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Japanese Journal of Ophthalmology

, Volume 54, Issue 5, pp 387–391 | Cite as

Efficacy of diagnostic criteria for the differential diagnosis between obstructive meibomian gland dysfunction and aqueous deficiency dry eye

  • Reiko Arita
  • Kouzo Itoh
  • Syuji Maeda
  • Koshi Maeda
  • Atsuo Tomidokoro
  • Shiro Amano
Clinical Investigation

Abstract

Purpose

To evaluate diagnostic criteria for obstructive meibomian gland dysfunction (MGD) using three parameters (symptom score, lid margin abnormality score, and meibomian gland morphologic change scores) for differentiating obstructive MGD from aqueous deficiency dry eye (ADDE).

Methods

Twenty-five eyes of 25 patients (mean age, 66.6 years) diagnosed with obstructive MGD and 15 eyes of 15 patients (mean age, 61.3 years) diagnosed with ADDE were analyzed. Ocular symptoms were scored from 0 to 14 according to the number of symptoms. Lid margin abnormality was scored from 0 to 4 according to the number of abnormalities. Meibomian gland changes were scored from 0 to 6 using noncontact meibography (meibo-score). Superficial punctate keratopathy was scored from 0 to 3. Meibum was graded from 0 to 3 according to volume and quality. Tear film break-up time was measured consecutively three times after instillation of fluorescein, and the median value was adopted. Tear film production was evaluated using the Schirmer test.

Results

Ocular symptom and lid margin abnormality scores and tear film break-up time did not differ significantly between the obstructive MGD and ADDE groups. The meibum score and meibo-score were significantly higher in the obstructive MGD group than in the ADDE group. The Schirmer value was significantly lower in the ADDE group than in the obstructive MGD group. When obstructive MGD was diagnosed on the basis of three scores (ocular symptom score, lid margin abnormality score, and meibo-score) all being abnormal, the sensitivity and specificity for differentiating between obstructive MGD and ADDE were 68.0% and 80%, respectively.

Conclusions

Although the criteria were moderately reliable for differentiating patients with obstructive MGD from those with ADDE when the diagnosis of obstructive MGD was made on the basis of three abnormal scores, they do not provide comprehensive diagnostic tools for differentiating MGD, ADDE, and healthy individuals. We need to add other parameters such as the Schirmer test value and the meibum score to the diagnostic criteria to enhance their reliability for differentiating MGD and ADDE.

Keywords

aqueous deficiency dry eye diagnostic criteria meibomian gland dysfunction 

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References

  1. 1.
    Mishima S, Maurice DM. The oily layer of the tear film and evaporation from the corneal surface. Exp Eye Res 1961;1:39–45.CrossRefPubMedGoogle Scholar
  2. 2.
    McCulley JP. Meibomitis. In: Kaufman HE, Barron BA, McDonald MB, Waltman SR, editors. The cornea. New York: Churchill Livingstone; 1988. p. 125–138.Google Scholar
  3. 3.
    Lemp MA. Report of the National Eye Institute/Industry Workshop on Clinical Trials in Dry Eyes. CLAO J 1995;21:221–232.PubMedGoogle Scholar
  4. 4.
    Mathers WD. Ocular evaporation in meibomian gland dysfunction and dry eye. Ophthalmology 1993;100:347–351.PubMedGoogle Scholar
  5. 5.
    Shimazaki J, Sakata M, Tsubota K. Ocular surface changes and discomfort in patients with meibomian gland dysfunction. Arch Ophthalmol 1995;113:1266–1270.PubMedGoogle Scholar
  6. 6.
    Lee SH, Tseng SCG. Rose Bengal staining and cytologic characteristics associated with lipid tear deficiency. Am J Ophthalmol 1997;124:736–750.PubMedGoogle Scholar
  7. 7.
    Arita R, Itoh K, Maeda S, et al. Proposed diagnostic criteria for obstructive meibomian gland dysfunction. Ophthalmology 2009;116:2058–2063.CrossRefPubMedGoogle Scholar
  8. 8.
    Arita R, Itoh K, Inoue K, Amano S. Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population. Ophthalmology 2008;115:911–915.CrossRefPubMedGoogle Scholar
  9. 9.
    Shimazaki J, Goto E, Ono M, et al. Meibomian gland dysfunction in patients with Sjögren syndrome. Ophthalmology 1998;105:1485–1488.CrossRefPubMedGoogle Scholar
  10. 10.
    Toda I, Fujishima H, Tsubota K. Ocular fatigue is the major symptom of dry eye. Acta Ophthalmol 1993;71:347–352.CrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society (JOS) 2010

Authors and Affiliations

  • Reiko Arita
    • 1
    • 2
  • Kouzo Itoh
    • 1
  • Syuji Maeda
    • 3
  • Koshi Maeda
    • 3
  • Atsuo Tomidokoro
    • 2
  • Shiro Amano
    • 2
    • 4
  1. 1.Itoh ClinicSaitamaJapan
  2. 2.Department of OphthalmologyUniversity of Tokyo School of MedicineTokyoJapan
  3. 3.Maeda Ophthalmologic ClinicAizuwakamatsu, FukushimaJapan
  4. 4.Department of OphthalmologyUniversity of Tokyo School of MedicineTokyoJapan

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