The effects of vitamin d replacement therapy on ocular surface health in children with vitamin d deficiency.

To investigate the efficacy of topical carbomer-based lipid-containing artificial tears (CLAT) and hyaluronate (HU) in patients with dry eye disease (DED) based on serum 25-hydroxyvitamin D (25HD) levels and cholecalciferol (vitamin D) supplementation. A total of 116 patients with DED from June 2015 to June 2016 were included. The participants were divided into the vitamin D deficiency (VDD) group and the non-VDD group according to their serum 25HD levels. The patients determined the ways of cholecalciferol supplementation. Ocular Surface Disease Index (OSDI) score, visual analog pain scale score, lid hyperemia, tear breakup time (TBUT), corneal fluorescein staining score, and Schirmer test were compared between baseline and 2 weeks posttreatment after topical applications and between before and after cholecalciferol supplementation. The OSDI and visual analog pain scale scores of both VDD and non-VDD groups decreased after application of topical CLAT and HU compared with baseline values (P < 0.05 for all, paired t test). TBUT, corneal fluorescein staining score, and lid hyperemia in the VDD group remained unaffected by topical CLAT and HU, whereas those in the non-VDD group were improved (3.2 ± 1.7 vs. 4.1 ± 2.2, 0.5 ± 0.7 vs. 0.4 ± 0.6, and 2.2 ± 0.8 vs. 1.9 ± 0.7 in the non-VDD group, P = 0.001, 0.030, and 0.012, respectively). OSDI score, TBUT, and lid margin hyperemia were improved in the intramuscular group after cholecalciferol supplementation compared with pretreatment (33.2 ± 23.2 vs. 28.5 ± 21.9, 3.5 ± 1.9 vs. 6.0 ± 2.5, and 2.2 ± 0.7 vs. 1.2 ± 0.8, P < 0.05, Wilcoxon rank test). The effect of topical CLAT and HU was dependent on serum 25HD levels. Cholecalciferol supplementation enhanced the efficacy of topical treatment and may be a useful adjuvant therapy for patients with DED refractory to topical lubricants.

Upper eyelid blepharoplasty, a corrective procedure for dermatochalasis, may transiently affect eyelid function and tear film stability. This study assessed the effect of upper eyelid blepharoplasty, subjectively through questionnaires, and objectively through tear film stability and production. This non-randomized, prospective, interventional study consecutively recruited the right eyes of patients with dermatochalasis who underwent bilateral upper eyelid blepharoplasty at a tertiary center. Preoperative assessments included a standardized ophthalmic examination, ocular surface disease index (OSDI) questionnaire, Schirmer's test I, tear break-up time (TBUT) test, and anterior segment optical coherence tomography (AS-OCT) to measure tear meniscus height (TMH) and tear meniscus area (TMA). Postoperative evaluations were conducted at 1, 3, and 6 months. At the final follow-up, scar quality and patient satisfaction were assessed using the Patient and Observer Scar Assessment Scale. Fifty eyes of 50 patients with a mean (standard deviation) age of 47.1 (1.6) years were included. Statistically significant postoperative changes were observed in the OSDI score, Schirmer's test value, TBUT, and TMH at the 6-month follow-up (all P < 0.001). These parameters initially worsened at 1 month and then improved significantly at 3 and 6 months, returning to or surpassing baseline levels. TMA showed a transient postoperative decline, with full recovery at 6 months. Exceptionally strong positive correlations were found between TMH or TMA and TBUT or the Schirmer's test value at most follow-up visits (all P > 0.05). Patient satisfaction was high, with 95% reporting satisfaction with cosmetic outcomes, and no cases of visible or hypertrophic scarring were observed at final follow-up. We observed significant yet transient changes in tear film parameters and subjective assessments following upper eyelid blepharoplasty. A strong correlation was observed between AS-OCT measurements and parameters of tear film stability and production. High patient satisfaction and favorable cosmetic outcomes, with no visible scarring, further support the safety and tolerability of this procedure. Further studies with larger cohorts, longer follow-up periods, and comparative designs are warranted to validate these findings and further explore the long-term effects on ocular surface health and patient-reported outcomes.

To examine the ocular surface disease in primary open-angle glaucoma (POAG) patients already on treatment versus POAG patients without treatment. A prospective cohort study was conducted on 120 eyes of 60 POAG patients: 60 treatment-naïve eyes (group I) and 60 eyes already on topical anti-glaucoma medications (AGMs) (group II). All patients had filled out the Ocular Surface Disease Index (OSDI) questionnaire and underwent a comprehensive glaucoma workup. Tear break-up time (TBUT) test, Schirmer's test (type I), corneal sensitivity, anterior segment-optical coherence tomography (AS-OCT), and corneal and conjunctival staining were done at day 1, 1 month, 3 months, 6 months, and 12 months follow-up. On presentation, TBUT, Schirmer's test, tear meniscus height (TMH), and tear meniscus depth (TMD) were significantly higher in group I compared to group II. No significant difference was noted in OSDI score, corneal sensitivity, and tear meniscus area (TMA) between the groups on presentation. Both, lissamine green and rose bengal staining, had higher grades in group II compared to group I. Worsening of ocular surface disease was noted in both groups on follow-up. OSDI score, TBUT, Schirmer's test, TMH, and TMD had better values in group I in comparison to group II on follow-up. The study has identified glaucoma patients on AGMs to be more affected by dry eye disease (DED) compared to treatment-naive glaucoma patients. We found statistically significant differences in values of TBUT, Schirmer tests, lissamine and rose bengal staining, and AS-OCT parameters at baseline and 3, 6, and 12 months follow-up. OSDI scores showed significant differences at 6 and 12 months of follow-up. We recommend consideration of evaluation and management of DED/ocular surface disease in glaucoma patients on topical AGMs, particularly multiple drugs and doses.

To investigate ocular surface disorders and tear function changes in patients with acne vulgaris and explore the potential relationship between acne vulgaris and dry eye. This cross-sectional study included right eyes of 53 patients with acne vulgaris and 54 healthy controls. The participants completed the Ocular Surface Disease Index (OSDI) questionnaire. The following ocular surface-related parameters were measured: tear meniscus height (TMH), noninvasive tear breakup time (NIBUT), Schirmer I test (SIT), lipid layer thickness (LLT) score of the tear film, meibum score, meibomian gland orifice obstruction score, the ratio of meibomian gland loss, conjunctival hyperemia score, and corneal fluorescein staining (CFS) score. The stability of the tear film decreased in acne vulgaris patients. In the acne group, the TMH and NIBUT were lower, whereas the OSDI, meibum score, meibomian gland orifice obstruction score, ratio of meibomian gland loss, and conjunctival hyperemia score were higher compared with controls (P<0.05). There were no significant differences in the CFS score, SIT, or LLT score between the groups (P>0.05). In two dry eye groups, the TMH, NIBUT, and LLT score were lower in the acne with dry eye (acne-DE) group, and the meibum score, meibomian gland orifice obstruction score, ratio of meibomian gland loss and conjunctival hyperemia score in the acne-DE group were higher (P<0.05). There were no significant differences between OSDI, SIT, and CFS score (P>0.05). Patients with moderate-to-severe acne vulgaris are more likely to experience dry eye than those without acne vulgaris. Reduced tear film stability and meibomian gland structure dysfunction are more pronounced in patients with moderate-to-severe acne and dry eye.

Low-level light therapy (LLLT) or photobiomodulation, the application of red light to the eye, is used for the treatment of dry eye. Limited studies have investigated the efficacy of LLLT as a stand-alone treatment. The investigation aimed to evaluate the effect of LLLT on signs and symptoms of dry eye. Participants with mild to moderate dry eye were recruited for this three-visit study. Visits were 7 (±3) days apart and all participants received 633 nm LLLT (eye-light®) for 15 min at each visit. Clinical measures including first and average non-invasive keratograph tear break-up time (NIKBUT), tear meniscus height (TMH), meibomian gland (MG) loss for upper and lower eyelids, ocular surface disease index (OSDI) score, tear film lipid layer thickness, meibum quality score, Schirmer's test, corneal fluorescein staining and eyelid temperature for external upper (EUL) and external lower (ELL) eyelids were measured from the right eye of participants before and after treatment. Thirty participants (mean [SD] age: 31.1 [9.5] years) completed the study. Treatment with LLLT resulted in significant differences in first and average NIKBUT, TMH, tear film lipid layer thickness, OSDI score, Schirmer's test, meibum quality score and eyelid temperature over time (all p < 0.05). Compared to baseline, TMH, tear film lipid layer thickness and eyelid temperature significantly increased by 0.06 mm (95% CI: 0.01-0.11), 12.9 nm (95% CI: 1.18-24.55), and 7.0°C, respectively,for both EUL (95% CI: 6.17-7.84) and ELL (95% CI: 6.17-7.73). The respective decrease in the OSDI score and Schirmer's test was 10.2 (95% CI: -15.15 to -5.26) and 4.4 mm (95% CI: -7.31 to -1.42; all p < 0.05). There was no significant difference in corneal fluorescein staining and MG loss after LLLT. Low-level light therapy treatment significantly improved signs and symptoms of dry eye in the early phases of treatment, suggesting its efficacy for dry eye management.

BackgroundTo evaluate tear meniscus height and tear meniscus area measured by optical coherence tomography (OCT) and to determine the prevalence of dry eye disease in video display terminal (VDT) users.MethodsThis was a case–control study performed on VDT users. The case group consisted of 53 subjects who vocationally use VDT more than six hours per day and the control group consisted of 49 subjects who used VDT not more than one hour per day. The pre‐vocational and post‐vocational tear meniscus height and tear meniscus area measurements were performed twice in one day using OCT. Tear‐film break‐up time, Schirmer's test, Ocular Surface Disease Index score and corneal staining score measurements were performed in all subjects.ResultsThe mean age was 38.9 ± 5.5-years in VDT users and 37.8 ± 5.8-years in the control group (p = 0.426). Twenty patients (37.7 per cent) had dry eye disease in VDT users and five patients (10.2 per cent) had dry eye disease in the control group (p = 0.001). The mean tear meniscus height and tear meniscus area values (pre‐vocational and post‐vocational) were significantly lower in VDT users than in the control group (p < 0.001, p < 0.001, p = 0.024 and p < 0.001, respectively). The Schirmer's test results, Ocular Surface Disease Index scores, corneal staining scores and tear‐film break‐up time values revealed significant differences between VDT users and control subjects (p = 0.002, p = 0.006, p < 0.001 and p < 0.001, respectively). In addition, significant correlations were demonstrated between Schirmer's test results, Ocular Surface Disease Index scores, corneal staining scores, tear‐film break‐up time measurements, tear meniscus height results and tear meniscus area values.ConclusionTear meniscus evaluation using OCT is an effective, non‐invasive and sensitive method for detection of dry eye disease in VDT users.

Clinical relevance The relationship between vitamin D status and eyehealth is important, as vitamin D is known to play a role in maintaining theintegrity of the tear film, which is important for overall eye function. Background Vitamin D insufficiency has been associated withvarious ocular conditions, including dry eyes. This study aimed to examine thedifferences in tear meniscus parameters between patients with serum vitamin Dinsufficiency and healthy controls without symptomatic dry eye disease. Methods A total of 68 participants (34 in each group) wereincluded. Tear meniscus parameters were measured with anterior segment spectraldomain optical coherence tomography (SD-OCT) and images were analysed by ImageJsoftware. Tear meniscus parameters of individuals with low serum vitamin Dlevels were comprehensively evaluated and compared to healthy controls. Tearmeniscus height (TMH) was evaluated as the primary outcome measure. Tearmeniscus depth (TMD), turbidity (TMT), percentage of area covered by particlesin the meniscus (PAOP), ocular surface disease index (OSDI), tear break-up time(TBUT) and Schirmer test results were evaluated. Results OSDI, Schirmer, and TBUT parameters were within thenormal range in both groups. However, the OSDI score was significantly higherin the low serum vitamin D group, and Schirmer and TBUT scores weresignificantly better in healthy controls (p < 0.05 for all). Moreover, TMH andTMD values were significantly lower in the low serum vitamin D group (TMH:p = 0.033, Cohen’s d = -0.09; TMD: p = 0.041, Cohen’s d = -0.07). No significantdifferences were observed in PAOP and TMT values”. Conclusion Lower TMH and TMD levels were observed in tear meniscus parameters in patientswith vitamin D insufficiency compared to healthy controls, suggesting thatvitamin D status may play a role in ocular surface health.

Several studies have previously reported the association between dry eye and depression along with the treatment of depression. The aim of this study was to investigate the effects of different antidepressant drugs on tear parameters in patients with major depressive disorder. We recruited 132 patients who were using different antidepressants and 58 healthy controls. Venlafaxine, duloxetine, escitalopram, and sertraline were used by 34, 28, 36, and 34 patients, respectively. The participants filled out and completed the Beck Depression Scale. We recorded Schirmer test, tear breakup time (TBUT) and corneal staining values of the participants. The Ocular Surface Disease Index was completed by the participants. In addition, we evaluated the tear meniscus parameters by using anterior segment optical coherence tomography. All conventional dry eye tests and tear meniscus parameters were significantly lesser in the depression group than in the control group (Schirmer test, 11.41 ± 6.73 mm and 22.53 ± 4.98 mm; TBUT, 5.29 ± 2.92 seconds and 13.38 ± 1.72; Corneal staining, tear meniscus area, 0.026 ± 0.012 mm2 and 0.11 ± 0.025 mm2; tear meniscus depth, 182.75 ± 78.79 μm and 257.48 ± 90.1 μm; tear meniscus height, 290.3 ± 133.63 μm and 459.78 ± 180.26 μm, in patients and controls, respectively). The tear parameters of the duloxetine group were lowest among the drug groups and Schirmer test, and TBUT of the venlafaxine group was statistically significantly different from the duloxetine group (P = 0.028 and P = 0.017, respectively). Ocular Surface Disease Index score of the depression group was significantly higher than the control group (31.12 ± 21.15 and 17.43 ± 11.75 in depression and control group, respectively.). We found that the usage of selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors affects the ocular surface by a mechanism other than the anticholinergic system. Besides serotonin blockage, the noradrenaline blockade of serotonin noradrenaline reuptake inhibitors may increase the dry eye findings on the ocular surface.

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.

Objective: To investigate the changes in dry eye parameters, tear meniscus height and epithelial thickness over a shortterm period (working week) in long-term computer users. Material and Methods: There were 46 eyes of 23 patients with dry eye symptoms who used computers for at least 6 h per day were included in this study. The Schirmer's test scores, tear break-up time (TBUT), ocular surface disease index (OSDI) score, epithelial thickness and tear meniscus levels by spectral domain-optical coherence tomography were recorded. All measurements of the patients were repeated on Monday morning before starting work (first visit) and on Friday of the same week after work (second visit) without medication. Results: The mean TBUT values were 12.41±2.68 s, 9.69±2.39 s, the Schirmer's test values were 20±5.47 mm, 11.89±3.62 mm (p<0.001); the tear meniscus levels were 158.65±41.18 μm, 118.15±31.99 μm (p<0.001); the OSDI scores were 12.13±4.89, 18±5.50 (p<0.001); and the central corneal epithelium thicknesses were 33.5±5.81 μm, 33.19±6.10 μm (p=0.703) upon the first and second visit, respectively. There was no significant difference in central corneal epithelial thickness (CET) between the two visits (p=0.703). Conclusion: While changes in the OSDI score, the TBUT, the Schirmer's test score and the tear meniscus levels were observed in long-term computer users in the short-term working week period, there was no short-term effect on central CET.

BackgroundWe aimed to evaluate dry eye diseases (DED) in patients with newly diagnosed depression and anxiety patients.MethodsForty newly diagnosed depression, 35 anxiety patients, and 37 controls without any history of taking psychiatric drugs (or before the beginning of psychiatric medication) and topical ophthalmic drop use, were included in the study. All depression and anxiety diagnoses were performed by an experienced psychiatrist. Beck depression and anxiety tests were used to measure disease severity. Tear film break up time (TBUT), Schirmer’s test, Oxford scores and ocular surface disease index (OSDI) were admiinistered to participants. Anterior segment optical coherence tomography was used to measure tear meniscus heights (TMH), tear meniscus depths (TMD) and tear meniscus areas (TMA).ResultsIn anxiety and depression groups, Schirmer’s test (mm) (7.24 ± 6.02, 6.58 ± 4.9 and 18.79 ± 4.9 respectively, p < 0.05) and TBUT (s) (5.62 ± 3.1, 5.6 ± 3.5 and 13.37 ± 1.7 respectively, p < 0.05) were significantly lower than control group. In addition, OSDI and Oxford scores were significantly higher than controls. OSDI scores were 28.01 ± 19, 30.43 ± 18.49, 14.38 ± 8.14 respectively (p = 0.002) and Oxford scores were 1.9 ± 0.7, 2.1 ± 0.6 and 0.7 ± 0.4 respectively (p = 0.001). TMD, TMH and TMA values were significantly lower in anxiety and depression groups compared with control groups. Correlations between disease inventory scores and dry eye tests were detected.ConclusionsThis study showed a relation between DED and newly diagnosed anxiety and depression patients with no history of psychiatric drug use. The presence of correlation between dry eye tests and disease inventory scores strengthens this association. This is an important knowledge that need to be evaluated in these patients before starting psychiatric medication.

The purpose of this study was to compare objective, noninvasive assessments of tear function using the OCULUS Keratograph with the corresponding clinical assessments [tear break-up time (TBUT), Schirmer test, and bulbar erythema] among patients with moderate-to-severe dry eye disease. Participants in the Dry Eye Assessment and Management study at centers having an OCULUS Keratograph were assessed using standardized procedures. Associations between the assessments from the Keratograph [noninvasive keratograph break-up time (NIKBUT), tear meniscus height (TMH), and bulbar redness (BR)] and clinical examination (TBUT, Schirmer test, and bulbar erythema) and between these test results and Ocular Surface Disease Index (OSDI) scores were summarized with Spearman correlation coefficients (r s ); 95% confidence intervals (95% CI) accounted for intereye correlation. Among 288 patients (576 eyes), the mean (standard deviation) age was 56.6 (13.8) years, 78.1% were female, and the mean baseline OSDI score was 44.3 (14.0). The mean was 2.9 (1.5) seconds for TBUT and 8.2 (5.7) seconds for NIKBUT (their correlation r s = 0.18, 95% CI = 0.09-0.28). The mean was 10.6 (7.6) mm for the Schirmer test and 0.3 (0.2) mm for TMH (r s = 0.15, 95% CI = 0.04-0.25). The median clinical grade redness was mild, and the mean BR score was 1.1 (0.5) (r s = 0.25, 95% CI = 0.15-0.35). Correlation between results of each of the 6 tests and OSDI scores was low (r s from -0.07 to 0.05). In the Dry Eye Assessment and Management study, NIKBUT, TMH, and BR were weakly correlated with their clinical counterparts. No measurements were correlated with the OSDI score.

To evaluate changes in dry eye-related parameters after posterior chamber phakic refractive lens (PC-PRL) implantation. This prospective study included 21 highly myopic patients (39 eyes) who underwent PC-PRL implantation at Lanzhou Huaxia Eye Hospital between January 2021 and June 2022, with a 3-month postoperative follow-up. In addition to routine preoperative examinations, dry eye assessments were conducted preoperatively and at 1 week, 1 month, and 3 months postoperatively. These assessments included the Ocular Surface Disease Index (OSDI) questionnaire score, non-invasive first tear break-up time (NIF-BUT), non-invasive average tear break-up time (NIA-BUT), tear meniscus height (TMH), meibomian gland loss (MGL) rate, and Schirmer I test (SIt). Repeated measures ANOVA was used to compare the differences in parameters across different time points, with pairwise comparisons conducted using the LSD-t test. After grouping, the Student's t-test was applied to compare normally distributed data, while the Mann–Whitney U test was used for non-normally distributed data. Categorical data were analyzed using the chi-square test. A total of 21 patients (39 eyes) were included, comprising 10 males (19 eyes) and 11 females (20 eyes), aged 19 to 49 years (33.76 ± 7.87). All patients completed the 3-month follow-up. Significant differences in OSDI scores were observed pre- and post-surgery (P = 0.008), with a peak at one week post-surgery (P < 0.001), then stabilizing at one and three months post-surgery. Postoperative NIF-BUT and NIA-BUT significantly decreased (P < 0.001 for both) but returned to preoperative levels within three months. There were no significant changes in TMH, MGL, or SIt postoperatively (P > 0.05). Significant differences in dry eye parameters were observed between the dry eye and control groups before and after surgery (P < 0.001). PC-PRL implantation impacts tear film stability on the ocular surface after surgery, leading to varying degrees of dry eye symptoms in patients. After surgery, all dry eye parameters return to their preoperative levels within three months.

Objectives: To evaluate the effect of astaxanthin in the treatment of mild-to-moderate dry eye disease (DED) in middle-aged and elderly patients.Methods: 120 eyes of 60 middle-aged and elderly patients with mild-to-moderate DED were enrolled in this prospective, one-group, quasi-experimental study. Six milligram Astaxanthin tablets (Weihong Haematococcus Pluvialis Astaxanthin, Hangzhou Xinwei Low Carbon Technology R&D Co., Ltd., China) were administered orally, twice daily for 30 ± 2 days. History of eye diseases, treatment, systemic disease, and medication before the test were recorded. In addition, the ocular surface disease index (OSDI) questionnaire, non-invasive tear break-up time (NIBUT), fluorescein break-up time (FBUT), corneal fluorescein staining (CFS) score, eyelid margin signs, meibomian gland (MG) expressibility, meibum quality, meibomian gland dropout (MGDR), Schirmer I test (SIt), tear meniscus height (TMH), bulbar conjunctiva congestion degree, blink frequency, incomplete blink rate, and thickness of tear film lipid layer were collected before treatment, 2 weeks after the initiation of treatment, and at the end of treatment. Visual acuity (VA), intraocular pressure (IOP), anterior segment, fundus, discomfort symptoms and other adverse reactions were also monitored throughout the study to assess the safety.Results: OSDI score, NIBUT, BUT, CFS score, eyelid margin signs, MG expressibility, meibum quality, and blink frequency improved significantly to varying degrees after treatment compared with those before the treatment (P < 0.05), while TMH, SIt, conjunctival congestion, the thickness of tear film lipid layer, MGDR, incomplete blink rate, VA and IOP did not differ (P > 0.05).Conclusions: Oral administration of astaxanthin improves the symptoms and signs of middle-aged and elderly patients with mild-to-moderate DED.