DISEASE & MANAGEMENT

Hyperosmolarity has been described in the literature as a primary marker of tear film integrity. When the quantity or quality of secreted tears is compromised increased rates of evaporation lead to a more concentrated tear film (increased osmolarity) that places stress on the corneal epithelium and conjunctiva. Levels of osmolarity correlate with the severity of the disease.

The Inflammadry is an in-office test that detects elevated levels of inflammation or elevated levels of MMP-9. It has been demonstrated that ocular surface disease demonstrates elevated levels of MMP-9 in the tears. Inflammation is present before the clinical signs of dry eye. Increased MMP-9 may contribute to increased corneal disruption and corneal surface irregularity.

Tear Meniscus Height (TMH): Measuring the TMH is helpful in diagnosing aqueous deficiencies as it is used to estimate tear volume. A TMH of less than 0.2mm is suggestive of dry eye. ​ Schirmer I Testing: Schirmer I testing measures aqueous secretion. A 5x35mm filter paper is used and the end of the paper is inserted into the outer 1/3 of the inferior conjunctival sac. The amount of strip wetting is measured after 5 minutes. Schirmer I is performed without anesthesia and measures both basal and reflex tear secretion.

Tear Break-Up Time: Tear Break-Up Time measure tear film stability and is helpful in the detection of lipid and mucin deficiencies. A moistened fluorescein strip is applied to the bulbar conjunctiva and the patient is asked to blink. The tear film is scanned using a biomicroscope with a cobalt filter and is evaluated for the first nonstaining area from the last blink. Normal TBUT readings are 15-45 seconds. ​ Ocular Surface Staining: Fluorescein dye is the most commonly used stain to evaluate the ocular surface. It is present any time the integrity of the epithelial surface is disrupted. Lissamine green dye stains devitalized cells and is helpful for evaluating the conjunctiva. The amount of ocular surface staining is graded using various methods.

The Meibomian glands can be evaluated by lid eversion and transillumination with light or with topographical instruments. At the Illinois Eye Institute, we have several instruments to help visualize the Meibomian glands (meibography). This allows us to analyze and quantify the amount of gland loss or atrophy and note areas of occlusion and dilation to manage the condition appropriately.

Sjo Testing: Sjögren’s Syndrome (SS) is a chronic, systemic progressive autoimmune inflammatory disease. It is characterized by immune-mediated destruction of lacrimal and salivary glands and early hallmark symptoms include dry eyes and dry mouth. The classical serological markers for SS are anti-Ro/SSA and anti-La/SS-B antibodies. Other antinuclear antibodies (ANA) and rheumatoid factors (RF) are also included as the more common serological markers detected for SS. The Sjö test is an advanced diagnostic panel for the early detection of SS for patients with dry eye. It includes the 4 traditional and 3 new proprietary biomarkers- salivary protein 1, carbonic anhydrase 6, parotid secretory protein. Oculus Keratograph 5: The Keratogrph 5M is an instrument that is very beneficial in the management of dry eye patients. It has the ability to measure non-invasive tear film break up time (NIKBUT), tear meniscus height, evaluate the lipid layer, measure tear film dynamics, and take high resolution images of the Meibomian glands and of the bulbar conjunctiva.