Clinical Signs Of Dry Eye Research Articles

Aim2 Deficiency Ameliorates Lacrimal Gland Destruction and Corneal Epithelium Defects in an Experimental Dry Eye Model.

Dry eye disease (DED) is a multifactorial disease that is associated with inflammation. Excessive DNA is present in the tear fluid of patients with DED. Absent in melanoma 2 (AIM2) is a key DNA sensor. This study aimed to investigate the role of AIM2 in the pathogenesis of DED. DED was induced by injection of scopolamine (SCOP). Aberrant DNA was detected by cell-free DNA (cfDNA) ELISA and immunostaining. Corneal epithelial defects were assessed by corneal fluorescein staining, zonula occludens-1 immunostaining and TUNEL. Tear production was analyzed by phenol red thread test. Lacrimal gland (LG) histology was evaluated by hematoxylin and eosin staining, and transmission electron microscopy examination. Macrophage infiltration in LG was detected by immunohistochemistry for the macrophage marker F4/80. Gene expression was analyzed by RT-qPCR. Protein production was examined by immunoblot analysis or ELISA. Aim2-/- mice displayed a normal structure and function of LG and cornea under normal conditions. In SCOP-induced DED, wild type (WT) mice showed increased cfDNA in tear fluid, and aberrant accumulations of dsDNA accompanied by increased AIM2 expression in the LG. In SCOP-induced DED, WT mice displayed damaged structures of LG, reduced tear production, and severe corneal epithelium defects, whereas Aim2-/- mice had a better preserved LG structure, less decreased tear production, and improved clinical signs of dry eye. Furthermore, genetic deletion of Aim2 suppressed the increased infiltration of macrophages and inhibited N-GSDMD and IL18 production in the LG of SCOP-induced DED. Aim2 deficiency alleviates ocular surface damage and LG inflammation in SCOP-induced DED.

Corneal lymphangiogenesis in dry eye disease is regulated by substance P/neurokinin-1 receptor system through controlling expression of vascular endothelial growth factor receptor 3

PurposeTo evaluate the role of substance P (SP)/neurokinin-1 receptor (NK1R) system in the regulation of pathologic corneal lymphangiogenesis in dry eye disease (DED). MethodsImmunocytochemistry, angiogenesis assay, and Western blot analysis of human dermal lymphatic endothelial cells (HDLECs) were conducted to assess the involvement of SP/NK1R system in lymphangiogenesis. DED was induced in wild-type C57BL/6 J mice using controlled-environment chamber without scopolamine. Immunohistochemistry, corneal fluorescein staining, and phenol red thread test were used to evaluate the effect of SP signaling blockade in the corneal lymphangiogenesis. The expression of lymphangiogenic factors in the corneal and conjunctival tissues of DED mouse model was quantified by real-time polymerase chain reaction. ResultsNK1R expression and pro-lymphangiogenic property of SP/NK1R system in HDLECs were confirmed by Western blot analysis and angiogenesis assay. Blockade of SP signaling with L733,060, an antagonist of NK1R, or NK1R-targeted siRNA significantly inhibited lymphangiogenesis and expression of vascular endothelial growth factor (VEGF) receptor 3 stimulated by SP in HDLECs. NK1R antagonist also suppressed pathological corneal lymphangiogenesis and ameliorated the clinical signs of dry eye in vivo. Furthermore, NK1R antagonist effectively suppressed the lymphangiogenic factors, including VEGF-C, VEGF-D, and VEGF receptor 3 in the corneal and conjunctival tissues of DED. ConclusionsSP/NK1R system promotes lymphangiogenesis in vitro and NK1R antagonism suppresses pathologic corneal lymphangiogenesis in DED in vivo.

Differentially Expressed Gene Pathways in the Conjunctiva of Sjögren Syndrome Keratoconjunctivitis Sicca.

Sjögren syndrome (SS) is an autoimmune condition that targets the salivary and lacrimal glands, with cardinal clinical signs of dry eye (keratoconjunctivitis sicca, KCS) and dry mouth. The conjunctiva of SS patients is often infiltrated by immune cells that participate in the induction and maintenance of local inflammation. The purpose of this study was to investigate immune-related molecular pathways activated in the conjunctiva of SS patients. Female SS patients (n=7) and controls (n=19) completed a series of oral, ocular surface exams. Symptom severity scores were evaluated using validated questionnaires (OSDI and SANDE). All patients fulfilled the ACR/EULAR criteria for SS and the criteria for KCS. Fluorescein and lissamine green dye staining evaluated tear-break-up time (TBUT), corneal and conjunctival disease, respectively. Impression cytology of the temporal bulbar conjunctiva was performed to collect cells lysed and subjected to gene expression analysis using the NanoString Immunology Panel. 53/594 differentially expressed genes (DEGs) were observed between SS and healthy controls; 49 DEGs were upregulated, and 4 were downregulated (TRAF5, TGFBI, KLRAP1, and CMKLRI). The top 10 DEGs in descending order were BST2, IFITM1, LAMP3, CXCL1, IL19, CFB, LY96, MX1, IL4R, CDKN1A. Twenty pathways had a global significance score greater or equal to 2. Spearman correlations showed that 29/49 upregulated DEGs correlated with either TBUT (inverse) or OSDI or conjunctival staining score (positive correlations). Venn diagrams identified that 26/29 DEGs correlated with TBUT, 5/26 DEGs correlated with OSDI, and 16/26 correlated with conjunctival staining scores. Five upregulated DEGs (CFB, CFI, IL1R1, IL2RG, IL4R) were uniquely negatively correlated with TBUT. These data indicate that the conjunctiva of SS patients exhibits a phenotype of immune activation, although some genes could be inhibitory. Some of the DEGs and pathways overlap with previous DEGs in salivary gland biopsies, but new DEGs were identified, and some of these correlated with symptoms and signs of dry eye. Our results indicate that gene analysis of conjunctiva imprints is a powerful tool to understand the pathogenesis of SS and develop new therapeutic targets.

Dry eye signs and symptoms in patients on aromatase inhibitor therapy.

The study aimed to test whether symptomatic dry eye in aromatase inhibitor (AI) patients is associated with the clinical features of evaporative dry eye. A cross-sectional, observational study of postmenopausal women treated with AI was conducted. Clinical information was gathered from their treating clinician. Ocular and treatment symptoms were assessed using validated questionnaires. Clinical assessments were performed to assess for dry eye. The primary outcome measure for this study was dry eye symptoms measured via questionnaire. The secondary outcome measures were clinical signs of dry eye and hormone levels. A total of 25 women on AI were recruited. 64% of women reported symptoms of dry eye (ocular surface disease index ≥ 13). Higher tear osmolarity (323 vs 307 mOsm/L, p = 0.002) and increased meibomian gland dropout (4 vs 1, p = 0.002) were observed in patients with symptomatic dry eye when compared to asymptomatic patients. Multivariate logistic regression identified that longer duration of AI use and higher tear osmolarity increased the likelihood of a patient experiencing dry eye symptoms. Our study found increased tear osmolarity and meibomian gland drop out in women on AI with symptomatic dry eye. Longer duration of AI therapy and higher tear osmolarity may increase the risk of developing dry eye.

Altered mucins and aquaporins indicate dry eye outcome in patients undergoing Vitreo-retinal surgery.

Vitreo-retinal (VR) surgeries induce conjunctival changes. However, there are no study reports regarding prevalence and severity of dry eye after these surgeries. This study evaluated dry eye outcome after VR surgery. Patients undergoing VR surgery classified as scleral buckle and microincision vitrectomy surgery (n = 44, mean age: 56.09±10.2 years) were recruited. Dry eye evaluation was done before and 8 weeks after surgery (2 weeks after omitting topical eye drops). Conjunctival imprint cytology for goblet cell count and tear Mucin 5AC (MUC5AC) protein estimation was done. Gene expressions of MUC5AC, MUC4, MUC16, Aquaporin 4 (AQP4) and AQP5 were analyzed in the conjunctival imprint cells by qPCR. None of the patients exhibited clinical signs of dry eye after VR surgery. But the conjunctival goblet cell density (GCD) was significantly lowered post-VR surgery (63% cases, **p = 0.012) with no alterations in the tear MUC5AC protein. Post-VR surgery, the conjunctival cell gene expression of MUC4, MUC16 and AQP4 were significantly increased (*p = 0.025, *p = 0.05 and *p = 0.02 respectively) and AQP5 was significantly lowered (*p = 0.037), with no change in MUC5AC expression. Tear cytokines were significantly increased post-VR surgery (anti-inflammatory: IL1RA, IL4, IL5, IL9, FGF; PDGFbb and pro-inflammatory: IL2, IL6, IL15, GMCSF and IFNg). Though clinical signs of dry eye were not observed after VR surgery, ocular surface changes in the form of reduced GCD, altered MUC5AC, MUC4, MUC16, AQP4, AQP5 and cytokines are suggestive of dry eye outcome at the molecular level especially inpatients aged above 51 years, especially female gender and those who are diabetic.

Efficacy of adjunctive therapy using Vizoovet in improving clinical signs of keratoconjunctivitis sicca in dogs: A pilot study.

To assess the clinical safety and efficacy of adjunctive therapy using Vizoovet to ameliorate clinical signs of keratoconjunctivitis sicca (KCS) in dogs. Twenty client-owned dogs. Canine patients diagnosed with KCS were enrolled in this prospective study. Patients were randomly selected to receive either Vizoovet or GenTeal drops twice daily in addition to twice daily tacrolimus 0.03% solution. Data were collected from only one eye of each patient and included STT-1, IOP, TFBUT, and results of objective clinical scoring performed by pet owners. Statistical significance was set at P≤.05. In all, 20 dogs (20 eyes) were enrolled in this prospective randomized study. Females (n=12; 60%) outnumbered males (n=8; 40%) and all dogs were spayed/neutered. Mean age of all dogs was 10.6±3.79years. In both treatment groups, the improvement in STT-1 values over the course of the study was significant (P=.002). When comparing the STT-1 improvements between groups, no significance was found (P=.78). In both groups, the improvement in TFBUT was significant (P=.0018). When comparing the TFBUT improvements between groups, no significance was found (P=.14). Squinting, rubbing, ocular discharge, and medication administration scores all significantly improved throughout the course of the study; however, they did not differ significantly between groups. Throughout the study, no adverse side effects were noted clinically or by the pet owner in either group. Adjunctive treatment with Vizoovet was as safe and effective as GenTeal drops at improving clinical signs of dry eye in dogs.

Shifting the IGF-axis: An age-related decline in human tear IGF-1 correlates with clinical signs of dry eye

ObjectiveThe human corneal epithelium expresses both the insulin-like growth factor type 1 receptor (IGF-1R) and the IGF-1R/insulin receptor (INSR) hybrid. Despite the previous identification of IGF-1 in human tear fluid, little is known regarding the regulation of IGF-1 in tear fluid and its role in corneal epithelial homeostasis. In the present study, we investigated the impact of biological parameters on the concentration of human tear levels of IGF-1. DesignTear levels of IGF-1 were measured in 41 healthy, human volunteers without any reported symptoms of dry eye. All volunteers underwent standard biomicroscopic examination of the cornea and tear film. In a subgroup of volunteers, corneal staining with sodium fluorescein, tear film break up time and tear production using a Schirmer's test strip were measured to assess clinical signs of dry eye. Tears were collected from the inferior tear meniscus using glass microcapillary tubes and IGF-1 levels were measured using a solid phase sandwich ELISA. ResultsTear levels of IGF-1 were highest in young adults and significantly decreased in older adults (P = 0.003). There were no differences in tear IGF-1 between males and females (P = 0.628). Tear IGF-1 levels were correlated with tear film break up time (R = 0.738) and tear production (R = 0.826). ConclusionsThese data indicate that there is a progressive decline in tear IGF-1 due to aging that is associated with clinical signs of dry eye. This effect is likely due to age-related changes in the lacrimal gland.

Treatment of contact lens related dry eye with antibacterial honey.

Contact lens induced dry eye affects approximately 50% of contact lens wearers. The aim was to assess the effects of Manuka (Leptospermum sp.) honey eye drops (Optimel, Melcare, Australia) on dry eye in contact lens wearers. The safety of the honey eye drops in contact lens wear and contact lens wearers' compliance were also evaluated. Prospective, randomised, cross over study, examiner masked, pilot treatment trial. Twenty-four participants aged 20 to 55 years with contact lens related dry eye were recruited and randomised to two treatment groups; 20 completed the study. One group used Optimel eye drops twice a day for two weeks followed by conventional lubricant (Systane Ultra, Alcon) therapy for two weeks; the other group completed the treatments in the reverse order. Before and after each treatment dry eye symptomology, ocular surface inflammation, and tear quantity and quality were assessed. Participants completed a daily log detailing their usage of treatments and any issues. Dry eye symptoms improved significantly after Optimel treatment. Patients with more severe symptoms at baseline showed a greater improvement in symptoms. No significant differences were observed in the objective signs of dry eye; presumably because of the short treatment duration. Seventy-five% of contact lens wearers reported good adherence to Optimel treatment and 95% reported no issues using this product. Optimel Eye Drops reduce the symptoms of dry eye in contact lens wearers and are safe to use. A longer treatment period to assess the effect on clinical signs of dry eye is required.

The Relationship between Symptomatic Assessment and Clinical Signs of Dryness in Dry Eye Subjects

Introduction: There was no previous study to assess relationship between dry eye symptoms and signs in the local population. The purpose of this study is to evaluate the relationship of symptomatic assessment and clinical signs of dryness in dry eye subjects. Materials and method: A Cross-sectional study with convenient sampling involving 321 subjects with 642 eyes was done. Subjects were divided into non-dry eye (NDE) and dry eye (DE) groups. The division of NDE and DE groups were done using two types of classification. In Classification 1(symptoms-based), DE was defined if the score of Ocular Surface Disease Index (OSDI) score was more than 33. The value of tear film break-up time (TFBUT) less than 5 seconds and Schirmer test with anaesthesia (STA) less than 5mm/5 minutes were considered as DE for Classification 2 (signs based). Results: There were poor correlations between OSDI and clinical signs of dryness in all subjects involved (p > 0.05). Similar findings were also noted within NDE subjects in Classification 1 and Classification 2. OSDI score was also not significantly correlated with the signs of dryness within DE subjects except with ocular protection index (OPI) (r = - 0.14, p = 0.047) in Classification 1 and with conjunctival lissamine green staining (CLGS) (r = 0.23, p = 0.040) in Classification 2. Conclusion: There were no significant correlation between the symptoms of dry eye and the clinical signs of dry eye. Therefore, the clinical diagnosis of dry eye can be made based on either just on the symptoms or the signs.

Effects of Pentadecapeptide BPC 157 on Experimental Rat Model of Dry Eye

AimWe hypothesize the stable gastric pentadecapeptide BPC 157 as a therapy of dry eye syndrome in rats. BPC 157 already cures ocular tissues. BPC 157 eye drops (ug‐ or ng‐regimen) rescued total debridement of corneal epithelium (Coll Antropol 2005;29(1):321–5), successfully closed perforating corneal incisions in rats (Exp Eye Res 2015;136:9–15), counteracted particular NO‐specific parallel miotic effect of L‐NAME and L‐arginine and atropine‐induced mydriasis in rats and guinea pigs (Eur J Pharmacol 2016;771:211–9). In addition, BPC 157 counteracts various ulcerative lesions in skin and gastrointestinal tract, and BPC 157/NO‐relationship is established in various experimental models and species (Curr Pharm Des 2014;20(7):1126–35), providing that it would counteract the damaging effects of lacrimal gland extirpation, and dry eye syndrome. Dry eye syndrome is a relatively common disease with multifactorial causes, which may cause simptoms variating from discomfort to blindness. This study aimed to evaluate the effect of BPC 157 on the rat dry eye model.MethodsWe used male Albino Wistar rats, 200g, randomly divided. After application of Ketmine‐HCl 50–60 mg/kg + Xylazine‐HCl 5–10 mg/kg, Tetrakain 0,5% drops, left extraorbital lacrimal gland was isolated from surrounding tissues and surgically removed. Rats received stable gastric pentadecapeptide BPC 157 (Diagen, Slovenia) topically (5 drops (2 μg/ml)) or an equivolume of destilled water (controls). Corneal defects were analyzed with microcamera observation using blue light after 0.5% fluorescein eye drop instillation. These examinations were performed in both treated and control eyes at baseline and on weeks 1, 2 and 4.ResultsPentadecapeptide BPC 157 administered topically significantly reduced clinical signs of dry eye by decreasing corneal defect in all treated groups (Figure 1), while in control groups corneal defect persisted (Figure 2)ConclusionBPC 157 was originally an anti‐ulcer peptide used in trials for ulcerative colitis and now is in trials for the treatment of multiple sclerosis (Curr Pharm Des 2014;20(7):1126–35). Now, we demonstrated that pentadecapeptide BPC 157 counteracts dry eye lesions in rats.Support or Funding InformationUniverity of Zagreb, Zagreb, Croatia (Grant number BM099)

Anti-Inflammatory and Antioxidative Effects of Camellia japonica on Human Corneal Epithelial Cells and Experimental Dry Eye: In Vivo and In Vitro Study.

To analyze the anti-inflammatory and antioxidative effects of Camellia japonica (CJ) on human corneal epithelial (HCE) cells and its therapeutic effects in a mouse model of experimental dry eye (EDE). Camellia japonica extracts of varying concentrations (0.001%, 0.01%, and 0.1%) were used to treat HCE cells. Dichlorofluorescein diacetate (DCF-DA) and dihydroethidium (DHE) assays were performed. The production of peroxiredoxin (PRX) 1-6 and manganese-dependent superoxide dismutase (MnSOD) in HCE cells was assessed using Western blot analysis. Furthermore, eye drops containing 0.001%, 0.01%, or 0.1% CJ extract or a balanced salt solution (BSS) were applied to the EDE. Clinical parameters were measured 7 days after treatment. The levels of inflammatory markers and intracellular reactive oxygen species (ROS) were measured. Treatment with 0.01% and 0.1% CJ extracts decreased apoptosis in HCE cells. In addition, band intensities of PRX 1, 4, and 5, as well as MnSOD, after hydrogen peroxide (H2O2) treatment showed a significant improvement after pretreatment with 0.01% and 0.1% CJ extracts. Mice treated with 0.1% CJ extract showed significantly improved clinical parameters when compared to those of the EDE control and BSS groups. A significant decrease in the levels of inflammatory markers and intracellular ROS was observed in the 0.01% and 0.1% CJ extract groups. Camellia japonica extracts promoted antioxidative protein expression and suppressed apoptosis in HCE cells. Furthermore, CJ extracts improved clinical signs of dry eye and reduced oxidative stress and the expression of inflammatory markers, suggesting that eye drops containing CJ extract could be used as an adjunctive treatment for dry eye.

Reduced Levels of Tear Lacritin Are Associated With Corneal Neuropathy in Patients With the Ocular Component of Sjögren's Syndrome.

PurposeTo determine whether levels of endogenous tear protein, lacritin, are linked to altered corneal innervation and dry eye severity in patients with Sjögren's syndrome (SS).MethodsClinical data were obtained from 10 SS and 10 age-matched controls. Enzyme-linked immunosorbent assay was used to assess total tear lacritin extracted from Schirmer strips. Western blot was used to detect active lacritin monomer (∼25 kDa), active lacritin fragment (∼12–15 kDa), and inactive tissue transglutaminase–generated lacritin (≥40 kDa). In vivo confocal microscopy was used to assess nerve fiber density (NFD) and length (NFL). Relationships between nerve morphology and tear lacritin were examined by Spearman correlation. Diagnostic performance of tear lacritin was analyzed using receiver operating characteristic.ResultsActive tear lacritin was significantly reduced in SS patients (3.72 ± 5.62 [SS] versus 18.17 ± 4.57 ng/100 ng total tear protein [controls]; P < 0.001), while inactive lacritin was increased (84.99% ± 11.15% [SS] versus 51.04% ± 12.03% [controls]; P < 0.001). Nerve fiber density (21.70 ± 18.93 vs. 31.80 ± 9.35; P = 0.03) and NFL (4.18 ± 3.44 vs. 6.54 ± 2.47; P < 0.05) were significantly decreased in SS patients compared to controls. Reduced NFL (r = 0.74, P < 0.01) and NFD (r = 0.70, P < 0.01) were highly correlated with reduced tear lacritin. Similarly, total tear lacritin was highly correlated with Schirmers (r = 0.77, P < 0.01), ocular staining (r = −0.80, P < 0.01), and corneal sensitivity (r = 0.81, P < 0.01). Tear lacritin showed equivalent or better diagnostic performance compared to traditional clinical measures for SS (100.00% sensitivity, 85.71% specificity, cutoff = 14.50 ng/100 ng tear protein).ConclusionsReduced tear lacritin levels in SS patients are highly correlated with clinical signs of dry eye, as well as decreased NFD and NFL. Lacritin and its components provide excellent diagnostic sensitivity and specificity in SS.

Transcutaneous periorbital electrical stimulation in the treatment of dry eye

PurposeTo evaluate efficacy and safety of transcutaneous application of electrical current on symptoms and clinical signs of dry eye (DE).Methods27 patients with DE underwent transcutaneous electrostimulation with electrodes placed onto...

Clinical Objective Dry Eye Tests in a Population of Tannery Workers in North India

ABSTRACTPurpose: To analyze the correlation between subjective symptoms and clinical signs of dry eye among tannery workers.Methods: In this cross-sectional study, three classic clinical tests, namely the fluorescein tear film break-up time (FTBUT) test, the fluorescein staining (FS) test, and the Schirmer test (ST), were performed to assess the clinical signs of dry eye disease in 246 tanners who were found symptomatic for dry eye in a prior ocular surface disease index survey.Results: All workers were male with a mean age of 35 ± 9 years, and the mean duration of work at tanneries was 8 ± 5 years. Among 246 symptomatic subjects, the FTBUT test, the FS test and the ST were positive in 63.8%, 30.9% and 41.9% workers, respectively. Mean FTBUT and ST scores were 10.6 ± 4.2 seconds and 10.1 ± 7.7mm, respectively. Mean FTBUT for mild, moderate and severe symptom categories differed significantly. Mean ST scores for the mild symptom group were significantly higher than that of the moderate group (p < 0.0001). The FTBUT and ST score showed a strong negative correlation with severity of symptoms (p < 0.0001). A moderate positive correlation was observed between FS positivity and increasing symptom severity (p < 0.0001). The effect of age was insignificant for FTBUT (p = 0.10), while significant for ST score (p < 0.001). The effect of duration of tannery work was significant for both FTBUT and ST scores (p < 0.0001).Conclusion: Clinical tests correlated well with symptom severity among tanners, and a multifactorial etiology is suggested for dry eye diseases.

Ocular surface disease in patients with diabetic peripheral neuropathy

PurposeTo analyse clinical signs and symptoms of ocular surface disease in patients with diabetes mellitus (DM), based on severity of diabetic peripheral neuropathy (DPN).MethodsThis cross-sectional study included participants who were...

Evaluation of a cyclosporine A ophthalmic ointment in an experimental mouse model of dry eye

PurposeDry eye syndrome is a common disease with multifactorial causes. Symptoms typically include irritation, dryness, burning and decreased or fluctuating vision. Anti‐inflammatory drugs are widely used for the treatment of the inflammation produced by the disease with corticoid or cyclosporine A (CsA). Restasis® (Allergan), a CsA emulsion, was approved by the FDA but is not available in Europe. Here we propose to show the action of Optimmune® (MSD Animal Health) a marketed veterinary ophthalmic ointment that contains CsA in an experimental mouse model of dry eye induced by scopolamine, a tropane alkaloid drug with muscarinic antagonist effects.MethodsAnimals were divided in three groups of ten pigmented mice: Two groups were exposed to desiccating conditions (relative humidity &lt;25%, air‐flow 15 L/min, temperature 20‐22°C) with transdermal scopolamine administration (0.5 mg/72 h) for 14 days. Animals were treated topically three times a day with 0.2% CsA ointment or vehicle. Controls were saline‐treated animals placed in a normal environment. Tear production was measured with the phenol red thread test, corneal defects were examined by slit‐lamp observation using blue light after 0.5% fluorescein eye drop. These examinations were performed in both eyes before exposure and on days 3, 7 and 14. A histological study was performed at the end of the study.ResultsCyclosporine A eye ointment appeared to show efficacy in this model.ConclusionsCyclosporine A eye ointment significantly reduced clinical signs of dry eye by decreasing corneal defect more than cyclosporine A ophthalmic emulsion (internal studies).

Prevalence of dry eye amongst black and Indian university students aged 18–30 years

Background: The overall prevalence of dry eye in South Africa seems to be increasing. University students work under conditions predisposing them to dry eye, which may affect some tasks. The predominant race groups at the University of KwaZulu-Natal (UKZN) are black and Indian, which suggested a study in this student population to assist the diagnosis and management of such subjects.Aim and setting: To compare the prevalence of dry eye amongst black and Indian students at the UKZN’s Westville campus.Methods: One hundred participants, equally divided by gender and race, between 18 and 30 years old were enrolled. Dry eye symptoms were investigated by the ocular surface disease index (OSDI), tear thinning time (TTT), tear breakup time (TBUT) and Schirmer’s 2 in that sequence on both eyes of each participant.Results: The OSDI revealed that 41% of participants had some dry eye symptoms whilst 59% had no symptoms. Clinical testing showed that 81% of participants had dry eye. Half of the black participants had dry eye symptoms and 82% had clinical signs of dry eye. Of the 50 Indian participants, 32% had dry eye symptoms and 80% had clinical signs. Of the 50 male participants, 34% were symptomatic and 86% had clinical signs. Of the 50 female participants, 48% had dry eye symptoms and 76% had clinical signs. Participants were asymptomatic even in the presence of clinical dry eye signs.Conclusion: For both races and genders, clinical signs of dry eye were more common than symptoms. Black participants were more likely to report symptoms than Indians, and more women than men reported having symptoms. Male participants were more likely than female to have clinical signs of dry eye.

Validity of subjective assessment as screening tool for dry eye disease and its association with clinical tests.

To determine the role of subjective assessment using McMonnies dry eye questionnaire in diagnosing dry eye disease and its association with clinical tests. There were 500 patients screened for dry eye using McMonnies dry eye questionnaire between May to October 2013 at the outpatient Department of Ophthalmology of a medical college hospital. All 500 patients were subjected to clinical tests. Dry eye was defined as having one or more symptoms often or all the time. Positive signs were if one or both eyes revealed tear film breakup time (TBUT) of ≤10s, a Schirmer test score of ≤10 mm, a Rose Bengal staining score of ≥1, a Lissamine green staining score of ≥1 or existence of meibomian gland disease (≥grade 1). Statistical analysis was performed to describe the distribution of symptoms and signs, to assess the correlations between McMonnies score (MS) and variable clinical signs of dry eye, and to explore the association between dry eye symptoms and variable clinical signs. Analysis was performed using software package Epi info. A Probability (P) value using Chi-square test of <0.005 was taken as significant. Dry eye prevalence with symptoms (questionnaire), Schirmer test, TBUT, Rose Bengal staining and Lissamine green staining was 25.6%, 15.20%, 20.80%, 23.60%, and 22.60% respectively. Among those with severe symptoms (MS>20), 75.86% had a low TBUT (<10s), 58.62% had a low Schirmer's I test (≤10 mm), 86.20% had Rose Bengal staining score of ≥1, 79.31% had Lissamine green staining score of ≥1. We found statistically significant associations between positive Schirmer test and arthritis (P<0.002), dryness elsewhere (P<0.001), contact lens use (P<0.002), systemic medication (P<0.0001), sleeping with eyes partly open (P<0.002), history of dry eyes treatment (P<0.0001), environmental factors (P<0.001), swimming (P<0.001). Subjective assessment plays an important role in diagnosing dry eye disease. There is strong correlation between MS and Schirmer test, TBUT, Rose Bengal staining and Lissamine green staining in normal as well as marginal and pathological dry eye.

Effects of cyclosporine in an experimental rat model of dry eye

AbstractPurpose Dry eye syndrome is a relatively common disease with multifactorial causes. It has been shown that rodent models of dry eye experimentally induced by scopolamine, a tropane alkaloid drug with muscarinic antagonist effects, could be helpful to test and select therapeutic candidates in the disease. Here we propose to show the action of cyclosporine A, an inhibitor of T‐cell activation and inflammatory cytokine production, after oral and topical administrations.Methods Experimental dry eye was induced in female albino rats by a systemic and continuous delivery of scopolamine (20 mg/day) over 21 days via osmotic pumps implanted subcutaneously on day 1. Animals were divided in three groups of five animals: The first two groups were instilled either saline or cyclosporine 0.05% eye drops and the third group received 20mg/kg/day cyclosporine by oral administration. Tear production was measured with the phenol red thread test, tear break‐up time was studied under slit‐lamp, and corneal defects were examined by slit‐lamp observation using blue light after 0.5% fluorescein eye drop instillation and in vivo confocal microscopy. These examinations were performed in both eyes at baseline and on days 7, 14 and 21.Results Cyclosporine orally or topically administered significantly reduced clinical signs of dry eye by increasing lacrimation and decreasing corneal defect.Conclusion Cyclosporine appears to show efficacy in this model, regardless of the mode of administration. Commercial interest

Effects of a New Lipid Tear Substitute in a Mouse Model of Dry Eye

The present investigation is aimed to evaluate the effect of a new lipid artificial tear on tear volume and ocular surface signs in a mouse model of dry eye and to test the hypothesis that the combined application with sodium hyaluronate can improve the performance of the treatments. A new oil-in-water emulsion, a 0.2% sodium hyaluronate solution, or their combined administration were given to dry eye mice maintained in a controlled environment chamber and treated with scopolamine (0.75-mg transdermal patch). Mice were treated 4 times a day with (a) sodium hyaluronate, (b) emulsion, and (c) sodium hyaluronate followed by emulsion. A control group of mice exposed to controlled environment chamber remained untreated (CTRL+). Tear volume and corneal damage were assessed after 3 and 7 days of treatment by cotton thread test and fluorescein staining. As regards tear volume, sodium hyaluronate did not show a statistically significant effect at either end point; the emulsion was effective after 7 days, whereas their combined administration counteracted the lacrimal decrease induced by the model both at 3 and 7 days. Corneal damage was reduced in all treated groups with respect to CTRL+. This effect was statistically significant after 3 days when the emulsion alone or in combination with sodium hyaluronate was used, while hyaluronate improved this clinical sign after 7 days. Our data suggest that the new lipid tear substitute can be used to treat clinical signs of dry eye and that the combined administration with hyaluronate can decrease the lag time before the effect, when the evaporative and the aqueous-deficient components are present.