The impact of the alternation status on the relationship between strabismus and dry eye disease

<i>Purpose</i>: To evaluate the association between strabismus and dry eye disease (DED), with a particular focus on the effect of alternation status on DED. <i>Methods</i>: Eighty eyes of 40 patients with constant strabismus were evaluated in this prospective, cross-sectional study. DED was evaluated using the Ocular Surface Disease Index (OSDI), Schirmer I test, noninvasive tear breakup time (NITBUT), tear film breakup time (TBUT). NITBUT values, including first breakup time (first NITBUT) and average breakup time (average NITBUT), were automatically calculated using a Scheimpflug corneal topography device. <i>Results</i>: The mean age was 16.9 ± 11.8 years, with an average deviation duration of 11.3 ± 11.4 years. Eighteen patients had good alternation, and 22 had poor alternation. Patients with poor alternation exhibited shorter first NITBUT and average NITBUT values in the deviating eyes compared to their sound eyes (<i>p</i> = .026 and <i>p</i> = .048, respectively). No significant correlations were found between DED findings and age, gender, deviation type or angle (all <i>p</i> > .05). However, OSDI scores correlated significantly with age (<i>p</i> < .001), duration of deviation (<i>p</i> < .001), and alternation status (<i>p</i> = .004). Additionally, the difference in first NITBUT values between the two eyes increased with a larger angle of distant deviation (<i>p</i> = .024) and worsening alternation status (<i>p</i> = .036). <i>Conclusion</i>: DED signs and symptoms may be more pronounced in the deviating eye of strabismus patients with poor alternation. Closer monitoring for DED in strabismus patients with poor alternation, especially in older individuals, may be advisable.