The Dry Eye Zone

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Abstract: Tear EGF levels and corneal subepithelial fibrosis

Corneal subepithelial fibrosis is associated with high tear epidermal growth factor levels in dry eye conditions.

Invest Ophthalmol Vis Sci. 2009 Oct 8. [Epub ahead of print]
Corneal subepithelial fibrosis is associated with high tear epidermal growth factor levels in dry eye conditions.
Rao K, Farley WJ, Pflugfelder SC.

Cullen Eye Institute, Ophthalmology - Ocular Surf Center, Baylor College of Medicine -, Houston, United States.

Purpose: To compare tear epidermal growth factor (EGF) concentration in dry eye (DE) conditions and determine correlations between EGF levels and severity of symptoms and ocular surface signs. Design: Prospective case control study.

Methods: Thirty five DE patients, including subgroups with meibomian gland disease (MGD), Sjögren's syndrome (SS) aqueous tear deficiency and neurotrophic keratopathy, and seventeen asymptomatic control subjects were evaluated. Symptoms, Schirmer test, fluorescein clearance test (FCT), EGF concentration, dye staining and presence of corneal subepithelial fibrosis and meibomian gland (MG) orifice metaplasia were recorded. Tear EGF and severity of irritation and ocular surface signs were correlated.

Results: Tear EGF was higher in MGD than control (p = 0.03) and was lower in SS than the control (p <0.0001), MGD (p <0.05) and NK (P < 0.01) groups. The DE subgroup with FCT > 3, Schirmer >/= 8 had higher EGF levels than the group with FCT > 3, Schirmer < 8 and both groups with good tear clearance (p <0.01). Tear EGF levels were inversely correlated with conjunctival (r= -0.49, p =0.0032) and corneal (r= -0.39, p = 0.022) dye staining and positively correlated with MG orifice metaplasia (r = 0.36, p=0.03) and corneal subepithelial fibrosis (r = 0.5, p =0.0006).

Conclusion: Tear EGF concentration was increased in eyes with MGD, corneal subepithelial fibrosis and MG orifice metaplasia. Elevated tear EGF may promote development of corneal subepithelial fibrosis and lid margin changes.
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