Aqueous Tear Deficiency Dry Eye Research Articles

Investigation of traditional Chinese medicine constitution in individuals afflicted by dry eye disease: A retrospective study.

The aim of this study is to explore the traditional Chinese medicine (TCM) constitution among individuals suffering from dry eye disease. Following the diagnostic criteria outlined in TFO DEWS II, a total of 114 patients with dry eye were included in this study. Based on the classification criteria for dry eye, the patients were categorized into 3 distinct dry eye subtypes. Each participant underwent a thorough clinical assessment for dry eye, and their TCM pattern manifestations were assessed using the "Traditional Chinese Medicine Questionnaire for Dry Eye." The Nine Constitutions Assessment Method was utilized for TCM pattern differentiation and classification. Spearman's correlation analysis was employed to investigate the associations between TCM constitution and dry eye subtypes, clinical indicators, and the relationships between TCM syndromes and dry eye subtypes. Among the 114 patients, the Qi-Stagnation constitution was the most common, with variations in constitution distribution among different dry eye subtypes. Significant correlations were observed between the Blood-Stasis, Yin-Deficiency, Qi-Deficiency, and Yang-Deficiency constitutions and 2, 4, 1, and 4 dry eye indicators, respectively. Spearman's analysis revealed that 5 out of 50 TCM syndromes were associated with mixed dry eye, 5 with evaporative dry eye, and 3 with aqueous tear deficiency dry eye. Further analysis, using lasso regression and binary unconditional logistic regression identified dizziness, lumbago, and weakness as influencing factors for both mixed-type and evaporative-type dry eye. In this study, we extensively examined the TCM constitution in individuals with dry eye, offering valuable insights and guiding future TCM-related research in the context of dry eye. Additionally, we established correlations between TCM syndrome patterns and dry eye indicators.

Anterior Segment Optical Coherence Tomography Imaging of the Lacrimal Gland in Patients With Chronic Ocular Graft-Vs-Host Disease.

The purpose of this study was to explore the image characteristics of the palpebral lobe of the lacrimal gland in patients with chronic ocular graft-vs-host disease (coGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) using anterior segment optical coherence tomography (AS-OCT). This comparative cross-sectional study included 32 patients with coGVHD, 21 patients with severe aqueous tear deficiency dry eye, and 20 healthy control subjects. All subjects underwent an AS-OCT examination on the palpebral lobe of the lacrimal gland. The main outcomes are the number of visible gland lobules, ducts, and blood vessels and the proportions of mille crêpe-like structures in the AS-OCT images. Compared with the other 2 groups, patients with coGVHD had significantly more blood vessels and slightly less visible lobules and ducts (all P <0.05) in the palpebral lacrimal gland. Mille crêpe-like structures were observed only in the coGVHD group. Number of blood vessels was positively correlated with time after allo-HSCT (β: 0.14, 95% confidence interval [CI], 0.01-0.26). Mille crêpe-like structure was positively correlated with coGVHD severity (odds ratio: 9.07, 95% CI, 1.75-16.38) and time after allo-HSCT (odds ratio: 0.13, 95% CI, 0.03-0.23). We reported the AS-OCT characteristics of the palpebral lacrimal gland in coGVHD and found an increased number of blood vessels and mille crêpe-like structures. AS-OCT has the potential in the disease monitoring of coGVHD.

Electroencephalogram-detected stress levels in the frontal lobe region of patients with dry eye

PurposeTo evaluate stress levels extracted from prefrontal electroencephalogram (EEG) signals and investigate their relationship with dry eye symptoms. MethodsThis prospective, cross-sectional, comparative study included 25 eyes of 25 patients with aqueous tear-deficient dry eye (low Schirmer group), 25 eyes of 25 patients with short tear breakup time dry eye (short breakup time group), and 24 eyes of 24 individuals without dry eye. An EEG test, the Japanese version of the Ocular Surface Disease Index (OSDI), and a stress questionnaire were administered. EEG-detected stress levels were assessed under three conditions: eyes closed, eyes open, and eyes open under ocular surface anesthesia. ResultsStress levels were significantly lower when the eyes were closed than when they were open in all groups (all P < 0.05). Stress levels during eyes open under ocular surface anesthesia were significantly lower than those during eyes open without anesthesia only in the low Schirmer group; no differences were found between the short breakup time and control groups. OSDI scores were associated with EEG-detected stress levels (P = 0.06) and vital staining score (P < 0.05) in the low Schirmer group; they were not associated with EEG-detected stress (P > 0.05), but with subjective stress questionnaire scores and breakup time values in the short breakup time group (P < 0.05). ConclusionsIn the low Schirmer group, peripheral nerve stimulation caused by ocular surface damage induced stress reactions in the frontal lobe, resulting in dry eye symptoms. Conversely, in the short breakup time group, the stress response in the frontal lobe was not related to symptom development.

Ocular Surface Evaluation in Immunoglobulin G4–Related Ophthalmic Disease

To evaluate the functional and structural changes of the meibomian glands and ocular surface in immunoglobulin G4-related ophthalmic disease (IgG4-ROD) patients. Cross-sectional, matched case-control comparison study. This study included 64 patients with biopsy-proven IgG4-ROD (aged 63.4 ± 12.2 years, 39 male) and 64 sex- and age-matched healthy controls. Patients were managed by hospitals covering the publicly funded ophthalmology service in Hong Kong. Outcome measures included anterior segment examination and keratographic and meibographic imagings. A total of 64 worst-affected eyes of the 64 IgG4-ROD patients were analyzed. Corneal fluorescein staining (P=.0187), lid margin telangiectasia (P=.0360), lid-parallel conjunctival folds (P=.0112), papillae (P=.0393), meibomian gland plugging (P=.0001), meibomian gland expressibility (P=.0001), and meibum quality (P=.0001) were more significant in IgG4-ROD patients compared with healthy controls. Both upper and lower meibomian gland dropouts (P=.001 and .0003), and tear meniscus height (P=.0001) were higher in IgG4-ROD patients. Non-invasive tear break-up time (NITBUT) (P=.0166) and Schirmer test results (P=.0243) were lower in IgG4-ROD patients. Upper (r=0.336, P=.0140) meibomian gland dropouts and NITBUT (r=-0.293, P=.0497) were positively and negatively correlated with the IgG4-ROD onset age, respectively. The number of extraocular organ involvement was negatively correlated with the Schirmer test(r=-0.341, P=.0167). Lower NITBUT was found in IgG4-ROD eyes with lacrimal gland enlargement than in IgG4-ROD eyes without lacrimal gland enlargement radiologically (P < .0001). IgG4-ROD patients showed features of both aqueous tear deficiency and evaporative dry eye disease. We recommend ocular surface evaluation to all patients newly diagnosed with IgG4-ROD. Further studies are warranted to clarify the mechanism of IgG4-related dry eye disease.

Autonomic Nerve Activity Features According to Dry Eye Type.

The purpose of this study was to investigate the association between autonomic nerve activity and symptom intensity according to the type of dry eye (DE). This prospective, cross-sectional, comparative study included 25 eyes of 25 patients with short tear break-up time DE (sBUTDE; mean age = 57.4 ± 11.4 years, range = 30-74 years) and 24 eyes of 24 patients with aqueous tear-deficient DE (ADDE; mean age = 62.3 ± 10.7 years, range = 29-76 years) were studied. Autonomic nerve activity was examined, and the Japanese version of the Ocular Surface Disease Index (J-OSDI) and a stress check questionnaire were administered. Autonomic nerve activity was continuously measured for 10 minutes. The parameters were low-frequency (LF) and high-frequency (HF) components of heart rate variability, reflecting cardiac sympathetic and parasympathetic nerve activity, and parasympathetic nerve activity alone, respectively; and the coefficient of variation of R wave-to-R wave (RR) interval (cvRR), component coefficient of variation of LF (ccvLF), and component coefficient of variation of HF (ccvHF), reflecting fluctuation of RR interval, LF, and HF, respectively. Higher J-OSDI scores were associated with higher HF, ccvHF, and subjective stress in sBUTDE, showing a significant correlation (r = 0.53, P < 0.01; r = 0.55, P = 0.01; and r = -0.66, P = 0.01); no correlations were observed between the J-OSDI score and autonomic parameters and stress in ADDE. DE symptoms were significantly associated with the magnitude and fluctuation of parasympathetic activity in sBUTDE. Thus, among the autonomic parameters, parasympathetic activity is involved in the development of symptoms in sBUTDE, whereas the involvement of the autonomic nervous system may be minimal in ADDE.

Contact Lenses Loaded with Melatonin Analogs: A Promising Therapeutic Tool against Dry Eye Disease.

Melatonin analogs topically administered evoke a potent tear secretagogue effect in rabbits. This route of drug administration requires high drug concentration and frequent dosing due to its reduced ocular surface retention. Therefore, contact lenses (CLs) have emerged as an alternative drug-delivery system that prolongs drug retention in the cornea, improving its therapeutic performance. This study explores the in vitro ability of five commercially available hydrogel CLs to act as a delivery system for melatonin analogs and the in vivo secretagogue effect of melatonin analog-loaded CLs. We soaked CLs with melatonin or melatonin analog solutions (1 mM) for 12 h. Spectroscopic assays showed that IIK7-loaded CLs led to the inadequate delivery of this compound. Conventional hydrogel lenses loaded with agomelatine released more agomelatine than silicone ones (16–33% more). In contrast, the CLs of silicone materials are more effective as a delivery system of 5-MCA-NAT than CLs of conventional materials (24–29%). The adaptation of CLs loaded with agomelatine or 5-MCA-NAT in rabbits triggered a higher tear secretion than the corresponding eye drops (78% and 59% more, respectively). These data suggest that CLs preloaded with melatonin analogs could be an adequate strategy to combat aqueous tear deficient dry eye disease.

HERPES SIMPLEX VIRUS (HSV) KERATITIS BILATERAL WITH FILAMENTOUS

Introduction : Herpetic keratitis is caused by herpes simplex virus and is a common cause of corneal blindness. Generally herpes simplex keratitis is a unilateral disease, but bilateral disease has been reported in 1,3 % to 10,9 % of patients. Filamentous keratitis most often caused by dry eye, especially aqueous tear-deficient dry eye. Objective: To report a case of bilateral herpes simplex virus keratitis bilateral with filamentous. Method: A 45 years old man was admitted to Dr. M. Djamil Hospital Padang presented with glare and blurred on both eyes since 1 week ago. VA RE is 6/30, VA LE is 6/60. On ophthalmology examination were conjunctival and ciliary injection. On the cornea of both of eyes, found infiltrate numular shaped almost all of layer of the cornea. Cornea sensitivity was decreased on both eyes. Patient diagnosed by numularis keratitis of both eyes and therapy is oral and topical acyclovir. After 2 weeks therapy, we found filamentous on left eye. Debridement of filament was performed and the therapy was continued. Result: There are improvement of visual acuity and clinical feature. VA RE 6/15, LE 6/40. Subjectively, patient feel comfort. The sign of glare and photophobia are decrease. Density of infiltrate was decrease and no filamentous was found.

Ocular surface microbiota in patients with aqueous tear-deficient dry eye

PurposeAn altered ocular surface microbiota may contribute to the pathophysiology of dry eye disease. The aim of the study was to explore potential differences in microbiota diversity and composition in aqueous tear-deficient dry eye (with and without ocular graft-versus-host disease) compared with controls. MethodsSwab samples from the inferior fornix of the conjunctiva were obtained from patients with aqueous tear-deficient dry eye with and without ocular graft-versus-host disease (n = 18, n = 21, respectively) and controls (n = 28). Isolated bacterial DNA from swabs were analyzed with 16S rRNA gene amplicon sequencing. ResultsDecreased microbiota diversity was observed in patients with aqueous tear-deficient dry eye (p ≤ 0.003) who also showed a difference in microbiota composition compared with controls (p = 0.001). Although several genera were less abundant in aqueous tear-deficient dry eye, a minimal core ocular surface microbiota comprising five genera was shared by >75% of the study participants: Enhydrobacter, Brevibacterium, Staphylococcus, Streptococcus and Cutibacterium. Pseudomonas was identified as a bacterial biomarker for controls and Bacilli for patients with aqueous tear-deficient dry eye. ConclusionsOcular surface microbiota in patients with aqueous tear-deficient dry eye was characterized by an aberrant microbiota composition in comparison to controls, with decreased diversity and reduced relative abundances of several genera. Additionally, a few genera were present in most of the study population, indicating that a minimal core ocular surface microbiota may exist.

High-Fat Diet–Induced Functional and Pathologic Changes in Lacrimal Gland

The lacrimal gland is critical for maintaining the homeostasis of the ocular surface microenvironment through secreting aqueous tears in mammals. Many systemic diseases such as Sjögren syndrome, rheumatoid arthritis, and diabetes can alter the lacrimal gland function, eventually resulting in aqueous tear-deficient dry eye. Here, a high-fat diet (HFD) experimental mouse model was used to clarify how hyperlipidemia affects lacrimal gland function. Aqueous tear secretion fell about 50% after 1 month on a HFD. Lipid droplets accumulated in the matrix and acinar cells of the lacrimal gland after this period, along with changes in the lipid metabolism, changes in gene expression levels, and disruption of fatty acid oxidative activity. Immune cell infiltration and rises in the gene expression levels of the inflammation-related cytokines Il1β, Tnfα, Tsg6, Il10, Mmp2, and Mmp9 were found. HFD also induced mitochondrial hypermegasoma, increased apoptosis, and decreased lacrimal gland acinar cell proliferation. Replacement of the HFD with the standard diet partially reversed pathologic changes in the lacrimal gland. Similarly, supplementing the HFD with fenofibrate also partially reversed the inhibited tear secretion and reduced lipid accumulation, inflammation, and oxidative stress levels. The authors conclude that a HFD induces pathophysiological changes and functional decompensation of the lacrimal gland. Therefore, ingestion of a HFD may be a causative factor of dry eye disease.

Importance of tear volume for positivity of tear matrix metalloproteinase-9 immunoassay.

The tear matrix metalloproteinase-9 (MMP-9) immunoassay (Inflammadry) exhibits variable results in dry eye (DE) patients. We investigated if the tear volume in DE patients affects the results of MMP-9 immunoassay in clinical and in vitro settings. This cross-sectional study enrolled 188 eyes of 188 DE patients. The clinical symptoms and signs of DE were assessed using the Ocular Surface Disease Index and visual analog scale, strip meniscometry, tear break-up time, and tear meniscus height (TMH), area (TMA), and depth (TMD) using swept-source optical coherence tomography and corneal and conjunctival staining scores. For quantitative evaluation, the bands produced by the InflammaDry test were analyzed with ImageJ. DE subjects were grouped according to MMP-9 positivity and TMH. The InflammaDry-positive group showed greater TMH, TMA, and TMD than the MMP-9-negative group (p < 0.05). InflammaDry test band density in the high TMH group was significantly greater than that in the low and normal TMH groups (p < 0.05). InflammaDry test band density correlated positively with TMH, TMA, and TMD (all p < 0.05). InflammaDry test results were influenced by tear volume. Low tear volume in aqueous tear-deficient DE may induce false-negative results, and reflex tearing during the test may induce false-positive results.

The Long-Term Clinical Efficacy of Smart Plug in the Treatment of Aqueous Tear Deficiency Dry Eye: Results of a 5-Year Study

Background: Dry eye syndrome, which affects 10% to 20% of adults, is a disorder of the tear film and is associated with symptoms of ocular discomfort. Smart Plug is a mechanical treatment in which the tear drainage system is blocked in order to aid in the preservation of natural tears on the ocular surface. Purpose: To evaluate the long-term clinical efficacy of Smart Plug in the treatment of aqueous tear deficiency dry eye. Patients and Methods: Retrospective study. Three hundred and two patients with aqueous tear deficiency dry eye were enrolled and all the patients accepted the punctual plug of Smart plug from Jan. 2011 to Jan. 2016. The clinical symptoms, Schirmer’s I test, Fluorescein staining (FL), tear break up time (TBUT), and complications were observed and analyzed. Results: Three hundred and two patients (604 eyes) were treated with Smart Plug (22 cases accepted upper and lower punctual plug, 280 cases only lower punctual plug). There were 109 males (36.1%) and 193 females (63.9%) with a mean age of 44.54 years old (Range from 25 to 83 years). Ten cases required the upper Smart Plug after lower punctual plug insertion because of no significantly improved symptoms. Smart plug was removed in 3 patients (1%) due to tearing. Six patients had mild postoperative tearing and no special treatment was required. Lacrimal canaliculitis occurred postoperatively in 8 cases (2.6%) (6 lower and 2 upper), and the affected plug was removed and treated with topical antibiotic eye drops. The BUT, SIT and FL scores of all patients were significantly improved from (2.11 ± 1.01, 4.20 ± 1.07, 6.06 ± 1.97) to (4.34 ± 1.22, 9.01 ± 1.56, 2.33 ± 1.28) respectively after at least 36 months of follow-up (All P P < 0.05). Conclusion: During a mean follow-up of 4.3 years, Smart plug is an effective method for the treatment of aqueous tear deficiency dry eye in spite of its postoperative complications such as canaliculitis and tearing.

Evaluation of patients with dry eye for the presence of primary or secondary Sjӧgren's syndrome.

PurposeTo assess the frequency of Sjӧgren’s syndrome (SS), either primary or secondary to rheumatic disease, in a cohort of patients with aqueous-deficient dry eye and to determine the most accurate objective test for diagnosis of SS.MethodsA total of 111 patients with dry eye were recruited from Minia University's ​Ophthalmology Outpatient Clinic (69 patients) and Rheumatology Outpatient Clinic (42 patients). The patients were screened for aqueous tear–deficient dry eye by abnormal test results of Schirmer test I (<10 mm) and tear-film break-up time (<10 seconds) in at least one eye. The diagnosis of SS was made according to the 2012 American College of Rheumatology​ criteria. A complete work up for SS was performed, including clinical examination, serological tests, ocular tests, and labial salivary–gland biopsy (LSGB).ResultsOf the 111 patients, 58 had aqueous-deficient dry eye: 23 in the ophthalmology clinic cohort (group I) and 35 in the rheumatology clinic cohort (group II). Three patients had pSS, and its frequency was 13% in group I and 5.2% among all studied patients. The ocular staining score is the most diagnostic ocular test (sensitivity 100% and specificity 90.9%). Anti-SSA/Ro antibody is the most accurate serological method (sensitivity 33.3% and specificity 100%). LSGB histopathology is the most diagnostic method for SS, with sensitivity, specificity, and positive and negative predictive values of 100%.ConclusionSS was detected with reasonable frequency among dry-eye patients, particularly pSS. Screening of dry eye for SS can select SS patients early in the disease course.

Dry Eye Disease: A Review of Epidemiology in Taiwan, and its Clinical Treatment and Merits.

Dry eye disease (DED) has become common on a global scale in recent years. There is a wide prevalence of DED in different countries based on various ethnicities and environment. DED is a multifactorial ocular disorder. In addition to advanced age and gender, such factors as living at high altitude, smoking, pterygium, prolonged use of consumer electronics or overingesting of caffeine or multivitamins are considered to be the major risk factors of DED. We report the DED epidemiology in Taiwan firstly in this article. According to the pathophysiological factors and changes inthe composition of the tear film in DED, it can be categorized into several subtypes, including lipid anomaly dry eye, aqueous tear deficiency, allergic and toxic dry eye among others. Each subtype has its own cause and disease management; therefore, it is important for ophthalmologists to identify the type through literature review and investigation. The management of DED, relies not only on traditional medications such as artificial tears, gels and ointments, but also newer treatment options such as acupuncture, SYL1001, and nanomedicine therapy. We also conducted a comprehensive literature review including common subtypes and treatment of DED. Clearly, more clinical trials are needed to assess the efficacy and safety of the various treatments and common subtypes of DED.

Sjögren's Syndrome, Non-Sjögren's Syndrome, and Graft-Versus-Host Disease Related Dry Eye.

I have reviewed available literature on dry eye related to Sjögren's syndrome (SS), non-Sjögren's syndrome (non-SS), and graft-versus-host disease (GVHD) to examine aqueous tear deficient dry eye as a subtype of dry eye. This section will focus on clinical studies regarding those subtypes of dry eye. I searched the PubMed database from 1990-2017 for discussion of clinical features, diagnostic criteria, and risk factors of SS, non-SS, and GVHD-related dry eye. In addition, therapeutic options for each subtype of dry eye are described. Although the clinical presentations of SS and chronic graft-versus-host disease (cGVHD) are similar, ocular surface fibrotic changes are characteristic of ocular GVHD but not SS- or non-SS-related dry eye. Recently, diagnostic criteria for each disease have been proposed and include the American College of Rheumatology/European League Against Rheumatism (ACR-EULAR) for SS and the International Chronic Ocular GVHD consensus criteria. Although there has been gradual progress, there are currently no specific therapies and few approved treatment options for these intractable diseases, including SS and GVHD. As judged by the findings, these subtypes of dry eye are different clinical entities from simple dry eye. Therefore, novel therapies, specific to these subtypes of dry eye, may be required in the future.

Social-economic analysis of patients with Sjogren\u2019s syndrome dry eye in East China: a cross-sectional study

BackgroundSjogren’s syndrome is the leading cause for aqueous tear-deficiency dry eye. Little is known regarding the relationship between Sjogren’s syndrome dry eye (SSDE) and patients’ medical expenditure, clinical severity and psychological status changes.MethodsThirty-four SSDE patients and thirty non-Sjogren’s syndrome dry eye (non-SSDE) subjects were enrolled. They were required to complete three self-report questionnaires: Ocular Surface Disease Index, Zung Self Rating Anxiety Scales, and a questionnaire designed by the researchers to study the patients’ treatment, medical expenditure and income. The correlations between expenditures and these parameters were analyzed.ResultsThe annual total expenditure on the treatment of SSDE was Chinese Yuan 7637.2 (approximately US$1173.8) on average, and the expense paid by SSDE patients themselves was Chinese Yuan 2627.8 (approximately US$403.9), which were 5.5 and 4.5 times higher than non-SSDE patients (both P < 0.001). The annual total expense on Chinese medicine and western medicine were 35.6 times and 78.4% higher in SSDE group than in non-SSDE group (both P < 0.001). Moreover, indirect costs associated with the treatment were 70.0% higher in SSDE group. In SSDE group, the score of Zung Self Rating Anxiety Scales had significantly positive correlation with total medical expenditure and the expense on Chinese medicine (ρ = 0.399 and ρ = 0.400,both P = 0.019). Nevertheless, total medical expenditure paid by the patients in non-SSDE group positively correlated with the score of Ocular Surface Disease Index (ρ = 0.386, P = 0.035).ConclusionsMedication expenditures and associated costs is an unignorable economic burden to the patients with SSDE. The medical expense had a significantly correlation with clinical severity of SSDE and the patients’ psychological status.

Lacrimal Gland Repair after Short-term Obstruction of Excretory Duct in Rabbits

Aqueous tear-deficient dry eye is a multifactorial chronic disorder in which the lacrimal glands fail to produce enough tears to maintain a healthy ocular surface. The existence of lacrimal gland stem/progenitor cells was proposed in several species, yet their origin and characteristics are not very clear. Here, we investigated the presence of resident progenitor cells and their regenerative potential in a rabbit model with lacrimal gland main excretory duct ligation-induced injury. The ligation-injured lacrimal glands temporarily decreased in weight and had impaired tear secretion. Protein expression profiles and transcriptional profiles were obtained from injured tissue. Isolated lacrimal gland progenitor cells were tested and characterized by stem cell-related marker evaluation, single cell clonal assay and three-dimensional (3-D) culture. The results of our study indicate that lacrimal glands are capable of tissue repair after duct ligation-induced injury, likely involving resident stem/progenitor cells and epithelial-mesenchymal transitions. Lacrimal gland progenitor cells isolated from ligated tissue can differentiate in 3-D culture. The results provide further insights into lacrimal gland stem/progenitor cell physiology and their potential for treating severe cases of tear deficiency.

Restoration of Fornix Tear Reservoir in Conjunctivochalasis With Fornix Reconstruction.

To determine whether conjunctivochalasis (CCh) obliterates the fornix tear reservoir and to discern whether there is concomitant aqueous tear deficiency (ATD) dry eye. Retrospective review of 18 eyes of 12 patients with CCh and ATD (CCh + ATD) and 18 eyes of 13 patients with CCh without ATD (CCh - ATD). Changes were compared before and after fornix reconstruction regarding symptoms, basal tear volumes, use of medications, conjunctival inflammation, and corneal staining. Fornix reconstruction with conjunctival recession and amniotic membrane transplantation effectively restored the fornix tear reservoir as evidenced by a significant increase of the basal tear volume in both CCh - ATD and CCh + ATD groups. Multivariate regression analysis confirmed that such improvement was significantly correlated with symptomatic resolution (r = 1, P < 0.001), which was also accompanied by significant resolution of corneal staining, conjunctival inflammation, and reduction of topical medications. Intriguingly, the prior diagnosis of ATD was no longer existent in 10 of the 18 eyes (56%) with CCh + ATD suggesting that ATD could be secondary to obliteration of the fornix tear reservoir by CCh. Obliteration of the fornix tear reservoir is a common pathogenic process regardless of whether CCh is associated with ATD dry eye. Restoration of the tear reservoir by fornix reconstruction with conjunctival recession and amniotic membrane transplantation results in significant resolution of symptoms and signs associated with ATD that is secondary to CCh and helps identify genuine ATD dry eye that is independent of CCh.

Three-Dimensional Culture of Functional Adult Rabbit Lacrimal Gland Epithelial Cells on Decellularized Scaffold.

Aqueous tear-deficient dry eye disease is a multifactorial chronic disorder, in which the lacrimal gland fails to produce enough tears to maintain a healthy ocular surface. Some severe cases may develop corneal damage and significant vision loss. Treatment primarily involves palliation using ocular surface lubricants, but can only provide temporary relief. Construction of a bioengineered lacrimal gland having functional secretory epithelial cells is a potentially promising option for providing long-term relief to severe dry eye patients. Using sphere-forming culture techniques, we cultured adult rabbit lacrimal gland progenitor cells and prepared a lacrimal gland scaffold by decellularization. When progenitor cells were seeded onto the decellularized scaffold, they formed duct- and acinar-like structures in the three-dimensional culture system. Lacrimal gland epithelial cells showed good cell viability, cell differentiation, and secretory function in decellularized lacrimal gland matrix, as indicated by morphology, immunostaining, and β-hexosaminidase secretion assay. This study demonstrated the potential suitability of utilizing tissue-specific progenitor cells and a tissue-derived bioscaffold for lacrimal gland restoration.

Tear Meniscus Evaluation Using Optical Coherence Tomography in Dry Eye Patients

Purpose: To evaluate the tear meniscus in aqueous tear-deficient dry eye patients using Fourier-domain optical coherence tomography (FD-OCT) and to investigate the clinical usefulness of tear meniscus values. Methods: The present study included 79 aqueous tear-deficient dry eyes and 50 normal eyes. Tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) were imaged using FD-OCT and measured with computer calipers. Schirmer’s test, tear break-up time, and corneal fluorescein staining were also performed and the correlations between the tests were analyzed. Additionally, the diagnostic power of tear meniscus values was compared using area under the receiver operating characteristic curve (AUROC). Results: Tear meniscus values were significantly decreased in the aqueous tear-deficient dry eye group (p < 0.05). TMH, TMD, and TMA were positively correlated with Schirmer’s test and tear break-up time (p < 0.05), and TMH and TMD were negatively correlated with corneal fluorescein staining in the aqueous tear-deficient dry eye group (p < 0.05). The AUROCs of TMH, TMD, and TMA were 0.978, 0.788, and 0.957, respectively. Conclusions: Tear meniscus values measured using FD-OCT were significantly lower in aqueous tear-deficient dry eyes and were correlated with Schirmer’s test, tear break-up time, and corneal fluorescein staining. Tear meniscus measurements obtained using FD-OCT can be useful clinical parameters for the diagnosis and treatment of aqueous tear-deficient dry eye. J Korean Ophthalmol Soc 2015;56(3):323-330

Tear Meniscus Evaluation Using Optical Coherence Tomography in Meibomein Gland Dysfunction Patients

Purpose: This study compared tear meniscus parameters between normal control, aqueous tear deficient dry eye, and meibomein gland dysfunction groups using Fourier-domain optical coherence tomography (FD-OCT). Methods: This study included 33 normal eyes, 79 aqueous tear-deficient dry eyes (ATD), and 48 meibomein gland dysfunction dry eyes (MGD). Following routine examination including Schirmer test, tear break-up time, corneal staining, and tear meniscus parameters such as tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) were obtained using FD-OCT. The differences among groups were assessed. Results: The averages of TMH, TMD, and TMA were 295.58 ± 58.36 μm, 166.67 ± 30.43 μm, and 0.0360 ± 0.01100 mm in normal eyes, respectively, 226.43 ± 42.18 μm, 147.44 ± 38.38 μm, and 0.0209 ± 0.01015 mm in ATD, respectively, 272.81 ± 64.21 μm, 159.37 ± 44.05 μm, and 0.0295 ± 0.01271 mm in MGD, respectively. Tear meniscus parameters were significantly lower in ATD. Tear meniscus parameters in MGD were higher than ATD and lower than normal eyes, but the TMA was the only statistically significant value. Conclusions: Although tear meniscus parameters in MGD were higher than ATD, they could not be distinguished from normal eyes. Tear meniscus evaluation using FD-OCT could be a useful measurement system in classification and treatment choice for dry eye patients. J Korean Ophthalmol Soc 2015;56(11):1684-1691