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Influence of Tear Film Condition in Keratoconus on the Results of Topographic and Tomographic Methods of Corneal Examination. Review

https://doi.org/10.18008/1816-5095-2025-2-237-243

Abstract

Modern methods of corneal visualization (Placido disk keratotopographs, Schimpflug tomographs) play a key role in the diagnosis of various pathological conditions of the cornea, as well as in the planning of surgical interventions. However, despite the accuracy of these devices, there are potential risks of high measurement error associated with destabilization of the precorneal tear film and the presence of signs of dry eye syndrome. Analysis of literature sources revealed a high degree of study of this problem from the position of keratorefractive and cataract surgery. Studies show that tear film instability leads to significant variability of keratometry parameters, increased aberration indices, increased light scattering and appearance of artifacts on topographic maps. In case of dry eye syndrome detection, symptomatic treatment allows to minimize instrument measurement errors and increase functional results of the planned surgical intervention.

Of particular interest is the impact of dry eye syndrome on the diagnosis and monitoring of keratoconus, as the two conditions often co-occur. Despite the existence of only a single publication, there are reasons to assume that the combination of signs of dry eye syndrome and SP destabilization in KC may have a significant impact on the results of these diagnostic methods and their interpretation.

About the Authors

A. Yu. Slonimsky
Moscow Eye Clinic
Russian Federation

Slonimsky Aleksei Yu. PhD, MD, professor

Kholzunov lane, 8/1, Moscow, 119021



V. V. Averich
Krasnov Research Institute of Eye Diseases; National Myopia Institute
Russian Federation

Averich Veronika V. PhD, researcher 

Rossolomo str., 11A, B, Moscow, 119021

Deguninskaya str., 7, Moscow, 127486



T. S. Mitichkina
Krasnov Research Institute of Eye Diseases
Russian Federation

Mitichkina Tatiana S. PhD, senior researcher

Rossolomo str., 11A, B, Moscow, 119021



References

1. Liu Z, Huang AJ, Pflugfelder SC. Evaluation of corneal thickness and topography in normal eyes using the Orbscan corneal topography system. Br J Ophthalmol. 1999 Jul;83(7):774–778. doi: 10.1136/bjo.83.7.774.

2. Ghemame M, Charpentier P, Mouriaux F. Topographie cornéenne en pratique [Cor‑ neal topography in practice]. J Fr Ophtalmol. 2020 Jan;43(1):67–79. French. doi: 10.1016/j.jfo.2018.12.033.

3. Sridhar U, Tripathy K. Corneal Topography. 2023 Sep 4. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan.

4. Uçakhan Ö. Current Corneal Topography/Tomography Systems. Eye Contact Lens. 2020 May;46(3):127–128. doi: 10.1097/ICL.0000000000000707.

5. Ambrósio R Jr, Belin MW. Imaging of the cornea: topography vs tomography. J Refract Surg. 2010 Nov;26(11):847–849. doi: 10.3928/1081597X20101006-01.

6. Kanclerz P, Khoramnia R, Wang X. Current Developments in Corneal Topography and Tomography. Diagnostics (Basel). 2021 Aug 13;11(8):1466. doi: 10.3390/dia‑gnostics11081466.

7. Roberts C. Corneal topography: a review of terms and concepts. J Cataract Refract Surg. 1996 Jun;22(5):624–629. doi: 10.1016/s0886‑3350(96)80022‑8.

8. Polunin GS, Polunina EG. From “dry eye” to “tear film disease”. Ophthalmology. 2012;9(2):4–7 (In Russ.). doi: 10.18008/1816‑5095‑2012‑2‑4‑7.

9. Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F, Na KS, Schaumberg D, Uchino M, Vehof J, Viso E, Vitale S, Jones L. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017 Jul;15(3):334–365. doi: 10.1016/j.jtos.2017.05.003.

10. Maychuk NV, Malyshev IS, Obraztsova MR. Dry eye syndrome before corneal refractive surgery: the prevalence and pathogenesis‑oriented therapy. Russian Journal of Clinical Ophthalmology. 2023;23(1):14–20 (In Russ.). doi: 10.32364/2311‑77292023‑23‑1‑14‑20.

11. Klokova OA, Damashauskas RO, Geidenrich MS. Ocular surface treatment in dry eye patients before corneal refractive surgery. Russian Journal of Clinical Ophthalmology. 2020;20(4):180–186. doi: 10.32364/2311‑7729‑2020‑20‑4‑180‑186.

12. Sakhnov SN, Yanchenko SV, Malyshev AV, Kalantaevskaya YA, Ismaylova RA, Ehieva EM, Grishenko MV, Gorbunova IV, Ozhug OF, Klokova OA. Dry Eye Epidemiology in Patients before Refractive Operations. Ophthalmology in Russia. 2018;15(1):92–101 (In Russ.). doi: 10.18008/1816‑5095‑2018‑1‑92‑101

13. Astahov SJu, Tkachenko NV. Efficacy of trehalose in the dry eye syndrome treatment of after phacoemulsification. Ophthalmology journal.2016;9(4):79–89 (In Russ.).

14. Liu Z, Pflugfelder SC. Corneal surface regularity and the effect of artificial tears in aqueous tear deficiency. Ophthalmology. 1999 May;106(5):939–943. doi: 10.1016/S0161‑6420(99)00513‑8.

15. Ozkan Y, Bozkurt B, Gedik S, Irkeç M, Orhan M. Corneal topographical study of the effect of lacrimal punctum occlusion on corneal surface regularity in dry eye patients. Eur J Ophthalmol. 2001 Apr‑Jun;11(2):116–119. doi: 10.1177/112067210101100202.

16. Huang FC, Tseng SH, Shih MH, Chen FK. Effect of artificial tears on corneal surface regularity, contrast sensitivity, and glare disability in dry eyes. Ophthalmology. 2002 Oct;109(10):1934–1940. doi: 10.1016/s0161‑6420(02)01136‑3.

17. de Paiva CS, Lindsey JL, Pflugfelder SC. Assessing the severity of keratitis sicca with videokeratoscopic indices. Ophthalmology. 2003 Jun;110(6):1102–1109. doi: 10.1016/s0161‑6420(03)00245‑8.

18. Beckman K. When dry eye deceives: A patient referred for corneal collagen cross‑linking is treated instead for ocular surface disease. Ophthalmology Management. 2017;21:34–46.

19. Feinbaum С. Wet and Dry Corneal Topography? — A New Contraindication for the LASIK Procedure in Refractive Surgery. EC Ophthalmology 5.3. 2017:121–128.

20. Dong J, Wu Q, Wang XG. Measurement of central corneal thickness and pre‑corneal tear film thickness of rabbits using the Scheimpflug system. Int J Ophthalmol. 2013 Oct 18;6(5):584–587. doi: 10.3980/j.issn.2222‑3959.2013.05.05.

21. Al‑Mezaine HS, Al‑Amro SA, Kangave D, Sadaawy A, Wehaib TA, Al‑Obeidan S. Comparison between central corneal thickness measurements by oculus pentacam and ultrasonic pachymetry. Int Ophthalmol. 2008 Oct;28(5):333–338. doi: 10.1007/s10792‑007‑9143‑9.

22. Hirnschall N, Crnej A, Gangwani V, Findl O. Effect of fluorescein dye staining of the tear film on Scheimpflug measurements of central corneal thickness. Cornea. 2012 Jan;31(1):18–20. doi: 10.1097/ICO.0b013e31821eea97.

23. Zhuang H, Zhou X, Xu J. A novel method for pachymetry mapping of human precorneal tear film using Pentacam with fluorescein. Invest Ophthalmol Vis Sci. 2010 Jan;51(1):156–159. doi: 10.1167/iovs.08‑3265.

24. Siyahkamari M, Asharlous A, Mirzajani A, Koohian H, Jafarzadepour E, Ostadimoghaddam H, Babaei N, Yekta A, Khabazkhoob M. Effect of Dry Eye Disease on Central Corneal Thickness and Corneal Topometric Indices Measured by Scheimpflug Tomography. Acta Med Iran. 2023;60(12):777–781. doi: 10.18502/acta.v60i12.11831.

25. Kundu G, Shetty R, Khamar P, Gupta S, Mullick R, Ganesan VL, D’Souza S. Impact of tear optics on the repeatability of Pentacam AXL wave and iTrace in measuring anterior segment parameters and aberrations. Indian J Ophthalmol. 2022 Apr;70(4):1150–1157. doi: 10.4103/ijo.IJO_2153_21.

26. Koh S, Maeda N, Ikeda C, Asonuma S, Mitamura H, Oie Y, Soma T, Tsujikawa M, Kawasaki S, Nishida K. Ocular forward light scattering and corneal backward light scattering in patients with dry eye. Invest Ophthalmol Vis Sci. 2014 Sep 18;55(10):6601–6606. doi: 10.1167/iovs.14‑15125.

27. Thibos LN, Hong X. Clinical applications of the Shack‑Hartmann aberrometer. Optom Vis Sci. 1999 Dec;76(12):817–25. doi: 10.1097/00006324‑199912000‑00016.

28. Himebaugh NL, Nam J, Bradley A, Liu H, Thibos LN, Begley CG. Scale and spatial distribution of aberrations associated with tear breakup. Optom Vis Sci. 2012 Nov;89(11):1590–600. doi: 10.1097/OPX.0b013e31826cfae5.

29. Diaz‑Valle D, Arriola‑Villalobos P, García‑Vidal SE, Sánchez‑Pulgarín M, Borrego Sanz L, Gegúndez‑Fernández JA, Benitez‑Del‑Castillo JM. Effect of lubricating eyedrops on ocular light scattering as a measure of vision quality in patients with dry eye. J Cataract Refract Surg. 2012 Jul;38(7):1192–1197. doi: 10.1016/j.jcrs.2012.02.040.

30. Salouti R, Nowroozzadeh MH, Zamani M, Ghoreyshi M, Salouti R. Comparison of the ultrasonographic method with 2 partial coherence interferometry methods for intraocular lens power calculation. Optometry. 2011 Mar;82(3):140–147. doi: 10.1016/j.optm.2010.07.025.

31. Epitropoulos AT, Matossian C, Berdy GJ, Malhotra RP, Potvin R. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015 Aug;41(8):1672–1677. doi: 10.1016/j.jcrs.2015.01.016.

32. Hiraoka T, Asano H, Ogami T, Nakano S, Okamoto Y, Yamada Y, Oshika T. Influence of Dry Eye Disease on the Measurement Repeatability of Corneal Curvature Radius and Axial Length in Patients with Cataract. J Clin Med. 2022 Jan 28;11(3):710. doi: 10.3390/jcm11030710.

33. Yang F, Yang L, Ning X, Liu J, Wang J. Effect of dry eye on the reliability of keratometry for cataract surgery planning. J Fr Ophtalmol. 2024 Feb;47(2):103999. doi: 10.1016/j.jfo.2023.04.016.

34. Taneja M. Commentary: Effect of dry eyes on the corneal diagnostic measurements. Indian J Ophthalmol. 2022 Apr;70(4):1157–1158. doi: 10.4103/ijo.IJO_3119_21.

35. Kim J, Kim MK, Ha Y, Paik HJ, Kim DH. Improved accuracy of intraocular lens power calculation by preoperative management of dry eye disease. BMC Ophthalmol. 2021 Oct 13;21(1):364. doi: 10.1186/s12886‑021‑02129‑5.

36. Montés‑Micó R, Alió JL, Charman WN. Dynamic changes in the tear film in dry eyes. Invest Ophthalmol Vis Sci. 2005 May;46(5):1615–1619. doi: 10.1167/iovs.050017.

37. Koh S, Maeda N. Wavefront sensing and the dynamics of tear film. Cornea. 2007 Oct;26(9 Suppl 1):S41–S415. doi: 10.1097/ICO.0b013e31812f69e8.

38. Denoyer A, Rabut G, Baudouin C. Tear film aberration dynamics and vision‑related quality of life in patients with dry eye disease. Ophthalmology. 2012 Sep;119(9):1811–1818. doi: 10.1016/j.ophtha.2012.03.004.

39. Kasem AMM, Awara AM, Shafik HM, Shalaby OE. Corneal topography and wavefront data changes in dry eye. Tanta Medical Journal. 2021;49(1):31–36 doi: 10.4103/tmj.tmj_199_20.

40. Rochet E, Levron A, Agard E, Chehab HE, Plas H, Bouvarel H, Chirpaz N, Billant J, Dot C. Should Artificial Tears Be Used During the Preoperative Assessment of Toric IOLs Before Age‑Related Cataract Surgery? The TORIDE Study. J Refract Surg. 2021 Nov;37(11):759–766. doi: 10.3928/1081597X‑20210826‑01.

41. Montés‑Micó R, Cerviño A, Ferrer‑Blasco T, García‑Lázaro S, Ortí‑Navarro S. Optical quality after instillation of eyedrops in dry‑eye syndrome. J Cataract Refract Surg. 2010 Jun;36(6):935–940. doi: 10.1016/j.jcrs.2009.12.044.

42. Avetisov SE, Averich VV, Pateyuk LS. Keratoconus: main lines of research. Russian Annals of Ophthalmology. 2023;139(3.2):11–20. (In Russ.). doi: 10.17116/oftalma202313903211.

43. Dogru M, Karakaya H, Ozçetin H, Ertürk H, Yücel A, Ozmen A, Baykara M, Tsubota K. Tear function and ocular surface changes in keratoconus. Ophthalmology. 2003 Jun;110(6):1110–1118. doi: 10.1016/S0161‑6420(03)00261‑6.

44. Carracedo G, Recchioni A, Alejandre‑Alba N, Martin‑Gil A, Crooke A, Morote IJ, Pintor J. Signs and Symptoms of Dry Eye in Keratoconus Patients: A Pilot Study. Curr Eye Res. 2015;40(11):1088–1094. doi: 10.3109/02713683.2014.987871.

45. Bubnova IA, Averich VV. Precorneal tear film condition in keratoconus. Modern technologies in ophthalmology. 2020;4:319–320 (In Russ.). doi: 10.25276/23124911‑2020‑4‑319‑320

46. Constantin MM, Corbu C, Potop V, Miruna B. Evaluation of Dry Eye Symptomatology at Patients with Keratoconus. Revista de Chimie. 2019;70(1):92–95. doi: 10.37358/RC.19.1.6858.

47. Bubnova IA, Egorova GB, Averich VV, Mitichkina TS. Medical treatment for dry eye in patients with keratoconus after corneal cross‑linking. Russian Journal of Clinical Ophthalmology. 2020;20(2):67–71 (In Russ.). doi: 10.32364/2311‑77292020‑20‑2‑67‑71.

48. Averich VV, Bubnova IA. Changes in the precorneal tear film at various stages of keratoconus. Russian Annals of Ophthalmology. 2024;140(3):43–49 (In Russ.). doi: 10.17116/oftalma202414003143.

49. Rattan SA, Anwar DS. Comparison of corneal epithelial thickness profile in dry eye patients, keratoconus suspect, and healthy eyes. Eur J Ophthalmol. 2020 Nov;30(6):1506–1511. doi: 10.1177/1120672120952034.

50. Averich VV. Dry eye disease in keratoconus: etiology and medical treatment. Russian Journal of Clinical Ophthalmology. 2022;22(2):122–126 (In Russ.). doi: 10.32364/2311‑7729‑2022‑22‑2‑122‑126.

51. Mirza E, Oltulu R, Oltulu P, Mirza GD, Okka M. Dry eye disease and ocular surface characteristics in patients with keratoconus. Saudi J Ophthalmol. 2022 Jul 11;36(1):117–121. doi: 10.4103/sjopt.sjopt_37_21.

52. Slonimsky AYu, Averich. VV Experience of Using Scleral Contact Lenses in Keratoconus in Combination with Dry Eye Syndrome. Ophthalmology 2024;21(3):546– 552 (In Russ.). doi: 10.18008/1816‑5095‑2024‑3‑546‑552.

53. Dienes L, Kiss HJ, Perényi K, Nagy ZZ, Acosta MC, Gallar J, Kovács I. Corneal Sensitivity and Dry Eye Symptoms in Patients with Keratoconus. PLoS One. 2015 Oct 23;10(10):e0141621. doi: 10.1371/journal.pone.0141621.

54. Loh IP, Sherwin T. Is Keratoconus an Inflammatory Disease? The Implication of Inflammatory Pathways. Ocul Immunol Inflamm. 2022 Jan 2;30(1):246–255. doi: 10.1080/09273948.2020.1780271.

55. D’Souza S, Nair AP, Sahu GR, Vaidya T, Shetty R, Khamar P, Mullick R, Gupta S, Dickman MM, Nuijts RMMA, Mohan RR, Ghosh A, Sethu S. Keratoconus patients exhibit a distinct ocular surface immune cell and inflammatory profile. Sci Rep. 2021 Oct 22;11(1):20891. doi: 10.1038/s41598‑021‑99805‑9.

56. Rahi A, Davies P, Ruben M, Lobascher D, Menon J. Keratoconus and coexisting atopic disease. Br J Ophthalmol. 1977 Dec;61(12):761–764. doi: 10.1136/bjo.61.12.761.

57. Zemova E, Eppig T, Seitz B, Toropygin S, Arnold S, Langenbucher A, Gräber S, Szentmáry N. Interaction between topographic/tomographic parameters and dry eye disease in keratoconus patients. Curr Eye Res. 2014 Jan;39(1):1–8. doi: 10.3109/02713683.2013.798667.


Review

For citations:


Slonimsky A.Yu., Averich V.V., Mitichkina T.S. Influence of Tear Film Condition in Keratoconus on the Results of Topographic and Tomographic Methods of Corneal Examination. Review. Ophthalmology in Russia. 2025;22(2):237-243. (In Russ.) https://doi.org/10.18008/1816-5095-2025-2-237-243

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