Abnormal Break-up Time Research Articles

Tear-film-oriented diagnosis for dry eye.

Tear-film (TF) stability protects the ocular surface epithelium from desiccation and is ensured via cooperation between the ocular surface components including constituents of the TF and ocular surface epithelium. Thus, when those components are insufficient or impaired, the TF breakup that initiates dry eye occurs. Recently, new, commercially available eye drops have appeared in Japan that enable TF stabilization via targeted supplementation of deficient ocular surface components. Hence, a new layer-by-layer diagnosis and treatment concept for dry eye, termed tear-film-oriented diagnosis and tear-film-oriented therapy (TFOD and TFOT, respectively), have emerged and become widely accepted in Asian countries and beyond. TFOD is a diagnostic method for dry eye based on the TF dynamics and breakup patterns (BUPs), through which dry-eye subtypes, including aqueous-deficient dry eye, decreased-wettability dry eye, and increased-evaporation dry eye, are diagnosed. BUPs and/or each diagnosed dry-eye subtype can, in a layer-by-layer fashion, reveal the insufficient ocular surface components responsible for the TF breakup. Using these data, the optimal topical TFOT to treat dry eye can be proposed by addressing the TF breakup via the supplementation of the insufficient components. In Japan, TF breakup is now regarded as a visible core mechanism of dry eye, and abnormal breakup time (ie, ≤ 5 seconds) and symptoms are currently considered part of the diagnostic criteria for dry eye. In this review, the importance of TF instability as a core manifestation of dry eye, the molecular mechanism of TF breakup, the concept of TFOD, and the methods for implementing TFOD for TFOT are introduced.

Tear Film-Oriented Diagnosis and Tear Film-Oriented Therapy for Dry Eye Based on Tear Film Dynamics.

In December 2010 and January 2012, 3% diquafosol sodium ophthalmic solution and 2% rebamipide ophthalmic suspension, respectively, appeared first in Japan as prescription drugs for the treatment of dry eye (DE). Since then, not only the diagnosis and treatment but also the understanding of the pathophysiology of DE have greatly advanced, and a new concept of layer-by-layer diagnosis and treatment for DE, respectively termed "tear-film-oriented diagnosis" (TFOD) and "tear-film-oriented therapy" (TFOT) was born. This new concept is currently in the process of expanding from Japan to other Asian countries. TFOD is the method used for the differential diagnosis of DE, which includes aqueous-deficiency DE (ADDE), decreased wettability DE (DWDE), and increased evaporation DE (IEDE), through the dynamics of tear film (TF) and breakup patterns (BUPs) after the eye is opened. BUPs and/or each diagnosed DE subtype are/is able to distinguish the insufficient components of the ocular surface that are responsible for each BUP in a layer-by-layer fashion. Aqueous fluid, membrane-associated mucins (especially MUC16), and the lipid layer and/or secretory mucins must be insufficient in ADDE, DWDE, and IEDE, respectively, and this allows for a layer-by-layer treatment to be proposed for each BUP via the supplementation of the insufficient components, using the topical therapy currently available. In Japan, TF breakup is regarded as a visible core mechanism for DE, and an abnormal breakup time (i.e., ≤5 seconds) and symptoms are currently used for the diagnosis of DE. Therefore, TFOD and TFOT could be an ideal and practical pathway for clinicians to manage DE.

Discrepancy between subjectively reported symptoms and objectively measured clinical findings in dry eye: a population based analysis

ObjectiveTo investigate the discrepancy between patient-reported symptoms and measured clinical findings and influencing factors in dry eye (DE).SettingA population-based, cross-sectional study was performed in July–August 2007 in northeast China. The...

Increased Tear Osmolarity in Patients with Severe Cases of Conjunctivochalasis

Purpose: To evaluate and compare tear osmolarity in different grades of conjunctivochalasis.Patients and methods: Forty subjects divided into four groups based on grading of conjunctivochalasis by lid-paralell conjunctival fold (LIPCOF) test and tear osmolarity evaluated by TearLab osmometer. Schirmer test, tear film break up time (BUT) and vital staining were also performed.Results: Patients with mild and moderate conjunctivochalasis showed similar tear osmolarity to normal subjects. A significant increase (P < 0.008) of osmolarity was found in patients with severe conjunctivochalasis. A significant increase of osmolarity was found in patients with abnormal BUT (P = 0.018) and in patients with positive lissamine-green staining (P = 0.023). No association could be elicited when results of osmolarity were compared to those of Schirmer test or when compared those of fluorescein staining to osmolarity, respectively.Conclusion: Hyperosmolarity of tear was reported as a fact of ocular surface inflammation. While in mild and moderate conjunctivochalasis tear osmolarity was similar to normal controls, increased osmolarity can refer to the presence of ocular surface inflammation in these patients with severe conjunctivochalasis.

Tear Film Function in Type 2 Diabetic Patients with Retinopathy

Purpose: To investigate whether diabetes mellitus is correlated with tear film dysfunction. Methods: Tear film function tests including tear film breakup time (BUT), fluorescein staining, Schirmer I test, rose Bengal staining, total tear protein detection, tear sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and TMS-4 corneal topography were performed. A dry-eye questionnaire was used. Results: Compared with the control group and nonproliferative diabetic retinopathy (NPDR) group, in the proliferative diabetic retinopathy (PDR) group, the BUT and the value of the Schirmer I test were reduced significantly (p < 0.01); corneal fluorescein staining scores, the positive rate of rose Bengal staining and the surface regularity index (SRI) and surface asymmetry index (SAI) were higher (p < 0.01); concentrations of lactoferrin and tear-specific prealbumin were lower (p < 0.01, p < 0.05, respectively). In diabetic patients, the SRI and SAI were positively correlated with fluorescein staining scores (r = 0.754, 0.480, p < 0.01, respectively), and the dry-eye symptoms were significantly related to an abnormal BUT and Schirmer I test (p < 0.01, respectively). Conclusion: The declined tear film function is severer in the patients with PDR than in those with NPDR. Besides the traditional methods, tear SDS-PAGE and TMS corneal topographic indices contribute to the discovery of tear film dysfunction in diabetic patients.

Subclinically Dry Eyes in Urban Delhi: An Impact of Air Pollution?

Purpose: To study the effects of air pollution on the eyes of persons staying in the metropolis of New Delhi. Materials and Methods: 400 healthy volunteers from within and outside the metropolis of Delhi were investigated for the presence of tear film abnormalities. All persons underwent slitlamp examination to rule out any ocular surface disorder. The tear break-up time (BUT) was assessed along with a Schirmer test and the tear lysozyme activity and the tear pH were determined. Results: Of the 210 persons staying in the metropolis, 50 (24%) had an abnormal BUT, 14 (6.6%) had an abnormal Schirmer test, and the tear lysozyme activity was found to be low in 12 (5%). In contrast, of those 190 persons living outside the metropolis, only 10 (5.2%) had an abnormal BUT, 4 (2%) had an abnormal Schirmer test, and none had a low lysozyme activity (p < 0.05). None of the persons in either group had significant eye symptoms. Conclusions: Tear film abnormalities are present in a large number of people staying within the metropolis of New Delhi who have apparently normal eyes. Air pollution over a long period of time could possibly be associated with their causation.