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Evaluation of dry eye subtypes and characteristics using conventional assessments and dynamic tear interferometry
  1. Yong Woo Ji1,
  2. Hyojin Seong1,2,
  3. Jeong Gi Seo1,
  4. Si Yoon Park1,
  5. Mutlaq Alotaibi1,3,
  6. Moonjung Choi2,
  7. Sangmin Nam4,
  8. Tae-Im Kim1,
  9. Hyung Keun Lee1,
  10. Kyoung Yul Seo1
  1. 1 Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
  2. 2 Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
  3. 3 Department of Ophthalmology, Prince Mohammad Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
  4. 4 Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
  1. Correspondence to Dr Kyoung Yul Seo, Department of Ophthalmology, Yonsei University College of Medicine, Seodaemun-gu 03722, Seoul, The Republic of Korea; SEOKY{at}


Background/aims To evaluate subtypes and characteristics of dry eye (DE) using conventional tests and dynamic tear interferometry, and to investigate determinants of disease severity in each DE subtype.

Methods 309 patients diagnosed with DE and 69 healthy controls were prospectively enrolled. All eyes were evaluated using Ocular Surface Disease Index (OSDI), Schirmer’s test I (ST1) and Meibomian gland dysfunction (MGD) grade were analysed. The tear interferometric pattern and lipid layer thickness were determined using DR-1α and LipiView II, respectively.

Results Dynamic interferometric analysis revealed 56.6% of patients with DE exhibited Jupiter patterns, indicative of aqueous-deficiency, while 43.4% exhibited crystal patterns, indicative of lipid deficiency. These findings were in accordance with classification based on ST1 scores and MGD grade. Conventional assessment indicated 286 patients exhibited evidence of evaporative DE (EDE) due to MGD, while only 11 exhibited signs of pure aqueous-deficient DE (pure ADDE, only ST1 ≤5 mm). Interestingly, of 286 patients with EDE, 144 were categorised into the mixed-ADDE/EDE group, in which ST1 was identified as a strong negative determinant of OSDI. In contrast, 72.2% of patients with mixed-ADDE/EDE exhibited Jupiter patterns (Jupiter mixed), while 27.8% exhibited crystal patterns (crystal mixed). OSDI values were significantly higher in the crystal-mixed group than in the Jupiter mixed, in which OSDI scores were independently associated with ST1 values only.

Conclusions Our findings indicate that majority of EDE patients also exhibit aqueous deficiency, which can aggravate symptoms even in patients with lipid-deficient mixed-ADDE/EDE. Conventional assessments should be combined with interferometric tear analysis to determine the most appropriate treatment for each DE patient.

  • cornea
  • ocular surface
  • tears
  • diagnostic tests/investigation

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors YWJ and KYS designed the study and wrote the manuscript. YWJ, HS, JGS, MA and KYS carried out the examinations. YWJ, SYP, MC and SN performed data analysis. T-IK, HKL and KYS contributed to review of research concept and editing of the manuscript.

  • Funding This study was supported by a grant from the Bio and Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science, ICT & Future Planning, South Korea (2013M3A9D5072551).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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