Preclinical Dry Eye Symptoms Need Attention in Patients Younger Than 40 Years

Researchers evaluate changes in tear film and meibomian gland morphology between patients with preclinical dry eye and patients without preclinical symptoms.

A significant number of individuals younger than 40 years who present for a regular eye examination are likely to have pre-clinical dry eye, according to a study published in Experimental Eye Research. Administering the ocular surface disease index (OSDI), performing noninvasive breakup time (NIBUT) measurements, and evaluating meibomian gland (MG) imaging are important for identifying pre-clinical dry eye in these patients.

Researchers enrolled 149 patients (mean age, 22.00; 78 men) in a prospective, cross-sectional analysis to evaluate changes in tear film and MG morphology between individuals with pre-clinical dry eye and those without pre-clinical symptoms. Overall, 43.6% of participants had pre-clinical dry eye (OSDI score ≥ 13). All participants completed the OSDI and the computer vision syndrome questionnaire (CVS-Q). Additional testing included NIBUT, tear meniscus height (TMH), lipid layer pattern, Schirmer testing, and corneal staining. Patients also underwent MG morphology imaging.

A significant moderate positive correlation was found between OSDI and CVS-Q scores (r=0.66, P <.001). CVS-Q scores were higher in the preclinical dry eye group compared with the scores of patients without preclinical symptoms (Z=-6.72, P <.0001). 

Participants with pre-clinical dry eye had significantly lower NIBUT compared with those without preclinical dry eye symptoms (9 vs 10 seconds; Z=-2.13; P =.03) and MG length was significantly reduced among patients with pre-clinical dry eye in the lower lids (Z=-2.58, P =.01). TMH was lower and MG length in the upper lids was reduced in patients with pre-clinical dry eye, but these values did not achieve statistical significance. No differences were noted in corneal staining or Schirmer testing parameters. 

Subjective analysis revealed a significant moderate positive correlation between OSDI and CVS-Q scores (r=0.66, P <.001). CVS-Q scores were higher in patients with preclinical dry eye compared with patients who did not have preclinical dry eye (Z=-6.72, P <.0001). 

“This study’s results indicate that the majority of the young individuals presenting for the regular eye examination may have pre-clinical dry eye,” according to the researchers. “Hence, it is important to administer the OSDI questionnaire and perform non-invasive tests such as NIBUT and [infrared] imaging of MG as routine tests to detect the pre-clinical dry eye.”

Study limitations include failure to assess functional changes in meibum quality, gland expression, lid margin irregularity, and telangiectasia and the use of convenience sampling. 


Fatima A, Vadla P, Konda N. Changes in the tear film and meibomian gland morphology between preclinical dry eye and normal subjects represented by ocular surface disease index scores. Exp Eye Res. Published online July 14, 2022. doi:10.1016/j.exer.2022.109188