Screening Method for Inflammatory Dry Eye

Purpose : To propose an algorithm for screening of inflammatory dry eye using tear tests, corneal staining and conjunctival hyperemia Methods : A total of 81 patients in 20-30s without ophthalmologic diseases participated. The inflammatory dry eyes were diagnosed using MMP-9 (metalloproteinase-9) test and performed Shirmer test, TBUT (tear break-up time), corneal staining and conjunctival hyperemia. Dry eye refers to the criteria which specifies the OSDI (ocular surface disease index) score of more than 12, TBUT (tear film break-up time) of less 5 seconds, Schirmer test without anesthesia of less than 5mm/5minutes, corneal staining, and conjunctival hyperemia more than grade 1. Chi-square test was used to find out the correlation between tear/ocular surface test and MMP-9 test, and ROC curve was used for the sensitivity, specificity and AUC (area under the curve) for the algorithm of inflammatory dry eye. Results : Neither of the methods, Schirmer test nor TBUT, showed statistically significant correlation with positive MMP-9 results(p>0.050). And, OSDI, corneal staining, and conjunctival hyperemia were significantly correlated with MMP-9 result(p<0.050). Among the OSDI scores, corneal staining, and conjunctival hyperemia, the sensitivity, specificity, and AUC for screening of inflammatory dry eye were as follows. The sensitivity, specificity, and AUC of ‘OSDI/corneal staining/conjunctival hyperemia’ were 44.00%, 100.00%, 0.720, and ‘OSDI/corneal staining’ were 44.00% 94.59%, 0.693, ‘OSDI/conjunctival hyperemia’ were 76.80%, 75.68%, 0.762, and ‘corneal staining/conjunctival hyperemia were 52.80% 97.30%, 0.750, respectively, showing that ‘OSDI/ conjunctival hyperemia’ was highest accuracy. Conclusion : The algorithm of ‘OSDI/conjunctival hyperemia’ showed high accuracy similar to MMP-9 test. It would be a useful method for screening inflammatory dry eye.