Tear Osmolarity- Indicator for Dry Eye Disease

 

 

Tear Osmolarity -Indicator for Dry Eye Disease

Tear film hyperosmolarity ( too thick) has been recognized as an important componebt in dry eye disease for many years.  This test has been added to the latest description of Dry Eye Disease (DED) as a part of the DEWS report in 2017.

Tear film osmolarity has shown to be repeatable in people with out dry eyes, but greatly varied in people with dry eyes.  This parameter is now important to track as dry eye symptoms improve.

In a recent published clinical study, it was shown that Tear Osmolarity Test is highly correlated with higher OSDI scores, cornea staining, and symptoms of dry eyes.  Better than Shirmer's Test or Tear Breakup Test. 

Abnrmal Tear Osmolarity seems to preceed dry eye symptoms.   However, not all eye doctors can perform Tear Osmolarity right now. 

Here is a brief excert-


Tear osmolarity varied between the various groups with the highest values in the clinically significant dry eye group (312 mOsm/L) and the lowest in the control group (305 mOsm/L). Subjects in the symptom only dry eye had a score in between the two other groups (307 mOsm/L). A higher variability in osmolarity was noted in the clinically significant eye group versus the other two groups. Higher osmolarity was also correlated with higher OSDI scores and staining (cornea/conjunctival) but not with tear film breakup or Schirmer’s test values.

The authors concluded that osmolarity values were the most consistent in the control group. Increased osmolarity and between-eye variability was shown in dry eye, with the clinically significant dry eye having higher and more variable osmolarity than the symptom-only dry eye. The authors propose that osmolarity might be a good indicator of a patient developing dry eye as a higher osmolarity value is present in the symptom-only group, likely prior to developing the corneal/conjunctival staining seen in clinically significant disease. In addition, osmolarity should be obtained in both eyes and a large variability between eyes may also be an indicator of dry eye. A cutoff value of 308 mOsm/L was felt to be the most useful value to potentially identify a dry eye patient.
Conclusions: Individuals with symptomatic dry eye that is not yet clinically significant seem to have higher and more variable osmolarity measurements than controls, potentially indicating that changes in osmolarity precede clinical findings. 

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