Skip to main content
PMC home page
Transactions of the American Ophthalmological Society logoLink to Transactions of the American Ophthalmological Society
. 2003;101:141–154.

Presumed hyposecretory/hyperevaporative KCS: tear characteristics.

James P McCulley 1, Ward E Shine 1, Joel Aronowicz 1, Deniz Oral 1, Jose Vargas 1
PMCID: PMC1358983  PMID: 14971572

Abstract

PURPOSE: To characterize patients with ocular surface drying and a diagnosis of keratoconjunctivitis sicca (KCS). METHODS: Patients with a prior diagnosis of KCS and symptoms of dryness or foreign-body sensation who also had vital staining of the interpalpebral fissure ocular surface in the absence of lid and ocular surface inflammation were entered into the study along with normal controls. Patients were segregated into those with "classic" KCS, who did not have concomitant meibomian gland dysfunction (MGD), and those with KCS and MGD. The latter had slit-lamp evidence of difficult-to-express or turbid meibomian secretions upon expression. Patients and normal controls were evaluated for tear volume, flow, and turnover using fluorophotometry; meibomian gland dropout by meibography; evaporation by evaporometry; and tear production by the Schirmer 1 test. RESULTS: All patients with KCS had decreased tear volume, flow, and Schirmer 1 values as well as increased meibomian gland dropout. None of the patient groups were found to have increased tear evaporation compared with normals or other disease subgroups. No correlation between degree of meibomian gland dropout and evaporation was found. The degree of total vital staining or presence of corneal staining correlated with a more severe aqueous deficiency. CONCLUSIONS: Patients with ocular surface drying in the absence of inflammation have decreased tear volume, flow, and Schirmer 1 values as well as increased meibomian gland dropout. The role of meibomian gland dropout or slit-lamp MGD in disease is unclear and in our study specifically did not correlate with increased tear evaporation.

Full Text

The Full Text of this article is available as a PDF (198.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Afonso A. A., Monroy D., Stern M. E., Feuer W. J., Tseng S. C., Pflugfelder S. C. Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms. Ophthalmology. 1999 Apr;106(4):803–810. doi: 10.1016/S0161-6420(99)90170-7. [DOI] [PubMed] [Google Scholar]
  2. Battat L., Macri A., Dursun D., Pflugfelder S. C. Effects of laser in situ keratomileusis on tear production, clearance, and the ocular surface. Ophthalmology. 2001 Jul;108(7):1230–1235. doi: 10.1016/s0161-6420(01)00623-6. [DOI] [PubMed] [Google Scholar]
  3. Creech J. L., Do L. T., Fatt I., Radke C. J. In vivo tear-film thickness determination and implications for tear-film stability. Curr Eye Res. 1998 Nov;17(11):1058–1066. doi: 10.1076/ceyr.17.11.1058.5233. [DOI] [PubMed] [Google Scholar]
  4. Eter N., Göbbels M. A new technique for tear film fluorophotometry. Br J Ophthalmol. 2002 Jun;86(6):616–619. doi: 10.1136/bjo.86.6.616. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Foulks Gary N. Challenges and pitfalls in clinical trials of treatments for dry eye. Ocul Surf. 2003 Jan;1(1):20–30. doi: 10.1016/s1542-0124(12)70004-6. [DOI] [PubMed] [Google Scholar]
  6. Goebbels M. Tear secretion and tear film function in insulin dependent diabetics. Br J Ophthalmol. 2000 Jan;84(1):19–21. doi: 10.1136/bjo.84.1.19. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Goto Eiki, Endo Koji, Suzuki Atsushi, Fujikura Yoshiaki, Matsumoto Yukihiro, Tsubota Kazuo. Tear evaporation dynamics in normal subjects and subjects with obstructive meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2003 Feb;44(2):533–539. doi: 10.1167/iovs.02-0170. [DOI] [PubMed] [Google Scholar]
  8. Gudmundsen K. J., O'Donnell B. F., Powell F. C. Schirmer testing for dry eyes in patients with rosacea. J Am Acad Dermatol. 1992 Feb;26(2 Pt 1):211–214. doi: 10.1016/0190-9622(92)70029-f. [DOI] [PubMed] [Google Scholar]
  9. Jordan A., Baum J. Basic tear flow. Does it exist? Ophthalmology. 1980 Sep;87(9):920–930. doi: 10.1016/s0161-6420(80)35143-9. [DOI] [PubMed] [Google Scholar]
  10. King-Smith P. E., Fink B. A., Fogt N., Nichols K. K., Hill R. M., Wilson G. S. The thickness of the human precorneal tear film: evidence from reflection spectra. Invest Ophthalmol Vis Sci. 2000 Oct;41(11):3348–3359. [PubMed] [Google Scholar]
  11. MISHIMA S. SOME PHYSIOLOGICAL ASPECTS OF THE PRECORNEAL TEAR FILM. Arch Ophthalmol. 1965 Feb;73:233–241. doi: 10.1001/archopht.1965.00970030235017. [DOI] [PubMed] [Google Scholar]
  12. Macri A., Pflugfelder S. Correlation of the Schirmer 1 and fluorescein clearance tests with the severity of corneal epithelial and eyelid disease. Arch Ophthalmol. 2000 Dec;118(12):1632–1638. doi: 10.1001/archopht.118.12.1632. [DOI] [PubMed] [Google Scholar]
  13. Macri A., Rolando M., Pflugfelder S. A standardized visual scale for evaluation of tear fluorescein clearance. Ophthalmology. 2000 Jul;107(7):1338–1343. doi: 10.1016/s0161-6420(00)00101-9. [DOI] [PubMed] [Google Scholar]
  14. Mathers W. D., Binarao G., Petroll M. Ocular water evaporation and the dry eye. A new measuring device. Cornea. 1993 Jul;12(4):335–340. doi: 10.1097/00003226-199307000-00010. [DOI] [PubMed] [Google Scholar]
  15. Mathers W. D., Daley T. E. Tear flow and evaporation in patients with and without dry eye. Ophthalmology. 1996 Apr;103(4):664–669. doi: 10.1016/s0161-6420(96)30637-4. [DOI] [PubMed] [Google Scholar]
  16. Mathers W. D., Lane J. A., Sutphin J. E., Zimmerman M. B. Model for ocular tear film function. Cornea. 1996 Mar;15(2):110–119. doi: 10.1097/00003226-199603000-00002. [DOI] [PubMed] [Google Scholar]
  17. Mathers W. D., Lane J. A., Zimmerman M. B. Tear film changes associated with normal aging. Cornea. 1996 May;15(3):229–234. doi: 10.1097/00003226-199605000-00001. [DOI] [PubMed] [Google Scholar]
  18. Mathers W. D. Ocular evaporation in meibomian gland dysfunction and dry eye. Ophthalmology. 1993 Mar;100(3):347–351. doi: 10.1016/s0161-6420(93)31643-x. [DOI] [PubMed] [Google Scholar]
  19. Mishima S., Gasset A., Klyce S. D., Jr, Baum J. L. Determination of tear volume and tear flow. Invest Ophthalmol. 1966 Jun;5(3):264–276. [PubMed] [Google Scholar]
  20. Prydal J. I., Artal P., Woon H., Campbell F. W. Study of human precorneal tear film thickness and structure using laser interferometry. Invest Ophthalmol Vis Sci. 1992 May;33(6):2006–2011. [PubMed] [Google Scholar]
  21. Rolando M., Refojo M. F., Kenyon K. R. Increased tear evaporation in eyes with keratoconjunctivitis sicca. Arch Ophthalmol. 1983 Apr;101(4):557–558. doi: 10.1001/archopht.1983.01040010557003. [DOI] [PubMed] [Google Scholar]
  22. Rolando M., Refojo M. F. Tear evaporimeter for measuring water evaporation rate from the tear film under controlled conditions in humans. Exp Eye Res. 1983 Jan;36(1):25–33. doi: 10.1016/0014-4835(83)90086-6. [DOI] [PubMed] [Google Scholar]
  23. Shimazaki J., Goto E., Ono M., Shimmura S., Tsubota K. Meibomian gland dysfunction in patients with Sjögren syndrome. Ophthalmology. 1998 Aug;105(8):1485–1488. doi: 10.1016/S0161-6420(98)98033-2. [DOI] [PubMed] [Google Scholar]
  24. Shimazaki J., Sakata M., Tsubota K. Ocular surface changes and discomfort in patients with meibomian gland dysfunction. Arch Ophthalmol. 1995 Oct;113(10):1266–1270. doi: 10.1001/archopht.1995.01100100054027. [DOI] [PubMed] [Google Scholar]
  25. Shine W. E., McCulley J. P. Keratoconjunctivitis sicca associated with meibomian secretion polar lipid abnormality. Arch Ophthalmol. 1998 Jul;116(7):849–852. doi: 10.1001/archopht.116.7.849. [DOI] [PubMed] [Google Scholar]
  26. Stolwijk T. R., van Best J. A., Lemkes H. H., de Keizer R. J., Oosterhuis J. A. Determination of basal tear turnover in insulin-dependent diabetes mellitus patients by fluorophotometry. Int Ophthalmol. 1991 Nov;15(6):377–382. doi: 10.1007/BF00137948. [DOI] [PubMed] [Google Scholar]
  27. Tsubota K., Yamada M. Tear evaporation from the ocular surface. Invest Ophthalmol Vis Sci. 1992 Sep;33(10):2942–2950. [PubMed] [Google Scholar]
  28. Webber W. R., Jones D. P., Wright P. Fluorophotometric measurements of tear turnover rate in normal healthy persons: evidence for a circadian rhythm. Eye (Lond) 1987;1(Pt 5):615–620. doi: 10.1038/eye.1987.95. [DOI] [PubMed] [Google Scholar]
  29. Xu K. P., Yagi Y., Toda I., Tsubota K. Tear function index. A new measure of dry eye. Arch Ophthalmol. 1995 Jan;113(1):84–88. doi: 10.1001/archopht.1995.01100010086025. [DOI] [PubMed] [Google Scholar]

Articles from Transactions of the American Ophthalmological Society are provided here courtesy of American Ophthalmological Society

RESOURCES