Risk factors for ocular surface damage in Mexican patients with dry eye disease: a population-based study

Alejandro Rodriguez-Garcia,1 Denise Loya-Garcia,1 Everardo Hernandez-Quintela,2 Alejandro Navas3 1Tecnologico de Monterrey, Medical School and Health Sciences, Cornea and External Diseases Service, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico; 2Cornea and Refractive Surgery Service, Asociacion para Evitar la Ceguera en Mexico, I.A.P. Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico; 3Cornea and Refractive Surgery Service, Instituto de Oftalmologia Conde de Valenciana, I.A.P. Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico Purpose: To analyze potential risk factors for ocular surface damage in a representative population of Mexican patients with dry eye disease (DED). Patients and methods: A prospective and cross-sectional population-based epidemiologic cohort study was conducted through a survey of patients with symptoms, signs, known pre-existing diagnosis, and clinical conditions related to DED. Fluorescein staining, tear break-up time (TBUT), and Oxford lissamine green staining were performed on both eyes of patients enrolled in the study. Results: A total of 2,725 surveys including 1,543 (56.6%) women and 1,182 (43.3%) men were analyzed. Most common pre-existing diagnosis included dry eye (58%), chronic blepharitis (17%), and ocular allergy (15%). More than 70% of patients had a positive fluorescein test, and this prevalence increased proportionally to the number of reasons for consultation. The same was true for gender (P<0.001) and age (P<0.0001), with women showing a strong correlation with age (R2=0.93912, P=0.001). The association between positive fluorescein staining and diagnosis was significant for dry eye (P<0.0001), Sjögren’s syndrome (P<0.0001), and glaucoma (P<0.05). No significant association between TBUT and age or gender was found, but the shorter the TBUT, the larger the prevalence of fluorescein staining. Reduced TBUT was seen more frequently in patients with dry eye (57%), ocular allergy (16%), and chronic blepharitis (15%). Most patients (39%) with Oxford grades III and IV were older, complained of red eye (51.0%), foreign body sensation (47.0%), burning (46.0%), and were using eye drops (67%) and systemic medications (47%). Conclusion: The Mexican profile of patients with significant ocular surface damage related to DED includes women at older ages, complaining of red eye, foreign body, and burning sensation. Diagnoses of dry eye, Sjögren’s syndrome, and glaucoma were also risk factors for significant ocular surface damage, along with long-term use of preserved eyes drops and systemic medications. Keywords: ocular surface disease, lacrimal dysfunction, tear break-up time, fluorescein ­staining, Oxford scal