Characterization of Individuals with High-Frequency Artificial Tear Supplement Use

TL;DR

This study identifies factors linked to frequent use of artificial tears in dry eye patients and finds that high users have worse symptoms and more severe eye conditions.

Contribution

The study identifies specific clinical parameters and symptom scores associated with high-frequency artificial tear use in dry eye patients.

Findings

High users had significantly higher symptom scores and more severe corneal staining compared to low users.

High users were more likely to receive cyclosporine treatment during follow-up.

Environmental triggers may contribute to hyperalgesia in high users.

Abstract

Objectives: We aimed to investigate dry eye parameters as potential predisposing factors and estimate the prevalence of high-frequency topical eye drop usage. Methods: A total of 5594 dry eye patients treated between November 2015 and June 2022 were included. High users (n = 180) were those who applied at least one artificial tear drop per hour, whereas those who used artificial tears fewer than four times daily were classified as low users (n = 5414). Differences in self-reported symptoms (OSDI, SPEED questionnaires) and tear-related parameters, including severity of corneal staining (SPK), fluorescein tear-film break-up time (FTBUT), lipid layer thickness (LLT), number of expressible meibomian glands (MGE), meiboscale, and blink patterns, were assessed. Subsequent follow-up comprehensive dry eye assessments were performed at 3 months. Results: There was no difference in age or sex between high users and low users (p = 0.075 and 0.508, respectively). High users had significantly higher symptom scores (p < 0.001), more total blinks (p = 0.001), lower Schirmer scores (p < 0.001), higher SPK grades (p < 0.001), shorter FTBUT (p = 0.010), and higher limbal redness scores (p = 0.002). However, there were no differences in the LLT, MGE, or meiboscale. The compliance with follow-up examinations at 3 months was significantly greater for the high users (p < 0.001). Patients with OSDI scores > 40, SPEED scores > 12, Schirmer scores ≤ 3 mm, and higher compliance with follow-up examinations had odds ratios of 4.0, 3.3, 1.7, and 4.1, respectively, for being high users (95% confidence intervals = 2.8–5.8, 2.4–4.7, 1.2–2.3 and 2.7–5.2, respectively). Among the high users, reducing topical drops significantly decreased the SPEED and OSDI scores, except for the environmental trigger factor in the OSDI questionnaire. During long-term follow-up, 1.1% of low users and 15.4% of high users received cyclosporine treatment (odds ratio 16.4, p < 0.001). Conclusions: OSDI scores > 40, SPEED scores > 12, and Schirmer scores ≤ 3 mm were associated with high-frequency eye drop usage, which accounted for 3.2% of moderate to severe dry eye patients. Susceptibility to environmental triggers could represent hyperalgesia/allodynia in high users. High users have a higher need for cyclosporine treatment.

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