Noninvasive tear breakup time evaluation with multifunctional topography supports the diagnosis of evaporative dry eye disease

Abstract Introduction: Dry eye disease (DED) is a multifactorial disorder that presents alterations in the homeostasis of the tear film and is accompanied by characteristic symptoms of ocular discomfort. In normal circumstances, the tear film has a uniform distribution on the eye, allowing for a normal function of the ocular surface unit. In patients with DED, the tear film presents a nonuniform, suboptimal distribution on the ocular surface that manifests with premature ruptures following the regular blinking pattern. In this study, we aimed to evaluate and identify the differences in the tear film breakup patterns in patients with evaporative dry eye when compared to healthy controls. Methods: We designed a prospective, cross-sectional, observational study to evaluate the tear film breakup patterns in two groups: (a) patients with a diagnosis of evaporative dry eye and (b) healthy subjects as controls. All the participants underwent a comprehensive assessment that included the following assessments: a symptom questionnaire, noninvasive tear film breakup using multifunctional topography, clinical evaluation of the ocular surface, and staining. Results: Seventy-two eyes from 72 participants were studied. Participants had a mean age of 34.9 ± 25.1 years, 51.4% were male, 36 were patients with evaporative dry eye, and 36 were healthy controls. All the patients with evaporative dry eye presented some type of tear rupture compared with only 50% of the healthy subjects. The lower temporal quadrant of the cornea was the region that most consistently presented tear film ruptures in patients with evaporative dry eye as compared with healthy subjects (22 vs. 9, P = 0.003) (odds ratio: 4.17, 95% confidence interval: 1.75–13.15). Conclusions: Evaluation of specific noninvasive tear film breakup patterns through multifunctional topography can be a valuable assessment for the screening of subjects to complement the diagnosis of evaporative dry eye.