**1. Introduction**

Dry Eye Disease (DED), a multifactorial disease of the ocular surface and loss of homeostasis of the tear film, is associated with visual disturbance, symptoms of ocular discomfort, and tear instability [1–3]. Tear film and Ocular Surface Society Dry Eye Workshop (TFOS DEWS) II reported that this disease a ffects about 5–50% of the population. The large variation is due to a large number of research studies on small geographically homogeneous populations. The epidemiology sub-committee emphasized the need to expand prevalence studies to more geographical regions, and to include

di fferent races and ethnicities [4]. Dry eye can have a significant impact in patients' visual function and quality of life, adversely hindering the ability to carry out daily activities, such as reading or driving. This disease of the ocular surface has thus been an increasing public health concern and it poses significant socioeconomic implications [5–9].

Blepharitis and meibomian gland dysfunction (MGD) are major associated factors of DED. MGD is characterized by chronic abnormalities of the meibomian glands, resulting in altered meibum delivery to the tear film, which can result in poor tear film stability or poor breakup times, a type of dry eye classified as evaporative dry eye. On the other hand, dry eye may also be due to aqueous tear deficiency [10,11].

There is scarce data on the epidemiology of dry eye in developing countries within Asia. In developing countries, dry eye has received minimal clinical managemen<sup>t</sup> and investigative attention compared to other eye diseases. The healthcare burden of dry eye in such countries is essentially unknown [12]. In Indonesia, the age adjusted prevalence of dry eye symptoms is 27.5% (95% CI: 24.8–32.2) [13]. In this report current smoking and pterygium were independent risk factors for the DED [13].

Bangladesh is a country in South Asia located between India and Myanmar, occupying an area of 57,000 square miles, the 8th most populous country in the world. The per capita GDP of Bangladesh is 4992 USD; the country is considered a low income but has the fastest growing real GDP country in the world. As Bangladesh is a populous country of 163 mil, a properly designed epidemiological study will elicit risk factors and knowledge on dry eye that may not be possible in smaller studies elsewhere.

Among the eye diseases in the urban slums of Dhaka, Bangladesh, ocular surface disease forms an important component. A population-based study in Bangladesh found a prevalence of 17.1% for conjunctivitis, 1.4% for blepharitis, 3.2% for DED, and 3.0% for pterygium. This study had limitations in its methodologies of ocular surface diseases assessment. For example, slit-lamp examination was only used in the study for diagnoses and symptoms were not quantified [14]. However, we believe that the reported figures are also underestimated, because the prevalence rates of conditions like dry eye and blepharitis are known to be higher when clinical symptoms are included [14].

Previous studies have shown that strip meniscometry is a rapid clinical test (five seconds per eye) for the assessment of lower meniscal tear volume and may be useful for screening. Unlike tests like Schirmer's I, it does not induce reflex tearing [15,16]. The results of this test have not been reported in a community setting.

In this study, we performed a community-based study of strip meniscometry in a group of garmen<sup>t</sup> factory workers in Bangladesh [17], and potential associations with demographic factors and other clinical factors related to tear function.

#### **2. Experimental Section**

#### *2.1. Study Design*

This was a cross-sectional study conducted in a single garmen<sup>t</sup> factory in the town of Gazipur, Bangladesh. Participants had given informed verbal consent. The study obtained approval from the local institutional review board (Bangladesh Medical Research Council BMRC/NREC/2017-2018/1157, approved on 2 August 2018), and only utilized clinically accepted procedures and complied with the Tenets of Declaration of Helsinki for human research.
