear function tests while it was positively correlated with the ocular surface disease index scores. CONCLUSIONS: Dry eye symptoms and findings are higher in migraine patients when compared with the healthy subjects without the presence of Sjögren syndrome.

Prevalence and severity of dry eye in candidates for laser in situ keratomileusis for myopia in Russia.

PURPOSE: To assess the prevalence and severity of dry-eye disease in patients with myopia being evaluated for laser in situ keratomileusis. SETTING: Nine ophthalmology centers in Russia. DESIGN: Prospective noninterventional cross-sectional study. METHODS: The assessments included the Schirmer I test, tear breakup time (TBUT), lissamine green and fluorescein staining (Oxford grading scheme), Ocular Surface Disease Index (OSDI) questionnaire, and Dry Eye Workshop (DEWS) dry-eye severity grading. RESULTS: The study comprised 400 patients with myopia (mean age 29.7 years); 145 (36.2%) wore contact lenses, and 81 (20.2%) used topical dry-eye medication. The mean Schirmer test score was 15.2 mm; 36.5% of patients had evidence of tear-volume deficiency (Schirmer score ≤10 mm). The mean TBUT was 11.7 seconds; 10.1% of patients had tear-film instability (TBUT <5 seconds). Conjunctival (lissamine green) staining intensity was categorized as minimal or greater (grade ≥1) in 62.3% of patients and mild or greater (grade ≥2) in 22.8% of patients. The mean OSDI score was 20.4, indicating mild ocular disability. Dry-eye severity (DEWS grading) was mild/episodic in 66.2%, moderate in 29.5%, and severe in 4.3% of patients. No clear correlation was evident between the Schirmer/TBUT scores and the lissamine green/OSDI scores. CONCLUSIONS: The prevalence of dry eye in this population was estimated at approximately 10% to 40% (based on clinical signs) and 40% to 55% (based on symptoms); dry-eye severity was predominantly mild/episodic. The proportion of patients requiring dry-eye therapy (based on OSDI and DEWS severity findings) was almost 2 times higher than the proportion receiving treatment.