Algorithm for dry eye disease diagnosis in individuals infected with human T-cell lymphotropic virus type 1.

Cristina Castro-Lima-Vargens,Maria Fernanda Rios Grassi,Paula Caroline Matos Almeida,Regina Helena Rathsam-Pinheiro,Bernardo Galvão-Castro,Ney Boa-Sorte

doi:10.5935/0004-2749.20170090

Abstract

To evaluate the accuracy of lacrimal film tests and propose an algorithm for the diagnosis of dry eye disease in individuals infected with human T-cell lymphotropic virus type 1. Ninety-six patients infected with human T-cell lymphotropic virus type 1 were enrolled in the study. To assess clinical complaints, patients completed the Ocular Surface Disease Index questionnaire. To evaluate lacrimal film quality, patients underwent the tear breakup time test, Schirmer I test, and Rose Bengal staining. Dry eye disease was diagnosed when at least two of the three test results were abnormal. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of the questionnaire as well as of each test alone and combined in parallel and in series were determined. The most sensitive test was the tear breakup time test (98%), whereas the most specific was the Schirmer I test (100%). Rose Bengal staining had the highest overall accuracy (88.64%), whereas the Ocular Surface Disease Index had the lowest overall accuracy (62.65%). The tear breakup time test, Schirmer I test, and Ocular Surface Disease Index combined in parallel showed increased sensitivity and decreased specificity for all tests. In contrast, when combined in series, these tests demonstrated increased specificity and decreased sensitivity. This study shows the need to use multiple tests to evaluate tear film quality and include a symptom questionnaire as part of the diagnostic algorithm for dry eye disease.

Highlights

Human T-cell lymphotropic virus type 1 (HTLV-1) is the etiologic agent of adult T-cell leukemia[1], HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP)(2), and infective dermatitis in children[3]
The aim of the present study was to evaluate the accuracy of the TBUT, Schirmer I test, Rose Bengal staining, and Ocular Surface Disease Index (OSDI) alone or combined for diagnosing dry eye disease (DED) in HTLV-1-infected individuals and to propose an algorithm for diagnosing DED using low-cost and minimally invasive procedures
The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy (OA) of each test alone and combined in parallel or in series are presented in table 1

Summary

Introduction

Human T-cell lymphotropic virus type 1 (HTLV-1) is the etiologic agent of adult T-cell leukemia[1], HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP)(2), and infective dermatitis in children[3]. It is estimated that 5-10 million people worldwide are infected with HTLV-1(4). HTLV-1-associated uveitis (HAU), an ophthalmologic disease, is linked to HTLV-1 infection[5,6]. In Japan, HAU has a prevalence of 9.5%-44.8%(7,8). Other ophthalmologic alterations such as corneal lesions, retinal vasculitis, and keratoconjunctivitis sicca (KCS) or dry eye disease (DED) are associated with HTLV-1(9-12). In individuals with HTLV-1, the prevalence of DED may reach 30%-40%(13-16), especially in symptomatic patients with HAM/TSP

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