Severe Dry Eye Symptoms Research Articles

Dysfunctional Coping Mechanisms Contribute to Dry Eye Symptoms.

Dysfunctional coping behaviors, such as catastrophizing, have been implicated in pain severity and chronicity across several pain disorders. However, the impact of dysfunctional coping has not been examined under the context of dry eye (DE). This study evaluates relationships between catastrophizing and measures of DE, including pain severity and pain-related daily interference. The population consisted of patients seen at Miami Veterans Affairs eye clinic between April 2016 and October 2017. Patients filled out standardized questionnaires assessing symptoms of DE and eye pain, non-ocular pain, mental health, coping behaviors (Pain Catastrophizing Scale, PCS), and pain-related daily interference as a perceived impact on quality of life (Multidimensional Pain Inventory, Interference Subscale, MPI-Interference), and all patients underwent an ocular surface examination. In total, 194 patients participated, with a mean age of 58.8 ± 9.6 years, the majority being male, non-Hispanic, and black. PCS (catastrophizing) was correlated with DE symptom severity, including Dry-Eye Questionnaire 5 (DEQ5; r = 0.41, p < 0.0005), Ocular Surface Disease Index (OSDI; r = 0.40, p < 0.0005), and neuropathic-like eye pain (Neuropathic Pain Symptom Inventory-Eye (NPSI-Eye; r = 0.48, p < 0.0005). Most tear metrics, on the other hand, did not correlate with PCS. Linear regressions showed that PCS, non-ocular pain intensity, and number of pain conditions were significant predictors of DEQ5 (overall DE symptoms), while PCS and non-ocular pain intensity were predictors of NPSI-Eye scores, as were insomnia scores and analgesic use. In a separate analysis, PCS and DE symptoms (OSDI) associated with pain-related interference (MPI-Interference) along with non-ocular pain intensity, post-traumatic stress disorder (PTSD), number of pain conditions, and non-Hispanic ethnicity. These findings suggest that catastrophizing is not significantly related to signs of DE, but is strongly associated to pain-related symptoms of DE and daily interference due to pain.

Individuals with migraine have a different dry eye symptom profile than individuals without migraine

BackgroundMany individuals with migraine report symptoms of dry eye (DE). However, it is not known whether DE profiles are similar between individuals with and without migraine. To bridge this gap,...

Prevalence and Effect of Eye Exercises on Dry Eye Symptoms among People in the age Group of 35-37 Years

The present study aimed to assess the prevalence of dry eye symptoms among the age group of 35 – 75 years, and the effect of eye exercises on dry eye symptoms between experimental and control group. Quantitative approach with quasi experimental pre–test post–test control group design was used. Structured questionnaire was used for collecting base line data and structured interview schedule to assess the prevalence of dry eye symptoms. Two hundred people were selected for assessing its prevalence; from among them 40 samples with dry eye symptoms were taken and assigned equally to experimental and control group by non-probability purposive sampling technique. Post-test was done after two weeks. Data analysis was done by frequency, percentage, paired and unpaired‘t’ test. Analysis shows that 49.5 percent had mild, 47.5 percent samples had moderate and 3% had severe dry eye symptoms. Mean post–test score (8.85) is less than mean pre–test score (16) in the experimental group which indicates eye exercises are effective (p&lt;0.05). Mean post–test score in experimental (8.85) and control group (19.65) shows that eye exercises reduce dry eye symptoms (p&lt;0.05). There is a significant association between the selected baseline variables such as age, education, occupation, consumption of drugs, use of computer, use of eye wear and dry eye symptoms.

Association Between Sleep Quality, Mood Status, and Ocular Surface Characteristics in Patients With Dry Eye Disease.

To evaluate sleep and mood status in patients with dry eye disease (DED) and analyze the association between sleep quality, mood status, and ocular surface characteristics. Consecutive patients with DED (N = 106) and age- and sex-matched healthy controls (N = 50) were enrolled. Tear fluid break up time (TBUT), corneal fluorescein staining, and Schirmer I tests were performed in the order listed here to evaluate dry eye. A visual analog scale was used to assess dry eye symptom severity. All subjects also completed the Pittsburgh Sleep Quality Index (PSQI, scores ≥5.5 indicated poor sleep), Patient Health Questionnaire (scores ≥5 indicated depression), and General Anxiety Disorder Scale (scores ≥5 indicated anxiety). Mean Pittsburgh Sleep Quality Index global score was significantly higher in patients with DED than that in controls (7.8 ± 3.9 vs. 5.4 ± 3.0, respectively; P < 0.001). Patients with DED demonstrated higher respective depression and anxiety scores compared with controls (P < 0.001 and 0.013, respectively). In the DED group, patients with poor sleep quality had more severe DED indicated by shorter TBUT and lower Schirmer I findings. A significant correlation was found between sleep quality and mood status in patients with DED. Regression analysis revealed that shorter TBUT and lower Schirmer I test results were associated with poorer sleep quality (adjusted p = 0.011 and 0.037, respectively). More severe symptoms of dry eye were significantly associated with a higher level of anxiety in patients with DED (adjusted p = 0.011). Sleep quality may play an important role in the development of DED by influencing tear secretion and tear film stability and/or by indirectly aggravating anxiety and depression, leading to higher self-reported symptom scores. It is also possible that DED contributes to reduced sleep quality, as well as the development of anxiety and depression.

Impact of Dry Eye on Psychosomatic Symptoms and Quality of Life in a Healthy Youthful Clinical Sample.

To determine the impact of dry eye on quality of life, depression, anxiety, and stress in a healthy youthful clinical sample. This was a clinic-based cross-sectional study. Subjects were patients visiting the University of Cape Coast Eye Clinic for comprehensive eye examination. The age range for recruitment into the study was 16 to 35 years. Eligible participants completed three questionnaires namely the Ocular Surface Disease Index (OSDI), short version of the depression, anxiety, and stress scale (DASS-21), dry eye quality of life score (DEQS) questionnaire. All eligible participants underwent clinical assessment including meibomian gland expressibility, corneal staining, tear breakup time, and Schirmer 1 test. The Spearman correlation coefficient was used to determine the relationship between variables. Univariate and multivariate analyses of variance were used to determine the impact of the OSDI score on DASS-21 subscales scores and the dry eye quality of life scores. All 211 subjects who met the inclusion criteria were included in the analysis. The mean age for the entire sample was 21.6±3.0 years with a range of (17-31) years. Spearman correlation coefficient showed a statistically significant association between OSDI scores and DEQSs (P<0.001), anxiety scores (P<0.001), depression scores (P<0.001), and stress scores (P<0.001). Spearman correlation coefficient showed no statistically significant association between clinical test results and quality of life scores (P>0.05), DASS-21 subscales scores (P>0.05), except anxiety subscale and meibomian gland expressibility score (P=0.026). There were no statistically significant association between clinical test results and OSDI scores (P>0.05) except for the tear breakup time (P=0.018). Using Pillai's trace in the multivariate analysis of variance (MANOVA), there was a significant effect of OSDI severity classification on depression, anxiety, and stress subscales scores of the DASS-21, V=0.37, F(3, 207)=9.67, P<0.001. Furthermore, separate univariate analyses of variances on the outcome variables revealed a significant effect of OSDI severity classification on depression F(3, 207)=35.24, P<0.001, anxiety F(3, 207)=25.27, P<0.001, and stress F(3, 207)=13.08, P<0.001. The MANOVA was followed up with a discriminant analysis, which revealed three discriminant functions. When subjects were classified according to the OSDI grading of severity, there were a statistically significant difference between all levels of severity dry eye symptoms for the DEQSs (F(3, 207) = 63.9.3 P<0.001, η=0.48). The study showed that the severity of dry eye symptoms impacted on psychosomatic symptoms and quality of life. The study also revealed that the severity of dry eye symptoms impacted more on the depressive symptoms compared with other psychosomatic symptoms in this youthful clinical sample.

Survey of Ophthalmologists Regarding Practice Patterns for Dry Eye and Sjogren Syndrome.

To survey ophthalmologists about current practice patterns regarding the evaluation of dry eye patients and referrals for a Sjogren syndrome (SS) workup. An online survey was sent to ophthalmologists affiliated with the Scheie Eye Institute or Wills Eye Hospital using REDCap in August 2015. Descriptive statistics were used to summarize the data. Four hundred seventy-four survey invitations were sent out and 101 (21%) ophthalmologists completed the survey. The common traditional dry eye test performed was corneal fluorescein staining (62%) and the most common newer dry eye test performed was tear osmolarity (18%). Half of respondents (51%) refer fewer than 5% of their dry eye patients for SS workups, with 18% reporting that they never refer any patients. The most common reasons for referrals included positive review of systems (60%), severe dry eye symptoms (51%) or ocular signs (47%), or dry eye that is refractory to treatment (42%). The majority (83%) felt that there is a need for an evidence-based standardized screening tool for dry eye patients to decide who should be referred for evaluation for SS. Ophthalmologists continue to prefer the use of traditional dry eye tests in practice, with the most common test being corneal fluorescein staining. There is an underreferral of dry eye patients for SS workups, which is contributing to the continued underdiagnosis of the disease. Most respondents felt that there was a need for an evidence-based standardized screening tool to decide which dry eye patients should be referred for SS evaluations.

Neuropathic-Like Ocular Pain and Nonocular Comorbidities Correlate With Dry Eye Symptoms.

To evaluate the association between dry eye (DE) symptoms and neuropathic-like ocular pain (NOP) features, chronic pain conditions, depression, and anxiety in patients presenting for routine ophthalmic examinations. Two hundred thirty-three consecutive patients ≥18 years of age presenting to a comprehensive eye clinic between January and August 2016 were included in this study. Information on demographics, chronic pain conditions, medication use, DE symptoms (dry eye questionnaire, DEQ5), NOP complaints (burning; wind, light, and temperature sensitivity), depression, and anxiety indices (patient health questionnaire 9, PHQ-9 and symptom checklist 90-revised, SCL-90-R) were collected for each individual. Pearson correlation was used to evaluate strengths of association. Logistic regression analysis examined risk factors for any (DEQ5≥6) and severe (DEQ5≥12) DE symptoms. The mean age of the population was 46.3 years (±13.0); 67.8% (n=158) were female. Per the DEQ5, 40.3% (n=94) had mild or greater DE symptoms and 12% (n=24) had severe symptoms. Severity of DE symptoms correlated with NOP complaints: burning (Pearson r=0.37, P<0.001); sensitivity to wind (r=0.37, P<0.001), sensitivity to light (r=0.34, P<0.001), and sensitivity to temperature (r=0.30, P<0.001). Sex, race, and ethnicity were not significant risk factors for DE symptoms. Risk factors for mild or greater DE symptoms included a greater number of chronic nonocular pain conditions (odds ratio [OR]=1.38, P<0.001), arthritic pain (OR=6.34, P<0.001), back pain (OR=2.47, P=0.004), headaches (OR=2.14, P=0.02), depression (OR=1.17, P<0.001), and anxiety (OR=1.13, P=0.02). Dry eye severity positively associated with NOP complaints, comorbid chronic pain conditions, and symptoms of depression and anxiety.

Photophobia and sensations of dryness in patients with migraine occur independent of baseline tear volume and improve following botulinum toxin A injections

BackgroundTo evaluate the efficacy of botulinum toxin A (BoNT-A) in reducing photophobia and dry eye symptoms in individuals with chronic migraine. Additionally, we aimed to evaluate tear film volume as...

Ethnic differences between the Asian and Caucasian ocular surface: A co-located adult migrant population cohort study

PurposeTo investigate the ethnic differences in tear film quality, ocular surface parameters, and dry eye symptomology between co-located Asian and Caucasian populations. MethodsTwo hundred and six participants (103 East Asian and 103 Caucasian) were recruited in an age and gender-matched cross-sectional study. Dry eye symptomology, ocular surface parameters, and tear film quality were evaluated for each participant within a single clinical session. ResultsThe mean ± SD age of the 206 participants (82 male, 124 female) was 45 ± 16 years. Overall, a greater proportion of Asian participants were symptomatic of dry eye and fulfilled the TFOS DEWS II dry eye diagnostic criteria than Caucasian participants (74% versus 51%, p = 0.002), with an odds ratio (95% CI) of 2.7 (1.5–4.8) times. Poorer OSDI scores, tear film stability, lipid layer quality, tear osmolarity, lid wiper epitheliopathy, meibomian gland dropout, and expressed meibum quality were observed in the Asian group (all p < 0.05). A significantly higher proportion of participants exhibited incomplete blinking in the Asian group than the Caucasian group (81% versus 45%, p < 0.001). ConclusionsAsian participants exhibited more severe dry eye signs and symptoms than Caucasian participants. The poorer meibomian gland function and higher degree of incomplete blinking observed among Asian participants may potentially contribute towards the ethnic predisposition towards dry eye development.

The Association of Dry Eye Symptom Severity and Comorbid Insomnia in US Veterans.

To investigate the association between dry eye (DE) and insomnia symptom severity. Cross-sectional study of 187 individuals seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding insomnia (insomnia severity index [ISI]) and DE symptoms, including ocular pain, followed by a comprehensive ocular surface examination. Using a two-step cluster analysis based on intensity ratings of ocular pain, the patient population was divided into two groups (high and low ocular pain groups: HOP and LOP). A control group was ascertained at the same time from the same clinic as defined by no symptoms of DE (Dry Eye Questionnaire 5 [DEQ5], <6). The main outcome measure was the frequency of moderate or greater insomnia in the DE groups. The mean age of the study sample was 63 years, and 93% were male. All insomnia complaints were rated higher in the HOP group compared with the LOP and control groups (P<0.0005). Most (61%) individuals in the HOP group experienced insomnia of at least moderate severity (ISI≥15) compared with the LOP (41%) and control groups (18%) (P<0.0005). Black race (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.0; P=0.02), depression severity (OR, 1.2; 95% CI, 1.1-1.3; P<0.0005), and DE symptom severity (DEQ5; OR, 1.1; 95% CI, 1.01-1.2; P=0.03) were significantly associated with clinical insomnia (ISI≥15) after controlling for potential confounders. After adjusting for demographics and medical comorbidities, we show that DE symptom severity is positively associated with insomnia severity.

IMPACT OF ORBICULARIS OCULI MUSCLE STRIP EXCISION DURING UPPER LID BLEPHAROPLASTY ON TEAR FILM BREAK UP TIME AND POSTOPERATIVE DRY EYE SYMPTOMS

Background: Dry eye syndrome (DES) is common after upper lid blepharoplasty (ULB), but tends to be self-limiting over the course of days to weeks. This occurs because the blink mechanism and tear film spread over the cornea are disrupted temporarily. More aggressive surgical techniques and over-excision of skin and orbicularis oculi muscle (OOM) appeared to increase the risk of dry eye following ULB. Objectives: to study the impact of OOM strip excision during ULB on the tear film break up time (TFBUT) and postoperative occurrence and severity of dry eye symptoms. Paitents and Methods: This interventional comparative study included 40 eyes of 20 patients (14 females and 6 males, the mean (M) age was 57.05 ± 4.80 years old. All patients had bilateral aesthetic ULB. Patients were divided into two groups: Group A: 8 patients (5 females and 3 males, M age was 58.38 ± 5.53 years old) who had bilateral ULB surgeries including OOM strip excision. And Group B: 12 patients (9 females and 3 males, M age was 56.17 ± 4.26 years old) who had bilateral ULB surgeries with preservation of OOM. Preoperative evaluation: General medical history and full ophthalmologic history were taken. Full ophthalmologic examination was performed including corneal and tear film examination, TFBUT and Schirmer's tests. Lid crease height, palpebral fissure and marginal reflex distance were measured. Patients with uncontrolled chronic systemic diseases were excluded. Patients with exophthalmos, lid retraction, ptosis, brow ptosis, entropion or ectropion were also excluded. Follow up: TFBUT and dry eye symptoms were assessed for each patient at one week and at one month postoperatively. Patients with continuous symptoms of dry eye postoperatively were followed up until three months. The changes of TFBUT of participants were statistically analyzed using the paired t-test. The M and standard deviation (SD) were used to obtain probability (P) value which was considered statistically significant when it was ≤ 0.05. Results: As regard changes of TFBUT; there was statistically significant decrease in TFBUT M values in group A from 11 ± 1.37 seconds (s) preoperatively to be 9.69 ± 2.18 s at one week postoperatively. This decrease in TFBUT M value was temporary and reversible as there was statistically significant increase of TFBUT M value from 9.69 ± 2.18 s at one week postoperatively to be 10.56 ± 1.86 s at one month postoperatively which was near to the preoperative value As regard group B, there were non-statistically significant changes in TFBUT M values. Dry eye symptoms had been recorded by four patients from group A (50%) and two patients from group B (16.7%). These symptoms were more severe in patients of group A. All these symptoms were reversible and frequent use of lubricating eye drops and gels for one week was enough to reduce the patients' discomfort in most of cases, but 2 female cases from group A with multiple combined risk factors had needed to use low dose steroid eye drops and night eye anti-inflammatory ointments in addition to relatively longer period of lubricating eye drops using to reduce dry eye symptoms. According to the present study results, the most important risk factor for postoperative dry eye symptoms was excision of OOM strip during ULB. History of lubricating eye drops using was also associated with increased incidence of postoperative dry eye symptoms. Hypothyroidism and diabetes mellitus (DM) were suspected risk factors which have needed to be proven by further specific studies. Changes of TFBUT and reported dry eye symptoms following ULB were temporary and reversible in all cases of the present study. Conclusion: Excision of OOM strip during ULB was associated with temporary statistically significant decrease in TFBUT and was also associated with more occurrences of reversible dry eye symptoms. Avoiding excision of OOM strip during ULB (if not indicated) was proven to minimize the occurrence of postoperative dry eye symptoms especially for patients with history of DES, for patient with repeated ULB, and those with systemic risk factors such as DM and thyroid dysfunctions.

The effect of individual biological rhythms on dry eye

This study aims to assess whether an individual’s chronotype (i.e. morningness versus eveningness) has an impact on tear film. Eighty-six dry eye patients not having any underlying systemic or metabolic diseases and either a morning or evening chronotype were included in the study. Tear film break-up time (BUT) and Schirmer tests are common objective tests that are used to diagnose the eye dryness. Using multivariate analysis of covariance (MANCOVA), we investigated the interaction effect of chronotype x sex on insomnia, Schirmer (mm) and BUT (sec) measurements after adjusting for age. We found that the participants who were more prone to evening chronotype characteristics reported to have more severe dry eye signs which monitor with the aid of the Schirmer and tear film break-up time test. In addition, those with higher scores in insomnia severity index had lower Schirmer test and tear film break-up time scores. These findings suggest that chronobiological factors may play a crucial role in the dry eye symptom severity.

A rating scale is a proper method to evaluate changes in quality of life due to dry eye symptoms

PurposeTo determine which utility value assessment method is more suitable to evaluate changes in the quality of life due to dry eye symptoms.MethodsDry eye outpatients with a presenting visual acuity of 20/25 or better in the worse-seeing eye were recruited. Presenting distance visual acuity, tear film break-up time, Schirmer I test and fluorescein were assessed. The severity of dry eye symptoms was assessed using the Ocular Surface Disease Index (OSDI), and utility values were measured using the time trade-off (TTO), standard gamble (SG1 and SG2) and rating scale (RS) methods. Different utility values were compared with each other. The most appropriate utility value method to evaluate quality-of-life changes solely due to dry eye symptoms is determined by calculating the correlation between the OSDI score and different utility values.ResultsA total of 104 patients were enrolled. The three sections of OSDI in the order of high to low scores were as follows: “environmental trigger,” “eye discomfort” and “visual function.” The utility scores measured with TTO, SG1, SG2 and RS were 0.95 ± 0.11, 0.96 ± 0.10, 0.99 ± 0.07 and 0.89 ± 0.10, respectively. The utility scores evaluated by the TTO, SG1, SG2 and RS methods were significantly different from each other (p < 0.05). Only the utility scores measured with RS were significantly correlated with the composite OSDI score, “environmental trigger” and “eye discomfort” section scores (p < 0.05).ConclusionsRS is more sensitive than TTO and SG for the evaluation of altered quality of life due to dry eye symptoms.

Long-term impact of dry eye symptoms on vision-related quality of life after phacoemulsification surgery

PurposeTo observe the long-term changes in dry eye symptoms and vision-related quality of life in age-related cataract patients after phacoemulsification.MethodsA total of 101 cataract patients after phacoemulsification combined with IOL implantation (Ph-IOL) in one eye were enrolled. Visual acuity, tear film breakup time (BUT), and Schirmer test 1 (ST1) were measured before and 1, 3, and 6 months after surgery. Ocular Surface Disease Index (OSDI) scores were used to evaluate the severity of dry eye symptoms. Utility values were assessed by the time trade-off (TTO), standard gamble for death (SGD), standard gamble for blindness (SGB) and rating scale (RS).ResultsThe average LogMAR visual acuity in the operated eye was 1.35 ± 0.50 and increased rapidly after Ph-IOL, approaching a peak at 3 months (0.26 ± 0.15). The BUT and ST1 results decreased abruptly 1 month after surgery and gradually recovered until 6 months. OSDI scores increased significantly after surgery and gradually decreased until 6 months. Utility values evaluated by TTO, SGD, SGB and RS before surgery were 0.67 ± 0.19, 0.75 ± 0.15, 0.67 ± 0.20 and 0.2 ± 0.18, respectively, and increased to 0.91 ± 0.06, 0.98 ± 0.04, 0.92 ± 0.52 and 0.91 ± 0.06, 6 months after. Utility values measured with TTO, SGB or RS correlated significantly (P < 0.05) with visual acuity and OSDI scores pre- and postoperatively.ConclusionsDry eye symptoms persist more than 3 months after Ph-IOL. Utility values were negatively influenced by dry eye symptoms.

The Location of Conjunctivochalasis and Its Clinical Correlation with the Severity of Dry Eye Symptoms.

Background: We aimed to investigate the clinical importance of conjunctivochalasis (CCH) and, further, to implement a new CCH classification system. Methods: 60 eyes of patients with whom, upon clinical examination, CCH was diagnosed were investigated for the presence of symptoms and signs characteristic of dry eye. The eyes were grouped based on two stages of severity, Stage 1 (minimal/mild) and Stage 2 (medium/severe), for each nasal, middle, and temporal position, and on the extent of CCH folds in each site. Results: In 40 (66.6%) out of 60 eyes, symptoms and signs of CCH were manifest: pain in 25 (41.6%), epiphora in 25 (41.6%), and lacrimal punctum obstruction from conjunctival folds in 22 (36.6%) eyes. Depending on the position of CCH, a greater percentage of symptoms appeared in Stage 2 in the nasal position (78.9%), followed by middle (68.7%) and temporal positions (60%). When TBUT values were compared, statistically significant differences were found proportional to grading (p < 0.001) and position (nasal more severe than temporal, p < 0.001), and such differences were also found when TBUT values of all eyes were compared with those of symptomatic eyes (p = 0.01) and with those of symptom-free eyes (p = 0.002). Conclusions: CCH is a rather frequent and commonly unrecognized condition that should always be considered in differential diagnoses of dry eye.

Meibomian Gland Dysfunction Associated With Periocular Radiotherapy.

To investigate the influence of periocular radiotherapy on meibomian glands. We evaluated 28 patients (40 eyes) who received radiotherapy (RT group) for conjunctival or orbital lymphoma and 30 age-matched control subjects (60 eyes). Subjects underwent slit-lamp examination of the eyelids, Schirmer test, meibography, and evaluation of tear film breakup time (TBUT), Ocular Surface Disease Index (OSDI) scores, meibomian glands evaluation (meiboscore, meibum expressibility, and lid margin abnormality scores), and tear film lipid layer thickness using an ocular surface interferometer. These parameters were compared between subjects in the RT and control groups. Meiboscores as well as meibum expressibility and OSDI scores in the RT group were significantly higher compared with those in the control group (1.6 ± 0.9 vs. 0.4 ± 0.6, 1.6 ± 1.0 vs. 0.2 ± 0.4, and 48.1 ± 21.4 vs. 6.2 ± 4.4, respectively, P < 0.001, all), whereas the Schirmer value (9.2 ± 5.1 vs. 12.3 ± 5.2, P = 0.004), TBUT (4.2 ± 2.5 vs. 6.4 ± 2.6, P = 0.001), and lipid layer thickness (61.0 ± 29.3 vs. 85.2 ± 20.0, P < 0.001) in the RT group were lower compared with those in the control group. The percentage of meibomian gland dropout was significantly correlated with age (P = 0.025) and total radiation dose (P = 0.012), regardless of the target location of irradiation. Even low-dose irradiated eyes (<30 Gy) exhibited significantly higher meiboscores (P < 0.001) and shorter TBUT (P = 0.005) compared with control eyes. Eyes that received periocular radiotherapy exhibited relatively high tear film instability induced by meibomian gland dysfunction, contributing to the high severity of dry eye symptoms.

Epidemiologic study of tear film lipid layer thickness measurement in the population of Taishitun Community in Beijing

Objective: To investigate the distribution of tear film lipid layer thickness (LLT) and the relationship between symptoms and signs of dry eye and tear film LLT in the population of Taishitun Community in Beijing. Methods: A cross-sectional study. From May 2016 to August 2016, three streets of Taishitun Community were randomly selected as survey districts and 540 persons were taken as investigation subjects. Every participant completed 6 items of dry eye examinations as follows: questionnaire (Ocular Surface Disease Index, OSDI), measurement of tear film LLT, tear film break-up time (TBUT), corneal and conjunctival staining, SchirmerⅠtest and the infrared meibomian photography. According to their age, all participants were divided into four groups: junior group (<18 years old), youth group (18 to 40 years old), middle-aged group (41 to 59 years old) and the elderly group (over 60 years old). With the OSDI criteria, no dry eye symptom group (score, <12 points), mild to moderate dry eye symptom group (score, 12 to 32) and severe dry eye symptom group (score, 33-100) were included. With the statistical methods of variance analysis and multivariate Logistic regression analysis, distribution of the variables of LLT and the relationship between dry eye symptoms and LLT were studied. Results: A total of 473 residents finally participated in this study, and the response ratio was 87.6%. The values of LLT were normally distributed. The average LLT was (59.87±18.50) nm [(60.16±19.15) nm in males and (59.67±18.57) nm in females], and the comparison of LLT with different genders was not statistically significant (t=0.198, P=0.843). The tear film LLT of four different age groups had statistical significance (F=15.092, P<0.05), and increased with age [(56.10±18.33) nm in the junior group, (54.60±16.29) nm in the youth group, (60.61±19.18) nm in the middle-aged group and (73.25±14.58) nm in the elderly group]. The LLT was inversely proportional to the severity of dry eye symptoms. With a thinner LLT, the symptoms of the subjects turned severe. In the elderly with different degrees of symptoms, the LLT was significantly different (F=0.019, P<0.05), while in the youth and middle-aged groups with different degrees of symptoms, the LLT was not significantly different (F=0.096, P>0.05. F=0.538, P>0.05). In the OSDI symptom questionnaire, only blurred vision and decreased visual acuity were related to the tear film LLT (P<0.05). There was no significant correlation between the TBUT, SchirmerⅠtest result, meibomian gland loss rate and the tear film LLT (P>0.05). Conclusions: In Taishitun Community of Beijing, the values of tear film LLT had a normal distribution. The LLT was positively correlated with age, but inversely correlated with the severity of the symptoms of dry eye. There was no significant correlation between the LLT and the TBUT, SchirmerⅠtest result and meibomian gland loss rate.(Chin J Ophthalmol, 2017, 53: 495-501).

Tear osmolarity and subjective dry eye symptoms in migraine sufferers

ObjectivePrevious studies have suggested an association between dry eye and migraine. In a busy ophthalmologist clinic, quick identification of dry eye in migraine sufferers may improve their quality of life. Tear osmolarity is an objective and reliable tool for diagnosing dry eye. It has not been investigated in any population with migraine. Using tear osmolarity and questionnaires, we aimed to explore the relationship between dry eye and clinical symptoms in patients with migraine. DesignProspective cross-sectional study. ParticipantsThirty-four adults with migraine sequentially recruited from a single neurologist’s practice. MethodsPatients were assessed for subjective and objective signs of migraine and dry eye by using the Migraine Disability Assessment Score, the Ocular Surface Disease Index, and tear osmolarity (TearLab). Headache characteristics were compared by using χ2, Fisher’s exact, and Mann-Whitney U tests. Osmolarity scores were compared with scores for headache features. ResultsMedian age of patients was 38 years, and 76.5% were females. Severe migraine disability was reported in 75.6%, and 34.5% reported moderate to severe dry eye symptoms. Objectively, 49.5% had evidence of dry eye, significantly higher than the 20% recognized in the general population (p < 0.0001). Aura was found to occur more frequently with dry eye (43.8% vs 5.9%; p = 0.02). Those with daily headaches were also more likely to have higher tear osmolarity with marginal significance (median osmolarity 310 mOsm/L vs 299 mOsm/L; p = 0.08). ConclusionsPatients with migraine, especially those with aura, appear more likely to have dry eye, as indicated by tear osmolarity. Tear osmolarity may also be greater in those who suffer from daily headaches.

Ocular surface effects of repeated application of povidone iodine in patients receiving frequent intravitreal injections

Background: The aim of this study was to investigate the patient reported symptoms and objective signs of tear film and ocular surface abnormalities experienced by patients undergoing repeated exposure to povidone iodine as a consequence of requiring frequent intravitreal injections for wet macular degeneration.Methods: This was a prospective study of consecutive patients who had received recent povidone 5% solution for sterile preparation of intravitreal injection less than 3 months prior to inclusion with a total of at least 3 intravitreal injections for macular degeneration. Each patient had one study eye which was undergoing regular intravitreal injection and a fellow eye which was not undergoing any injections. Each patient underwent evaluations of various tear film parameters on a single occasion for both eyes. The primary outcome was severity of dry eye symptoms as measured by the Schein dry eye questionnaire. The secondary outcomes were tear film osmolarity and corneal punctate staining using the Oxford Grading Scale.Results: A total of 90 patients were included in the study. 43.3% n = 39, were using ocular lubricating medication on a regular basis. A significantly greater proportion of study eyes had a Schein dry eye questionnaire score of 7 or higher; 12.2%, n = 11 amongst study eyes vs 4.4%, n = 4 amongst control, fellow eyes (p < 0.05). In terms of secondary outcomes, the study eyes had a slightly higher mean tear film osmolality compared to control, fellow eyes: 305.5 ± 1.7 in study eyes vs 302 ± 1.6 in control eyes although this difference was not statistically significant (p = 0.087). The study eyes had statistically significantly worse corneal staining as determined by the Oxford grading scale; 0.69 in study eyes vs 0.58 in control, fellow eyes (p = 0.02).Conclusion: Our results confirm the detrimental impact of repeated application of povidone iodine for intravitreal injection procedures on symptoms of dry eyes as experienced and reported by patients.

Réaction oculaire du greffon contre l’hôte : une étiologie de syndrome sec à ne pas méconnaître

To report a case of severe ocular graft-versus-host disease (GVHD) after cataract surgery. Observational case report. We describe the case of a 59-year-old man with postoperative corneal ulcer on his only functional eye. His past history reported allogenic bone marrow transplant. His visual acuity (VA) was limited tohand motions. Slit lamp examination revealed diffuse conjunctival hyperemia, severe blepharitis, Meibomian dysfunction, total corneal opacification with epithelial and stromal keratitis and neovascular invasion. Because of the severe dry eye symptoms and history of allogenic hematological stem cell transplantation, ocular GVHD was diagnosed. Functional and anatomical improvement occurred rapidly with topical cyclosporine 2%, with improved VA after treatment. With any severe dry eye syndrome in the context of allogenic bone marrow transplant, ocular GVHD must be considered. For planned ocular surgery, we recommend adding cyclosporine 0.1% treatment before and after surgery to prevent severe ocular GVHD.