Dry Eye Patients Research Articles

Effects of aerobic exercise on tear secretion and tear film stability in dry eye patients

BackgroundTo study the effects of aerobic exercise (AE) on tear secretion and tear film stability in dry eye patients.MethodsThis study consisted of two parts, each part included 3 groups, namely dry eye without AE group, dry eye with AE group and pre-clinical dry eye with AE group. In part 1, we studied the variations of Schirmer I test and six tear compositions before and after AE (34 eyes in each group). In part 2, we studied the variations of tear meniscus height, first and average non-invasive tear breakup time (F-NITBUT and A-NITBUT), lipid layer thickness, number of incomplete and complete blinks, partial blink rate (PBR) and visual acuity before and after AE (30 eyes in each group).ResultsIn dry eye with AE group, Schirmer I test at 0 min after AE increased significantly compared to baseline (P < 0.001), the oxidative stress marker 8-hydroxy-2′-deoxyguanosine after AE decreased significantly compared to baseline (P = 0.035, P = 0.045), F-NITBUT and A-NITBUT after AE prolonged significantly compared to baseline (P < 0.001, P = 0.007, P = 0.036; P < 0.001, P = 0.001, P = 0.044), number of incomplete blinks and PBR at 10 min after AE decreased significantly compared to baseline (P < 0.001; P < 0.001) while number of complete blinks increased significantly (P < 0.001). Besides, significant differences were also found between dry eye with AE group and dry eye without AE group at all above corresponding time point (P < 0.05).ConclusionAE promotes tear secretion and improves tear film stability in dry eye patients. AE may be a potential treatment for dry eye.Trial registrationChinese Clinical Trial Registry, ChiCTR2000038673. Registered 27 September 2020,

Analysis of the first tear film break-up point in Sj\xf6gren\u2019s syndrome and non-Sj\xf6gren\u2019s syndrome dry eye patients

BackgroundTear film instability plays an important role in the course of Sjögren’s Syndrome dry eye (SSDE) even though it is generally classified as aqueous-deficient dry eye. The measurement of the first tear film break-up point (FTBUP) helps to evaluate the most unstable position of the tear film on ocular surface. We aim to investigate FTBUP in Sjögren’s Syndrome dry eye (SSDE) and non-Sjögren’s Syndrome dry eye (NSSDE) patients, and explore its correlation with dry eye indices.MethodsTwenty-two SSDE patients (44 eyes) and 22 NSSDE patients (44 eyes) were enrolled in the study. Oculus Keratograph K5M was used to measure FTBUP, the first and average non-invasive keratographic breakup time (f-NIKBUT and av-NIKBUT), the tear meniscus height, and meibomian gland dropout. Other tests of tear film were also performed including Ocular Surface Dryness Index (OSDI), Schirmer I test, fluorescein break-up time and corneal fluorescein staining. Dry eye indices and the locations of the FTBUP were compared between SSDE and NSSDE patients. Generalized estimating equation (GEE) was used to ajusted the correlations between right and left eyes. The correlations between the FTBUP and ocular symptoms and signs were investigated using Pearson’s correlation coefficient test.ResultsThe FTBUP occurred at the supranasal quadrant in 12/88 eyes, supratemporal quadrant in 8/88 eyes, inferonasal quadrant in 34/88 eyes, and inferotemporal quadrant in 34/88 eyes. The percentage eyes with inferior FTBUP was significantly higher in the SSDE than in the NSSDE subjects (86.3% vs 68.1%, P = .049). Moreover, in SSDE subjects, temporal breakup point was seen more often in those who presented corneal fluorescein staining in any location, while nasal breakup point was more frequent in those who did not present any corneal fluorescein staining (P = .045).ConclusionThe location of the FTBUP in SSDE patients had specific characteristics. However, the diagnostic potential of FTBUP in early recognition of SSDE needs further validation.

The Effect of Artificial Tear Treatment on Central Corneal Thickness in Dry Eye

Purpose: To evaluate the effect of artificial tear treatment on central corneal thickness in dry eye patients using corneal topography. Materials and Methods: In this before and after study, central corneal thickness measurements using corneal topography (SIRIUS CSO ITALIA) were performed on 192 eyes of 96 patients with dry eye at the ophthalmology department of Tishreen University Hospital/Lattakia from August 2020 to August 2021. Patients underwent ocular examinations, including Schirmer test, slit lamp examination for tear break-up time (BUT), and central corneal thickness (CCT) measurements using corneal topography before and after artificial tear treatment (carboxymethylcellulose and sodium hyaluronate 0,5% eye drop formulations) 3-4 times a day for one month, patients were examined again at a second visit and the results were compared. Results: The mean CCT was (545.79±10.5) before treatment and (571.30±11.3) after treatment (p=0.0001, p=0.0001). CCT statistically significantly increases of 4,7% from baseline (p=0.000) 1. The mean tear BUT and Schirmer-1 tests revealed significant improvement after treatment. Conclusion: Artificial tear treatment in dry eye patients significantly increases the central corneal thickness. This increase could be used as a criterion in the diagnosis and follow up of dry eyes, and this increase in thickness should be considered in intra ocular pressure measurements as well as in refractive surgical procedures.

Outcomes of Sjögren's versus non-Sjögren's related dry eye in a longitudinal, tertiary clinic-based sample.

PurposeTo assess the long-term treatment outcomes of dry eye in patients with and without underlying primary Sjögren’s syndrome (SS).DesignRetrospective longitudinal cohort.MethodsSS and non-SS dry eye patients with clinic visits for a minimum of 5 consecutive years at a tertiary, dedicated dry eye clinic were included. Electronic health records were reviewed to collect data regarding demographics, objective dry eye parameters, treatments utilized at baseline and final visit, and corneal complications observed during follow-up.ResultsTwo hundred and two patients (101 SS and 101 randomly selected non-SS), with a mean follow-up of 7.1 years were included. At baseline, mean conjunctival lissamine green staining score was 2.9 and mean corneal fluorescein staining score was 2.0. At last visit, notable improvement in staining score for cornea (–1.1, P < .001) and conjunctiva (–1.8, P < .001) was seen equally in both dry eye groups. Most patients (88.1%) had an escalation of treatment by the final visit, with similar rates in both groups (P = .51). Half (48.9%) of the patients had no conjunctival staining, and a third (34.4%) had no corneal staining at their last visit. Twenty (9.9%) patients experienced a vision-threatening corneal complication, including ulcers and melt, with no difference in occurrences between the groups (P = .64).ConclusionsThe majority of patients in this longitudinal, tertiary clinic-based sample demonstrated improvement in their ocular surface staining score by the final visit with escalation in treatment. Treatments used, improvement achieved, and corneal complication rates leading to loss of vision were similar in both SS and non-SS dry eye groups.

The Etiology of Dry Eye Syndrome in a Group of Patients visited Ophthalmic Department of Azady Teaching Hospital in Kirkuk

Purpose: To clarify the etiology of dry eye syndrome, distribution of age and gender among study group and to identify risk factors for dry eye. Method: A descriptive study done in Azady Teaching Hospital from 1 of July 2020 to 1 September 2021. The research included 946 patients above 40 years of mixed population. Result: the mean age of study group was 55,5 years, mean age of dry eye group was 57,2 years, The prevalence of dry eye in was 17.8 % and founded to be maximum in the elderly as majority of diagnosed dry eye patients were in their sixties 42%. Dry eye syndrome funded to be more common in female (19.4%) than in male (15.8%). The main etiological factors in our study were either:1-Ocular causes: eye lid diseases (blepharitis and MGD) 20%, abnormal ocular surface 12%, old trachoma 4.8%, ocular surgery (3.6%). 2-systemic disease: were founded to be rheumatoid arthritis (12%), diabetes (10.8%), thyroid disease (4.8%) Sjogren disease (2.4%) and pemphigus (1.2%). 3-Drug induced dry eye: Drugs that contribute to dry eye syndrome discovered to be mainly antihypertensive (15.4%), antiglaucoma (8.4%), antihistamine (2.4%) and anticholinergic (1.2%). Conclusions: Dry eye disease is more common in people over 40,and this should be taken into account when examining patients in ophthalmology clinics, Dry is more common in women, especially postmenopausal Dry eye is a frequent disease and correct diagnosis is the main line in treatment and, so we need to keep in mind those at higher risk.

Effects of dietary high dose DHA omega-3 supplement in dry eye with meibomian gland dysfunction.

To evaluate the clinical efficacy of dietary supplement of high dose DHA omega-3 in dry eye with meibomian gland dysfunction (MGD). Prospective randomized double-masked, placebo-controlled clinical trial was conducted in mild to moderate dry eye patients with MGD. Patients have no history of taking any dietary omega-3 supplements before 3mo. Patients were divided into two groups: 24 patients in the omega-3 group and 26 patients in the placebo group. The omega-3 group received two capsules of Easyeye Dry®, total containing 600 mg of EPA and 1640 mg of DHA, while the placebo group received two capsules containing 3000 mg of olive oil. All patients take two pills once a day. The examination of MGD scores, tear break-up time (TBUT), corneal staining test (NEI), strip meniscometry (SM tube), and ocular surface disease index (OSDI) scores were performed at baseline, after 4 and 8wk. A total of 50 patients were included. There were no differences in baseline characteristics between the two groups, such as age, sex, and other ocular examination findings. The TBUT, NEI, and OSDI scores significantly improved after 4 and 8wk in both groups. While after 8wk TBUT (6.00±1.62s vs 5.08±1.28s, P=0.034) and MGD score (7.2±1.8 vs 8.1±2.6, P=0.033) in the omega-3 group was more significantly improved than that of the placebo group. Dry eye with the MGD patient, a high dose of DHA omega-3 dietary supplement can improve TBUT and MGD score after 8wk, effective in stabilizing the tear film.

Efficacy of Artificial Tears Based on an Extract of Artemia salina Containing Dinucleotides in a Rabbit Dry Eye Model.

(1) Background: Artemia salina is a brine shrimp containing high concentrations of dinucleotides, molecules with properties for dry eye treatment. For this reason, the purpose of the study was to evaluate the effect of the artificial tears based on an extract of Artemia salina in a rabbit dry eye model. (2) Methods: A prospective and randomized study was carried out. Twenty rabbits were divided into 4 groups (n = 5, each group): healthy rabbits, dry eye rabbits, dry eye rabbits treated with hypromellose (HPMC), and dry eye rabbits treated with Artemia salina. Dry eye was induced by the topical instillation of 0.2% benzalkonium chloride. The measurements were performed before and after the treatment for 5 consecutive days. (3) Results: The topical instillation of artificial tears containing Artemia salina showed beneficial effects on tear secretion, tear break-up time, corneal staining, the density of Goblet cells, heigh of mucin cloud secreted by these cells, and mRNA levels of IL-1β and MMP9 in conjunctival cells. Compared with the HPMC, there was a statistically significant improvement (p < 0.05) with the Artemia salina in all the variables under study, except for the conjunctival hyperemia, density of Goblet cells, and mRNA levels of IL-6. (4) Conclusions: The potential of artificial tears based on Artemia salina as a secretagogue agent for dry eye treatment was confirmed, opening the door for future clinical trials and studies to extrapolate the findings for dry eye patients.

Clinical improvement of ocular surface parameters in dry eye patients following treatment with urea/crosslinked-hyaluronate eyedrops correlates with the secretion of MUC-4

ABSTRACT Objectives to assess the ocular surface status and patient’s satisfaction before and after treatment with urea/crosslinked hyaluronate (U-HACL) tear substitute in dry eye (DE) patients. Methods 17 DE patients were included in the study. They instilled U-HACL drops 3 times/day for two months. Symptoms (by OSDI questionnaire and VAS), osmolarity, tear film (through Schirmer test and tear film break-up time), corneal and conjunctival damage (with NEI and van Bijsterveld scores), impression cytology (number of PAS positive cells and MUC-4 immunostaining) and tear sampling were analyzed pre- and post-treatment. Results After the treatment, there was a significant improvement of VAS (7.16±2.59 vs. 3.94±2.23), OSDI (56.96±25.97 vs. 29.94±20.15), Schirmer (8.22±6.86 vs. 10.66±6.92), TFBUT (3.16±2.28 vs. 5.55±2.47), NEI (7.16±2.50 vs. 2.88±2.80) and van Bijsterveld (10.27±4.25 vs. 6.5±3.79) score, p<0.01. No significant changes in osmolarity were found. There was a significant increase of PAS positive cells and in the expression levels of MUC-4 (respectively, 44.21 ± 14.8 vs. 67.0 ± 10.1 and 49.79 ± 20.0 vs. 75.9 ± 20.7), p<0.01. Conclusion Patients showed significant clinical improvement following the administration of U-HACL eye drops. In particular, the rise of MUC-4 expression probably contributed to the increase in ocular wettability and amelioration of clinical parameters.

Comparative of meibomian gland morphology in patients with evaporative dry eye disease versus non-dry eye disease

Many recent studies have showed that morphological changes are one of the key signs of meibomian gland disease (MGD). These changes can be seen even before symptom onset, potentially underestimating the prevalence of MGD; however, until now, there is no conclusive information about the impact of meibomian gland (MG) morphology in tear film physiology and disease. This study aimed to investigate the prevalence of anatomical and morphological MG alterations between patients with evaporative dry eye disease (DED) and healthy controls. Retrospective chart review of seventy-five patients with evaporative DED and healthy individuals who had dry eye assessments included Ocular Surface Disease Index questionnaire, meibum quality, meibum expressibility, lid margin abnormality, ocular staining, non-invasive tear film break-up time, and meibography. We did not find significant differences in MG alterations in the upper lid between healthy and DED subjects. Patients with evaporative DED presented MG alterations in the lower lid more frequently than healthy subjects (54.8 vs. 30.3%; p = 0.03). The presence of shortened glands was the only MG alteration that was more prevalent in the lower lid in dry-eye patients than in healthy subjects (p < 0.05). Subjects with evaporative DED presented more alterations in the lower lid than healthy subjects.

Safety and Efficacy of BroadBand Intense Pulsed Light Therapy for Dry Eye Disease with Meibomian Gland Dysfunction.

BackgroundBroadBand light intense pulsed light (BBL-IPL) therapy has shown to reduce hordeolum and blepharitis frequency. This study aims to evaluate the efficacy and safety of BBL-IPL therapy in patients with dry eye disease (DED) from meibomian gland dysfunction (MGD).MethodsThis is a retrospective, consecutive case series of 48 patients with DED from MGD who underwent BBL-IPL therapy from October 2016 to January 2019 at a single, outpatient clinic in Ontario, Canada. Clinical outcomes included first and average non-invasive keratograph tear break-up times (NIKBUT), bulbar redness (BR) scores, tear meniscus heights (TMH), visual acuity (VA) and meibograph grades. Patient-reported outcomes included the Canadian dry eye assessment (CDEA) questionnaire and patient subjective assessment (PSA) scores. Outcomes were measured at baseline and after completion of 4 monthly BBL-IPL sessions.ResultsThe mean severity of dry eye symptoms as measured by the CDEA and PSA decreased significantly from 19.78 ± 9.62 to 12.08 ± 7.40 (p<0.001) and from 7.65 ± 1.74 to 4.77 ± 2.03 (p<0.001), respectively. Twenty-five percent of patients reported no dry eye symptoms after treatment. The meibograph grade improved significantly in both eyes (p<0.001). Approximately 71.0% and 80.1% of patients had an improved meibograph grade in the right and left eye, respectively. Near-significant improvements were observed for BR scores and VA. There was also a trend towards improved first/average NIKBUT and TMH scores. No adverse events were noted.ConclusionBBL-IPL appears to be an effective and safe treatment modality in improving dry eye symptoms and meibomian gland function in patients with DED from MGD.

Comparison of the Ocular Microbiomes of Dry Eye Patients With and Without Autoimmune Disease.

PurposeThe pathogenesis of dry eye concomitant with autoimmune disease is different from that of dry eye without autoimmune disease. The aim of this study was to explore differences in the microbiota diversity and composition in dry eye with and without autoimmune disease.MethodsSwab samples from the inferior fornix of the conjunctival sac were obtained from dry eye patients without autoimmune disease (n = 49, dry eye group) and from those with autoimmune disease (n = 38, immdry eye group). Isolated bacterial DNAs from swabs were analyzed with 16S rRNA amplicon sequencing.ResultsAnalysis of the alpha diversity revealed no significant differences between subjects in the dry eye and immdry eye groups. Those in the immdry eye group had a distinct microbial composition compared with those in the dry eye group. The combination of the genera Corynebacterium and Pelomonas distinguished subjects in the immdry eye group from those in the dry eye group, with an area under the curve of 0.73 (95% CI = 0.62–0.84). For the same bacteria, the correlations between microbe abundance and the ocular surface parameters were different in the two groups. In addition, the functions of the microbial communities were altered in the two groups.ConclusionsOur study demonstrates changes in the composition and function of the ocular microbiome between subjects in the immdry eye and dry eye groups, which suggests that the potential pathogenesis is different.

Effects of warm compress on tear film, blink pattern and Meibomian gland function in dry eyes after corneal refractive surgery

BackgroundTo assess the effects of warm compress (WC) on tear film lipid layer, blink pattern and Meibomian gland function in patients with dry eye following femtosecond laser small incision lenticule extraction (SMILE) and laser-assisted subepithelial keratomileusis (LASEK).Methods We enrolled 37 eyes of 37 participants, each with dry eye for more than 2 years following SMILE (25 eyes) or LASEK (12 eyes). WC was performed using a spontaneously heating eye mask. Tear film break-up time (TBUT), tear film lipid layer thickness (TFLLT), blink pattern, Meibomian secretory function scores (MGS), visual acuity, spherical equivalent (SE), keratometry, central corneal thickness (CCT) and aberration were assessed before and after WC.ResultsAfter WC, the following mean values all increased relative to baselines: CCT, SE, minimum (Min-), maximum (Max-) and average (Ave-) TFLLT, TBUT, total MGS (TMGS), number of glands secreting any liquid (MGL), and complete blink rate (CBR) (p values ranging from < 0.001 to 0.042). Partial blink frequency (PBF) and partial blink rate (PBR) decreased (p = 0.002 in both cases). The decrease of PBF was higher in SMILE subgroup than in LASEK (p = 0.030). TBUT variation was positively correlated with that of Ave-TFLLT and TMGS (p = 0.046, 0.028, respectively). Max-TFLLT variation was correlated with that of TMGS (p = 0.020).ConclusionsWC may temporarily increase tear film thickness and stability, decrease partial blink, and partly augment Meibomian gland function in dry eye patients after corneal refractive surgeries. Future studies are required to investigate long term clinical efficacy and safety.

Prevalence of Ocular Surface Disorder and Dry Eye in Patients with Glaucoma using Topical Antiglaucoma Medications

Background: The main aim of the study is to establish the prevalence of ocular surface disorders in glaucoma patients treated with topical antiglaucoma medications. Methods: Investigation of 50 eyes of 25 patients has been performed using two or more antiglaucoma medications for six months, and compared with 50 eyes of 25 normal subjects without any ocular problem. After one year each patient was evaluated by Schirmer’s (SCH) test-I Tear break-up time (TBUT), Corneal staining score. Results: The mean values in the glaucoma cases and control groups respectively were as follows: Schirmer’s test-1 (7.63 ± 2.64mm / 12.86 ± 1.93mm; p= 0.001), Tear breakup time (9.44 2 ±.76 sec / 11.8 ± 1.88 sec; p=0.001), Corneal staining score (5.7 ± 2.33 /1.1 ± 0.58; p=0.001). Conclusion: Patients on antiglaucoma therapy have a greater prevalence of ocular surface disease and dry eye. The causative factors were medications with preservatives and longer treatment duration. Keywords: Antiglaucoma medication, dry eye, ocular surface diseases (OSD), Schirmer’s (SCH) test, Tear breakup time, Corneal staining score.

Prevalence of dry eye in patients with systemic lupus erythematosus: a meta-analysis

ObjectivesTo investigate dry eye disease (DED) in patients affected by systemic lupus erythematosus (SLE).MethodsWe conducted a systematic search of the literature on PubMed, EMBASE and the Cochrane Library databases from...

Meibomian gland atrophy with duration of Sjogren's syndrome in adult females.

To investigate the correlation between the duration of Sjögren syndrome (SS) and ocular surface parameters in patients with SS-related dry eye. We analyzed 108 eyes of 108 female patients with primary SS-related dry eye. All patients underwent rheumatoid serologic tests and ocular surface assessments. The ocular surface assessment included the Standard Patient Evaluation of Eye Dryness (SPEED) score, meibomian gland (MG) atrophy, lipid layer thickness (LLT), partial and total blinking, partial blinking rate, Schirmer's I test, non-invasive tear break-up time, and ocular surface staining score. Correlations between the duration of SS and ocular surface assessments were calculated. The average age and SS duration of the participants were 56.7 ± 10.2 (range 21-78) years and 54.15 ± 41.10 (range 1-134) months, respectively. There was a strong positive correlation between SS duration and MG atrophy (r = 0.766, p < 0.001). The correlation between SS duration and MG atrophy rate remained significant after controlling for age (r = 0.559, p < 0.001). Average, maximum, and minimum LLTs showed weak negative correlations with SS duration (r = -0.310, -0.211, and-0.304, respectively, p = 0.014, 0.028, and 0.022, respectively) and MG atrophy (r = -0.191, -0.326, and -0.299, respectively, p = 0.049, 0.002, and 0.009, respectively). SPEED score showed a weak positive correlation to SS duration (r = 0.303, p = 0.042) and a moderate positive correlation to MG atrophy (r = 0.450, p = 0.029). Longer duration of primary SS was related to more severe MG atrophy. Therefore, it is necessary to perform meibography in SS patients to verify MG atrophy status. A comparative study with non-SS dry eye patients is required to validate this study.

Evaluation of preoperative dry eye in people undergoing corneal refractive surgery to correct myopia.

To investigate the incidence of preoperative dry eye and related factors in patients undergoing corneal refractive surgery to correct myopia. A total of 141 patients with myopia who underwent corneal refractive surgery were surveyed by questionnaires, tear film break-up time (BUT) test, Schimer I test (SIt), corneal fluorescein staining (FL) test and diagnosed according to the currently recognized domestic diagnostic criteria for dry eye. Correlation analysis of factors such as age, gender, regular wearing of contact lens (CL), diopter (spherical equivalent), corneal thickness, and corneal curvature that may affect the onset of dry eye was carried out to clarify the main influencing factors. There were 64 patients (45.39%) diagnosed with dry eye. The male patients (20.31%) was significantly less than that of non-dry eye subjects (41.56%; χ 2=7.260, P=0.007); the proportion of patients with dry eye wearing CL (81.25%) was significantly higher than that of non-dry eye subjects (51.95%; χ 2=13.234, P<0.001); the median diopter level of dry eye patients was -6.59 (IQR: -8.87, -4.58) D, and the median diopter level of non-dry eye subjects was -5.69 (IQR: -7.15, -4.03) D. The diopter level of dry eye patients was significantly higher (Z=-2.086, P=0.019). However, the age, best corrected visual acuity, and intraocular pressure of dry eye patients were not statistically different from those of non-dry eye subjects (t=-0.257, -0.383 and 0.778, P=0.798, 0.702, and 0.438); the corneal thickness and corneal curvature (K1 and K2) were also not statistically different either (Z=-1.487, -1.036 and -1.707, P=0.137, 0.300, and 0.088). The research further analyzes the three significant factors in the single factor analysis (gender, CL wear, and diopter) in a multi-factor way: CL wear and diopter were the influencing factors of dry eye disease. Among them, CL wear increased the risk of dry eye by 2.934 times compared with no CL wear; for every 1 D increase in diopter, the risk of dry eye increased by 0.761 times. Preoperative dry eye is relatively common in patients who undergo corneal refractive surgery to correct myopia, especially in patients who have a history of CL wear and a high diopter level before surgery. Therefore, it is necessary to carry out preoperative screening and timely treatment of dry eye to obtain the best treatment outcome and postoperative satisfaction.

Assessment of the Compliance with 0.1% Cyclosporine A in Dry-Eye Patients with Sjögren&amp;apos;s Syndrome

Purpose: To evaluate the compliance with 0.1% cyclosporine A in dry eye patients with Sjögren's syndrome and identify factors affecting the compliance. Methods: This study included 67 dry eye patients with Sjögren's syndrome who had used 0.1% cyclosporine A for over 6 months. Clinical parameters including sex, age, the number of eye drops used, side effects, the use of steroid eye drops, and the visit interval were investigated. Additionally, the ocular surface disease index, tear break-up time (TBUT), Schirmer test score, and corneal fluorescein staining (CFS) score were assessed. Patients were classified into compliant and non-compliant groups, using a criterion of 50% compliance; relevant factors were evaluated accordingly. Results: Of the 67 patients, 36 (53.7%) were classified into the compliant group and 31 (46.3%) into the non-compliant group. Compared to the non-compliant group, the compliant group showed a longer TBUT (p = 0.03) and a lower CFS score (p = 0.04) at 6 months of follow-up. Altogether, 39 subjects (58.2%) experienced side effects, of which the most common was stinging pain (71.8%). In the multivariate analysis, severe dry-eye symptoms (p = 0.03), non-use of the steroid eye drops (p = 0.02), and longintervals between exam vitists (p = 0.02) were identified as factors reducing compliance. Conclusions: Factors related to a decrease in the compliance with 0.1% cyclosporine A in dry-eye patients with Sjögren's syndrome, included severe dry eye symptoms, long visit intervals, and non-use of steroid eye drops. Taking these factors into consideration may help increase patient compliance.

The importance of tears stability in SARS-CoV-2 transmission: COVID-19 prevalance in dry eye patients

ObjectiveTo investigate whether dry eye disease (DED) is a risk factor for COVID-19.MethodIn this retrospective cohort study, patients who were diagnosed with DED by an ophthalmologist and whose Schirmer test was less than 5 mm were identified. Patients who missed follow-up examinations, patients with malignancy, Human Immunodeficiency Virus patients and patients having undergone bone marrow transplantation were excluded. Among the DED patients, patients with positive SARS-CoV-2 PCR tests were identified on October 11, 2020. Subsequently, patients were divided into four age groups (25–49; 50–64; 65–79; and 80+). The COVID-19 prevalence per 100,000 people was determined for each age group, and risk analysis was performed by comparing this with the general population in Turkey.ResultsIn total, 10,023 DED patients were identified and included in the study. Among these, the PCR test was positive in 359 patients. The COVID-19 prevalence per 100,000 population in DED patients was calculated as 3581.7, while according to the Ministry of Health data, it was 524.7 in the general Turkish population. The odds ratio of DED patients versus the general population was 6.62 (P < 0.001) (7.66 in the 25–49 group; 6.59 in the 50–64 group; 6.23 in the 65–79 group; and 7.24 in the 80+ age group).ConclusionsThe present study showed a high COVID-19 prevalence in DED patients compared to the general population. These findings support the concept that the ocular surface may be a gateway for SARS-CoV-2 and that the tear film is important part of the immune system.

Calcitriol Alleviates Hyperosmotic Stress-Induced Corneal Epithelial Cell Damage via Inhibiting the NLRP3-ASC-Caspase-1-GSDMD Pyroptosis Pathway in Dry Eye Disease.

PurposeInflammasome activation in response to elevated tear osmolarity behaves as an initial signal in dry eye-related corneal inflammation. Pyroptosis is another prominent consequence of inflammasome activation, which is featured by gasdermin D (GSDMD)-driven cell lysis. This study aims to explore the role of pyroptosis in dry eye, and also to verify if calcitriol, a potential therapeutic agent for dry eye, has certain effects against hyperosmotic stress (HS)-induced pyroptosis in human corneal epithelial cells (iHCECs) and the underlying mechanism.MethodsThe expression of pyroptosis executor GSDMD in tears from dry eye patients was examined using western blotting. iHCECs were grown in hyperosmotic medium (450 mOsM) to mimic the feature of elevated tear osmolality of dry eye in vitro. Exogenous calcitriol or pyroptosis inhibitor disulfiram was used. The extent of pyroptosis of iHCECs under various treatments was examined by scanning electron microscopy, caspase-1 and propidium iodide (PI) double staining by flow cytometry, immunofluorescent staining for ASC speck formation, and western blotting. Cell viability was measured by a CCK-8 assay and an LDH release assay.ResultsWe found that pyroptosis was presented in dry eye patients, shown as the elevation of its effector GSDMD N-terminal domain (N-GSDMD) in patients’ tears. Further in vitro results showed that HS promoted pyroptosis in human corneal epithelial cells, while exogeneous supplementation of disulfiram could reduce the number of iHCECs with pyroptotic markers. More importantly, we demonstrated that, in line with the effect of disulfiram, calcitriol could also alleviate HS-induced pyroptosis, through inhibiting the NLRP3–ASC–caspase-1–GSDMD pyroptosis pathway.ConclusionThe current study provided direct evidence showing increased pyroptosis in dry eye patients. We demonstrated that calcitriol was able to effectively alleviate HS-induced corneal epithelial cell damage through inhibiting the NLRP3–ASC–caspase-1–GSDMD pyroptosis pathway. This study underlined calcitriol as a promising therapeutic agent for dry eye given its multiple therapeutic targets.

A clinical study of prevalence, risk factors and management of dry eye at regional eye hospital

Background and Objectives: Dry eye is a common multifactorial disorder of tear film resulting in ocular discomfort and tear-film instability with potential damage to ocular surface, due to decreased tear production or increased tear evaporation. It progressively increases in severity and if not detected may lead to sight threatening complications. This study was undertaken to study the prevalence, risk factors and diagnostic tests for dry eye. Methods: This study was conducted in Ophthalmology OPD at Regional Eye Hospital and attached to kakatiya Medical College, Warangal from September 2017 to August 2019. 300 patients were enrolled in this study. Occupation, smoking history and other systemic co-morbidities were documented. They were given OSDI questionnaire and subjected to four tests (Schirmer’s test, TBUT, Rose Bengal test, Fluorescein staining). If ≥2 tests were positive, the patients were diagnosed as dry eye. All dry eye patients were treated with tear substitutes and those with MGD were treated with tablet Doxycycline 100mg BD. Results and Conclusion: Dry eye prevalence was found to be 46.7%. It was more prevalent in females >40 years of age (60.4%). The prevalence increased with increasing age more among patients >50 years of age (49.3%) followed by age group 30-39 years (35%). Patients with outdoor jobs such as farmers, labourers had higher percentage of dry eye (50%) followed by office workers (22.1%). 70% of the dry eye patients had refractive error with or without history of spectacle use (p