ABSTRACT 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.

Background: Dry eye, a common complication after refractive surgery, can be treated with artificial tears, but these provide temporary relief and may have limitations. Chamomile tea, known for its anti-inflammatory and soothing properties, could serve as a natural alternative therapy. Objective: To compare the effects of chamomile tea and commercial artificial tears in post-refractive surgery in dry eye. Methods: This prospective, comparative interventional study involved 30 individuals who developed dry eye symptoms after undergoing refractive surgery. The study involved participants divided into two groups: one using chamomile tea as a natural remedy and the other using conventional treatment. Participants aged 18-35, with uncomplicated refractive surgery within the last six months, and showing signs of dry eye were included. The study used the Schirmer test and Tear Break-Up Time (TBUT) tests to assess treatment adherence. An ANOVA test was used to compare mean scores within and between groups, with a significance level set at p &lt; 0.05. Results: Participants in a study showed progressive improvement in TBUT and Schirmer scores from baseline to week 4. The Chamomile group showed higher mean TBUT (10.65 vs. 10.16) and Schirmer scores (10.62 vs. 10.06) compared to the Artificial Tears group, suggesting a potentially greater improvement in ocular surface health. The average Schirmer score was 7.43 mm (SD = 1.47), and the average TBUT was 7.56 seconds (SD = 1.51). However, no statistically significant differences were found between the two groups, indicating comparable efficacy. Conclusion: Artificial Tears and Chamomile showed progressive improvement in TBUT and Schirmer scores over four weeks, with Chamomile showing slightly higher mean scores, indicating comparable efficacy but showing no statistically significant differences.

Efficacy of 0.38% and 0.18% sodium hyaluronate ocular lubricants for dry eye: A randomized trial in adult gazan participants.

Abstract Purpose To evaluate the ocular surface and tear film quality in post-penetrating keratoplasty patients in comparison with healthy individuals. Methods Slit lamp examination of lid parallel conjunctival folds (LIPCOF), tear osmolarity measurement, Schirmer I, fluorescein break-up time (FBUT) and corneal fluorescein staining tests were performed on 38 eyes of 34 patients underwent penetrating keratoplasty for different indications. In addition, 34 eyes of 18 healthy age-matched individuals served as normal controls. Results Average age was 55.86 ± 16.75 years in the post-keratoplasty group and 51.05 ± 18.85 years in the control group (p = 0.289). There were significant differences in LIPCOF (1.45 ± 0.76 vs. 1.03 ± 0.83; p = 0.035) and FBUT values (5.82 ± 4.48 s vs. 11.03 ± 6.72 s; p &lt; 0.001) between the operated and control eyes. Schirmer I and tear osmolarity tests demonstrated no significant differences. The frequencies of corneal staining (p &lt; 0.001), abnormal LIPCOF (p = 0.030) and artifical tear use (p &lt; 0.001) were significantly higher in the post-keratoplasty group. However, proportions of abnormal FBUT and Schirmer I test were similar in the two groups. Tear osmolarity was slightly higher in the post-keratoplasty group (311.53 ± 23.75 mOsm/l vs. 308.12 ± 15.83 mOsm/l), but the difference was not significant (p = 0.524). There were no significant differences in the proportion of hyperosmolar ocular surfaces between the two groups using cut-off values either ≥ 308 mOsm/l (p = 0.635) or ≥ 316 mOsm/l (p = 0.805). Conclusions Abnormal dry eye tests are more prevalent in patients after penetrating keratoplasty. Reduced tear film stability, conspicuous corneal staining and lid parallel conjunctival folds represented further deterioration of the ocular surface homeostasis despite normal tear production and osmolarity. These findings highlight the importance of comprehensive ocular surface assessment and management in the postoperative care of keratoplasty patients.

Secondary pulmonary amyloidosis due to Sjögren's syndrome (SS) is an uncommon disease. However, pulmonary amyloidosis detected before the diagnosis of SS is exceedingly rare. Herein, we report a unique case of a 40-year-old female who presented with pulmonary calcified nodules and cysts as an initial manifestation of pulmonary amyloidosis. Further diagnostic evaluation revealed SS. A 40-year-old non-smoking female presented with a cough, whose chest computed tomography (CT) scan revealed many lung cysts along with calcified nodules. Pathology revealed nodular pulmonary amyloidosis. Subsequent investigations excluded common related lymphoproliferative disorders and plasma cell dyscrasias. Combined with elevated levels of antinuclear antibody (1:640), positivity for the anti-Sjögren's syndrome A (SS-A)/Ro antibody, abnormal tear break-up time (BUT) and Schirmer test, the diagnosis of SS was established. Pulmonary amyloidosis is a rare pulmonary manifestation of SS, especially with atypical early clinical symptoms, which can render diagnosis challenging. This case highlights that amyloidosis diagnosis precedes SS diagnosis. Moreover, it aims to alert clinicians that when multiple calcified nodules and cystic lesions are observed on chest CT, secondary pulmonary amyloidosis should be considered, and further investigations into related diseases such as SS should be conducted to avoid missed diagnoses.

Dry eye syndrome is a common postoperative complication following small incision lenticule extraction (SMILE) surgery that significantly impacts patients’ quality of life. Intense pulsed light (IPL) therapy is widely used for managing dry eye syndrome, but its efficacy and safety warrant further evaluation. This study first analyzed baseline characteristics of patients with dry eye syndrome after SMILE surgery, comparing differences between the conventional medication group and the IPL treatment group. Multivariable linear regression was then used to assess the effects of IPL treatment and baseline factors on dry eye indicators 6 months posttreatment. To minimize selection bias, inverse probability of treatment weighting was applied. Furthermore, multivariable logistic regression evaluated the impact of IPL on adverse event occurrence, while generalized estimating equations assessed IPL efficacy at multiple time points. Multivariable linear regression revealed that diabetes and prolonged screen time were associated with increased ocular surface disease index (OSDI) scores, while IPL treatment significantly reduced OSDI scores (P < .05). Diabetes correlated with decreased tear breakup time and Schirmer test results, whereas IPL improved these measures. For eye dryness scores and meibomian gland scores, diabetes showed a positive association, but IPL treatment significantly decreased both. After inverse probability of treatment weighting adjustment, the effects of screen time and diabetes on OSDI and Schirmer test values lost statistical significance. Multivariable logistic regression demonstrated that diabetes increased the risk of adverse events by 14.2%, while IPL treatment reduced this risk to 7%. Generalized estimating equations analysis indicated that IPL efficacy improved significantly over time, with marked long-term benefits. IPL therapy offers superior efficacy and safety compared to conventional medication in treating dry eye syndrome after SMILE surgery, particularly in the long term. Diabetes remains a key factor affecting treatment outcomes and adverse event rates in this population.

To evaluate the diagnostic potential of body fluid electroconductivity for dry eye disease (DED) and compare its accuracy with commonly used DED tests. Individuals with dry eye (n = 36) and controls (n = 26) were enrolled in this case-control prospective study. Electroconductivity measurements were performed on blood, serum, tears, urine, and saliva. Dry eye assessments included tear film breakup time (TBUT) and Schirmer test (Schirmer), with symptoms evaluated using the Ocular Surface Disease Index (OSDI). Blood and urine analyses were performed to assess the baseline systemic profiles of both groups. Among all body fluids, saliva (saliva electroconductivity [ESaliva]) showed the most significant differences in electroconductivity between controls and dry eye individuals (2514.02 ± 329.18 vs. 3262.00 ± 992.47 µS/cm, P < 0.001). ESaliva showed robust diagnostic performance (area under the curve [AUC] = 0.800), comparable to TBUT (AUC = 0.693, P = 0.103) and superior to Schirmer (AUC = 0.536, P < 0.001). OSDI showed a moderate correlation with ESaliva (r = 0.43, P < 0.001), representing the strongest association, followed by TBUT (r = -0.26, P = 0.004) and Schirmer (r = -0.09, P = 0.313). Cross-validation procedure identified ESaliva cutoffs of 2373 µS/cm (95% confidence interval [CI], 2340-2456) for low-to-moderate and 2880 µS/cm (95% CI, 2845-2931) for moderate-to-high DED risk. Net reclassification improvement and integrated discrimination improvement analyses confirmed ESaliva's superior predictive ability. A single cutoff of 2880 µS/cm yielded 64% sensitivity and 89% specificity for DED prediction. ESaliva effectively distinguishes patients with DED and exhibits superior diagnostic performance. ESaliva: offers a noninvasive and self-assessable tool for DED diagnosis.

Purpose: Diagnosis and management of dry eye disease (DED) differ across clinics due to the variable diagnostic and treatment equipment and the lack of guidelines for managing DED. This study aims to understand the current landscape of DED diagnosis and management in the Malaysian healthcare setting, as well as to evaluate the feasibility of implementing a DED framework in local settings. Study design: A quantitative cross-sectional survey. Methods: A 12-question multiple-choice questionnaire was administered to 13 local cornea specialists from May 2023 to September 2023. The questionnaire comprised of six dimensions: guidelines utilisation for DED diagnosis and management; standardisation for DED diagnosis and management between clinics; administration of validated DED questionnaire to patient; availability of clinical and screening tests in their clinics; treatment availability in their clinics; and follow-up and patient education. Results: Most respondents (84.6%) use one or more international guidelines or national guidelines from other countries in their clinical practice. All respondents agreed that DED diagnosis and management should be standardised among ophthalmologists, while 92.3% would consider implementing a standardised DED diagnosis and management algorithm in their practice. More than two-thirds of the respondents (69.2%) do not have the resources for their patients to self-administer DED questionnaire. All respondents have slit-lamp examination, fluorescein tear film breakup time test and corneal fluorescein staining as screening tools, as well as ocular lubricants, cyclosporine A and corticosteroids as treatment options in their clinics. Most respondents (92.3%) were able to follow-up with their patients at least every six months. Less than half of the respondents (38.5%) were able to spend an average of 13 minutes for patient education. Conclusion: This study revealed that most of the local cornea specialists would consider implementing a standardised DED framework in managing their patients with DED. However, factors impeding its implementation (e.g. diagnostic and treatment equipment availability, cost and clinical workflow differences, and patient loads) in local settings should be identified and tackled to standardise DED management and improve the quality of patient care in Malaysia.

Primary Sjögren's syndrome (pSS) is a chronic inflammatory autoimmune disease characterized by lymphocyte proliferation and progressive exocrine gland damage, which can involve multiple organs, including the lungs. However, secondary pulmonary amyloidosis is rare. This study summarizes the clinical features of this condition through the diagnosis and treatment of a 44-year-old female patient and a literature review. The patient was admitted due to "bilateral pulmonary nodules discovered over 4 years ago." Chest CT revealed scattered multiple nodules and mass shadows in both lungs, some with calcification. Blood tests indicated leukopenia and thrombocytopenia. Immunological tests showed positive anti-nuclear antibodies and anti-SS-A antibodies. Combined with symptoms of dry mouth and dry eyes, as well as tear film breakup time and salivary secretion function tests, the patient was diagnosed with primary Sjögren's syndrome. Percutaneous lung biopsy pathology revealed amyloidosis with granulomatous reactions, and Congo red staining was positive, confirming the diagnosis of primary Sjögren's syndrome complicated by pulmonary amyloidosis. The patient was treated with hydroxychloroquine and remained stable upon discharge, with follow-up ongoing for 6 months. A literature search (May 2014 to May 2024) identified 15 relevant articles (3 in Chinese, 12 in English). The results showed that all reported patients were female, with a median age of 66 years. Only 46.7% presented with symptoms of dry mouth and dry eyes at initial diagnosis, 14 cases had immunological abnormalities, and 1 case had cytopenia. Chest imaging revealed that 53.3% of patients had pulmonary nodules with cystic changes, and 26.7% had calcifications. Pulmonary amyloidosis, as a rare complication of pSS, is prone to misdiagnosis and missed diagnosis, and its treatment and prognosis lack evidence-based medical support. pSS often has an insidious onset, with some patients presenting initially with extraglandular organ damage rather than exocrine gland involvement. Pulmonary involvement may manifest as multiple nodules with calcifications and/or cystic changes or interstitial lung disease on imaging. When patients present with these imaging features that cannot be explained by common diseases, pSS should be considered. Lung biopsy is crucial for diagnosis and exclusion of confounding diseases such as lymphoma. Recognizing the pulmonary imaging characteristics of pSS can help reduce missed diagnoses, enable early diagnosis, and guide appropriate treatment.

Background/Objectives: To investigate the effect of strabismus surgery on ocular surface parameters, meibomian glands, and conjunctival impression cytology. Methods: Preoperative and postoperative (10th day, first month, and third month) tear break-up time (TBUT) tests, Schirmer 1 tests, corneal staining scores (CSS), meibomian gland (MG) loss rates, ocular surface disease index (OSDI) scores, and conjunctival impression cytology (IC) results of 30 patients who underwent strabismus surgery were compared. Results: Significant differences were found between preoperative TBUT test results and those evaluated on the postoperative 10th day and at the postoperative first month (p < 0.0001 for both). There were also significant differences between the preoperative and postoperative first- and third-month Schirmer 1 test results (p = 0.02 and p < 0.0001, respectively). Furthermore, mean OSDI scores significantly differed between preoperative and postoperative 10th-day measurements (p < 0.0001). The mean postoperative 10th-day CSS was found to be significantly higher than the preoperative mean CSS (p < 0.0001). The stages in preoperative conjunctival IC samples were found to be significantly lower than those evaluated at all postoperative times (p < 0.0001 for all). Significant differences were observed between the preoperative lower eyelid MG loss rate and all postoperative MG loss rates (p < 0.0001 for the 10th day and first month and p < 0.001 for the third month). Lastly, the preoperative upper eyelid MG loss rate significantly differed from all postoperative MG loss rates (p < 0.0001 for the 10th day, p < 0.003 for the first month, and p < 0.0001 for the third month). Conclusions: We observed changes indicative of dry eye in the mean OSDI score, TBUT, Schirmer 1 test, MG loss rates, and conjunctival IC findings up to the postoperative third month in patients who underwent strabismus surgery. Therefore, we believe that patients undergoing strabismus surgery should be followed up for ocular surface diseases, particularly dry eye.

The aim of this prospective study was to evaluate whether the duration and intensity of pain induced by commonly used diagnostic eye drops correlate with the presence and severity of dry eye syndrome. This study included 33 patients (66 eyes) undergoing routine evaluations at tertiary ophthalmology clinics from 2016 to 2017. Each eye received one drop of either oxybuprocaine or tropicamide. Pain intensity and duration were assessed using a visual analog scale and a stopwatch. Dry eye syndrome was diagnosed and graded according to international guidelines, incorporating clinical signs and standardized tests. Statistical analyses included Kruskal-Wallis tests for discrete variables and Pearson correlations for continuous variables, with significance set at P <0.05. Patients with dry eye syndrome experienced significantly longer pain duration compared with those with healthy eyes (P = 0.035). Pain intensity was notably higher in patients with severe dry eye (P = 0.048). Duration of pain correlated with corneal fluorescein staining (P = 0.027). In eyes treated with oxybuprocaine, shorter tear break-up time and lower Schirmer test results were significantly associated with pain response (P = 0.021 and P = 0.037, respectively). In eyes treated with tropicamide, pain intensity was significantly associated with functional limitations (P = 0.042). This study highlights that pain sensitivity to commonly used diagnostic eye drops is a potential marker for the presence and severity of dry eye syndrome. Clinicians should consider evaluating pain responses during routine examinations as a simple, supplementary tool for identifying patients who may benefit from further diagnostic investigations and tailored management.

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.

Thalassemia is a hereditary blood disorder characterized by impaired hemoglobin production, necessitating regular blood transfusions to manage anemia and associated complications. This condition also poses a significant risk for a range of ophthalmic manifestations due to factors such as iron overload from repeated transfusions, organ dysfunctions, and metabolic imbalances. This research aimed to evaluate the prevalence of ophthalmic anomalies in patients with transfusion-dependent thalassemia (TDT) and to ascertain their correlation with serum ferritin levels, hemoglobin concentrations, and the length of chelation therapy. This cross-sectional study was carried out at a tertiary care center in Central India in the pediatric and ophthalmology departments. All patients diagnosed with beta-thalassemia major between the ages of one and 15 were included in the study. Written informed consent was taken from the parents of participants. Patients with congenital ocular abnormalities, patients with a history of ocular trauma and surgery, and patients with hemoglobin diseases other than beta-thalassemia major were excluded. Complete medical history, including the disease's onset and course, blood transfusion frequency, splenectomy (performed or not), iron-chelating agents (nature, amount, time, and adherence to the regimen), positive consanguinity, and related conditions in the family, was recorded from the parents of every child. The ocular examination consisted of refraction, visual acuity,fundoscopy, slit-lamp examination, tonometry, perimetry in glaucoma suspects, tear break-up time (TBUT) test, and color vision testing. The data were analysed using the Statistical Product and Service Solutions (SPSS, version 19; IBM SPSS Statistics for Windows, Armonk, NY) software. Mean (±standard deviation) age of study participants was 8.10±3.83 years (age range: 1.5-14 years). Males comprised a smaller proportion of study participants than females, at 44% and 56%, respectively. We found one or more ocular manifestations in 38 (76%) of the patients,whereas the remaining 12 (24%) had none.Among all the ophthalmic manifestations, refractive errors were found in56% of patients, followed by vascular tortuosity (32%).In this study, black pigmentation near the optic disc was found in 12% (6) of the patients, 4% hadoptic disc edema, and 4% had a high cup disc ratio. Yellowish pigmentation of the conjunctiva was seen in 8% of the patients, and 4% haddry eyes with TBUT shorter than 10 seconds. Ophthalmic manifestations such as refractive errors, vascular tortuosity, pigmentation near the optic disc, and disc edema are common findings in thalassemia patients. This comprehensive study highlights the importance of regular ophthalmic evaluations in TDT patients, emphasizing the need for an interdisciplinary approach that includes hematologists and ophthalmologists. Early detection and management of ophthalmic complications can significantly enhance a patient's quality of life and preserve vision. Future research should focus on understanding the underlying mechanisms of these ocular manifestations and developing targeted interventions to mitigate their impact.

Background/Objectives: Epithelial basement membrane dystrophy (EBMD) is a common corneal dystrophy characterized by recurrent corneal erosions and visual impairments due to surface irregularities and opacities. This study aims to evaluate the effectiveness of alcohol-assisted delamination (ALD) of the corneal epithelium in patients with EBMD affecting the visual axis, who experience decreased vision quality due to higher-order aberrations (HOAs) and irregular astigmatism. Methods: Eleven eyes of nine patients (four males and five females) were treated with ALD, with a mean age of 51.3 ± 19.7 years. All patients underwent refraction, best-corrected visual acuity (BCVA) assessment, a comprehensive slit-lamp examination for EBMD pattern identification, anterior segment imaging with and without fluorescein, tear break-up time (BUT) testing, corneal topography, corneal aberrometry (Zernike coefficients (Znm) were calculated for a 5.0 mm simulated pupil), and anterior segment optical coherence tomography preoperatively and at 1-day, 14-day, 1-month, 3-month, 6-month, and 12-month intervals. Results: All patients demonstrated improvements in BCVA and visual quality, ocular comfort, and BUT results. The mean root mean square (RMS) value of total corneal aberrations decreased from 1.72 ± 0.90 μm to 0.90 ± 0.62 μm, while the mean RMS value of HOAs reduced from 0.92 ± 0.48 μm to 0.53 ± 0.28 μm. Astigmatism and trefoil were the aberration components that exhibited the most significant reductions. Conclusions: Alcohol-assisted delamination of the corneal epithelium is a safe and effective treatment for central EBMD patients experiencing visual quality deterioration. Astigmatism and trefoil appear to be the primary aberrations contributing to visual disturbances in this patient population.

This study aimed to evaluate choroidal and macular thickness, as well as vascular structures in female fibromyalgia syndrome (FMS) patients using optical coherence tomography angiography (OCTA) and optical coherence tomography (OCT), and to compare the results with healthy controls. Additionally, the relationship between these findings and disease severity was explored. The study included 62 female FMS patients and 60 healthy controls, conducted between January 2022 and October 2022 at the Antalya Training and Research Hospital. FMS patients were assessed based on American College of Rheumatology criteria. Tear production and stability were evaluated using Schirmer and Tear Break-Up Time (TBUT) tests, while OCTA and OCT were used to examine vascular and choroidal structures. The mean age of the FMS group was 43.11 ± 7.94years. No significant difference was found in the Schirmer test, but the TBUT was significantly lower in the FMS group (p < 0.001). OCTA showed significantly lower deep capillary plexus (DCP) values in the FMS group, with a weak negative correlation between DCP and disease severity (r = -0.227, p = 0.012). Foveal avascular zone (FAZ), non-flow, and choroidal thickness were significantly higher in FMS patients (p < 0.050). The study demonstrated a relationship between dry eye, vascular changes, and increased choroidal thickness with disease severity in female patients with FMS. The reduction in DCP, along with increases in FAZ, non-flow, and choroidal thickness, may be linked to vascular and inflammatory processes involved in FMS pathogenesis. The decrease in tear quality may be due to autonomic nervous system dysfunction. In conclusion, we suggest that autonomic dysfunction and inflammation in FMS may negatively affect retinal vascular structures and tear function.

ABSTRACT Clinical relevance The tear break-up time (BUT) test is important in diagnosing and monitoring tear film stability, and understanding potential changes in tear film dynamics during repeated measurements could improve the accuracy and reliability of the test in clinical practice. Background The study aimed to examine the changes in BUT value caused by subsequent measurements made in BUT test. Methods A total of 120 female participants were divided into groups (30 individuals each). Participants were divided into four groups based on the interval between two non-invasive tear break-up time (NI-BUT) tests: Group 1 (1-minute interval), Group 5 (5-minute interval), Group 10 (10-minute interval), and Group 15 (15-minute interval). The first NI-BUT test was called Initial NI-BUT (NI-BUT(I)), and the second test was called Subsequent NI-BUT (NI-BUT(S)). The first BUTvalue (BUT1st), the second BUT value (BUT2nd), the third BUT value (BUT3rd), the fourth BUT value (BUT4th), the fifth BUT value (BUT5th), and the average value of the first three BUTs (BUTA3) were compared between the NI-BUT(1) and NI-BUT(S) tests. Results Participant ages ranged from 18 to 36 years, with a mean of 25.1 ± 3.2 years. The mean values of BUT1st, BUT2nd, BUT3rd, BUT4th, BUT5th, and BUTA3 in the NI-BUT(I) test were statistically significantly shorter than those in the NI-BUT(S) test for all groups (p < 0.05). The changes in the parameters were statistically significantly greater in Group 1 compared to the other groups (p < 0.05). Conclusions Subsequent measurements cause increased BUT values. The longer the interval between two measurements, the smaller the differences between the subsequent measurements. When performing the BUT test, a single measurement should be preferred if possible. If the clinician finds the results of a single measurement unsatisfactory and wishes to consider the average of multiple measurements, the interval between tests should be longer than 15 minutes.

Introduction: Multifocal keratitis can result from infectious and non-infectious causes, and its etiology is often challenging to pinpoint. Ocular complications are common in β-thalassemia and can have serious consequences. This case highlights an unusual presentation of multifocal keratitis in a patient with β-thalassemia. Case Presentation: A 23-year-old woman with β-thalassemia, diagnosed 12 years ago, was referred by a hematologist for pain in her right eye persisting for the past two weeks. She reported redness, tearing, and light sensitivity. Six months prior, she experienced similar symptoms, which had left a white spot in her right eye. Recently, this spot had multiplied and spread across the ocular surface. Visual acuity (VA) was 6/40 in the right eye on examination. Findings included palpebral spasm, conjunctival and pericorneal injection, and multiple infiltrates on the anterior corneal surface. Fluorescein staining was positive for numerous infiltrates. Schirmer and break-up time (BUT) tests indicated an unstable tear film. Treatment included antibiotic eye ointment, preservative-free artificial tears, mucous membrane pemphigoid (MMPs) inhibitors, and oral ascorbic acid. Two weeks later, VA improved to 6/9, with a reduction in infiltrates and fluorescein staining. Conclusion: Prompt management is essential for preserving vision and preventing complications in ocular surface diseases while diagnostic procedures are underway.

Investigation of corneal topographic and ocular surface parameters in ocular rosacea based on skin subtypes.

Corneal endothelial cells, vital for maintaining transparency and unable to regenerate, compensate for cell loss by enlarging adjacent cells, which leads to increased size and varying morphology with age. This study emphasizes how dry eye affects these cells, stressing the need to address this frequently neglected condition. This cross-sectional study explored alterations in corneal endothelial cell characteristics among 33 individuals with dry eye disease (DED) compared to 33 age- and gender-matched controls, aged between 18 and 78 years. Participants underwent comprehensive ophthalmic evaluations, and various grades of DED were diagnosed using the Ocular Surface Disease Index questionnaire, Tear Meniscus Height measurement, Tear Film Break-Up Time test, Schirmer’s I test, and Lissamine Green staining and endothelium cells were assessed for endothelial cell density (ECD), cell morphology and central corneal thickness (CCT) by specular microscopy. Compared to the control group (57.73±8), the average cell morphology showed significant changes in individuals with moderate DED (52±9) with p=0.0497, and in those with severe DED (49±7) with p=0.004. Additionally, Central Corneal Thickness (CCT) was notably lower in the severe DED group (485±32 µm) with p=0.002 as compared to control group (533±34 µm). The mean ECD was lower in severe DED patients compared to controls, but not statistically significantly. The research found a correlation between DED severity and corneal endothelial cell characteristics. Severe DED leads to significant morphological alterations and reduced CCT. These findings highlight DED's impact on corneal cells, emphasizing early detection and intervention for preserving corneal health and improving intraocular surgery outcomes.

Purpose This study aimed to assess the prevalence, pattern and associated risk factors with dry eye disease (DED) at a tertiary eye care centre in Central India. Methods This prospective cross-sectional study, conducted over 48 months, enrolled patients with systematic random sampling. Evaluation of DED was done with subjective and objective methods comprising of the Ocular Surface Disease Index (OSDI) questionnaire, slit lamp examination, Schirmer's tests and fluorescein tear-film breakup time (FTBUT) test. Patients were categorised into mild, moderate, severe and very severe DED. Association with various etiological factors like age, sex, occupation, diabetes mellitus, autoimmune disorders and any other systemic illness was assessed. The chi-square test/Fischer's exact test was used to analyse categorical data. Bivariate logistic regression analysis was used to calculate the odds ratio (OR). Multivariate analysis was performed to identify independent risk factors. Results A total of 2,560 patients were evaluated, of which 640 patients (25%) had DED. Prevalence was higher in patients aged >50 years, household workers, students, government employees and farmers. Uncorrected refractive status, cigarette smoking, ocular allergy and contact lens usage were associated with increasing odds of developing DED. Conclusion The prevalence of DED was estimated to be 25% in central India. Certain occupations like household workers, students, government employees, farmers, uncorrected refractive status, cigarette smoking, ocular allergy and contact lens use were significant risk factors for dry eyes.