A Study of Tear Ferning Patterns in Elderly Individuals with Dry Eye Disorder

• Main Authors: Amit Kumar Singh, Shubha Nagpal, Rupali Tyagi
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2018-05-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: lissamine green staining; mucin deficiency; old age; schirmer’s test
• Online Access: https://jcdr.net/articles/PDF/11497/27666_CE[Ra]_F(P)_PF1(MJ_AP)_PFA(MJ_SS)_PB(MJ_AP)_PN(AP).pdf

Introduction: Anomalies of the mucin layer of the tear film have generally been studied in relation to contact lens users who represent a young population. Since the prevalence of dry eye increases with age and causes considerable discomfort to elderly patients, a proper assessment of tear film quality is required to facilitate a targeted approach in managing Dry Eye Disorder (DED) in older age. Aim: To study the ferning pattern of the precorneal tear film in elderly individuals and compare the results with standard tests for dry eye. Materials and Methods: A questionnaire based screened cohort of 75 individuals with DED and 75 controls, all above 50 years of age, were studied using Schirmer’s Test, Tear Break Up Time (TBUT), Lissamine green staining and ferning tests. Ferning patterns were graded by Rolando’s classification. Data were analysed by Fisher’s-exact test. Results: Dry eye tests and tear ferning were found to be abnormal in majority of the subjects who had positive scores on screening with the dry eye questionnaire. Abnormal ferning patterns (62% Grade III and 24% Grade IV) correlated significantly with positive Schirmer’s test (p≤0.001), positive TBUT test (p≤0.001) and positive Lissamine green staining (p≤0.001) of eyes with DED. Less than 14% individuals (22 eyes) exhibited Grade II ferning in the dry eye group. Greater disturbances of ferning patterns were seen with increased age. All patients above the age of 75 (n=22 eyes) with symptomatic DED had abnormal ferning. Amongst the controls, all 150 eyes, regardless of age, showed normal ferning patterns (56% Grade 1 and 44% Grade 2). Conclusion: A significant majority of elderly individuals with DED have an abnormal mucin layer in the tear film. Tear ferning test is a simple and inexpensive test and if combined with the other tear film tests may be helpful in a better assessment of DEDs, especially in the elderly. This is relevant especially for targeted treatment in cases of DED where the cause is not aqueous deficiency.