• 1.

    Mishima S, Maurice DM. The oily layer of the tear film and evaporation from the corneal surface. Exp Eye Res. 1961;1:3945.

  • 2.

    Gelatt KN, Ben-Shlomo G, Gilger BC, Hendrix DVH, Kern TJ, Plummer CE. In: Featherstone HJ, Heinrich CL, eds. The eye examination and diagnostic procedures. Veterinary Ophthalmology. 6th ed. John Wiley and Sons Inc; 2021:601618.

    • Search Google Scholar
    • Export Citation
  • 3.

    Millar TJ, Schuett BS. The real reason for having a meibomian lipid layer covering the outer surface of the tear film – a review. Exp Eye Res. 2015;137:125138.

    • Search Google Scholar
    • Export Citation
  • 4.

    Moore CP. Qualitative tear film disease. Vet Clin North Am Small Anim Pract. 1990;20(3):565581.

  • 5.

    Cullen CL, Ihle SL, Webb AA, McCarville C. Keratoconjunctival effects of diabetes mellitus in dogs. Vet Ophthalmol. 2005;8(4):215224.

    • Search Google Scholar
    • Export Citation
  • 6.

    Grahn BH, Sisler S, Storey E. Qualitative tear film and conjunctival goblet cell assessment of cats with corneal sequestra. Vet Ophthalmol. 2005;8(3):167170.

    • Search Google Scholar
    • Export Citation
  • 7.

    Saito A, Watanabe Y, Kotani T. Morphologic changes of the anterior corneal epithelium caused by third eyelid removal in dogs. Vet Ophthalmol. 2004;7(2):113119.

    • Search Google Scholar
    • Export Citation
  • 8.

    Biondi F, Dornbusch PT, Sampaio M, Montiani-Ferreira F. Infrared ocular thermography in dogs with and without keratoconjunctivitis sicca. Vet Ophthalmol. 2015;18(1):2834.

    • Search Google Scholar
    • Export Citation
  • 9.

    Cullen CL, Lim C, Sykes J. Tear film breakup times in young healthy cats before and after anesthesia. Vet Ophthalmol. 2005;8(3):159165.

    • Search Google Scholar
    • Export Citation
  • 10.

    Lim CC, Cullen CL. Schirmer tear test values and tear film break-up times in cats with conjunctivitis. Vet Ophthalmol. 2005;8(5):305310.

    • Search Google Scholar
    • Export Citation
  • 11.

    Moore CP, Wilsman NJ, Nordheim EV, Majors LJ, Collier LL. Density and distribution of canine conjunctival goblet cells. Invest Ophthalmol Vis Sci. 1987;28(12):19251932.

    • Search Google Scholar
    • Export Citation
  • 12.

    Arnold TS, Wittenburg LA, Powell CC. Effect of topical naltrexone 0.3% on corneal sensitivity and tear parameters in normal brachycephalic dogs. Vet Ophthalmol. 2014;17(5):328333.

    • Search Google Scholar
    • Export Citation
  • 13.

    Carrington SD, Bedford PG, Guillon JP, Woodward EG. Biomicroscopy of the tear film: the tear film of the Pekingese dog. Vet Rec. 1989;124(13):323328.

    • Search Google Scholar
    • Export Citation
  • 14.

    Sebbag L, Kass PH, Maggs DJ. Reference values, intertest correlations, and test-retest repeatability of selected tear film tests in healthy cats. J Am Vet Med Assoc. 2015;246(4):426435.

    • Search Google Scholar
    • Export Citation
  • 15.

    Monclin SJ, Farnir F, Grauwels M. Determination of tear break-up time reference values and ocular tolerance of tetracaine hydrochloride eyedops in healthy horses. Equine Vet J. 2011;43(1):7477.

    • Search Google Scholar
    • Export Citation
  • 16.

    Palella Gómez A, Mazzucchelli S, Scurrell E, Smith K, Pinheiro de Lacerda R. Evaluation of partial tarsal plate excision using a transconjunctival approach for the treatment of distichiasis in dogs. Vet Ophthalmol. 2020;23(3):506514.

    • Search Google Scholar
    • Export Citation
  • 17.

    Shukla AK, Pinard CL, Flynn BL, Bauman CA. Effects of orally administered gabapentin, tramadol, and meloxicam on ocular variables in healthy dogs. Am J Vet Res. 2020;81(12):973984.

    • Search Google Scholar
    • Export Citation
  • 18.

    Evans PM, Lynch GL, Labelle P. Effects of oral administration of diphenhydramine on pupil diameter, intraocular pressure, tear production, tear film quality, conjunctival goblet cell density, and corneal sensitivity of clinically normal adult dogs. Am J Vet Res. 2012;73(12):19831986.

    • Search Google Scholar
    • Export Citation
  • 19.

    Saito A, Kotani T. Estimation of lacrimal level and testing methods on normal Beagles. Vet Ophthalmol. 2001;4(1):711.

  • 20.

    Perry HD. Dry eye disease: pathophysiology, classification, and diagnosis. Am J Manag Care. 2008;14(suppl 3);S79S87.

  • 21.

    Downie LE. Automated tear film surface quality breakup time as a novel clinical marker for tear hyperosmolarity in dry eye disease. Invest Ophthalmol Vis Sci. 2015;56(12):72607268.

    • Search Google Scholar
    • Export Citation
  • 22.

    Davidson HJ, Kuonen VJ. The tear film and ocular mucins. Vet Ophthalmol. 2004;7(2):7177.

  • 23.

    Gelatt KN, MacKay EO, Widenhouse C, Widenhouse TC, Stopek JB. Effect of lacrimal punctal occlusion on tear production and tear fluorescein dilution in normal dogs. Vet Ophthalmol. 2006;9(1):2327.

    • Search Google Scholar
    • Export Citation
  • 24.

    George O, Omokhua P. Comparative analysis of the effects of topical anaesthetic agents on tear quantity and tear quality. J Niger Optom Assoc. 2010;16(1):3033.

    • Search Google Scholar
    • Export Citation
  • 25.

    Lemp MA, Hamill JR Jr. Factors affecting tear film breakup in normal eyes. Arch Ophthalmol. 1973;89(2):103105.

  • 26.

    Venturi F, Blocker T, Dees DD, Madsen R, Brinkis J. Corneal anesthetic effect and ocular tolerance of 3.5% lidocaine gel in comparison with 0.5% aqueous proparacaine and 0.5% viscous tetracaine in normal canines. Vet Ophthalmol. 2017;20(5):405410.

    • Search Google Scholar
    • Export Citation
  • 27.

    Oriá AP, Rebouças MF, Martins Filho E, Dórea Neto FA, Raposo AC, Sebbag L. Photography-based method for assessing fluorescein clearance test in dogs. BMC Vet Res. 2018;14(1):269.

    • Search Google Scholar
    • Export Citation
  • 28.

    Webber WR, Jones DP, Wright P. Fluorophotometric measurements of tear turnover rate in normal healthy persons: Evidence for a circadian rhythm. Eye (Lond). 1987;1(5):615620.

    • Search Google Scholar
    • Export Citation
  • 29.

    Herring IP, Bobofchak MA, Landry MP, Ward DL. Duration of effect and effect of multiple doses of topical ophthalmic 0.5% proparacaine hydrochloride in clinically normal dogs. Am J Vet Res. 2005;66(1):7780.

    • Search Google Scholar
    • Export Citation
  • 30.

    Maki E. Interclass reliability in healthcare studies: calculating the intraclass correlation coefficient (ICC) in SAS. Accessed April 23, 2020. https://www.sas.com/content/dam/SAS/en_ca/User%20Group%20Presentations/Health-User-Groups/Maki-InterraterReliability-Apr2014.pdf

    • Search Google Scholar
    • Export Citation
  • 31.

    Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155163.

    • Search Google Scholar
    • Export Citation
  • 32.

    Nagymihályi A, Dikstein S, Tiffany JM. The influence of eyelid temperature on the delivery of meibomian oil. Exp Eye Res. 2004;78(3):367370.

    • Search Google Scholar
    • Export Citation
  • 33.

    Iwashita H, Saito A. Comparing two different methods of tear film break up time testing in dogs. Vet Ophthalmol. 2019;22(3):E17. Abstract.

    • Search Google Scholar
    • Export Citation
  • 34.

    Yokoi N, Komuro A. Non-invasive methods of assessing the tear film. Exp Eye Res. 2004;78(3):399407.

  • 35.

    Mengher LS, Bron AJ, Tonge SR, Gilbert DJ. Effect of fluorescein instillation on the pre-corneal tear film stability. Curr Eye Res. 1985;4(1):912.

    • Search Google Scholar
    • Export Citation
  • 36.

    Savini G, Prabhawasat P, Kojima T, Grueterich M, Espana E, Goto E. The challenge of dry eye diagnosis. Clin Ophthalmol. 2008;2(1):3155.

    • Search Google Scholar
    • Export Citation
  • 37.

    Johnson ME, Murphy PJ. The effect of instilled fluorescein solution volume on the values and repeatability of TBUT measurements. Cornea. 2005;24(7):811817.

    • Search Google Scholar
    • Export Citation
  • 38.

    Kim KT, Kim J-H, Kong YT, Chae JB, Hyung S. Reliability of a new modified tear breakup time method: dry tear breakup time. Graefes Arch Clin Exp Ophthalmol. 2015;253(8):13551361.

    • Search Google Scholar
    • Export Citation
  • 39.

    Paugh JR, Tse J, Nguyen T, et al. Efficacy of the fluorescein tear breakup time test in dry eye. Cornea. 2020;39(1):9298.

  • 40.

    Korb DR, Greiner JV, Herman J. Comparison of fluorescein break-up time measurement reproducibility using standard fluorescein strips versus the dry eye test (DET) method. Cornea. 2001;20(8):811815.

    • Search Google Scholar
    • Export Citation
  • 41.

    Abdul-Fattah AM, Bhargava HN, Korb DR, Glonek T, Finnemore VM, Greiner JV. Quantitative in vitro comparison of fluorescein delivery to the eye via impregnated paper strip and volumetric techniques. Optom Vis Sci. 2002;79(7):435438.

    • Search Google Scholar
    • Export Citation
  • 42.

    Wang MTM, Craig JP. Comparative evaluation of clinical methods of tear film stability assessment: a randomized crossover trial. JAMA Ophthalmol. 2018;136(3):291294.

    • Search Google Scholar
    • Export Citation
  • 43.

    Sebbag L, Kirner NS, Allbaugh RA, Reis A, Mochel JP. Kinetics of fluorescein in tear film after eye drop instillation in Beagle dogs: does size really matter? Front Vet Sci. 2019;6:457.

    • Search Google Scholar
    • Export Citation
  • 44.

    Sebbag L, Allbaugh RA, Wehrman RF, et al. Fluorophotometric assessment of tear volume and turnover rate in healthy dogs and cats. J Ocul Pharmacol Ther. 2019;35(9):497502.

    • Search Google Scholar
    • Export Citation
  • 45.

    Behrens A, Doyle JJ, Stern L, et al. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea. 2006;25(8):900907.

    • Search Google Scholar
    • Export Citation

Investigation of fluorescein stain–based tear film breakup time test reliability in dogs in a clinical setting

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  • 1 From the Departments of Clinical Sciences (Seyer, Betbeze) and Comparative Biomedical Sciences (Wills), College of Veterinary Medicine, Mississippi State University, Starkville, MS 39763.

Abstract

OBJECTIVE

To determine intra- and interobserver reliability of a fluorescein stain–based tear film breakup time (TFBUT) test as performed in a clinical environment with and without administration of a topical anesthetic.

ANIMALS

21 privately owned dogs.

PROCEDURES

A randomized study design was used. Two independent observers that commonly perform the TFBUT test in clinical practice read the same description of TFBUT. Observers performed TFBUT testing for each dog before and after topical administration of 0.5% proparacaine solution in 4 testing periods with a 1-hour interval between periods. Intraclass correlation coefficient (ICC) analysis was used to assess inter- and intraobserver test reliability. Linear mixed models were used to assess the main effects of testing period, observer, eye, and presence of ophthalmic disorders and their interactions on TFBUT.

RESULTS

Mean TFBUT measurements performed by observer 1 and observer 2 were 5.9 seconds and 8.6 seconds, respectively, when adjusted for other effects in the model. Intraobserver ICC was poor for one observer and moderate for the other. Interobserver ICC was poor without use of topical anesthetic and slightly lower when anesthetic was used. Observer and testing period were each significantly associated with TFBUT; the measurements decreased and were more variable after multiple applications of fluorescein stain and proparacaine.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested tear film stability is negatively affected by topical administration of 0.5% proparacaine solution and repeated applications of fluorescein stain. The TFBUT test as performed in this study had poor to moderate reliability.

Abstract

OBJECTIVE

To determine intra- and interobserver reliability of a fluorescein stain–based tear film breakup time (TFBUT) test as performed in a clinical environment with and without administration of a topical anesthetic.

ANIMALS

21 privately owned dogs.

PROCEDURES

A randomized study design was used. Two independent observers that commonly perform the TFBUT test in clinical practice read the same description of TFBUT. Observers performed TFBUT testing for each dog before and after topical administration of 0.5% proparacaine solution in 4 testing periods with a 1-hour interval between periods. Intraclass correlation coefficient (ICC) analysis was used to assess inter- and intraobserver test reliability. Linear mixed models were used to assess the main effects of testing period, observer, eye, and presence of ophthalmic disorders and their interactions on TFBUT.

RESULTS

Mean TFBUT measurements performed by observer 1 and observer 2 were 5.9 seconds and 8.6 seconds, respectively, when adjusted for other effects in the model. Intraobserver ICC was poor for one observer and moderate for the other. Interobserver ICC was poor without use of topical anesthetic and slightly lower when anesthetic was used. Observer and testing period were each significantly associated with TFBUT; the measurements decreased and were more variable after multiple applications of fluorescein stain and proparacaine.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested tear film stability is negatively affected by topical administration of 0.5% proparacaine solution and repeated applications of fluorescein stain. The TFBUT test as performed in this study had poor to moderate reliability.

Contributor Notes

Address correspondence to Dr. Betbeze (cbetbeze@cvm.msstate.edu).