Comparative assessment of tear function tests, tear osmolarity, and conjunctival impression cytology between patients with pterygium and healthy eyes

Abstract

Purpose: To compare histologic abnormalities of tear film and tear osmolarity between normal eyes and eyes with pterygium. Methods: This was a prospective, hospital-based, case-control study involving 95 patients (65 men, 30 women) with unilateral pterygium. The tear meniscus height (TMH), Schirmer's test-1 (SCH-1) score, Rose Bengal staining (RBS) score, tear film breakup time (TBUT), tear osmolarity (TO), and conjunctival impression cytology (CIC) were assessed in both eyes. The Chi-square and Student's t-tests were used to compare the results between the two groups. P values <0.05 were considered statistically significant. Results: The mean patient age was 50.9 years, with the largest age group being the 45-55 year-old bracket across both genders. Most patients (82.1) had nasal pterygium, and 80 were involved in outside activities. The mean assessment values in the case and control groups were as follows: TMH, 0.21 vs. 0.24 mm; SCH-1, 13.2 vs. 17.8 mm; RBS, 4.38 vs. 2.51 points; TBUT, 8.7 vs. 13.2 seconds; TO, 306 vs. 299 mOsm/L (P < 0.001 in all cases). The proportions of abnormal assessment values in the case and control groups were as follows: TMH, 82.1 vs. 3.16; SCH-1, 20 vs. 2.1; RBS, 30.53 vs. 4.22; TBUT, 61.05 vs. 6.3; TO, 10.52 vs. 1.05; CIC, 33.7 vs. 7.37 (P < 0.05 for all comparisons). Conclusion: This study showed that the quantity and quality of tear film, as well as the number of goblet cells, decreased, but the tear osmolarity increased in eyes with pterygium. Furthermore, the TMH, RBS results, TBUT, and CIC have more precise state of the patient's tear condition with the disease of the pterygium. Safarzadeh Masoud 1 Department of Optometry, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran Heidari Sahel 2 Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran Azizzadeh Parvin 3 Bahman Ophthalmology Research Center, Bahman Hospital, Tehran Sheibani Kourosh 4 Basir Eye Safety Research Center, Basir Eye Clinic, Tehran Nassiri Nader 5 Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran Heidari Laleh 6 Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran Aghataheri Sattar 7 Department of Optometry, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran Moukoury Nyolo E, Epee E, Nsangou JFI, Noa Noa Tina B. Pterygiun in a tropical region: Analysis of 344 cases in Cameroon. Bull Soc Belge Ophtalmol 2009;311:11-15. Shiroma H, Higa A, Sawaguchi S, Iwase A, Tomidokoro A, Amano S. Prevalence and risk factors of pterygium in a southwestern island of Japan: The Kumejima Study. Am J Ophthalmol 2009;148:766-771. Cajucom-Uy H, Tong L, Wong TY, Tay WT, Saw SM. The prevalence of and risk factors for pterygium in an urban Malay population: The Singapore Malay Eye Study (SiMES). Br J Ophthalmol 2010;94:977-981. Rajab AY. Evaluation of tear film stability in pterygium and pingueculae. Ann Coll Med Mosul 2013;39:132-135. Ganeshpuri AS, Kamble BS, Patil P, Wadgaonkar SP. A comparative study of tear film stability and secretion in pterygium patients-Diabetic vs. nondiabetic. Int J Health Sci Res 2014;4:86-97. Anguria P, Ntuli S, Carmichael T. Relationships of heredity and dry eye with pterygia in black African patients. SAMJ 2011;101:110. Yanoff, Duker. Ophthalmology. 4th edition chapter. Vol. 23. 2013. p. 274-6. ISBN 978-1455-7398-44. Wang S, Jiang B, Gu Y. Changes of tear film function after pterygium operation. Ophthalmic Res 2011;45:210-215. Srinivasan S and Nichols KK. Collecting tear osmolarity measurements in the diagnosis of dry eye. Exp Rev Ophthalmol 2009;4:451-453. Ozsutcu M, Arslan B, Erdur SK, Gulkilik G, Kocabora SM, Muftuoglu O. Tear osmolarity and tear film parameters in patients with unilateral pterygium. Cornea 2014;33:1174-1178. Singh R, Joseph A, Umapathy T, Tint NL, Dua HS. Impression cytology of the ocular surface. Br J Ophthalmol 2005;89:1655-1659. Viso E, Gude F, Rodríguez-Ares MT. Prevalence of pinguecula and pterygium in a general population in Spain. Eye (Lond) 2011;25:350-357. Antony AT, Mini PA, Dalia S. Pterygium and Dry Eye- A Clinical Correlation. J Med Scie Clin Res 2017;5:23654-23659. Rahman A, Yahya K, Fasih U, Huda W, Shaikh A. Comparison of Schirmer's test and tear film breakup time test to detect tear film abnormalities in patients with Pterygium. J Pak Med Assoc 2012;6:1214-1216. Lee AJ, Lee J, Saw SM, Gazzard G, Koh D, Widjaja D, Tan DT. Prevalence and risk factors associated with dry eye symptoms: A population based study in Indonesia. Br J Ophthalmol 2002;86:1347-1351. Fotouhi A, Hashemi H, Khabazkhoob M, Mohammad K. Prevalence and risk factors of pterygium and pinguecula: The Tehran Eye Study. Eye (Lond) 2009;23:1125-1129. Dolezalova V. Is the occurrence of a temporal pterygium really so rare? Ophthalmologica 1977;174:88-91. Asokan R, Venkatasubbu RS, Velumuri L, Lingam V, George R. Prevalence and associated factors for pterygium and pinguecula in a South Indian population. Ophthalmic Physiol Opt 2012;32:39-44. Jang SY, Lee SY, Yoon JS. Meibomian gland dysfunction in longstanding prosthetic eye wearers. Br J Ophthalmol 2013;97:398-402. Das P, Gokani A, Bagchi K, Bhaduri G, Chaudhuri S, Law S. Limbal epithelial stem-microenvironmental alteration leads to pterygium development. Mol Cell Biochem 2015;402:123-139. Onkar A, Pandey DJ, Bist HK, Sen S. Tear and pterygium: A clinico-pathological study of conjunctiva for tear film anomaly in pterygium. J Eye Cataract Surg 2017;3:24. Bekibele CO, Baiyeroju AM, Ajaiyeoba A, Akang EE, Ajayi BG. Case control study of dry eye and related ocular surface abnormalities in Ibadan, Nigeria. Int Ophthalmol 2010;30:7-13. Rajiv, Mithal S, Sood AK. Pterygium and dry eye-A clinical correlation. Indian J Ophthalmol 1991;39:15-16. Oh HJ, Park YG, Yoon KC. Changes of ocular surface and tear film in patients with pinguecula and pterygium. J Korean Ophthalmol Soc 2006;47:717-724. Moreno JC, Garcia VG, Garcia L. Evaluation of tear film in patients with Pterygium. Eur J Ophthalmol 2011;00 (00). Roka N, Shrestha SP. Assessment of tear secretion and tear film instability in cases with pterygium and normal subjects. Nepal J Ophthalmol 2013;5:16-23. El-Sersy TH. Role of pterygium in ocular dryness. J Egypt Ophthalmol Soc 2014;107:205-208. Lemp MA, Baudouin C, Baum J. The definition and classification of dry eye disease: Report of the definition and classification subcommittee of the international Dry Eye WorkShop. Ocul Surf 2007;5:75-92. Manhas A, Gupta D, Gupta A, Kumar D, Manhas RS, Manhas GS. Clinical correlation between dry eye and pterygium: A study done at government medical college Jammu, Jammu and Kashmir, North India. Int J Res Med Sci 2017;5:3087-3094. Lemp MA, Bron AJ, Baudouin C. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol 2011;151:792-798. Julio G, Lluch S, Pujol P, Alonso S, Merindano D. Tear osmolarity and ocular changes in pterygium. Cornea 2012;31:1417-1421. Detorakis ET, Zaravinos A, Spandidos DA. 'Growth factor expression in ophthalmic pterygia and normal conjunctiva'. Int J Mol Med 2010;25:513-516. Bandyopadhyay R, Nag D, Mondal SK, Gangopadhyay S, Bagchi K, Bhaduri G. Ocular surface disorder in pterygium: Role of conjunctival impression cytology. Indian J Pathol Microbiol 2010;53:692-695. Shreya T, Poorvi G. Role of impression cytology in detecting gobletcell damage in various ocular surface disorder. Austin J Clin Ophthalmol 2016;3:1065. © 2019 Journal of Ophthalmic and Vision Research | Published by Wolters Kluwer - Medknow