Predictors of Discordance between Symptoms and Signs in Dry Eye Disease

• Published in: Ophthalmology (Rochester, Minn.) Vol. 124; no. 3; pp. 280 - 286
• Main Authors: Vehof, Jelle, MD, PhD, Sillevis Smitt-Kamminga, Nicole, MD, Nibourg, Simone A., BSc, Hammond, Christopher J., MD, FRCOphth
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2017
• Subjects: Adult; Aged; Cohort Studies; Cross-Sectional Studies; Depressive Disorder - diagnosis; Diagnosis, Differential; Dry Eye Syndromes - diagnosis; Eye Pain - diagnosis; Eyelid Diseases - diagnosis; Female; Humans; Hypersensitivity, Immediate - diagnosis; Male; Meibomian Glands - pathology; Middle Aged; Ophthalmology; Osmolar Concentration; Osteoarthritis - diagnosis; Physical Examination; Staining and Labeling; Surveys and Questionnaires; Tears - chemistry; DED; CPS; dry eye disease; GVHD; TBUT; OSDI; SLE; tear breakup time; systemic lupus erythematosus; GLOSSY; Groningen LOngitudinal Sicca StudY; Ocular Surface Disease Index; chronic pain syndrome; graft-versus-host disease
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2016.11.008

Purpose To investigate predictors of discordance between symptoms and signs in dry eye disease (DED). Design Cross-sectional association study. Participants A total of 648 patients with dry eye from the Groningen LOngitudinal Sicca StudY (GLOSSY), a tertiary dry eye clinic patient cohort from the Netherlands. Methods Patient symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire. Dry eye signs were assessed by tear osmolarity, Schirmer test, tear breakup time, corneal and conjunctival staining, and meibomian gland dysfunction, all in both eyes, and a composite dry eye signs severity score was calculated from these 6 tests for each patient. Linear regression analysis was used to test the association of discordance between symptoms and signs with a wide range of independent variables (demographic and environmental variables, systemic diseases, ocular traits, and medications). Main Outcome Measures Predictors of discordance between symptoms and signs in DED, defined by the difference between the rank score of the OSDI and the rank score of the dry eye signs severity score. Results Of the 648 subjects in this cohort, 536 (82.7%) were female and the mean age was 55.8 years (standard deviation, 15.6 years). Significant predictors of greater symptoms than signs were the presence of a chronic pain syndrome, atopic diseases, a known allergy, the use of antihistamines (all P < 0.001), depression ( P  = 0.003), osteoarthritis ( P  = 0.008), and the use of antidepressants ( P  = 0.02). Predictors of lesser symptoms than signs were increased age ( P < 0.001) and the presence of Sjögren's disease ( P < 0.001) (primary Sjögren's disease ( P  < 0.001) more than secondary Sjögren's disease ( P  = 0.08), and graft-versus-host disease ( P  = 0.04). Furthermore, greater symptoms compared with signs were highly associated with lower self-perceived health ( P < 0.001). Conclusions This large clinical study has shown that discordance between symptoms and signs in DED is an indicator of self-perceived health. The study found important predictors of greater symptoms to signs but also predictors of lesser symptoms to signs. Awareness of these predictors is helpful in assessing patients with dry eye in clinical practice.