Dry Eyes? Have Your Optometrist Check for Eyelid Sensitivity
Author: Wolters Kluwer Health
Published: 2012-10-07 : (Rev. 2015-04-19)
Synopsis and Key Points:
Optometrist test called esthesiometry can measure the sensitivity of your eyelid margins sensitivity to touch.
Got dry eyes? Measuring eyelid sensitivity may reflect the causes. A simple test of eyelid sensitivity may help vision professionals in evaluating one of the most common eye-related symptoms: dry eyes. A new study linking increased eyelid sensitivity to decreased function of the eyelid margins is presented in the article - "Lid Margins: Sensitivity, Staining, Meibomian Gland Dysfunction, and Symptoms", appearing in the October issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
Dry Eyes - Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly. Other names for dry eye include dry eye syndrome, keratoconjunctivitis sicca (KCS), dysfunctional tear syndrome, lacrimal keratoconjunctivitis, evaporative tear deficiency, aqueous tear deficiency, and LASIK-induced neurotrophic epitheliopathy (LNE). Dry eye can make it more difficult to perform some activities, such as using a computer or reading for an extended period of time, and it can decrease tolerance for dry environments, such as the air inside an airplane. Inflammation of the surface of the eye may occur along with dry eye. If left untreated, this condition can lead to pain, ulcers, or scars on the cornea, and some loss of vision. However, permanent loss of vision from dry eye is uncommon. The National Eye Institute (NEI) is part of the National Institutes of Health (NIH) and is the Federal government's lead agency for vision research that leads to sight-saving treatments and plays a key role in reducing visual impairment and blindness - www.nei.nih.gov/health/dryeye/dryeye.asp
Isabelle Jabert, OD, MPH, PhD, FAAO, and colleagues of The University of New South Wales, Sydney, used a test called esthesiometry to measure the sensitivity of the eyelid margins "the very edge of the upper and lower eyelids. The test, easily performed in the optometrist's office, provides an accurate measure of the lid margin's sensitivity to touch. The pilot study included 27 healthy adults, average age 31 years.
The researchers then looked at how eyelid sensitivity was related to the function of some specialized structures of the eyelid margin. A special dye was also used to stain the innermost layer of the eyelid margin to assess the function of the meibomian glands, which secrete a specialized oil-like substance into the tear fluid.
The results showed some surprising differences between the upper and lower eyelids - including greater sensitivity of the lower-lid margin, compared to the upper lids.
And it was this increased lower lid sensitivity that was found to be related to hyperosmolarity of the tear film that is, more concentrated tears. The finding suggests the potential for a new approach to clinically assessing tear osmolarity via lower lid sensitivity measures. Whereas past studies have shown a relationship between corneal sensitivity and osmolarity, none have addressed the possible lid sensitivity relationship. The ease with which the non-transparent lids can be accessed to measure sensitivity provides a potential clinical advantage over measuring sensitivity to touch on the cornea.
By comparison, the relationship between tear osmolarity and staining appears much more ambiguous.
The authors' results emphasize clear differences in staining and sensitivity between the upper and lower lids; for example the upper lids appear to be less sensitive and they stain less. Such findings may turn out to be important for interpretation of future studies of the dry eye condition.
Increased osmolarity and decreased meibomian gland function have both been linked to symptoms related to dry eye: one of the most common ocular complaints, especially in older people.
Recent research has led to increased understanding of the delicate structure and function of the lid margin, and their contribution to common eye-related symptoms. "There is renewed interest in the role of the eyelids in dry eye and meibomian gland dysfunction," comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science.
The new results suggest that esthesiometry could provide optometrists with a simple test of lid margin sensitivity, providing evidence of tear osmolarity.
"This suggests a promising new tool for evaluating ocular health and effectiveness of treatment in dry eye disease and meibomian gland dysfunction," Dr Adams adds. The findings may provide "an expanded set of tools" for identifying problems leading to dry eye, and possibly for evaluating the effectiveness of new treatments.
To read the article Lid Margins: Sensitivity, Staining, Meibomian Gland Dysfunction, and Symptoms", please visit journals.lww.com/optvissci/Fulltext/2012/10000/Lid_Margins___Sensitivity,_Staining,_Meibomian.5.aspx
Optometry and Vision Science for the iPad app is available as a free download from the iTunes App Store. For a limited time, all users will have free full content to the current issue. After the free introductory period, American Academy of Optometry members and subscribers will continue to enjoy full access via a simple login process. Each issue will be posted on the same schedule as the current online and print editions.
About Optometry and Vision Science - Optometry and Vision Science, official journal of the American Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 75 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide.
About the American Academy of Optometry - Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning. All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.
About Lippincott Williams & Wilkins - Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of 3.4 billion ($4.7 billion).
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