Conjunctival Folds Research Articles

In vivoconfocal microscopic evaluation of corneal Langerhans cell density, and distribution and evaluation of dry eye in rheumatoid arthritis

Corneal Langerhans cells (LCs) offer the opportunity to gain insight into the activity of the innate immunity. We examined the density and the distribution of LCs and compared the results with dry-eye parameters in rheumatoid arthritis (RA). Fifty-two RA patients with various degrees of disease activity and 24 healthy subjects were enrolled. Peripheral and central LC number and morphology were assessed with invivo laser confocal microscopy. In addition, ocular surface disease index (OSDI), lid parallel conjunctival folds, Schirmer test, and tear break-up time (TBUT) were evaluated. The prevalence of central and peripheral LC, and the central LC morphology values (LCM) were higher than normal in RA. Within the RA group, LC prevalence and morphology were not affected by disease activity. However, patients on anti-TNF or glucocorticosteroid (GCS) therapy exhibited normal LCM, and normal central and peripheral LC density. OSDI was higher and TBUT was lower than normal in RA. The alteration of LC in RA suggests an active inflammatory process in the cornea, which may reflect an increased activation state of the innate immune system-even in inactive stages of RA and without ocular symptoms. The results also indicate ocular effects of GCS therapy in RA.

Lipid-Containing Lubricants for Dry Eye

Dry eye is a common eye condition with significant impact on its sufferers' quality of life. We conducted a systematic review of randomized controlled treatment trials to assess the effectiveness of lipid-containing lubricants (LCLs) on dry eye treatment. An online database was searched without any language or date restrictions. Clinical trials on LCL with non-lipid-containing control eyedrops were included. The outcome measures of each study (including symptoms and clinical signs), their risk of bias (assessed using the Cochrane tool), and strength of evidence were discussed. Three studies on liposomal lid sprays and four on lipid-containing eyedrops were included. All studies found significant improvements in most of the symptoms/signs of dry eye in patients who used LCL during the study period. Subjects in all trials reported greater symptom relief with LCLs, although this was shown to be short lived in two studies. Lipid layer structure improvement after LCLs application was demonstrated in two studies, although only up to 90 min in one study. Improvement in Schirmer test results was shown in two out of four studies, tear breakup time in four out of five studies, meibomian gland status in three out of three studies, conjunctival folds and tear evaporation rates in two out of two studies each. None of the studies were completely free of risks of bias; only three studies were double masked. Three of the studies were assigned high level of evidence, three were assigned as moderate evidence, and the final one low level of evidence. Most studies have demonstrated the effectiveness of LCLs on improving select signs of dry eye. Based on the overall substantial level of evidence, this type of eyedrop can be recommended for use in clinical practice where the aim is to reduce the signs and symptoms of dry eye.

Lid-parallel conjunctival folds (LIPCOF) and dry eye: a multicentre study

AimsThe study was designed to test the clinical application of the grading of lid-parallel conjunctival folds (LIPCOF) as a diagnostic test for dry eye.MethodsAt 12 centres in 11 countries, 272...

In vivo confocal microscopic examination of corneal Langerhans cell density, distribution and evaluation of dry eye in rheumatoid arthritis

AbstractPurpose To examine the density and the distribution of corneal Langerhans cells (LCs) and to compare the results with dry‐eye related parameters in rheumatoid arthritis (RA).Methods 52 RA patients (mean age: 58 [49‐66]) with various degree of disease activity and 24 healthy subjects (mean age: 61 [52.5‐67]) were enrolled. Central and peripheral LC number and morphology were assessed with in vivo confocal laser corneal microscopy. In addition, lid parallel conjunctival folds (LIPCOF), tear break up time (TBUT), Schirmer’s‐test (ST), and ocular surface disease index (OSDI) were also evaluated. .Results The prevalence of central and peripheral LCs and the central LC morphology values (LCM) were higher in RA compared to controls (median [interquartile range]: 42.50 [22.95‐93.50] vs 10.00 [0.00‐42.33] cell/mm2, 98.00 [62.00‐154.5] vs 59.50 [45.25‐94.75] cell/mm2, and 2.00 [1.00‐2.00] vs 1.00 [0.25‐1.00], respectively, p<0.05 for all). Within the RA group, LC prevalence and morphology were not affected by disease activity. However, patients on anti‐TNF or corticosteroid therapy exhibited LCM and central and peripheral LC density comparable to controls. TBUT values were lower and OSDI scores were higher in RA than in controls (9.00 [7.00‐12.00] vs 12.00[9.00‐14.00] seconds and 20.00 [10.93‐38.21] vs 9.75 [4.93‐16.28], respectively, p<0.05 for all). ST results were comparable in RA and controls.Conclusion Dendritic cell accumulation and maturation in the corneal center suggest the involvement of the cornea in RA, even in patients in inactive stage and without ocular symptoms.

Evaluation of Tear Osmolarity in Non-Sjögren and Sjögren Syndrome Dry Eye Patients With the TearLab System

To evaluate tear osmolarity with the recently introduced TearLab system (TearLab Corporation, San Diego, CA) in patients with non-Sjögren syndrome dry eye (NSSDE) and Sjögren syndrome dry eye (SSDE), and in healthy subjects, and to compare the results with those from classical dry eye tests. Thirty-nine eyes of 21 patients with NSSDE, 39 eyes of 20 patients with SSDE, and 44 eyes of 22 healthy individuals were included in the study. Tear osmolarity was measured with the TearLab system, lid-parallel conjunctival folds score was examined with the slit lamp, and then the classical diagnostic tests such as Schirmer I test, tear film break-up time, and corneal staining were carried out, followed by the examination of meibomian glands and corneal transparency. Mean tear osmolarity was 296.77 ± 16.48 mOsm/L in NSSDE (15% abnormal), 303.36 ± 17.22 mOsm/L in SSDE (23% abnormal), and 303.52 ± 12.92 mOsm/L in the control group (16% abnormal; P = 0.018, Kruskal-Wallis). Schirmer test, corneal staining, tear film break-up time, and meibomian gland status were significantly different in the 2 patient groups when compared with those in the control group (P < 0.0001). In the control and SSDE groups, no significant correlation was disclosed between tear osmolarity and any of the dry eye tests performed. Tear hyperosmolarity is considered a key factor that leads to dry eye symptoms and to the progression of clinical signs. Osmolarity measurements with the TearLab system disclosed no ability to distinguish between healthy individuals and patients with dry eye. This suggests that the TearLab device should not be used alone but in combination with classical dry eye tests.

Increased Tear Osmolarity in Patients with Severe Cases of Conjunctivochalasis

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

OCT Imaging of Lid-Parallel Conjunctival Folds in Soft Contact Lens Wearers

To visualize, using Fourier-domain optical coherence tomography (FD-OCT), the alterations in lid-parallel conjunctival fold (LIPCOF) morphology in eyes with contact lenses and after their removal. One randomly selected eye of each of 24 volunteers with normal ocular surface status was examined using FD-OCT. The study group included 18 female and 6 male subjects, with a mean age of 28.9 years (range, 18-50 years). The presence, height, and number of conjunctival folds and the tear meniscus area were evaluated by FD-OCT, and the difference between "before and after lens removal" were analyzed by the Wilcoxon signed-rank test. To determine the coverage of the folds, the OCT-LIPCOF grading system was applied. Visualization of the folds was compared on linear and raster scans. The Spearman rank test was applied for correlations (SPSS 16.0; SPSS Inc., Chicago, MI). OCT scans were able to visualize and objectively describe the LIPCOF and its relation to the tear film in contact lens wearers. Raster scanning provided more information about the folds, but the measurements were easier to carry out on the single line scans. After removal of the contact lens, the height of the conjunctival folds significantly decreased (p < 0.001), and the tear meniscus area significantly increased (p = 0.017). The number of LIPCOF did not change (p = 0.971), but LIPCOF coverage by the tear film increased after lens' removal and resulted in changes in the OCT-LIPCOF grading (p < 0.001). FD-OCT could be a quick, non-invasive, quantitative method for the imaging of LIPCOF in contact lens patients. When grading LIPCOF, the mechanical forces of the lens and the tear meniscus changes caused by the lens should be taken into account as these factors influence results. Follow-up of the patients using the same methods is suggested with or without contact lenses.

Imaging Lid-Parallel Conjunctival Folds with OCT and Comparing Its Grading with the Slit Lamp Classification in Dry Eye Patients and Normal Subjects

To visualize and describe the morphologic appearance of lid-parallel conjunctival folds (LIPCOFs) by using optical coherence tomography (OCT) and to relate it to dry eye signs and symptoms. The LIPCOF grade, noninvasive tear film breakup time (NIBUT), lipid layer interference pattern, and dry eye symptoms were recorded in 17 normal subjects and 33 patients with dry eye. LIPCOFs were evaluated with a slit lamp and visualized by OCT. Three different algorithms for OCT were developed to grade LIPCOFs according to tear meniscus height or the covering tear film on the folds. The three OCT methods showed significant correlation with the slit lamp method (r = 0.470-0.473, P < 0.01). The OCT LIPCOF imaging methods were independent of NIBUT. The Dry Eye Questionnaire (DEQ) scores correlated with the height of the folds and the absence of tear film coverage of the folds (r = 0.574, P < 0.001 and r = -0.527, P < 0.001, respectively). The OCT LIPCOF grades correlated with the DEQ scores (r = 0.494, P < 0.001 and r = 0.310, P = 0.029, respectively). The slit lamp grade did not correlate with the DEQ scores in the whole population, but did in the normal group (r = 0.458, P = 0.024). The OCT LIPCOF grades showed inverse correlation with lipid pattern in the normal group (r = -0.422-0.481, P = 0.05); however, this association disappeared in the dry eye group. OCT enabled a noninvasive, high-resolution method of imaging, evaluating, and classifying LIPCOFs. These new classifications correlated well with the slit lamp grade and the DEQ scores, promising a new, more objective evaluation of dry eye.

Sicca complex among Egyptian patients with chronic hepatitis C virus infection

The objective of this study was to assess the prevalence of sicca complex (SC) in patients with chronic hepatitis C virus (HCV) infection and its association with clinical and laboratory features of liver disease. Subjective and objective criteria of xerophthalmia and xerostomia were investigated in 120 HCV Egyptian patients. The lacrimal gland function was assessed by: tear film break-up time and lid parallel conjunctival folds test (LIPCOF), dacroscintigraphy (DSG) for lacrimal drainage and that of salivary glands by sialoscintigraphy. Sixty six of 120 patients (55%) had SC; all (100%) were proved to have xerostomia by sialoscintigraphy and xerophthalmia detected by ophthalmologic tests. Using dacroscintigraphy all SC patients (100%) were positive for lacrimal drainage abnormalities. Only 10.1% were symptomatic for SC. None of our patients had anti-Ro or anti-La antibodies. The presence of SC was associated with older age (r = 0.28, p = 0.00), female gender (p = 0.001), cirrhosis (r = 0.34, p = 0.00), thrombocytopenia (r = -0.72, p = 0.00), and rheumatologic manifestation (p = 0.000), but not with viral load (r = 0.19, p = 0.06). DSG showed significant statistical correlation with ophthalmologic tests (r = 0.87, p = 0.00). High prevalence of SC in HCV Egyptian patients was detected. LIPCOF and DSG are objective and noninvasive methods for early diagnosis of xerophthalmia and assessment of the nasolacrimal drainage, respectively. Hindrance of lacrimal drainage proved by DSG was frequently encountered in HCV patients with SC (100%) and strongly correlated with xerophthalmia.

The relationship between clinical signs and dry eye symptoms.

To evaluate (i) the relationship between traditional and new clinical tests (lid-wiper epitheliopathy (LWE), lid-parallel conjunctival folds (LIPCOF)) and dry eye symptoms in non-contact lens wearers, and (ii) that a combination of these tests can improve predictive ability for the development of dry eye symptoms. Tear meniscus height (TMH), non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test (PRTT), corneal and conjunctival staining, and LWE grades were observed in a cohort of 47 healthy, non-lens wearers (male=17, female=30, median age=35 years, range=19-70). Symptoms were assessed using the Ocular Surface Disease Index (OSDI). LWE was significantly correlated to both temporal and nasal LIPCOF (0.537<r<0.607, P<0.05). LIPCOF and LWE were significantly correlated to NIBUT and PRTT (r > -0.248, P < 0.001). Significant correlations were found between NIBUT and TMH (r=0.461, P=0.001) and PRTT (r = 0.640, P < 0.001). OSDI scores were significant correlated to NIBUT, TMH, PRTT, LIPCOF, and LWE (r>∣0.31∣; P<0.05). Significant discriminators of OSDI+/- were NIBUT (area under the receiver operative characteristic curve (AUC)=0.895), TMH (0.715), PRTT (0.781), LIPCOF (temporal/nasal/Sum 0.748/0.828/0.816), and LWE (0.749). Best predictive ability was achieved by combining NIBUT with nasal LIPCOF (AUC=0.944). The individual tests NIBUT, TMH, PRTT, LIPCOF, and LWE were significantly, but moderately, related to OSDI scores. The strongest relationship appeared by combining NIBUT with nasal LIPCOF.

Quantitative Evaluation of Ocular Surface Inflammation in Patients with Different Grade of Conjunctivochalasis

Purpose: To evaluate and compare HLA-DR expression of conjunctival epithelial cells in different grade of conjunctivochalasis (CCh).Patients and Methods: Thirty patients and seven healthy subjects underwent clinical examination, grading of CCh by lid-parallel conjunctival fold (LIPCOF) test, and impression cytology of the bulbar conjunctiva. HLA-DR expression was analyzed by flow cytometry. Schirmer test, tear break-up time, and vital staining were also performed.Results: Patients who presented with mild and moderate CCh showed a similar expression of HLA-DR to normal subjects. A significant increase (p < 0.005) of HLA-DR was found in patients with severe CCh. Positive correlation was found between fluorescein staining and HLA–DR expression (r = 0.36, p = 0.009) and between lissamine–green staining and HLA-DR expression (r = 0.30, p = 0.027). Neither correlation was found between Schirmer test nor break up time and HLA-DR expression.Conclusion: Inflammation plays a pivotal role on the ocular surface of patients with severe CCh. Since mild and moderate CCh HLA-DR expression was similar to normal controls, we can speculate that the source of inflammation could be the presence of conjunctival folds.

Vergleichende Untersuchung zur Therapie des evaporativen trockenen Auges

Evaporative dry eye is the most common form of tear film dysfunction. The present trial aims to evaluate the efficacy of two established treatment options with different modes of action by comparison. 216 patients suffering from evaporative dry eye were included in this prospective, randomised two-centre trial. Divided into two treatment groups, patients either received treatment with hyaluronate artificial tears (Vismed light) or a phospholipid-liposome eye spray (Tears Again), each for three months. Tests (lid-parallel conjunctival folds [LIPCOF], non-invasive break-up time [NIBUT], Schirmer's test, inspection of lids and subjective assessment) were performed before as well as 4 and 12 weeks after initiation of this study. In the patients of the eye spray group there was a significantly greater reduction of the LIPCOF grade (p < 0.02) and the grade of inflammation of the lid margin (p < 0.002). With respect to the tear film break-up time (NIBUT) there was a significant difference between the results of both groups (p < 0.003). The improvement of the break-up time in patients of the eye spray group turned out to be more than twice as high as that in the artificial tears group. Both therapies improved evaporative dry eye, but patients on phospholipid-liposomal eye spray demonstrated greater clinical benefit from their therapy, particularly regarding the degree of inflammation of the lid margins as well as the grade of LIPCOF. When compared to hyaluronate artificial tears, NIBUT more than doubled in the phospholipid-liposome eye spray group. Clinical severity of dry eye is more pronounced when evaporative dry eye and aqueous tear deficiency coincide. A combination of the phospholipid-liposome eye spray and artificial tears appears to represent a considerable advancement in tear replacement therapy for severe cases of dry eye.

A Novel Method to Predict the Dry Eye Symptoms in New Contact Lens Wearers

Lid wiper epitheliopathy (LWE) and lid parallel conjunctival folds (LIPCOF) give moderate prediction levels for dryness symptoms in experienced contact lens (CL) wearers. This study investigated whether a combination of LWE and LIPCOF plus other tear film tests and subjective evaluation before contact lens fitting was better able to predict CL-induced dry eye (CLIDE) symptoms. Tear meniscus height, non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test, corneal and conjunctival staining, and LWE of the right eye of 33 new soft CL wearers (12 males, 21 females, median age = 30.5 years; range = 19 to 44) were assessed in a prospective 2-mo longitudinal study. Symptoms were evaluated by the Ocular Surface Disease Index (OSDI) and subjects were grouped according to their response in the Contact Lens Dry Eye Questionnaire (CLDEQ) during the study (20 symptomatic and 13 asymptomatic). The subjects were fitted with vifilcon A and senofilcon A lenses for a 2-week period, consecutively. Limbal hyperaemia (repeated measures analysis of variance; p < 0.05) and LWE (Friedman; p < 0.004) increased significantly during the study but not LIPCOF (p > or = 0.318; temporal, nasal, and Sum), bulbar hyperaemia (p = 0.432), staining (p > or = 0.060), OSDI (p = 0.126), or CLDEQ (p = 0.317, kappa = 0.279). Limbal hyperaemia significantly decreased in senofilcon A lenses. Wearing comfort among symptomatics was significantly better with senofilcon A (p = 0.005). At the enrolment visit, the subjects who became symptomatic exhibited significantly decreased NIBUT and increased LIPCOF and OSDI (range, p < 0.027). The best test combination to predict CLIDE (logistic regression analyses) was LIPCOF Sum plus NIBUT and OSDI, (positive predictive value = 87% and accuracy = 91%). LIPCOF, NIBUT, and OSDI are significant discriminators for CLIDE in new CL wearers compared with hyperaemia, tear meniscus height, phenol red thread test, staining, and LWE. The best test combination is NIBUT plus LIPCOF Sum and OSDI (named the Contact-Lens-Predicting-Test).

The effectiveness of questionnaires in the determination of Contact Lens Induced Dry Eye

This study investigates how well the recently introduced Ocular Comfort Index (OCI) and the more established McMonnies Dry Eye Index are able to detect contact lens induced dry eye (CLIDE). Seventy volunteer contact lens wearers (mean age = 28.7 +/- 8.0; 52 female, 18 male) were grouped as CLIDE positive or CLIDE negative depending on three sets of criteria: Method I: objective (tear meniscus height, lid parallel conjunctival folds, phenol red thread test and tear break-up time); Method II: objective and/or subjective [contact lens dry eye questionnaire (CLDEQ)] (i.e. being positive by Method I and/or Method III); Method III: subjective (CLDEQ). Symptoms were measured using the McMonnies Dry Eye Index and the OCI. Discrimination was analysed by the receiver operating characteristic (ROC) curves; positive predictive values (PPV) and cut-off values were calculated. ROC results for Methods I and II were statistically significant only for the McMonnies (p = 0.008; p < 0.001; respectively). In Method III ROC results were statistically significant for both the McMonnies (p = 0.001) and OCI (p = 0.005). The McMonnies showed the best prediction of Method I [0.646/10.5 (PPV/cut-off value)], while the OCI gave the best predictability in Method III only (0.518/30.6). A McMonnies scoring of > or = 10.5 or an OCI scoring of > or = 30.6 indicates CLIDE. The McMonnies performs better in prediction of CLIDE than the OCI.

Clinical Tests for Successful Contact Lens Wear: Relationship and Predictive Potential

Although comfort is important for contact lens wearers, common clinical tests can fail to predict patients' symptoms. Lid wiper epitheliopathy (LWE) and lid parallel conjunctival folds (LIPCOF) are related to dry eye symptoms in lens wearers. This study investigates the predictive value of LWE and LIPCOF as objective measures of discomfort, and their relation to the ocular surface in soft contact lens wearers. Subjects were classified as symptomatic or asymptomatic, using the Contact Lens Dry Eye Questionnaire (CLDEQ). Pre-lens tear break-up time (PLBUT), limbal and bulbar hyperaemia, corneal staining, LWE and LIPCOF were assessed in the right eyes of 61 (23 M, 38 F; mean age 32.1 years; range = 18 to 55) experienced contact lens wearers. Differences between groups, and relationships between LWE, LIPCOF (nasal, temporal and sum) and objective signs were examined using non-parametric analyses. The positive and negative predictive values for symptoms of each objective measure were calculated. Thirty eight subjects were classified as asymptomatic, 23 symptomatic. LWE and LIPCOF severity scores were significantly increased in symptomatic patients (U-test, p < 0.03), while no significant differences were found between groups for PLBUT, corneal staining or hyperaemia (0.29 < p < 0.88). Significant positive correlations were found between LWE and LIPCOF scores (temporal r = 0.67, p < 0.001; nasal r = 0.39, p < 0.001), and between LWE and hyperaemia (bulbar, r = 0.28, p < 0.001; limbal r = 0.36, p < 0.001). Age and gender were different in the two groups (p < 0.05). The predictive value of temporal LIPCOF was positive = 56.9%, negative = 77.1% with a cutoff value of > or =2 (PPV/NPV/cutoff value), of nasal LIPCOF 70.7%/75.0%/> or =1, of LIPCOF Sum 79.8%/86.5%/> or =2, and of LWE 53.1%/81.1%/> or =1. Contact lens wearers with dryness symptoms exhibit significantly more LWE and LIPCOF, but not increased corneal staining, bulbar hyperaemia or decreased PLBUT. LWE and LIPCOF are significantly correlated: this may reflect their common frictional origin. LIPCOF Sum severity scores appear to be most predictive for symptoms.

Mucins and Ocular Signs in Symptomatic and Asymptomatic Contact Lens Wear

Lid wiper epitheliopathy (LWE) and lid parallel conjunctival folds (LIPCOF) are related to dry eye symptoms in contact lens wearers. Both clinical signs are assumed to be related to mechanical forces during blinking. As the mucus layer is a protector of the ocular surface tissue, this study investigates whether any alterations of mucins are detectable comparing symptomatic and asymptomatic soft contact lens wearers. Comfort was evaluated using the Contact Lens Dry Eye Questionnaire. Corneal staining, LWE, and LIPCOF were assessed in the right eyes of 50 (19 men, 31 women; mean age, 32.1 +/- 11.4 years) experienced lens wearers. The tear film was sampled using Schirmer strips pressed onto the temporal conjunctiva and from harvested contact lenses. Mucins were assessed in dot-blots and Western blots after electrophoresis on 1% agarose or 4 to 12% NuPAGE Gels. Non-parametric analyses were used to study differences between groups and correlations between objective tests, mucins, and symptoms. Thirty-one subjects were classified asymptomatic and 19 symptomatic by the questionnaire. LWE and LIPCOF were significantly increased in the symptomatic group (p < 0.035). MUC5AC reactivity was significantly decreased in symptomatics (p = 0.050). MUC4 was correlated to temporal LIPCOF and LWE, (r = -0.47 and -0.46; p < 0.01). MUC16 and MUC5AC correlated with corneal staining (0.36 < r < 0.53; p < 0.04). Symptomatic contact lens wearers exhibit significantly more LWE and LIPCOF, and decreased MUC5AC reactivity. LWE and LIPCOF are significantly correlated; this may reflect their common frictional origin. Increased friction might follow from insufficient mucins, or an altered composition of the resident mucins at the ocular surface. In this study, we show that decreased mucin production is associated with the severity of LWE and LIPCOF.

Comparison between liposomes spray and non preserved tears substitutes in patients with meibomian gland dysfunction

Abstract Purpose Many elderly people present with lachrymal film lipid phase disorder caused by a meibomian dysfunction. During a prospective randomised study performed in Poitou‐Charente, we compared the use of vegetal liposomes in spray (intended for stabilizing the lipid phase) against one of the gold standard lachrymal substitutes. Methods 50 patients aged 75 years old or older with a functional dry eye syndrome due to a meibomian dysfunction were studied between March and June 2007 in the department of ophthalmology of St Louis Hospital. The first group was treated with vegetal liposomes spray (Vyséo®) (3 sprays /day, eyelids closed). The control group received lachrymal substitutes (Refresh Tears® (Polyvynilic alcohol and Polyvidone) 1 eyedrop 6 tid). The following criteria have been studied: inflammation of the eyelids edge, lid‐parallel conjunctival folds (LIPCOF), break up time (BUT), Schirmer I, best corrected visual acuity (BCVA) and Root Mean Square (RMS) with the Imagine Eyes IRX3 wavefront aberrometer. The statistical analysis was done with Prism for Windows. Results The improvement of inflammation at the eyelids edge, LIPCOF, BUT, and RMS was significantly higher in the group treated by Vyséo®. The Schirmer I had not been modified in neither of the two groups. The best patients’ satisfaction and ease of use scores were found in the Vyséo® group. Conclusion Vegetal liposomes spray is easy to use for elderly patients with meibomian dysfunction and provide them with effective long term discomfort relief.

Lid wiper epitheliopathy, ocular surface and tear film in symptomatic contact lens wearers

Abstract Purpose Lid wiper epitheliopathy (LWE) as well as lid parallel conjunctival folds (LIPCOF) are related to dry eye symptoms in contact lens weares and are thought to be caused by mechanical forces during blinking. This study investigates whether any correlations are detectable between LWE and LIPCOF and the ocular surface and tear film in soft contact lens wearers. Methods 38 subjects were classified asymptomatic and 23 symptomatic by the Contact Lens Dry Eye Questionnaire. Pre‐lens break‐up time, ocular hyperaemia, corneal staining, LWE and LIPCOF were assessed in the right eyes of 61 (23 males, 38 females; mean age = 32.1 ±11.4yrs) experienced lens wearers. Pre‐ocular fluid was sampled using Schirmer strips pressed onto the temporal conjunctiva, and from harvested contact lenses. Mucins were assessed in dot‐blots and in Western blots after electrophoresis on 1% agarose or 4‐12% NuPAGE Gels. Results LWE and LIPCOF were significantly increased in the symptomatic group (p&lt;0.03). Significant correlations were found between LWE and both temporal LIPCOF (r=0.67, p&lt;0.001), and nasal LIPCOF (r=0.39, p&lt;0.001), and between LWE and bulbar hyperaemia (r=0.28, p&lt;0.001). MUC5AC reactivity was significantly decreased in symptomatics (p=0.050). MUC4 was negatively correlated to temporal LIPCOF and LWE (r=‐0.47 and ‐0.46; p&lt;0.01), MUC16 and MUC5AC correlated with corneal staining (0.36&lt;r&lt;0.53;p&lt;0.04) Conclusion Symptomatic contact lens wearers exhibit significantly more LWE and LIPCOF, and decreased MUC5AC reactivity. Decreased mucins are associated with LWE and LIPCOF severity. Correlations between LWE and LIPCOF may reflect their common frictional origin. Increased friction might follow from insufficient mucins at the ocular surface.

Sutureless Amniotic Surgery for Pterygium

P terygium is one of the oldest pathologies known to ophthalmologists. Surgery for this condition can range from simple excision to techniques with exotic detail and meticulous maneuvers with task-specific instruments beckoning an era of raised expectations and cosmetic outcomes in the field of ocular surface surgery itself. In my previous publications, I had emphasized on complete removal along with amniotic grafting as a key concept for success. The part of the pterygium that is visible is only the tip of the iceberg (iceberg concept). By removing only this visible portion, the main pathology with its tentacles is not addressed and remains hidden under the conjunctiva. Theories about the etiology of pterygia are diverse and range from hereditary, neurotrophic, angioplastic, and immunologic causes to ultraviolet light exposure. Regardless of the cause, the result is elastotic degeneration with vesiculation of Bowman’s membrane in the cornea and formation of epithelial islets (Fuchs patches) as cysts around the pterygium (seen as glove-finger appearance on histopathologic study). Anatomically, the pterygium is composed of several segments, including Fuchs patches and Stocker line (the iron line), the hood, the head, the body, and the superior and inferior edges. Having previously classified pterygia into 4 categories, I have continuously studied the presentations and the outcomes in improving the surgical approach and outcomes over the years to add an additional way to classify the pterygium based on the adhesion of the head to the ocular surface and vascularity along with the draw test on the cornea. Pterygia can therefore have the following: Head/neck adhesion. Peripheral or central adhesion. In cases of peripheral adhesion, the pterygium easily peels off the cornea. Vascularity. Engorged, tortuous vessels and simultaneous conjunctival fold contracture signifies a more aggressive pterygium. This same concept can be used to determine outcomes postoperatively. Draw test. On tugging on the cornea, some pterygia may be small but outright gritty and deep into the cornea resulting in thin cornea when removed. Preparation for this before surgery helps plan a smooth outcome (amniotic graft itself can be used as a lamellar fill). Also, removal of these pterygia is more difficult from the corneal surface. Amniotic membrane. The advantages of the commercially available membrane are that there is no immune reaction, and it has anti-inflammatory functions, is antiadhesive and antibacterial, encourages epithelial differentiation and growth, and has an antitissue growth factor effect.

623 Évaluation des liposomes végétaux dans le traitement des patients présentant un dysfonctionnement meibomien

Elderly people often complain about symptoms that are often catalogued as dry syndrome and are usually treated by lachrymal substitutes replacing the aqueous phase from the lachrymal film. However, many of these patients have in reality a lachrymal film lipid phase disorder caused by a meibomian dysfunction. During a prospective randomised study performed in Poitou-Charente, we compared the use of vegetal liposomes in spray (intended for stabilizing the lipid phase) against one of the gold standard lachrymal substitutes. 50 patients aged 75 years old or older with a functional dry eye syndrome due to a meibomian dysfunction were studied between March and June 2007 in the department of ophthalmology of St Louis Hospital. The first group was treated with vegetal liposomes spray (Vyséo ® ) (3 sprays/day, eyelids closed). The control group received lachrymal substitutes (Polyvynilic alcohol and Polyvidone) 1 eyedrop 6 tid. The following criteria have been studied: inflammation of the eyelids edge, lid-parallel conjunctival folds (LIPCOF), break up time (BUT), Schirmer I, best corrected visual acuity (BCVA) and Root Mean Square (RMS) with the Imagine Eyes IRX3 wavefront aberrometer. The statistical analysis was done with Prism for Windows. The improvement of inflammation at the eyelids edge, LIPCOF, BUT, and RMS was significantly higher in the group treated by Vyséo ® . The Schirmer I had not been modified in neither of the two groups. The best patients’ satisfaction and ease of use scores were found in the Vyséo ® group. Vegetal liposomes in spray provide quick relief of the functional symptoms in elderly patients with meibomian dysfunction. They also show long term benefits, improving the manifestations linked to chronic ocular surface inflammation. Vegetal liposomes spray is easy to use for elderly patients with meibomian dysfunction, provide them with effective long term discomfort relief and help achieve better compliance to the treatment.