Developing and validating a questionnaire to assess the symptoms of blepharitis accompanied by dry eye disease

Abstract

Purpose: To propose additional items for established dry eye disease (DED) instruments that cover blepharitis-specific signs and symptoms and to determine the association between the clinical findings and subjective complaints.

Methods: Thirty-one patients with blepharitis and DED were prospectively included in the pretest period for selecting suitable questions. In the main phase of the study, the selected questions were then tested on 68 patients with blepharitis and DED and 20 controls without blepharitis or DED. Pearson's coefficient of correlation was calculated between the blepharitis-specific questions, tear break-up time (TBUT), the Schirmer test score, and the ocular surface disease index (OSDI) score; and the similarity between the blepharitis-specific questions, OSDI questions, and objective parameters for DED was assessed via hierarchical clustering. Furthermore, the discriminatory power of the blepharitis-specific questions was investigated with the receiver operating characteristic (ROC) curve.

Results: The additional question about heavy eyelids revealed a significant correlation with the OSDI score (r = 0.45, p < 0.001) and Schirmer score (r = - 0.32, p = 0.006). Cluster analysis demonstrated the similarity between the question about heavy eyelids and TBUT. In addition, the OSDI questionnaire had the highest discriminatory power in ROC analysis, and the OSDI score significantly correlated with the specific questions about eyelids sticking together (r = 0.47, p < 0.0001) and watery or teary eyes (r = 0.34, p = 0.003).

Conclusions: The blepharitis-specific additional questions were closely associated with objective parameters for DED. The question about heavy eyelids might be well suited for recording the symptoms of hyposecretory and hyperevaporative dry eye with blepharitis.

Keywords: Blepharitis; Dry eye disease; Ocular surface disease index.

Fig. 1

Blepharitis-specific questions in the main phase of the study

Fig. 2

Violin plot visualization of the bivariate correlation between blepharitis-specific additional questions about eyelids sticking together, heavy eyelids and tearing, and clinical parameters for DED

Fig. 3

Cluster analysis of the seven blepharitis-specific additional questions in the main phase, the OSDI questions, TBUT, and the Schirmer test score. Each column represents a patient. Each row represents one blepharitis-specific additional question. Similarity structures were detected for the questions about heavy eyelids a, eyelids sticking together b, tearing c, redness at the eyelid margins d, crust or flakes on eyelashes e, swollen eyelid margins f, and the question whether the patient is more bothered by how the eyes look or the eyes feel g

Fig. 4

ROC curves for the discriminatory power analysis of the OSDI and blepharitis-specific additional questions in the main phase of the study