Diagnostic value of three simple and rapid dry eye tests – lid parallel conjunctival folds, tear meniscus height, and tear ferning

Abstract

Introduction/Objective The objective of this paper was to assess the diagnostic value of three simple dry eye (DE) tests: lid parallel conjunctival folds (LIPCOF), tear meniscus height (TMH), and tear ferning (TF).

Methods LIPCOF, TMH, and TF diagnostic DE tests were performed in 100 patients. Eighty of them were referred to us by rheumatologists and general practitioners either during evaluation for Sjögren’s syndrome, or because of DE symptoms. The control group was composed of 20 patients, with no DE-related symptoms. Ocular Surface Disease Index questionnaire was used for DE symptoms’ evaluation. Results of LIPCOF, TMH, and TF tests were compared with results of the Copenhagen criteria DE tests i.e., tear fluorescein breakup time, Schirmer I and Rose Bengal tests. Ability of the tests to recognize DE in various grades according to Dry Eye Work Shop (DEWS) report score system was assessed.

Results Compared to the Copenhagen criteria, sensitivity of LIPCOF and TMH was high (92.8% and 83.5%, respectively), while specificity was low (34.4% and 49.2%, respectively). TF had low sensitivity (59.1%) but high specificity (82.7%). Mean values of both LIPCOF and TMH differed significantly (F = 7.222, p < 0.001 and F = 11.802, p < 0.001, respectively) between the control group and all DEWS grades, but not among different grades of DE.

Conclusion TMH and LIPCOF diagnostic tests showed high sensitivity, which makes them excellent screening DE tests. Low sensitivity of TF suggests that it is not truly a good screening test on its own, but its high specificity is of definite value.

Keywords: dry eye disease; lid parallel conjunctival folds; tear meniscus height; tear ferning