Screening of Influencing Factors of Dry Eye Disease and the Exploration of New Diagnosis and Treatment Model Based on Community Health Management Combined with Tertiary Hospitals

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).

Background: Dry eye is a multifactorial disorder of the tear film due to lack of tears or its excessive evaporation which can potentially damage the ocular surface and is associated with symptoms of ocular discomfort as defined by the National Eye Institute (NEI) Industry workshop in 1995. Objective of the study was to study the prevalence and the clinical profile of dry eye in hospital-based normal healthy population. Methods: In this observational study, 503 patients were screened for dry eye on the basis of questionnaire adopted from Dry Eye Workshop questionnaire which included five symptoms. On the basis of two or more than two symptoms, patients were divided into two groups Group I and Group II respectively. All patients underwent routine ophthalmological examination along with evaluation of tear parameters like Schirmer's test I, tear film break-up time, slit lamp assisted tear meniscus height measurement, Rose Bengal staining and tear film thinning time. On the basis of questionnaire and tear parameters, 235 patients were found eligible for the study. Final grading of dry eye into four grades was done according to Dry Eye Workshop. Severity of dry eye was divided into three grades as mild, moderate and severe with total score of 4 respectively. The data was analysed by using Pearson’s correlation of coefficient and multiple comparison tests with SPSS 22 version. P value<0.05 was taken statistically significant. Results: The prevalence of dry eye in our study was found to be 46.71%. Mean age of the patients was 47.80±16.37 years. Mild, moderate and severe dry eye was seen in 136 (57.87%), 92 (39.14%) and 3 (1.27%) patients respectively. Mean standard value of Schirmer’s test I , tear film break-up time, tear meniscus height and tear film thinning time were 13.59±6.65, 9.66±2.45, 0.39±0.15 and 10.15±2.24 respectively. The P values of all tear parameters were 0.001 which were statistically significant. Conclusions: Dry eye disease prevales to greater extent even in asymptomatic healthy patients and its reliable diagnosis can be done on the basis of both symptoms and tear parameters. Screening of symptomatic patients without any sign of dry eye in the preclinical phase is important for its early detection.

To investigate the efficacy of umbilical cord serum eyedrops after laser epithelial keratomileusis (LASEK). Sixty patients (120 eyes) with myopia who underwent LASEK were studied. Thirty-two patients (64 eyes) were treated with 20% umbilical cord serum eyedrops in combination with conventional treatment (group A), and 28 patients (56 eyes) received conventional treatment only (group B). Epithelial healing time was analysed. Visual acuity, refraction, haze score (0-4) and tear film and ocular surface parameters were evaluated at 1, 2, 4 and 12 weeks after LASEK. The concentration of transforming growth factor (TGF)-β1 in tears was measured with ELISA at 1 week after LASEK. No significant differences in visual acuity and refraction were found between groups. The mean time to epithelial healing was 3.53 ± 1.19 days in group A and 3.91 ± 1.41 days in group B (p = 0.18). The mean haze scores at 2 and 4 weeks were 0.59 ± 0.80 and 0.31 ± 0.54 in group A and 1.06 ± 0.91 (p = 0.02) and 0.69 ± 0.78 (p = 0.03) in group B. Four and 12 weeks after LASEK, tear film break-up time was longer and keratoepitheliopathy score was lower in group A compared with group B. The mean concentration of TGF-β1 was lower in group A compared with group B (p = 0.01). Application of 20% umbilical cord serum eyedrops in addition to conventional treatment after LASEK can reduce early postoperative corneal haze and improve tear film and ocular surface parameters.

Objective To describe the prevalence of dry eye in a population of Uighurs in Kashi, Xinjiang, and to analyze the risk factors and characteristics of dry eye. Methods This was a cross-sectional study. Uighurs in the Kashi area of Xinjiang Province were invited to participate in the study from January 2013 to December 2013. An oral consent was obtained from each participant. Every study subject completed a dry eye questionnaire. Slit-lamp microscopy examination, fluorescein staining of the cornea (FL) , tear-film break-up time (BUT) and a Schirmer Ⅰ test (SⅠT) were performed to evaluate the clinical manifestations of the disease. Chi-square test and logistic regression were performed to evaluate the differences between various groups. Results In this population of Uighurs, 21.7% (180/829) were diagnosed with dry eye. The prevalence of dry eye in males was 19.1% (45/235) and 22.7% in females (135/594). The difference between genders was not significance. The prevalence of dry eye in people over 60 years of age was higher than in people under 60 years (χ2=8.94, P<0.05). The prevalence of dry eye was higher in females than in males in people over 60 years of age (χ2=6.49, P<0.05). The relative risk factors for dry eye were gender, age, diabetes, and hypertension. Conclusion The prevalence of dry eye among Uighurs in Kashi was different from people who live in the eastern plains area of China. The prevalence of dry eye increases as people become older. The relative risk factors for dry eye were gender, become older, diabetes, and hypertension. Key words: Xerophthalmia; Prevalence; Risk factors; Uyghur nationality; Kashi; Epidemiologic studies

<b>Aim</b> : The aim of this study was to find out the prevalence of dry eye and evaluate personal and environmental risk factors attributable to dry eye in a hospital-based population. <b>Materials and Methods</b> : In this cross-sectional study, 1890 patients above 15 years of age were screened randomly for dry eye. McMonnies Dry Eye Questionnaire, Schirmer's test, tear film breakup time (TBUT), presence of conjunctival injection, punctate epithelial erosions (PEE), and meibomian gland dysfunction (MGD) were used to diagnose dry eye. Patient demographics including age, sex, smoking, and occupation and working environment were also recorded. Correlation of dry eye signs with symptoms and TFBUT and Schirmer's tests was also assessed. <b>Results</b> : The prevalence of dry eye was 10.58%. The prevalence was higher in outdoor workers (17.77%). The male: female ratio was 2.33:1. The number of males was highest in the 56-60 (13%) and 60-65 (14%) years age groups while that of females was highest in the 46-50 (16.67%) years age group. A total of 10% of the patients were smokers, while 8% were tobacco chewers. A 2.15-fold increase was found in the odds for dry eye in those exposed to excessive wind, 1.91-fold to sunlight exposure, and 2.04 for air pollution. Abnormally low TBUT and Schirmer's tests were significantly associated with dry eye signs (<i>P</i>=0.009 and 0.014, respectively). <b>Conclusion</b> : Dry eye is a leading cause of ocular discomfort in OPD patients. Excessive exposure to wind, sunlight, high temperature, and air pollution was significantly related to dry eyes. There was a significant correlation between patient's history, symptoms, dry eye signs and objective tests for tear film. The rural people and those with outdoor occupation are more exposed to extraneous influences of environmental factors in tropical climate. These factors affect the tear film and ocular surface causing the dry eye syndrome.

ABSTRACTPurpose: To describe and compare the prevalence and characteristics of dry eye among Han and Uyghur persons living in Kashi, the most inland city of China.Methods: A total of 1015 residents of Kashi participated in this 2013 cross-sectional study. To evaluate clinical characteristics, each subject completed (1) a dry-eye questionnaire detailing symptoms of dry eye, (2) Schirmer’s I-test (SIT), (3) tear-film break-up time (BUT) test, and fluorescein staining of the cornea. Dry eye was defined as the existence of dry eye symptoms and at least two positive clinical signs. Data were analyzed using SPSS software. The prevalence and risk factors of dry eye were evaluated using a multivariate model.Results: Overall, 282 (27.8%) of the 1015 participants were diagnosed with dry eye (95% confidence interval (CI): range, 25.5–30.1). The prevalence of dry eye among Han persons (37.9 %) (95% CI: range, 35.8–40.0) was higher than that among Uyghurs (21.8%) (95% CI: 19.6–24.0) (p < 0.05). The prevalence of dry eye was 25.6% (95% CI: range, 23.3–27.8) among men and 28.7% (95% CI: 26.5–30.9) among women (p > 0.05). Risk factors for dry eye included ethnicity, age, occupation, arthritis, and dry mouth.Conclusions: Our study revealed a higher prevalence of dry eye among Han than Uyghur persons in Kashi. Dry eye was significantly associated with environment and ethnicity.

To assess the severity of dry eye in individuals with pterygium in a tertiary care hospital. This cross-sectional study was done on 70 individuals with pterygium who were attending the outpatient department of ophthalmology. Objective dry eye tests were done, including Schirmer's tests 1 and 2, tear film breakup time, and tear meniscus height (TMH). In this study, patients with one or more positive clinical tests were diagnosed to have dry eyes. Dry eye was graded as mild, moderate, severe, or severe disabling. Among 140 eyes, 79 eyes had pterygium. According to Schirmer's test 1 in eyes with pterygium, 29.1% of the eyes had mild dry eyes, and 26.6% had moderate dry eyes. According to Schirmer's test 2 in eyes with pterygium, 25.3% of the eyes had mild dry eyes, and 26.6% had moderate dry eyes. Tear film breakup time in eyes with pterygium showed a mild dry eye in 25.3% and moderate dry eye in 17.7%. TMH in eyes with pterygium was low at 7.6%. The majority of eyes with pterygium have mild or moderate dry eye according to Schirmer's test 1, Schirmer's test 2, and tear film breakup time. No eyes with pterygium have severe dry eyes. TMH was also low in a small proportion of eyes with pterygium. Dry eye evaluation by Schirmer's test and tear breakup time is, therefore, a crucial clinical tool for early detection and prompt management of dry eye syndrome in pterygium patients.

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

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.

Lacrimal Gland in Sjögren's Syndrome

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.

Place du NIBUT automatisé dans l’évaluation multimodale de la surface oculaire dans le syndrome sec avec le Lacrydiag

AIM : To investigate the correlation between dry eye and different degrees of diabetic retinopathy( DR) in type 2diabetic patients.METHODS: In the cross-sectional study,340 patients( 340 eyes) with type 2 diabetes were enrolled. Tear film function tests including tear meniscus height,tear film breakup time( BUT),fluorescein staining,Schirmer Ⅰtest were perform ed followed by surveying questionnaires about dry eye. Retinal status was evaluated by retinal color photography and indirect ophthalm oscopy exam with dilated pupils to evaluate DR and whether com panied by macular edem a.RESULTS: The prevalence of dry eye was 49. 41%. The m ean duration of diabetes in patients with dry eye was11. 15±7. 07 a,while 6. 92±5. 45 a without dry eye( P<0. 01).Dry eye had the positive correlation to the development of DR. The incidence of dry eye in people with mild nonproliferative diabetic retinopathy( NPDR),moderate NPDR,severe NPDR and proliferative diabetic retinopathy( PDR) was 1. 097 times,1. 724 times,2. 86 times and 5. 43 times respectively, com pared with people without DR.The occurrence of dry eye in people with m acular edem a increased by 3. 697 times com pared with people without m acular edem a.CONCLUSION: Dry eye was more prevalent in people with type 2 diabetes. The incidence of dry eye increased gradually with the occurrence and developm ent ofdiabetic retinopathy.

Diquafosol ophthalmic solution improves objective findings in the ocular surface and subjective symptoms in patients with dry eye. The Dry Eye-Related Quality-of-Life Score (DEQS) questionnaire was developed to assess dry eye symptoms and their effects on quality of life. However, because little research using the DEQS has been reported, we evaluated the effects of diquafosol ophthalmic solution on ocular surface findings and quality of life using the DEQS in patients with dry eye. Sixty-three patients with dry eye were assigned to the control group (artificial tears) or diquafosol group. Both groups instilled 1 drop of the solution in both eyes 6 times daily and were evaluated after 2 weeks; the diquafosol group also was instructed to be examined at 1 and 3 months. We evaluated the subjective symptoms using the DEQS, fluorescein staining score, tear film breakup time (BUT), Schirmer testing, and lower tear meniscus height with anterior-segment optical coherence tomography. In the diquafosol group, the fluorescein staining score, BUT, tear meniscus height, and DEQS scores improved significantly compared with before treatment in contrast to the control group. Furthermore, in the diquafosol group, the staining score and BUT improved significantly compared with the control group. Analysis of each DEQS item indicated that diquafosol ophthalmic solution relieved foreign body sensation and problems when reading and using visual display terminals compared with the control group. Diquafosol ophthalmic solution was effective in patients with dry eye, especially those with foreign body sensation and problems when reading and using visual display terminals.

Objective To compare the tear related indexes of patients with type-2 diabetes and the healthy subjects, analyze the functions of tear film of these two groups and provide significant theoretical evidences for the causes of the increased prevalence of dry eye in patients with type-2 diabetes and their pathogenesis. Methods A case-control study was designed.During the epidemiological investigation of dry eye in communities, 79 patients with diabetes and 74 normal healthy subjects were randomly selected as participants in this case-contol study.Dry eye tests including tear film break-up time (BUT), SchirmerⅠtest (SⅠt) and corneal fluorescein staining were performed.The tears were collected to detect mucoprotein-5AC (MUC-5AC), matrix metalloproteinase 9 (MMP-9), receptor of advanced glycation endproducts (RAGEs) and the content of insulin.The diagnosis standard referred to Experts Consensus on Clinical Diagnosis and Treatment of Dry Eye published in 2013.The study was followed the Declaration of Helsinki.This study protocol was approved by Medical Ethics Committee of the Shanghai General Hospital, Shanghai Jiaotong University(No.2016KY005), and written informed consent was obtained from all subjects. Results There were significant differences between 79 diabetes patients and 74 normal healthy subjects in the value of BUT, SⅠt and corneal fluorescein staining (all at P<0.05). The value of BUT and SⅠt in patients with diabetes were lower than those in the control group, while the corneal fluorescein staining scores of patients were higher than those of normal healthy subjects, with significant differences (P<0.05). In addition, compared with normal healthy subjects, the diabetic patients were higher in the value of MMP-9 and RAGEs, but lower in the content of insulin and MUC-5AC, with significant differences (P<0.05). There were significant differences in gender, diabetes duration, MMP-9, and MUC-5AC between the dry and non-dry eyes in the diabetic group (P<0.05). Women were more likely to develop dry eyes with a significant difference (t=4.35, P=0.04). The duration of diabetes in dry eye group was higher than that in non-dry eye group, with a significant difference (t=2.56, P=0.01); the value of MMP-9 in dry eye group was (1 052.37±157.68)pg/ml, which was significantly higher than that in non-dry eye group ([459.11±258.67]pg/ml)(t=11.92, P<0.01); the value of MUC-5AC in dry eye group was (867.83±121.82)pg/ml, which was significantly lower than in non-dry eye group ([972.93±153.52] pg/ml)(t=-3.30, P<0.01). There was no statistical difference in age and insulin between the two groups.Pearson correlation analysis showed that MMP-9 was negatively correlated with BUT (r=-0.349, P<0.01), and positively correlated with corneal fluorescein staining (r=0.181, P=0.026). MUC-5AC was positively correlated with SⅠt (r=0.367, P<0.01). Conclusions Dry eye prevalence is significantly related with the decrease in MUC-5AC and the increase in MMP-9 in community-based diabetic patients. Key words: Diabetes mellitus; Tear index detection; Tear film function; Dry eye