Abstract
ObjectiveTo assess a novel eyelid pressure measurement device and study the relationship between eyelid pressure and ocular surface parameters of moderate-to-severe dry eye disease (DED).MethodsThe present study included 70 eyes of 35 moderate-to-severe DED patients. All subjects were subjected to the following examinations for DED assessment: Ocular Surface Disease Index (OSDI) questionnaire, tear meniscus height (TMH), lipid layer thickness (LLT), number of partial blink (PB), total blink (TB) and partial blink rate (PBR), fluorescein tear breakup time (FBUT), corneal fluorescein staining (CFS), lid margin abnormality, meibum expression assessment (meibum score), meibomian gland dropout (MGd) and Schirmer I test. Pressure of the upper eyelid was measured thrice with the novel pressure measurement device. Repeatability of the device was evaluated by intraclass correlation coefficient (ICC). Safety of the device was evaluated by observing ocular adverse reactions of each subject prior to measurement, at day 1 and day 7 following measurement. Correlations between eyelid pressure and ocular surface parameters of moderate-to-severe DED were analyzed by using Pearson correlation coefficient and Kendall's tau-b correlation coefficient.ResultsICC of the measurement results in our study was 0.86. There was no abnormality presenting in all subjects recorded prior to measurement, 1 and 7 days following measurement. The eyelid pressure was significantly correlated with PBR (r = 0.286, P = 0.016), FBUT (r = −0.331, P = 0.005), CFS (r = 0.528, P = 0.000), lid margin abnormality (r = 0.408, P = 0.011) and MGd (r = 0.226, P = 0.016) in moderate-to-severe DED patients, but not significantly correlated with OSDI score (r = 0.016, P = 0.912), TMH (r = −0.002, P = 0.988), meibum score (r = −0.196, P = 0.317), LLT (r = 0.114, P = 0.346), PB (r = 0.116, P = 0.338), TB (r = 0.074, P = 0.544), meibum score (r = −0.196, P = 0.317) and Schirmer I test (r = 0.028, P = 0.821).ConclusionThe novel pressure measurement device exhibited good repeatability and safety in measuring eyelid pressure. Significant correlations were noted between the eyelid pressure and PBR, FBUT, CFS, lid margin abnormality and MGd in moderate-to-severe DED. The measurement of eyelid pressure combined with ocular surface parameters may be valuable for the assessment of DED.
Highlights
Dry eye disease (DED) has become a common health problem worldwide, which significantly influences the life quality of the patients [1]
According to Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II, the friction caused by relative movement of the eyelid and eyeball is one of the important reasons for the destruction of the corneal epithelial barrier, which may lead to the development of DED symptoms [4]
We found that eyelid pressure was significantly correlated with partial blinking rate (PBR), fluorescein tear breakup time (FBUT), corneal fluorescein staining score (CFS), lid margin abnormality and meibomian gland dropout (MGd), but not with Ocular Surface Disease Index (OSDI) score, tear meniscus height (TMH), LLT, partial blink (PB), total blink (TB), meibum score and Schirmer I test
Summary
Dry eye disease (DED) has become a common health problem worldwide, which significantly influences the life quality of the patients [1]. In 2017, the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) updated the definition of DED as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”(2). As a chronic ocular surface disease, DED affects the quality of life, but even causes harm to mental health [1]. While there are many causes of DED, such as environmental changes, medication use, local inflammation, poor eye usage habits and so on. The friction between the eyelid and the eyeball during blinking and eye movement can cause the occurrence of DED symptoms [4]
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