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Lid-parallel conjunctival folds (LIPCOF) and dry eye: a multicentre study
  1. János Németh1,
  2. Eszter Fodor1,
  3. Zsolt Lang2,
  4. Krisztina Kosina-Hagyó1,
  5. András Berta3,
  6. Tímea Komár3,
  7. Igor Petricek4,
  8. Mohamed Higazy5,
  9. Marek Prost6,
  10. Christina Grupcheva7,
  11. Ozlem Evren Kemer8,
  12. Petra Schollmayer9,
  13. Ameed Samaha10,
  14. Katarina Hlavackova11
  1. 1Department of Ophthalmology, Semmelweis University, Budapest, Hungary
  2. 2Department of Biomathematics and Informatics, Szent István University, Budapest, Hungary
  3. 3Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
  4. 4Eye Department, Zagreb University Hospital, Zagreb, Croatia
  5. 5Ophthalmology Department, Benha University, Benha, Egypt
  6. 6Department of Ophthalmology, Military Institute of Aviation Medicine, Warsaw, Poland
  7. 7Department of Ophthalmology, Medical University, Varna, Bulgaria
  8. 8Department of Ophthalmology, Ankara Numune Research and Education Hospital, Ankara, Turkey
  9. 9University Eye Hospital, University Medical Centre, Ljubljana, Slovenia
  10. 10Ophthalmology Department, International Eye and Ear Hospital, Naccache, Lebanon
  11. 11Department of Ophthalmology, Bratislava University Hospital, Bratislava, Slovakia
  1. Correspondence to
    Professor János Németh, Department of Ophthalmology, Semmelweis University, Tömö u. 25-29, Budapest H-1083, Hungary; nemeth.janos{at}


Aims The study was designed to test the clinical application of the grading of lid-parallel conjunctival folds (LIPCOF) as a diagnostic test for dry eye.

Methods At 12 centres in 11 countries, 272 eyes of 272 dry eye patients (75 men, 197 women) were examined. Their mean age was 52.7±16.2 years. The LIPCOF were graded according to the method of Höh et al. The tear film break-up time (BUT) was measured, and fluorescein staining and the Schirmer 1 test were performed. The subjective symptoms were evaluated by 16 questions.

Results The LIPCOF score demonstrated significant positive correlations with age, dry eye disease severity and fluorescein staining (r>0.2, p<0.001), and negative correlations with BUT and results of the Schirmer 1 test (r<–0.2, p<0.001). The LIPCOF score exhibited a significant correlation with the overall subjective symptoms (r=0.250, p<0.001). The sensitivity and specificity of LIPCOF grading for discriminating between normal and dry eyes were best with the cut-off between LIPCOF degrees 1 and 2.

Conclusions The displayed medium sensitivity and specificity, and good positive predictive value of the LIPCOF test support the use of LIPCOF grading as a simple, quick and non-invasive dry eye screening tool.

  • Diagnostic tests/Investigation
  • Tears
  • Ocular surface
  • Conjunctiva
  • Cornea

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