1. FLUORESCEIN CLEARANCE TEST AS AN ADDITIONAL DIAGNOSTIC TOOL FOR DYSFUNCTIONAL TEAR SYNDROME Rodrigo de Nápole Azevêdo, MD Jamília Barros da Silva, MD Aline Guimarães, MD Vera Lúcia Liendo, MD Rossen Mihaylov Hazarbassanov, MD José Álvaro Pereira Gomes,MD Authors have no financial interest Departamento of Oftalmologia, UNIFESP, São Paulo, SP, Brazil

2. Purpose Investigate the fluorescein clearance test (FCT) as an additional tool for diagnosis of dysfunctional tear syndrome (DTS).

3. Introduction Tear function depends on necessary tear components and on hydrodynamic elements, which include tear secretion (flow), tear volume, and tear clearance or turnover. 1 In dry eye, the ocular surface tends to dry out when normal blinking is suppressed and, consequently, difficulties to maintain clear vision while gazing. 2

4. Introduction Dry eye is divided into two groups: aqueous tear- deficient dry eye (ADDE) and evaporative dry eye (EDE). Each form calls for a different therapeutic approach and it is therefore essential to apply a combination of diagnostic tests in order to establish the exact diagnosis. 3

5. Methods and Patients Forty patients, of both sexes, 20 with evaporative dye eye (EDE) and 20 with aqueous dysfunction dry eye (ADDE), were submitted to routine ophthalmological examination, Ocular Surface Disease Index (OSDI) 4 questionnaire and to the following tests: Fluorescein Break-Up Time (FBUT) 5, color scales of fluorescein20, Schirmer I without topic anesthesia.

6. Methods and Patients FCT1 was performed in a second visit: one drop of 0.5% Proparacaine was applied to the inferior fornix of each eye 5 minutes before the FCT and dried carefully with filter paper. An aliquot of 5 μl of 0.25% fluorescein was then applied to the inferior fornix of each eye through an pipette without directly touching the conjunctival surface. After a lapse of 5 minutes, a Schirmer paper strip was inserted into the inferior fornix of each eye. After 1 minute, the strip was removed. Dilution of fluorescein observed on Schirmer filter paper compared to standardized dilution curve was significantly higher for ADDE group for 5, 10, 15 and 20 minutes from the beginning of the test.

7. Photos EDTS SS

8. Results Diagnosis of DTS was defined by OSDI for EDE was 49.59±17.87 percent and for ADDE was 48.99±25.61 percent (t test, p>0.05) and for FBUT for EDE was 6.08±3.18 seconds and ADDE was 5.31±3.58 seconds (t test, p>0.05). Schirmer II test after 30 min with stimulus for EDE was higher 20.81±9.37mm and for ADDE 12.06±11.95mm (t test p=0.0175).

9. Results For FCT it was statistically significant for EDE after 5 minutes was 11.81±8.8 mm (Schirmer strip) and for ADDE was 6.14±7.34mm (Schirmer strip) (t test p=0.0373) and clearance was statistically significant deluded for EDE after 5, 10, 15 and 20 minutes compared to ADDE (t test; p=0.0012, p<0.0001, p<0.0001, and p<0.0001).

10. Results *p<0.05 **p<0.0001

11. Conclusions FCT is a promising tool for diagnosis of DTS and determinates the difference between EDE and ADDE for 5 and 10 minutes intervals.

12. References 1.Prabhasawat P, Tseng SC. Frequent association of delayed tear clearance in ocular irritation. Br J Ophthalmol 1998;82(6):666- 75. 2. Kaido M, Dogru M, Ishida R, Tsubota K. Concept of functional visual acuity and its applications. Cornea 2007;26(9 Suppl 1):S29-35. 3.Kaercher T, Bron AJ. Classification and diagnosis of dry eye. Dev Ophthalmol 2008;41:36-53. 5. Schiffman RM, Christianson MD, Jacobsen G, et al. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol 2000;118(5):615-21. 6. Pflugfelder SC, Tseng SC, Sanabria O, et al. Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea 1998;17(1):38-56.