Microplastic entry into the ocular surface through eye drops usage

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

Background: Corneal and conjunctival squamous lesions are uncommon but important because of their potential for causing ocular and even systemic morbidity and mortality. The ocular surface tumors can be congenital or acquired and show a broad spectrum ranging from non-neoplastic benign tumours and others demonstrate premalignant or malignant tumours such as Squamous cell carcinoma, Malignant Melanoma or Kaposi Sarcoma. The types and frequency of conjunctival tumours differ with demographic features such as age and race, systemic immune status, and chronic exposures, along with specific location within the conjunctiva. Objectives of this study was to study ocular surface neoplasm in terms of demographics, histopathological and clinical presentation.Methods: This histopathological, prospective biopsy specimen series comprised of 107 patients of either sex and all age groups presenting with conjunctival lesion either benign or malignant. The study was carried out from December, 2017 to December, 2019 in the Department of Ophthalmology, S. P. Medical College and Associated Group of Hospitals, Bikaner in collaboration with Pathology Department. All enrolled cases of conjunctival lesion were screened by consecutive sampling after obtaining written consent.Results: 39.25% patients had nevus followed by ocular surface squamous neoplasia (OSSN) (20.56 %). Various ocular surface neoplasia with respect to mean age, age group, occupation was statistically highly significant (p<0.05) whereas gender was statistically non-significant. On histopathological examination most common benign ocular surface neoplasia was nevus and most common malignant tumor was ocular squamous surface neoplasia (OSSN).Conclusions: A large variety of conjunctival lesions may appear in the eye with variable presentation, most common benign ocular surface neoplasia was nevus and most common malignant tumor was ocular squamous surface neoplasia.

Amniotic membrane in the surgical management of acute toxic epidermal necrolysis

Dry eye disease (DED) has high personal and societal costs, but its pathology remains elusive due to intertwined biophysical and biochemical processes at the ocular surface. Specifically, mucin deficiency is reported in a subset of DED patients, but its effects on ocular interfacial properties remain unclear. Herein a novel in vitro mucin‐deficient mimetic ocular surface (Mu‐DeMOS) with a controllable amount of membrane‐tethered mucin molecules is developed to represent the diseased ocular surfaces. Contact angle goniometry on mimetic ocular surfaces reveals that high surface roughness, but not the presence of hydrophilic mucin molecules, delivers constant hydration over native ocular surface epithelia. Live‐cell rheometry confirms that the presence of mucin‐like glycoproteins on ocular epithelial cells reduces shear adhesive strength at cellular interfaces. Together, optimal surface roughness and surface chemistry facilitate sustainable lubrication for healthy ocular surfaces, while an imbalance between them contributes to lubrication‐related dysfunction at diseased ocular epithelial surfaces. Furthermore, the restoration of low adhesive strength at Mu‐DeMOS interfaces through a mucin‐like glycoprotein, recombinant human lubricin, suggests that increased frictional damage at mucin‐deficient cellular surfaces may be reversible. More broadly, these results demonstrate that Mu‐DeMOS is a promising platform for drug screening assays and fundamental studies on ocular physiology.

Considerations in Understanding the Ocular Surface Microbiome

Corneal surface reconstruction - a short review

To evaluate the efficacy and safety of new moist cool air device (MCAD) for ocular symptoms, tear film stability and ocular surface status in office workers with dry eye disease (DED). In this prospective single-centre clinical trial, 40 eyes of 20 patients with DED were recruited and randomly divided into two groups (group with MCAD exposure and group without MCAD). All subjects are visual display terminals (VDTs) workers spending at least 4 h/day in front of VDTs. Patients using MCAD underwent moist air applications for 4 h/day for a total of five working weekdays during VDT works at their offices. The other group of patients performed their VDT work without moist cool air device exposure. The change in symptoms of ocular surface (OS) dryness, fatigue and discomfort was evaluated using visual analogue scale (VAS) scores. Changes in visual function, tear functions and ocular surface status were evaluated using best-corrected visual acuity (BCVA), the functional visual acuity (FVA) test, blink rate, BUT measurements, strip meniscometry (SM), tear evaporation rate, fluorescein staining and rose bengal staining scores. Tear film lipid layer interferometry was also performed to assess the status of the lipid layer over the tear film. In addition, adverse events were recorded. In group with MCAD, symptoms of OS dryness during VDTs work, and FVA and BUT were significantly improved. SM and tear evaporation rate were significantly improved. There were no statistically significant differences on lipid layer stability and corneal staining scores in both groups. Blink rate was significantly increased in group without MCAD. No adverse events were reported during this trial. Moist cool air device use provided symptomatic relief of ocular dryness and improvement on tear stability in office workers with DED. This new device seems to be a safe and promising alternative in the treatment of DED.

AimTo assess the ocular surface parameters, inflammatory marker level in tears, and mucin expression in conjunctival epithelium before and after treatment with trehalose/hyaluronate tear substitute in dry eye (DE) patients.Patients and methodsFifteen DE patients were evaluated in an open-label, pilot study at enrollment, after 2 days of washout (baseline) and after 1 and 2 months (endpoint) of treatment with a trehalose/hyaluronate tear substitute (one drop/eye/three times daily). Data for symptoms of discomfort (Ocular Surface Disease Index and Visual Analogue Scale pain score), tear film (Schirmer test I, tear film breakup time), ocular surface damage (corneal National Eye Institute) and conjunctival van Bijsterveld scores, impression cytology scored by Nelson’s grade and goblet cells (GCs) number/mm2 analysis, and MUC4 immunostaining, and inflammation (interleukin [IL]-1β, IL-6, and IL-8 levels) were measured.ResultsSignificant changes at endpoint as compared to baseline were found for Ocular Surface Disease Index score (respectively, mean±SD, 22.2±2.9 vs 38.7±12.7), Visual Analogue Scale score (3.4±1.3 vs 6.6±1.4), tear film breakup time (8.6±1.28 vs 6.17±1.9 seconds), corneal staining (National Eye Institute grade 1.23±0.64 vs 3.37±0.49), conjunctival staining (1.73±1.14 vs 4.17±0.91), impression cytology (Nelson grade 1.10±0.20 vs 1.63±0.54), and GC density (139.9±22.0 vs 107.8±16.2 GC/mm2). IL-1β, IL-6, and IL-8 tear levels showed a significant decrease at endpoint as compared to baseline (respectively, pg/mL tears: 12.3±6.9, 26.6±25.2, 743.5±477.7 vs 33.6±17.3, 112.0±24.3, 1,139.2±671.7).ConclusionsA decrease in ocular discomfort symptoms, surface damage, and tear cytokine levels was shown after 2 months’ treatment with trehalose/hyaluronate tear substitute in DE patients, along with a significant GC density recovery. These results may be associated with the synergic action of both trehalose and hyaluronic acid in targeting different entries of the DE vicious loop.

Stevens-Johnson syndrome and its more severe form, toxic epidermal necrolysis, are immunologic disorders that cause widespread blistering of the skin and mucous membranes. Its incidence is higher in children and can lead to long-term disabling ocular surface complications that can be averted with amniotic membrane transplantation early in the disease. To introduce an amniotic membrane treatment technique that is time efficient and minimally invasive but still allows for extensive coverage of the ocular mucosal surfaces to prevent and lessen the severity of the complications from ocular surface sequelae. The procedure was undertaken in the operating room under general anesthesia. Symblephara were divided before an amniotic membrane-covered conformer was placed into the fornices. Fibrin glue was used to secure the conformer and to keep the palpebral aperture closed. Topical chloramphenicol 0.5% and prednisolone 0.5% were prescribed 4 times a day. After 7 days, the conformers were removed and new amniotic membrane-covered conformers were reapplied in both eyes for a further week. After the second round of treatment, the conformers were left out for 3 days. Inferior symblephara reformed in the left lower fornix, and therefore, a third round of treatment was undertaken in the left eye only, which was then removed after 7 days. A follow-up at 8 weeks revealed 20/20 vision with minimal symblephara in either eye. This novel technique, using an amniotic membrane-covered conformer in combination with fibrin glue, allows for the coverage of the entire ocular surface and protection of the lid margins while requiring minimal preparation and surgical time. This technique could also be used in patients with other cicatrizing ocular surface conditions, such as chemical or thermal injuries or postreconstructive surgery of the fornices.

To determine whether tear osmolarity contributes to the assessment of the ocular surface in soft contact lens (CL) wearers. Prospective, case-control series in 44 CL wearers (28 tolerant and 16 intolerant) and 34 healthy subjects. Every patient underwent a thorough ophthalmic examination with a tear osmolarity test (TearLab System), conjunctival impression cytology and meibomian lipid sampling. Symptoms, break-up time (BUT), tear osmolarity, conjunctival expression of HLA-DR and meibomian fatty acid composition were evaluated. Tear osmolarity did not differ between controls and CL wearers (p= 0.23). Flow cytometry results expressed in antibody-binding capacity (ABC) units and percentage of positive cells revealed a significant difference between the intolerant CL wearer group and the control group (p< 0.0001). Comparisons between tolerant and intolerant CL wearers showed only a significant difference for mean fluorescence levels expressed in ABC units (p< 0.0001). The BUT was significantly shorter in intolerant and tolerant CL wearers subjects than in healthy subjects (p< 0.0001), whereas there was no significant difference in meibomian fatty acid composition (p= 0.99) between the two groups. Contact lens wear is responsible for ocular surface alterations whose patterns are very similar to those reported in early dry-eye syndrome. However, tear osmolarity was not modified in these selected CL wearers. The yield of tear osmolarity with TearLab™ in assessing ocular surface disorders in CL wearers deserves further investigation.

Ocular surface disease (OSD), one of the major side-effects of long-term use of antiglaucoma drugs, is thought to develop secondary to reduced tear production, corneal epithelial damage, decreased number of subbasal nerves and corneal sensitivity, reduced number of goblet cells and damage to the mucous layer of the tear film resulting in tear film instability (Pisella et al. 2002). OSD in elderly is also associated with several conditions including conjunctivochalasis (CCh), a frequently overlooked ocular surface problem of the ageing population characterized by looseness and redundancy of inferior bulbar conjunctiva between the globe and the eyelid, which causes OSD symptoms by inducing tear film instability, delayed tear clearance and ocular surface inflammation (Liu 1986; Di Pascuale et al. 2004). The aim of this study was to evaluate whether the effect of CCh on ocular surface parameters differs according to the type of topical antiglaucoma medication in primary open-angle glaucoma patients. A total of 190 eyes of 190 subjects with or without CCh were included in this prospective study. Participants were divided into three groups: Group I was composed of patients treated with prostaglandin (PG) analogues (n = 46); Group II was composed of patients treated with beta-adrenergic antagonists (n = 45); Group III (control group) was composed of healthy subjects (n = 99). The subjects were categorized into two subgroups according to the presence or the absence of CCh. The tear break-up time (BUT), lissamine green (LG) staining and Schirmer test were performed and ocular surface disease index (OSDI) questionnaire scores were noted for each subject. Mann–Whitney U test, Kruskal–Wallis test and one-way anova were used for statistical analysis. All ocular surface parameters were found worse in each group with CCh. Patients with CCh in Group I had significantly lower Schirmer test values and higher LG grading and OSDI scores than those of patients with CCh in Group II and Group III (p < 0.05; Table 1). Ocular surface parameters of patients with grade 2 CCh were significantly different than those of grade 1 CCh in all groups (p < 0.05). Both beta-blockers and PG analogues increase the inflammatory marker expression and decrease MUC5AC-related mucin production in epithelial cells compared with normal subjects (Pisella et al. 2004). These factors may be crucial in development of ocular surface changes in patients without CCh who are on PG analogue therapy or beta-adrenergic antagonists. In addition, it is also known that preservatives have adverse effects on ocular surface (Pisella et al. 2002). Thus, we cannot rule out BAK as a co-pathogenic factor for the observed ocular surface alterations detected in our study. We found that ocular surface parameters were adversely affected in the presence of CCh in medically treated glaucoma patients compared with healthy control subjects. In addition, grade 2 CCh had evidence of more profound alterations in ocular surface testing than those of grade 1 CCh in both glaucoma patients and control subjects. Patients who were on PG analogue therapy and had coexistent CCh showed evidence of a more severe ocular surface disease compared with patients who were on beta-adrenergic antagonists. This could be due to the contribution of both PG use and CCh separately to ocular surface disease, as both PG use and CCh are known to be associated with ocular surface inflammation (Fodor et al. 2012). In conclusion, long-term monotherapy with topical antiglaucoma therapy is associated with OSD in patients with and without CCh. The severity of CCh is associated with both objective and subjective alterations. It seems reasonable to evaluate and follow-up glaucoma patients treated with a long-term antiglaucoma drug for the presence of CCh and the ocular surface disease.

To report the outcomes of Boston type I keratoprosthesis (BKPro) in the management of ocular burn injuries. This was a prospective study including all cases of BKPro implantation for ocular burns at the External Diseases and Cornea Service of the Federal University of São Paulo, between February 2008 and February 2010. Ten patients (10 eyes) were enrolled. Procedures performed to manage ocular injury were identified, and data were collected regarding patients' ocular history, surgical procedure(s) performed, and postoperative outcomes, including visual acuity, retention, complications and required surgical procedures. A total of 11 Type 1 BKPro were implanted in 10 eyes of 10 patients. The mean follow-up period was 25.7 ± 10.8 months. Preoperative best-corrected visual acuity (BCVA) ranged from count fingers to light perception. Postoperative BCVA was better than 20/200 in 90% of the patients and better than 20/60 in 60% of the patients. The overall BKPro retention rate was 90%. The most common complications were retroprosthetic membrane formation (50%) and persistent corneal epithelial defect evolving to corneal melting (40%). Patients who underwent ocular surface procedures such as limbal transplantation prior to BKPRo implantation had a lower incidence of corneal melting/thinning (p = 0.07), although this was not statistically significant. The anatomical and functional results identified in this study support the use of BKPro in managing bilateral limbal stem cell deficiency secondary to ocular burns.

Ocular surface inflammation is regulated by innate immunity

Spdef Null Mice Lack Conjunctival Goblet Cells and Provide a Model of Dry Eye

Acid-sensing ion channels detect moderate acidifications to induce ocular pain.