Three New Zealand researchers have developed a standardised clinical evaluation tool for dry anophthalmic socket syndrome (DASS), crucial to understanding a condition affecting 63% of anophthalmic patients.
“Prosthetic eyes are significantly under-investigated but there has been a resurgence of research interest in the last 10 years,” said Dr Keith Pine, an Auckland-based ocular prosthetics specialist and honorary research fellow at the University of Auckland. “Being able to identify a syndrome by name provides relief for both patients and clinicians as it deepens understanding, removes uncertainty and moves the conversation on to how best to treat the effects.”
DASS is characterised by a loss of tear film homeostasis accompanied by socket discomfort, in which tear film instability, conjunctival inflammation and damage, as well as eyelid and neurosensory abnormalities play etiological roles, said the study’s co-authors, Dr Pine, Associate Professor Rob Jacobs, from the university’s School of Optometry and Vision Science (SOVS), and ophthalmologist Dr Brian Sloan, from Greenlane Clinical Centre who has subspecialties in oculoplastic, lacrimal and orbital surgery.
Their research, undertaken in collaboration with the University of Cologne, Germany, evaluated 87 unilateral anophthalmic patients using the Ocular Surface Disease Index (OSDI), the five-item Dry Eye Questionnaire (DEQ-5) and a modified version of the Symptom Assessment in Dry Eye (SANDE) questionnaire for the anophthalmic socket and, separately, for the healthy fellow eye. Conjunctival inflammation was semi-quantitatively graded and Schirmer’s test with topical anaesthesia was also performed bilaterally.
The findings showed patients had significantly higher OSDI, DEQ-5 and SANDE scores at the anophthalmic side compared to the healthy eye (p≤0.019, respectively) with 63% of patients complaining of anophthalmic socket dryness in at least one of three questionnaires. Patients also had higher inflammation (p<0.001) and more tear volume (p≤0.024) on the anophthalmic side compared to the other eye.
