Influential Signs of Dry Eye–Related Ocular Symptoms in Participants With Unstable Tear Film

Abstract

Purpose: The aim of this study was to investigate the factors influencing dry eye disease (DED)-related ocular symptoms in participants with short fluorescein tear break-up time (FTBUT). Methods: This cross-sectional study included 82 participants with short FTBUT (<10 seconds). Examinations included Ocular Surface Disease Index (OSDI), FTBUT, average noninvasive tear break-up time (NIBUTave), lid wiper epitheliopathy, lipid layer thickness, blink rate, partial blink, tear meniscus height, and meibomian gland (MG) evaluation which included ratio of residual MG area (RMGA) and MG grade in tarsal plates. One-way analysis of variance was used to detect differences between symptomatic tear film instability group (FTBUT <5 s, OSDI ≥13), asymptomatic tear film instability group (FTBUT <5 s, OSDI <13), and control group (FTBUT ≥5 s, OSDI <13). A bivariate correlation, partial correlation, and multiple linear regression analyses were used to identify major factors. Only the right eye was included. Results: Among the participants with FTBUT <5 seconds, symptomatic group showed less upper RMGA (P < 0.001) and NIBUTave (P = 0.010). OSDI was negatively associated with upper RMGA (r = −0.450, P < 0.001) and NIBUTave (r = −0.414, P = 0.001), and positively associated with upper MG grade (r = 0.277, P = 0.027). Linear regression analysis showed that the upper RMGA significantly affected OSDI (B = −41.895, P = 0.001), while not significantly correlated with age, upper MG grade, and NIBUTave. Conclusions: The upper RMGA might be the main factor affecting DED-related discomfort in participants with unstable tear film, indicating an early ocular change in DED.