Classification of Fluorescein Breakup Patterns: A Novel Method of Differential Diagnosis for Dry Eye

• Published in: American journal of ophthalmology Vol. 180; pp. 72 - 85
• Main Authors: Yokoi, Norihiko, Georgiev, Georgi As, Kato, Hiroaki, Komuro, Aoi, Sonomura, Yukiko, Sotozono, Chie, Tsubota, Kazuo, Kinoshita, Shigeru
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2017; Elsevier Limited
• Subjects: Aged; Automobiles; Classification; Contact angle; Cornea; Cross-Sectional Studies; Diagnosis, Differential; Dry Eye Syndromes - diagnosis; Dry Eye Syndromes - metabolism; Eye care products; Female; Fluorescein - metabolism; Fluorescent Dyes - metabolism; Fluorophotometry - classification; Fluorophotometry - methods; Humans; Male; Medical diagnosis; Methods; Middle Aged; Ophthalmology; Surveys and Questionnaires; Tears - metabolism; tear abnormalities; dry eye symptoms; dry eye; ocular surface epithelial abnormalities; fluorescein breakup patterns
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2017.05.022

To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. Cross-sectional study. In 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19); spot (SB, n = 22); line (LB, n = 24); dimple (DB, n = 19); random (RB, n = 22 eyes); and dry eye–related symptoms using the visual analog scale (VAS, 100 mm = maximum), tear meniscus radius (TMR, mm), tear film lipid layer interference grade (IG) (grades 1–5; 1 = best) and spread grade (SG) (grades 1–4; 1 = best), tear film noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points = maximum), ocular surface epithelial damage (OSED) score (9 points = maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP. In each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, and foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB, and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and -RB; SB-DB and -RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (P < .05 in each comparison). The 5 different FBUPs constituted different groups, reflecting different pathophysi-ologies.