Classification of Fluorescein Breakup Patterns: A Novel Method of Differential Diagnosis for Dry Eye

Norihiko Yokoi, Georgi As Georgiev, Hiroaki Kato, Aoi Komuro, Yukiko Sonomura, Chie Sotozono, Kazuo Tsubota, Shigeru Kinoshita

Research output: Contribution to journalArticlepeer-review

101 Citations (Scopus)


Purpose To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. Design Cross-sectional study. Methods In 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19); spot (SB, n = 22); line (LB, n = 24); dimple (DB, n = 19); random (RB, n = 22 eyes); and dry eye–related symptoms using the visual analog scale (VAS, 100 mm = maximum), tear meniscus radius (TMR, mm), tear film lipid layer interference grade (IG) (grades 1–5; 1 = best) and spread grade (SG) (grades 1–4; 1 = best), tear film noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points = maximum), ocular surface epithelial damage (OSED) score (9 points = maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP. Results In each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, and foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB, and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and -RB; SB-DB and -RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (P <.05 in each comparison). Conclusions The 5 different FBUPs constituted different groups, reflecting different pathophysi-ologies.

Original languageEnglish
Pages (from-to)72-85
Number of pages14
JournalAmerican Journal of Ophthalmology
Publication statusPublished - 2017 Aug

ASJC Scopus subject areas

  • Ophthalmology


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