Use of a high molecular weight fluorescein (fluorexon) ophthalmic strip in assessments of tear film break-up time in contact lens wearers and non-contact lens wearers

Abstract

Purpose: To assess whether fluorexon strips could be used in tear stability [tear film break-up time (TBUT)] measures, as compared with fluorescein strips.

Methods: The pre-ocular tear film stability was assessed in 40 adults (19-29 years of age), half of whom were adapted soft contact lens wearers, using the dye-assisted tear film break-up time (TBUT) method. The measures were carried out between 10.00 and 17.00 hours, with contact lens wearers removing their lenses just before the assessments. For all subjects, fluorescein or fluorexon ophthalmic strips (pre-wetted with preservative-free saline) were used to add dye to the tear film, the TBUT was assessed three times and then the eye lightly irrigated with saline. The measures were repeated 45 min later with the other dye, with half the subjects receiving fluorescein first and the other half receiving fluorexon first.

Results: Overall, the mean TBUT times were 12.2 +/- 5.9 s for fluorescein and 12.6 +/- 5.6 s for fluorexon (p = n.s.), but the non-lens wearers had longer TBUT times (14.6 and 14.5 s for the two dyes) compared with contact lens wearers (9.8 and 10.7 s, p < 0.01). While the inter-subject variability (as S.D.) was larger for non-contact lens wearers, the intra-subject variability [as coefficient of variation (COV)] was greater in the contact lens wearers when fluorescein was used (p < 0.001). When analysed as a function of the time of day that the measures were made, there were clear trends for both the fluorescein and fluorexon. TBUT values to increase in non-contact lens wearers and decrease in contact lens wearers. These trends failed to reach statistical significance, but the results with the contact lens wearers showed less variation than the non-contact lens wearers.

Conclusion: The use of a fluorexon dye-impregnated strip (pre-wetted with preservative-free saline) yielded comparable results with a fluorescein strip for assessments of tear film stability based on TBUT. The studies also indicate that further research is needed on changes in TBUT values during the day.