Dry Eye Epidemiology in Patients before Refractive Operations

Purpose. To evaluate the prevalence, clinical severity, clinical and pathogenetic variants and etiology of dry eye (DE) in patients
before refractive surgery. Methods. OSDI testing, lipid interferential test, TBUT, Shirmer-1, -2 tests, compression Norn test in Korb
modification, calculation of xerosis index by Bijsterveld, tear meniscus index evaluation, LIPCOF test, evaluation of epitheliopaty and microerosion by Tseng and lid viper epitheliopaty were performed in 600 myopia (with or without astigmatism) patients (234 men, 366 women; 30.1 ± 6.26 years old) before refractive surgery. The structure of the DE etiological conditions, was studied both in DE patients and non-DE subjects with calculation of the Pearson xi-square test. To estimate the strength of the connection between the etiological condition and the DE, the normalized value of the Pearson coefficient (C') was used. Results. The dry eye prevalence was 38.83% (of them, 71.76% was mild, 28.83% — moderate, by Brzhesky). Clinical and pathogenetic variants of mild DE included: lipid deficiency (53.29%); lipid-mucin deficiency (26.95%); mucin deficiency (11.38%); state without signs of lipid or mucin deficiency (8.38%). In patients with moderate DE were identified: isolated aqueous deficiency (6.06%); aqueous-lipid deficiency (34.85%); aqueous-mucin deficiency (7.58%); aqueous-lipid-mucin deficiency (51.52%). Statistically significant (р < 0.01) etiological conditions for the disease in patients with diagnosed DE include: contact lenses wearing (C' = 0.349); visual display use (C' = 0.342); the use of medication affecting tear production or tear film stability (C' = 0.41); application of cosmetics (cosmetic pencil or mascara) in the intercostal space of the eyelid margin — in the area of the excretory ducts of the meibomian glands (C' = 0.44); meibomian glands dysfunction (C' = 0.782); chronic allergic conjunctivitis (C' = 0.543); the presence of gynecological pathology (C' = 0.413); thyroid gland diseases (C' = 0.32); allergy (C' = 0.563); female sex (C' = 0.559). Conclusion: Raising the awareness of ophthalmologists about the prevalence of early DE manifestations in patients before refractive surgery will help optimize the detection of this pathology. The obtained data on the structure of DE clinical and pathogenetic variants and the etiological prerequisites can serve as a basis for the development of therapy. One of the most prevalence and significant etiological condition for DE was MGD, leading to lipid-deficiency, which determines the direction of etio-pathogenetic treatment — the eyelids hygiene.

1. Эскина Э.Н., Паршина В.А., Степанова М.А. Опыт применения препарата на основе трегалозы у пациентов после эксимерлазерных операций. Офтальмология. 2016:14(3):213-218 [Eskina E.N., Parshina V.A., Stepanova M.A. Dry eye epidemiology in patients before refractive operations. Ophthalmology in Russia=Oftalmolodiya. 2016;14(3):213–218 (in Russ)]

2. Denoyer A., Landman E., Trinh L. Dry eye after refractive Surgery. Comparative outcomes of small incision lenticule extraction versus LASIK. Ophthalmology. 2015:122 (4):669–676. DOI: 10.1016/j.ophtha.2014.10.004

3. Shtein R.M. Post-LASIK dry eye. Expert. Rev. Ophtalmol. 2011:6(5):575–582. DOI: 10.1586/eop.11.56

4. Solomon K.D., Fernandes de Castro L.E., Sandoval H.P. Joint LASIK study task force. LASIK word literature review: quality of life and patient satisfaction. Ophthalmology. 2009;116:691–701. DOI: 10.1016/j.ophtha.2008.12.037

5. Shoja M.R., Besharati M.R. Dry eye after LASIK for myopia: incidence and risk factors European Journal of Ophthalmology. 2007:17(1):1–6.

6. Donnenfeld E. Dry eye after LASIK. Cataract & Refractive Surgery Today. 2011:5:31–33.

7. Levitt A.E., Galor A., Weiss J.S. Chronic dry eye symptoms after LASIK: parallels and lessons to be learned from other persistent post-operative pain disorders. Mol. Pain. 2015:21:11–21.

8. Xie W., Zhang D., Chen J. Tear menisci after laser in situ keratomileusis with mechanical microkeratome and femtosecond laser. IOVS. 2014 55(9): 5806–5812. DOI: 10.1167/iovs.13-13669

9. Maychuk D.Y. Prevalence and severity of dry eye in candidates for laser in situ keratomileusis for myopia in Russia. J. Cataract. Refract. Surg. 2016:42:427–434. DOI: 10.1016/j.jcrs.2015.11.038

10. Янченко С.В., Малышев А.В., Сахнов С.Н. Гигиена век в подготовке к лазерной рефракционной хирургии. Вестник офтальмологии. 2016:5:83–88 [Yanchenko S.V., Malyshev A.V., Sakhnov S.N. Eye lid hygiene in chronic allergic blepharoconjunctivitis patients before laser refractive surgery. Annals of Ophthalmology=Vestnik oftal’mologii. 2016:5:83–88 (in Russ)]. DOI: 10.17116/oftalma2016132586-92

11. Craig J.P., Nelson J.D., Azar D.T., Belmonte C., Bron A.J., Chauhan S.K., de Paiva C.S., Gomes J.A.P., Hammit K.M., Jones L., Nichols J.J., Nichols J.S., Novak G.D., Stapleton F., Wilcox M.D.P., Wolffsohn J.S., Sullivan TFOS DEWS II Report Executive Summary. The Ocular Surface: 2017:XXX: 1–11. DOI: 10.1016/j. jtos.2017.08.003

12. Stapleton F., Optom M.C., Alves M., Bunya V.Y., Jalbert I., Lekhanont K., Malet F., Na Kyung-Sun, Schaumberg D., Ushino M., Vehof J., Viso E., Vitale S., Jones L., Optom F.C. TFOS DEWS II Epidemiology Report. The Ocular Surface. 2017:15:334–365.

13. Nichols K.N., Foulks G.N., Bron A.J., Glasgow B.J., Dogru M., Tsubota K., Lemp M.A., Sullivan D.A. The International Workshop on Meibomian Gland Dysfunction: Executive Summary IOVS, Special Issue. 2011:52(4):1923–1929. DOI: 10.1167/iovs.10-6997a

14. Baudouine C., Messmer E., Aragona P., Geerling G., Akova Y.A., Benitez-del-Castilio J., Boboridis K.G., Merayo-Lloves J., Rolando M., Labetoulle Revisiting the vicious circle of the dry eye disease: focus on the pathophysiology of meibomian gland dysfunction. Br. J. Ophthalmol. 2016:100(3):300–306.

15. Шпак А.А. Вопросы статистического анализа в российских офтальмологических журналах. Офтальмохирургия. 2016:1:73–77. [Shpak A.A. Issues of the statistical analysis in the Russian ophthalmic journals. The Fyodorov Journal of Ophthalmic Surgery=Oftalmohirurgiya. 2016:1:73–77. (in Russ)] DOI: 10.25276/0235-4160-2016-1-73-77

16. Бржеский В.В., Егорова Г.Б., Егоров Е.А. Синдром «сухого глаза» и заболевания глазной поверхности. М.: ГЭОТАР-Медиа, 2016. 448 с. [Brzhesky V.V., Egorova G.B., Egorov E.A. Dry eye and ocular surface diseases. GEOTAR-Media. 2016: 448 (in Russ)]

17. Lopez Garsia J.S., Garsia Lozano I., Martinez Garchitorena J. Measure of the fatty layer thickness of precorneal tear film by interference colours in different types of dry eye. Arch. Soc. Esp. Oftalmol. 2003:78(5):257–264.

18. Korb D.R. The tear film — its role today and in future. In The Tear Film, structure, function and examination. Butterworth — Heiman. 2002:254.

19. Bijesterveld O.P. Diagnostic tests in the sicca syndrome. Arch. Ophthalmol. 1969:82:10–14.

20. Шипилов В.А., Янченко С.В., Сахнов С.Н., Малышев А.В., Эксузян З.А. Фиксатор устройства для получения фотоизображений «глазной поверхности». Современные проблемы науки и образования. 2013:6:689-690. URL: www.scienceeducation. ru/113-11843. [Shipilov V.A., Yanchenko S.V., Sakhnov S.N., Malyshev A.V., Jeksuzjan Z.A. Latch device for obtaining photos of ocular surface. Modern problems of science and education=Sovremennie problemi nauki I obrazovaniya. 2013:6:689-690 (in Russ)]

21. Григорьева В.В., Ханферян Р.А., Сундатова Т.В. Распространенность аллергических заболеваний в Краснодарском крае. Кубанский научный медицинский вестник. 2006:3–4 (84–85):23–27. [Grigorieva V.V., Khaferyan R.A., Sundatova T.V. The prevalence of allergic diseases in Krasnodar region. Kuban scientific medical bulletin=Kubanskij nauchnyj medicinskij vestnik/ 2006:3–4(84–85):23–27 (in Russ)]