Effects of preservative-free artificial tears on dry eye syndrome in prolonged computer use

Understanding the Dual Dilemma of Dry Eye and Glaucoma: An International Review.

Dry Eye Disease (DED) is a chronic and multifactorial condition that significantly impacts patient quality of life. Topical ophthalmic drugs (TODs) have emerged as key treatments for DED, offering the potential to address the underlying pathology rather than merely alleviating symptoms. This review aims to assess the efficacy of various TODs in managing the symptoms of DED. A comprehensive search was conducted across three electronic databases to identify relevant articles for inclusion in this review. Two independent authors screened the articles according to predefined eligibility criteria. A total of 16 randomized controlled trials (RCTs) were included, summarizing data from 2,680 patients. The data were analyzed using Review Manager 5.4, with pooled analysis conducted on key symptoms including corneal fluorescein staining (CFS), Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), and Schirmer test scores. From 632 articles identified, 16 RCTs were selected for inclusion. The pooled analysis revealed that cyclosporine therapy resulted in a significant improvement in CFS scores (mean difference (MD) -0.24; 95% confidence interval (CI) (-0.42, -0.07), P = 0.006). However, no significant improvements were observed in OSDI, TBUT, or Schirmer test scores (MD -0.35; 95% CI (-5.66, 4.96), P = 0.9; MD 0.12; 95% CI (-0.65, 0.89), P = 0.76; MD -0.22; 95% CI (-0.46, 0.02), P = 0.07, respectively). Similar results were found for loteprednol etabonate (LE) and diquafosol sodium, with no significant changes in OSDI, CFS, or Schirmer test scores. For diquafosol, no significant improvements were observed in any of the DED symptoms, including OSDI (MD -3.82; 95% CI (-8.31, 0.67), P = 0.10), CFS (MD -0.31; 95% CI (-0.82, 0.20), P = 0.23), TBUT (MD -0.20; 95% CI (-1.37, 0.98), P = 0.74), and Schirmer test (MD -1.00; 95% CI (-2.60, 0.60), P = 0.22). The study concluded that cyclosporine therapy offers improvements in corneal fluorescein staining but does not significantly affect other common DED symptoms, such as OSDI, TBUT, and Schirmer test scores. Similarly, no significant improvements in DED symptoms were observed with loteprednol etabonate or diquafosol sodium. Further research is needed to explore the efficacy of these treatments in managing DED symptoms more comprehensively.

To clinically evaluate how dry eye symptoms in preoperatively diagnosed dry eye patients change with the use of sodium hyaluronate- and dexpanthenol-containing eye drops (HYLO CARE (HC), URSAPHARM Arzneimittel GmbH, Saarbruecken, Germany) after cataract surgery. The aim of the study was not to compare different eye drops but to implement standard treatment in patients with dry eye undergoing cataract surgery. The impact of treatment was evaluated using Symptom Assessment Tools for Dry Eye. In this prospective, single-center, open-label clinical trial, 49 patients undergoing cataract surgery were included who showed signs and symptoms of dry eye disease assessed by the Symptom Assessment in Dry Eye (Visual Analogue Scale (VAS)) questionnaire, Ocular Surface Disease Index (OSDI), and fluorescein tear break-up Time (TBUT). Patients were instructed to apply HC three to four times a day for 5 weeks in the operated eye in addition to the standard postoperative topical anti-inflammatory regimen. The primary endpoint was the change in TBUT. Secondary endpoints were the assessment of the subjective symptoms (VAS), corrected distance visual acuity (CDVA), and slit-lamp examination including the corneal staining score, Schirmer test, and intraocular pressure. At 5 weeks after operation, the mean TBUT increased from 6.42 ± 1.57 s (s) to 7.81 ± 1.83 s in the per-protocol (PP) population (p > 0.001) and from 6.33 ± 1.64 s to 7.71 ± 2.05 s in the intention-to-treat (ITT) population (p < 0.001). There was a statistically significant decrease in all scores (p < 0.05) from the VAS questionnaire except for the tearing score (p = 0.062) at 5 weeks after operation. The mean total corneal staining score also decreased statistically significantly from 8.85 ± 2.49 before operation to 5.61 ± 3.37 at 5 weeks after operation on a 15-point scale. Controlled standardized dry eye treatment (with HC) improved tear film stability, ocular surface defects, and subjective symptoms of dry eye disease in patients 5 weeks after undergoing cataract surgery. Both the patient and physician assessments indicated high efficacy, tolerability, and a reliable safety profile, as indicated by the low number of at least possibly related adverse events (AE), suggesting its beneficial role in the postoperative management of the ocular surface (OS) in patients with dry eye symptoms prior to and after cataract surgery.

Dry eye disease (DED) is a multifactorial condition often characterized by a reduction in tear film quantity or quality. This study aimed to determine the frequency of DED and its associated subjective symptoms among students of Mu'tah University. In this cross-sectional study conducted at Mu'tah University, Mu'tah, Jordan, from January to April 2022, 489 students completed an online patient-reported DED symptom questionnaire and the ocular surface disease index (OSDI) questionnaire. Moreover, 106 participants underwent clinical examinations using the Schirmer test I and fluorescein tear breakup time (TBUT). Approximately 74.6% of the students self-reported experiencing DED symptoms, and 72.6% had an OSDI score > 12, which is considered the threshold for an abnormal ocular surface. Clinical examinations revealed low Schirmer test scores ( < 10 mm) in 26.4% (n = 28) and 25.5% (n = 27) of the right and left eyes, respectively. We observed low TBUT scores ( < 5 s) in 19.8% (n = 21) and 18.9% (n = 20) of the right and left eyes, respectively. We noted significant differences between the self-reported DED symptoms and the Schirmer test scores (P = 0.003 for both right and left eyes), TBUT (P < 0.001 for both right and left eyes), and OSDI score (P < 0.001 for each self-reported DED symptom). We observed a weak significant positive correlation between Schirmer test scores and TBUT in the right (r = + 0.30; P = 0.002) and left (r = + 0.34; P < 0.001) eyes; a negligible significant inverse correlation between OSDI scores and Schirmer test scores in the right (r = - 0.24; P = 0.013) and left (r = - 0.23; P = 0.019) eyes; and a negligible significant inverse correlation between the OSDI score and TBUT of the left eye (r = - 0.25; P = 0.011) but not of the right eye (r = - 0.17; P = 0.077). The frequency of DED symptoms in this study was higher than that previously reported based on foreign statistics. The presence of self-reported DED symptoms was significantly associated with higher OSDI scores. Self-reported DED symptoms were more frequent than the abnormalities detected using objective methods. Therefore, a combination of subjective and objective measures may provide higher diagnostic yield for DED. Further studies are required to confirm this hypothesis.

Purpose: Diquafosol ophthalmic solution (DQS) stimulates P2Y2 receptors on the ocular surface, which enhances mucin secretion from goblet cells. Therefore, tear film stability and hydration of the ocular surface can be achieved independent from lacrimal gland function. Methods: This prospective, open-label pilot study included 60 eyes of 30 diabetic patients diagnosed with dry eye disease (DED) and were randomly assigned to either DQS (n = 30 eyes) or hyaluronate (HA) group (n = 30 eyes). Participants in the DQS group received 3% diquafosol ophthalmic solution, whereas HA group received 0.1% sodium HA preservative-free artificial tears. The dosage for both drugs was 1 drop, 6 times per day for 4 weeks. Tear film lipid layer (TFLL), noninvasive breakup time (NITBUT), corneoconjunctival staining (CS) score, meibomian gland (MG), conjunctival hyperemia [redness score (RS)], ocular surface disease index (OSDI) was assessed and compared at baseline, day 14, and day 28. Results: Comparing baseline and day 28 measurements revealed that both groups found significant improvements in NITBUT, CS, MG quality, MG expressibility, and OSDI scores significantly (P < 0.05), in addition TFLL improvements were only found in the DQS group. At day 28, the magnitude of change in mean NITBUT was 1.74 (DQS) versus 0.31 (HA), 1.16 (DQS) versus 0.37 (HA) point grade reduction in corneoconjunctival staining score and 9.80 (DQS) versus 4.80 (HA) point grade in mean OSDI score. Conclusion: Three percent diquafosol ophthalmic solution treatment demonstrated the ability to improve the tear film dry eye parameters and clinically reduced sign and symptoms of DED in diabetic dry eye patients. Clinical Trials.gov ID: NCT04980144.

How effective and safe are punctal plugs in treating dry eye disease? A systematic review and meta-analysis.

Aim: To compare the effect of preservative-containing artificial tears and preservative-free artificial tears on tear film stability among adults with dry eye syndrome. Methods: A randomized controlled trial was conducted on 80 participants (40 females and 40 males), aged 19 to 69 years, who were randomly selected after completing the Ocular Surface Disease Index (OSDI) questionnaire, with only those with OSDI scores of 13 and above included in the study. Participants were divided into two groups. One group received artificial tears containing 0.3% hydroxypropyl methylcellulose preserved with 0.01% benzalkonium chloride (Hypromellose eye drops, manufactured by Martindale Pharmaceuticals), and the other group received preservative-free artificial tears containing 0.5% carboxymethylcellulose sodium and 0.9% glycerin (Refresh eye drops, manufactured by AbbVie). Each participant was instructed to instill one drop in each eye, four times daily, for four weeks. Tear film stability, measured using Tear Break-Up Time (TBUT), and Tear Flow Rate assessed with Schirmer’s test, were recorded for each participant before and after the application of the respective artificial tear eye drops. Paired T-test and one-way ANOVA were employed to analyze data using the Statistical Package for Social Sciences (SSPS version 22.0) Results: Both groups showed statistically significant increases in tear film stability and tear flow rate post-treatment, as evidenced by paired T-tests (p &lt; 0.05). However, the comparison using ANOVA indicated no significant differences in the tear film stability and tear flow rate after four weeks (p &gt; 0.05). Conclusion: There was no notable difference between preservative-containing artificial tears eye drops and preservative-free artificial tears eye drops on tear film stability and tear flow rate, therefore clinicians can confidently recommend both non-preservative-free and preservative-free artificial tears as effective management options for dry eye.

To describe dry eye disease in French elderly subjects. The Alienor Study is a population-based study on age-related eye disease in 963 residents of Bordeaux (France), aged 73 years or more. Self-reported dry eye disease and use of artificial tears were documented through face-to-face interview. Dry eye symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire and tear film stability by tear break-up time measurements (TBUT). Definite dry eye disease was defined as self-reported dry eye, confirmed by use of artificial tears and/or OSDI greater or equal to 22. Nine hundred and fifteen subjects, with mean age of 80 ± 4 years, returned the OSDI questionnaire. Of these, 271 (29.6%) subjects reported a dry eye disease and 135 (14.7%) were using artificial tears. An OSDI score > 22 was found in 359 (39.2%) subjects and a TBUT < 5 seconds in 335/746 (44.9%) subjects. Overall, definite dry eye affected 21.9% of subjects and was more frequent in women (27.1%) than in men (13.6%). After multivariate adjustment, dry eye disease was also significantly less frequent in subjects with high educational level (odds ratio (OR) = 0.49, 95% confidence interval (CI): 0.31-0.78 for long secondary school) and more frequent in subjects with ocular hypertension (OR = 1.61, 95% CI: 1.02-2.57) and those using anxiolytics (OR = 1.53, 95% CI: 1.02-2.29). This large observational study confirmed the high prevalence of dry eye symptoms among elderly subjects and confirmed some of the previously identified risk factors (in particular female gender and use of anxiolytics).

ABSTRACTPurpose: To compare the responses to dry eye treatment of patients sorted by the degree of lower lid laxity.Methods: Sixty patients were grouped into three groups according to the degree of lower lid laxity. Tear break-up time (TBUT), Schirmer test (ST) scores, ocular surface disease index (OSDI) scores, and changes in OSDI score in each group were compared, before and at 3 months after treatment.Results: TBUT, ST, and OSDI scores were not different among the three groups at baseline. TBUT improved in each group at 3 months after treatment, and no differences between groups were found. ST scores were not increased after treatment, while OSDI were improved to 22.57 ± 5.243, 31.16 ± 11.353, and 37.85 ± 13.342 in the no, moderate, and high laxity groups, respectively; these improvements were statistically significant (p = 0.003, <0.001, <0.001, respectively). Patients with greater than moderate lower lid laxity saw the smallest improvement in response to dry eye treatment, as assessed by change in OSDI score (p = 0.005 versus moderate laxity group, p = 0.005 versus no laxity group).Conclusions: Lower lid laxity is one of the factors contributing to the responses to dry eye treatment assessed by change in OSDI score, independent of TBUT and ST scores.

Effects of Prolonged Reading on Dry Eye

PurposeTo compare the 3-month results of treatment with 20% autologous serum orcombination treatment with preservative-free artificial tears and 0.05%cyclosporine in patients with dry eye disease due to primarySjögren’s syndrome.MethodsA total of 130 eyes of 65 patients with newly diagnosed dry eye disease dueto primary Sjögren’s syndrome were included in the study. Thepatients were divided into two treatment groups: 66 eyes of 33 patients wereassigned to the autologous serum treatment group, and 64 eyes of 32 patientswere assigned to the combination treatment group. Schirmer test, tearbreak-up time and Ocular Surface Disease Index (OSDI) scores were recordedat pretreatment and at 3 months of treatment.ResultsAt 3 months of treatment, the mean Schirmer value and the mean tear break-uptime were significantly higher in the combination treatment group(p<0.0001 and p=0.034, respectively). The OSDI score at 3 months wassignificantly lower in the autologous serum Group (p=0.004). When the twogroups were evaluated separately, the improvements in Schirmer, tearbreak-up time test, and OSDI scores from before to after treatment werestatistically significant: p<0.0001, p<0.001, and p<0.0001,respectively, for the authologus serum Group, and p<0.0001, p<0.001,and p<0.0001, respectively, for the combination treatment group.ConclusionsIn short-term treatment of dry eye disease due to primary Sjögren’ssyndrome, treatment with autologous serum was significantly superior to-combination treatment with preservative-free artificial tears and 0.05%cyclosporine in terms of improvement in OSDI scores. Improvements inSchirmer test and tear break-up time scores were significantly superior inthe group treated with preservative-free artificial tears and 0.05%cyclosporine.

IntroductionAn innovative eye drops formulation containing 0.2% hyaluronic acid and a low concentration of hydrocortisone (0.001%; hereafter HALH) has been recently placed on the market (Idroflog®, Alfa Intes, Italy) to manage the dysregulated parainflammation in patients with dry eye disease (DED). In the present paper, the effectiveness of HALH on the signs and symptoms of DED was retrospectively evaluated and compared with that one obtained using standard tear substitutes (STS) by means of low- and high-tech (Keratograph®) assessments.MethodsThis was a multicenter retrospective study carried out between February and April 2023, involving adult patients with DED diagnosis owing to post-cataract surgery, meibomian gland dysfunction, allergy, or glaucoma medications. The primary aim was to compare the changes induced by different therapies on Keratograph® parameters (noninvasive Keratograph tear breakup time [NIKBUT], tear meniscus height [TMH], eyelid meibography, conjunctival hyperemia, and conjunctivochalasis) or collected by traditional low-tech measures (tear breakup time [TBUT], Schirmer test, Efron score, and epithelial alterations) and the Ocular Surface Disease Index score.ResultsData from 155 patients were analyzed. The effectiveness of HALH and STS was reported by both high- and low-tech measures. NIKBUT-first showed a significant improvement in the HALH group versus the STS one at 15 days (6.4 ± 3.6 vs 5.4 ± 3.7 s, p = 0.02), whereas this difference was latent with low-tech TBUT until 45 days (6.8 ± 2.6 vs 5.6 ± 2.3 s, p = 0.03). Patients with DED occurring after cataract surgery reported an enhanced activity of HALH versus STS, particularly for NIKBUT-first, TMH, Schirmer test, and hyperemia stage.ConclusionThese findings highlighted the effectiveness of HALH in all DED subtypes, especially in patients with post-cataract surgery, as well as its superiority versus STS in terms of tear film stability improvement. We recommend longer observation (i.e., 3–6 months) to fully ascertain whether the early improvement detected by high-tech measures will be confirmed in subsequent time points even using low-tech tests.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-023-00833-7.

To evaluate the subjects of possible ocular surface dysfunction in dry eye syndrome (DES) by using Ocular Surface Disease Index (OSDI) questionnaire and correlating it with the tear film break-up time (TBUT) test and Schirmer test. Cross-sectional, observational study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology (AFIO), National University of Medical Sciences (NUMS), Rawalpindi, Pakistan, from March to August 2022. Demographics and detailed ophthalmological examinations were carried out for all the patients using slit lamp biomicroscopy. The questionnaire for OSDI was filled to calculate the OSDI score, Schirmer test, and TBUT test were performed for all patients. For statistical analysis, the mean test score of both eyes was used. Correlations between tests were drawn and reported. This study was conducted on ninety-seven adult participants with mean age of 31.3 ± 10.7 years, comprising of forty-five (46.4%) females and fifty-two (53.6%) males. The mean score for OSDI, TBUT, and Schirmer test was found to be 16.03 ± 14.22 (range 0 - 62.5), 9.63 ± 4.54 seconds (range 2.5 - 22.5), and 24.6 ± 10.85 mm (range 4.5 - 35.5), respectively. An inverse correlation was found between the OSDI and Schirmer, and OSDI and TBUT test scores which was also statistically significant. Schirmer and TBUT test scores also showed significant correlation. The OSDI is quick, precise, feasible for self-assessment, and non-invasive standardised tool for evaluating symptoms of dry eye disease, hence it can aid in the diagnosis of DES. Dry eye syndrome, Ocular surface, Tear flim break-up time, Schirmer test.

Background: Dry eye disease (DED) is a multifactorial condition with a globally rising prevalence. Diagnosis relies on both symptoms and clinical tests, but these methods demonstrate variability. Strip meniscometry (SMTube) represents a rapid, non-invasive alternative method, but its diagnostic value remains uncertain. We evaluated the correlation of its findings with those of established DED evaluations. Methods: In this cross-sectional study, we recruited 100 individuals with and without DED (n = 50 each) who visited a tertiary ophthalmology clinic. Diagnosis of DED was based on symptomatology and standard criteria, including a tear break-up time (TBUT) &lt; 5 s or Schirmer test I result &lt; 5 mm, along with an Ocular Surface Disease Index (OSDI) score &gt; 12 and corneal fluorescein staining grade &gt; 1. The exclusion criteria included ocular surgery, allergy, or contact lens use. All participants underwent comprehensive ophthalmic examination and standardized DED assessments (OSDI, tear meniscus height [TMH], SMTube, TBUT, corneal fluorescein staining, and Schirmer test I), conducted in a controlled setting by a single examiner during 9–11 AM to ensure consistency. Results: The DED group was significantly older (P &lt; 0.05). No significant sex difference was observed between groups (P &gt; 0.05). The OSDI, TMH, SMTube, TBUT, corneal fluorescein staining, and Schirmer test I findings differed significantly (all P &lt; 0.001), while SMTube application discomfort rates were similar between groups (P &gt; 0.05). In the DED group, SMTube correlated moderately with TBUT (r = + 0.41, P &lt; 0.05) and OSDI (r = + 0.43, P &lt; 0.05), while the Schirmer test I correlated weakly with TBUT (r = + 0.34, P &lt; 0.05) and moderately with TMH (r = + 0.52, P &lt; 0.05). In the controls, no significant correlations were observed between tear metrics and SMTube or Schirmer test I findings (all P &gt; 0.05), except for corneal fluorescein staining, which showed a weak negative correlation with SMTube (r = - 0.28, P &lt; 0.05) and a moderate positive correlation with Schirmer test I findings (r = + 0.51, P &lt; 0.05). Conclusions: SMTube findings differed significantly between the DED and control groups and correlated moderately with those of established diagnostic assessments, particularly the TBUT and OSDI. Unlike Schirmer testing, SMTube results are closely associated with symptom severity, suggesting its utility in reflecting patient-reported discomfort. Given its simplicity, non-invasiveness, and correlation with key clinical indicators, SMTube may serve as a valuable adjunct in the multimodal assessment of DED. However, further studies are needed to establish its diagnostic accuracy and to confirm its clinical utility.

Purpose To compare the responses to dry eye treatment of patients sorted by the degree of lower lid laxity.Methods Sixty patients were grouped into three groups according to the degree of lower lid laxity. Tear break‐up times (TBUT), Schirmer test (ST) scores, ocular surface disease index (OSDI) scores, and changes in OSDI score in each group were compared, before and at 3 months after treatment.Results TBUT, ST, and OSDI scores were not different among the three groups at baseline. TBUT improved in each group at 3 months after treatment, and no differences between groups were found. ST scores were not increased after treatment, while OSDI were improved to 22.57±5.243, 31.16±11.353, and 37.85±13.342 in the no, moderate, and high laxity groups, respectively; these improvements were statistically significant (p=0.003, &lt;0.001, &lt;0.001, respectively). Patients with greater than moderate lower lid laxity saw the smallest improvement in response to dry eye treatment, as assessed by change in OSDI score (p=0.005 vs. moderate laxity group, p=0.005 vs. no laxity group).Conclusion Lower lid laxity is one of the factors contributing to the manifestation of dry eye symptoms, independently of TBUT and ST scores.