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Prevalence of Conjunctival Shrinkage and Its Association With Dry Eye Disease: Results From a Population-Based Study in Spain

Viso, Eloy MD, PhD; Rodríguez-Ares, María T. MD, PhD; Bóveda, Francisco J. MD; Touriño, Rosario MD, PhD; Gude, Francisco MD, PhD

doi: 10.1097/ICO.0000000000000091
Clinical Science

Purpose: The aim of this study was to describe the epidemiological characteristics of conjunctival shrinkage (CS) and the association between this disorder and dry eye disease (DED) in a general adult population in northwestern Spain.

Methods: A total of 1155 subjects 40 years or older were selected using an age-stratified random sample procedure in O Salnés (Spain). A standardized DED symptom questionnaire was administered, and a comprehensive ophthalmic evaluation that included DED tests was carried out. Disappearance of half or more of any of the lacunar folds after maximum abduction was considered evidence of CS. The prevalence and associations of CS and its relationship with DED symptoms and signs were investigated.

Results: From 937 eligible subjects, 622 (66.4%) participated [mean age (SD), 63.4 (14.5) years, range, 40–96, 37.0% males]. The prevalence of CS was 38.2% [95% confidence interval (CI), 35.0–41.5]. This prevalence increased with aging (P < 0.001) and was not associated with sex (P = 0.696). The prevalence of symptoms, abnormal tear breakup time, fluorescein and rose bengal staining was significantly higher among subjects with CS. After controlling for age and sex, outdoor activity was directly (adjusted odd ratio, 1.83) and high level of education was inversely (adjusted odd ratio, 0.43) associated with CS. No associations were found with ocular or systemic diseases.

Conclusions: CS is a common pathological reaction that can be used as an indicator of moderate to severe DED. Aging and outdoor activity are strongly associated factors. The simplicity and reproducibility of this diagnosis recommend its inclusion in DED diagnostic and grading schemes.

*Servicio de Oftalmología, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain;

Servicio de Oftalmología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain;

Departamento de Oftalmología, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; and

§Unidad de Epidemiología Clínica, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.

Reprints: Eloy Viso, Servicio de Oftalmología, Complexo Hospitalario Universitario de Pontevedra, Pontevedra 36004, Spain (e-mail:

Supported by grants from the Xunta de Galicia (PGIDIT05SAN52PR) and the Fondo de Investigaciones Sanitarias (RD06/0018/0006). F. Gude was supported by a grant from the Instituto de Salud Carlos III (Ministerio de Ciencia y Tecnología) (BAE09/90052).

The authors have no other funding or conflicts of interest to disclose.

Received August 03, 2013

Accepted January 14, 2014

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.