New Comprehensive Clinical Classification of Dry Eye Syndrome Severity 2024. Part 1

Over the past ten years, the scientific ophthalmological community has shown a significant interest increase in studying dry eye syndrome (DES), as the number of such patients is steadily increasing every year. According to research conducted by the international DEWS working group, which studies DES, there is no single “gold standard” for diagnosing DES, as its manifestations are very diverse. A set of diagnostic tests is used to diagnose DES, reflecting both subjective and objective indicators of tear production. Subjective diagnostic criteria include questionnaires, the most widely used of which are the OSDI and SPEED questionnaires. It should be noted that these questionnaires characterize only subjective indicators and do not take into account objective criteria. In addition, the peculiarity of DES is that the presence of complaints is already a sign of this disease. However, the symptoms, namely the complaints of patients, do not always coincide with the clinical manifestations of dry eye syndrome — objective indicators of the state of tear production, such as the indicators of tear production tests. Based on modern concepts of the etiology and pathogenesis of dry eye syndrome, the state of the tear-producing system directly depends on the state of the tissues of the ocular surface — the conjunctiva, cornea and eyelids. Any inflammatory process affecting the tissues of the ocular surface leads to a violation of the stability of the tear film, its evaporation and an increase in osmolarity, which in turn causes an inflammatory process. Therefore, it is necessary in diagnosing dry eye syndrome to take into account a set of indicators characterizing the state of the tissues of the ocular surface, including the inflammatory process, in particular, conjunctival hyperemia, as well as the stability of the tear film, which depends primarily on its lipid component. The comprehensive clinical classification of dry eye syndrome presented in this article reflects not only objective indicators of impaired tear production and inflammation of the ocular surface, but also subjective indicators — quality of life according to the SPEED scale, characterizing the intensity and frequency of complaints of dryness and discomfort in the eyes. The above indicators allow to differentiate the severity of dry eye syndrome, which is of fundamental importance for choosing treatment methods and the volume of drug therapy, and assessing its effectiveness in dynamics. The developed diagnostic algorithm does not require special skills when carried out by a doctor, so it can be recommended for its use in wide ophthalmological practice.

1. Jones L, Downie LE, Korb D, et al. TFOS DEWS II management and therapy report. Ocul Surf. 2017;15(3):575–628. doi:10.1016/j.jtos.2017.05.006.

2. Kasparova EA, Marchenko NR. Neurotrophic Keratitis. Etiology, Pathogenesis, Clinical Manifestations. Review. Part 1. Ophthalmology in Russia. 2022;19(1): 38-45 (In Russ.). doi: 10.18008/1816-5095-2022-1-38-45.

3. Kasparova EA, Marchenko NR. Neurotrophic Keratitis. Etiology, Pathogenesis, Clinical Manifestations. Review. Part 2. Ophthalmology in Russia. 2022;19(2):265– 271 (In Russ.). doi: 10.18008/1816-5095-2022-2-265-271.

4. Amparo F, Schaumberg DA, Dana R. Comparison of Two Questionnaires for Dry Eye Symptom Assessment: The Ocular Surface Disease Index and the Symptom Assessment in Dry Eye. Ophthalmology. 2015 Jul;122(7):1498–1503. doi: 10.1016/j.ophtha.2015.02.037.

5. Asiedu K, Kyei S, Mensah SN, Ocansey S, Abu LS, Kyere EA. Ocular Surface Disease Index (OSDI) Versus the Standard Patient Evaluation of Eye Dryness (SPEED): A Study of a Nonclinical Sample. Cornea. 2016 Feb;35(2):175–180. doi: 10.1097/ICO.0000000000000712.

6. PastorZaplana JÁ, Borrás F, Gallar J, Acosta MC. OSDI Questions on Daily Life Activities Allow to Detect Subclinical Dry Eye in Young Contact Lens Users. J Clin Med. 2022 May 6;11(9):2626. doi: 10.3390/jcm11092626.

7. Asghari B, Brocks D, Carrasquillo KG, Crowley E. OSDI Outcomes Based on Patient Demographic and Wear Patterns in Prosthetic Replacement of the Ocular Surface Ecosystem. Clin Optom (Auckl). 2022 Jan 10;14:1–12. doi: 10.2147/OPTO.S337920.

8. Hashmani N, Munaf U, Saleem A, Javed SO, Hashmani S. Comparing SPEED and OSDI Questionnaires in a NonClinical Sample. Clin Ophthalmol. 2021 Oct 19;15:4169–4173. doi: 10.2147/OPTH.S332565.

9. Trubilin VN, Poluninа EG, Kozhukhov AA, Kurenkov VV, Moreva NV, Trubilin AV, Chinenova KV. Differential Diagnostic Indicators for the Appointment of NonSteroidalAntiInflammatoryTherapy in the Treatment of Red Eye Syndrome at the Stage of Primary Outpatient Admission. Part 1. Ophthalmology in Russia. 2023;20(2):332– 340 (In Russ.). doi: 10.18008/1816-5095-2023-2-332-340.

10. Sanches AL, Leite SG, Nunes A, Caixinha M, Monteiro P, Nunes A. Adaptação do Questionário Standardized Patient Evaluation of Eye Dryness para Português (SPEEDVp) numa População Não Clínica [Adaptation of the Standardized Patient Evaluation of Eye Dryness Questionnaire to European Portuguese (SPEEDVp) in a NonClinical Sample]. Acta Med Port. 2023 Nov 2;36(11):714–722. Portuguese. doi: 10.20344/amp.18557.

11. Facchin A, Boccardo L. Italian translation, validation, and repeatability of Standard Patient Evaluation of Eye Dryness (SPEED) Questionnaire. Cont Lens Anterior Eye. 2022 Oct;45(5):101497. doi: 10.1016/j.clae.2021.101497. Epub 2021 Aug 11. PMID: 34391671.

12. Singh S, McGuinness MB, Anderson AJ, Downie LE. Interventions for the Management of Computer Vision Syndrome: A Systematic Review and Metaanalysis. Ophthalmology. 2022 Oct;129(10):1192–1215. doi: 10.1016/j.ophtha.2022.05.009.

13. Vehof J, Sillevis SmittKamminga N, Nibourg SA, Hammond CJ. Predictors of Discordance between Symptoms and Signs in Dry Eye Disease. Ophthalmology. 2017 Mar;124(3):280–286. doi: 10.1016/j.ophtha.2016.11.008.

14. Trubilin VN, Polunina EG, Angelova DV, Kurenkov VV, Kapkova SG, Chinenova KV, Konovalov ME, Pozharitsky MD. Current Concepts about the Etiology of Dry Eye Syndrome. Ophthalmology in Russia. 2019;16(2):236–243 (In Russ.). doi: 10.18008/1816-5095-2019-2-236-243.

15. Villani E, Marelli L, Bonsignore F, Lucentini S, Luccarelli S, Sacchi M, Serafino M, Nucci P. The Ocular Surface Frailty Index as a Predictor of Ocular Surface Symptom Onset after Cataract Surgery. Ophthalmology. 2020 Jul;127(7):866–873. doi: 10.1016/j.ophtha.2019.12.012.

16. Maychuk NV, Petrova MG, Yarkin DA, Sarhadov NSh. Dry Eye Syndrome in the Practice of a Cataract Surgeon: A Clinical Case. Ophthalmology in Russia. 2024;21(3):577–584 (In Russ.). doi: 10.18008/1816-5095-2024-3-577-584.

17. Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, Lemp MA, Sullivan DA. The International Workshop on Meibomian Gland Dysfunction: Executive Sammary.Invest Ophthalmol Vis Sci. 2011;52:1922–1929. doi: 10.1167/iovs.10-6997a.

18. Trubilin VN, Polunina EG, Kozhukhov AA, Andzhelova DV, Trubilin AV, Chinenova KV, Moreva NV. Comprehensive Classification of the Severity of Bulbar and Tarsal Hyperemia in Conjunctivitis. Ophthalmology in Russia. 2023;20(3):471–478 (In Russ.). doi: 10.18008/1816-5095-2023-3-471-478.

19. Trubilin АV, Poluninа EG, Trubilin VN, Zakatianskii VS. Prevention of Dry Eye Syndrome Before Phacoemulsification of Cataracts in Patients with a History of Cosmetic Procedures in the Periorbital Area. Ophthalmology in Russia. 2024;21(3):517–526 (In Russ.). doi: 10.18008/1816-5095-2024-3-517-526.