Ocular surface inflammation may be the core problem for dry eye disease (DED) patients who have dot-like tear film breakup patterns, new research published in Eye & Contact Lens reports. On the other hand, the researchers suggest that DED subjects with a more random pattern will likely have signs and symptoms related to tear film instability.

The investigation included 91 eyes of 91 participants with DED who were divided into two groups, 37 individuals with a dot breakup pattern and 54 with a random breakup pattern. The study evaluated DED severity through Ocular Surface Disease Index (OSDI) score, Oxford stain score and tear film breakup time.

Patients with the dot breakup pattern had a statistically shorter tear film breakup time and a higher Oxford stain score than those with a random pattern. The researchers noted other differences, including a statistically higher concentration and more evident expression of interleukin (IL)-6 and IL-8 in patients with the dot breakup pattern. Although there was no difference in OSDI scores between groups, patients with dot breakup patterns had more severe dry eye and a higher concentration of inflammatory cytokines in their tears.

DED patients with the dot breakup pattern should be treated primarily for ocular surface inflammation, with a focus on corneal epithelial cell regeneration, the investigators suggested.

By contrast, patients in the random pattern group had tear cracks that took the shape of a wavy line because of the distribution of the lipid layer. Patients with this pattern had relatively low corneal staining scores, and their corneal surfaces were smoother and had more regular hydrophilicity. Since the mechanism of DED in patients with this breakup pattern was related to the tear film, treatment should focus on stabilizing this region, the study authors said.

Eom HD, Jung JU, Lee KP, et al. Simplified classification of tear film break-up patterns and their clinicopathological correlations in patients with dry eye disease. Eye Contact Lens. May 14, 2020. [Epub ahead of print].