Clinical Assessment of Dry Eye Disease in Patients with Keratoconus in Saudi Arabia

Purpose: The purpose of this study was to investigate dry eye disease (DED) characteristics in patients with keratoconus (KC) using non-invasive methods. Methods: A total of 34 participants were included in the study. Corneal topography was conducted for each participant utilizing Pentacam, followed by grouping according to the results obtained. The patients with Kmax > 47.2 D (KC) were considered the keratoconus group (n = 17). Healthy control participants with Kmax < 47.2 D were considered the control group (n = 17). Non-invasive tear breakup time (NITBUT), tear meniscus height (TMH), (OSDI) questionnaire, meibography, and lipid layer evaluation were assessed across the groups. Results: Dry eye assessment revealed that the mean non-invasive tear breakup time (NITBUT) was significantly shorter in the keratoconus group (9.88 ± 3.25 s) compared to the control group (18.94 ± 4.26 s, p < 0.001). Tear meniscus height was also reduced in the keratoconus group (0.185 ± 0.053 mm) versus the control group (0.358 ± 0.076 mm, p < 0.001). OSDI scores were higher in the keratoconus group (21.41 ± 5.93) compared to the control group (7.52 ± 5.05, p < 0.001), reflecting greater subjective dry eye symptoms. Meibography showed more severe Meibomian gland dropout in the keratoconus group (2.11 ± 0.60 vs. 0.70 ± 0.34, p < 0.001). Lipid layer evaluation showed no significant difference between groups (p = 0.070). Conclusions: These findings suggested a significant correlation between keratoconus and dry eye disease, with keratoconus patients showing reduced tear film stability, decreased tear volume, and increased meibomian gland dysfunction. While lipid layer changes were not significant, the results emphasized the need for comprehensive evaluation of ocular surface parameters in keratoconus management.