Dry Eye Symptoms Research Articles

Clinical Efficacy of Rebamipide Eyedrops in Patients with Sjögren’s Syndrome Accompanied by Meibomian Gland Dysfunction

Purpose: To investigate the clinical efficacy of rebamipide eyedrops in patients with meibomian gland dysfunction (MGD) associated with Sjögren’s syndrome.Methods: The study included 50 patients with Sjögren’s syndrome accompanied by MGD treated with 0.05% (w/v) cyclosporine and 0.15% (w/v) sodium hyaluronate eyedrops. They were divided into two groups: 25 who added rebamipide eyedrops to their existing treatments and a control group of 25 whose treatments did not change. We evaluated the tear breakup time, the Schirmer test and conjunctival staining scores, meibomian gland quality and function, and eyelid margin irregularity before prescribing rebamipide eyedrops and 1 and 3 months after prescription. Additionally, before eyedrops use and 3 months later, meibographic scores were assessed via imaging of the meibomian gland and ocular surface disease index values also were assessed.Results: The rebamipide group exhibited significant improvements in the tear breakup time, conjunctival staining score, and ocular surface disease index compared to before treatment (all <i>p</i> < 0.05). However, the Schirmer test result, meibomian gland quality and function, and eyelid margin irregularity did not differ between either groups before or after treatment. After 3 months of eyedrop use, the rebamipide group exhibited a significantly higher tear breakup time (<i>p</i> < 0.01) and Schirmer test score (<i>p</i> < 0.01) than the control group (<i>p</i> = 0.01), and significantly lower ocular surface disease index and conjunctival staining scores (<i>p</i> < 0.01).Conclusions: Addition of rebamipide eyedrops to the conventional treatment of patients with Sjögren’s syndrome accompanied by MGD effectively improves dry eye symptoms and the ocular surface parameters.

Intense Pulsed Light in the Treatment of Dry Eye and Meibomian Gland Dysfunction in Patients With Chronic Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

To evaluate the efficacy and safety of intense pulsed light (IPL) combined with meibomian gland expression (MGX) for the treatment of dry eye disease and meibomian gland dysfunction associated with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis. This prospective noncomparative interventional study included 29 patients (58 eyes) who underwent 3 sessions of IPL and MGX at 2-week intervals. Subjective symptoms (ocular surface disease index score) and objective dry eye tests: matrix metalloproteinase 9, tear meniscus height, bulbar redness score, tear film lipid layer thickness (LLT), Schirmer I test, conjunctival and corneal staining, meibomian gland loss, MGX score [meibomian gland score (MGS)], and tear break-up time were assessed at the baseline and after 4, 8, and 12 weeks. Twenty-nine individuals (57 eyes) were included in this analysis. The ocular surface disease index score decreased significantly from 60.07 ± 23.34 (baseline) to 38.36 ± 22.39 (after 90 days) (P < 0.01). The fluorescein and lissamine green staining scores, MGS, and LLT improved significantly (P < 0.01). In contrast, there were no significant changes in the tear meniscus height values, matrix metalloproteinase 9 positivity, bulbar redness score, Schirmer test, meibography of the superior and inferior eyelids, and tear break-up time. Ocular or skin complications were not observed. Three IPL therapy sessions followed by MGX seemed to be safe and effective in treating dry eye disease and meibomian gland dysfunction, improving vision-related quality of life, dry eye symptoms, and ocular surface signs, such as corneal and conjunctival staining scores, MGS, and LLT after 90 days in patients with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis.

ANALYSIS OF MULTISYSTEMIC MANIFESTATIONS OF SJÖGREN'S SYNDROME: A FOCUS ON DERMATO-OPHTHALMOLOGICAL INTERRELATIONS

Sjögren’s Syndrome (SS) is a systemic autoimmune disease known for its hallmark symptoms of dry eye and dry mouth, but it also presents a spectrum of extraglandular manifestations affecting the skin, lungs, nervous system, and other organs. This systematic review examines the multisystemic impacts of SS, highlighting advancements in diagnostics, therapeutic strategies, and clinical challenges. A comprehensive search was conducted across PubMed, MEDLINE, and Embase for studies published between 2013 and 2024, using keywords such as "Sjögren’s Syndrome," "Multisystemic Manifestations," "Autoimmune Disease," and "Extraglandular Complications." Of the 56 initially identified articles, 13 met the inclusion criteria. Findings reveal that pulmonary complications, including interstitial lung disease, occur in 9–20% of SS cases, as reported by Flament et al. (2016), emphasizing the importance of imaging and biopsy for early detection. Dermatological manifestations, such as vacuolar interface dermatitis and vasculitis, were detailed in studies by El Hasbani et al. (2023) and Kakurai et al. (2021), which underscore the need for dermatological vigilance in systemic autoimmune diseases. Neurological symptoms, including peripheral neuropathies and neuropsychiatric complications, were identified as early indicators in studies by Posso-Osorio et al. (2019) and Salehi et al. (2024), suggesting that such presentations require immediate multidisciplinary evaluation. Therapeutic advancements include the use of corticosteroids, hydroxychloroquine, and biologic agents such as rituximab, which have shown efficacy in managing systemic manifestations. Chu et al. (2020) emphasized the benefits of immunosuppressive therapy in improving systemic outcomes while acknowledging the limited efficacy for glandular symptoms. Advanced diagnostic tools like PET/CT, explored by Sharma and Chatterjee (2015), have improved diagnostic precision, aiding in the differentiation of SS from other systemic conditions. Despite these advancements, challenges remain in addressing disease heterogeneity and atypical presentations, particularly in men, children, and patients without classic glandular involvement. Standardized diagnostic protocols and tailored therapeutic strategies are needed to improve outcomes and reduce the burden of extraglandular complications.

ASSESSING THE IMPACT OF LEVATOR RESECTION BY ANTERIOR APPROACH WITH AND WITHOUT UPPER LID BLEPHAROPLASTY ON DRY EYE SYNDROME

Background: Dry eye disease is a multifactorial condition that significantly affects tear film homeostasis, resulting in ocular discomfort and surface damage. Surgical interventions like upper eyelid blepharoplasty, often performed for aesthetic and functional purposes, can disrupt the tear film, particularly when combined with levator resection. Understanding the impact of these procedures on dry eye parameters is crucial for optimizing patient outcomes, especially in populations predisposed to dry eye symptoms due to age or other risk factors. Objective: To evaluate and compare the effects of upper eyelid blepharoplasty with levator resection versus levator resection alone on dry eye parameters, focusing on tear film stability and subjective symptoms. Methods: This prospective study included 120 eyes from 120 patients diagnosed with acquired ptosis, equally divided into two groups: one undergoing upper eyelid blepharoplasty combined with levator resection and the other undergoing levator resection alone. Dry eye parameters, including tear break-up time (TBUT), Schirmer's test, and Ocular Surface Disease Index (OSDI) scores, were assessed preoperatively, and at 1 and 3 months postoperatively. The surgeries were performed under local anesthesia, and postoperative evaluations excluded the use of lubricants to ensure unbiased tear film assessments. Results: In the blepharoplasty with levator resection group, the mean preoperative TBUT decreased from 15.27 ± 2.62 seconds to 14.32 ± 2.89 seconds at 1 month, followed by partial recovery to 14.87 ± 2.72 seconds at 3 months. Schirmer’s test values dropped from 14.88 ± 2.12 mm preoperatively to 13.87 ± 2.29 mm at 1 month, improving to 14.60 ± 2.13 mm at 3 months. The OSDI score increased from 48.05 ± 19.12 preoperatively to 48.95 ± 19.24 at 1 month and improved to 46.55 ± 19.13 at 3 months. In contrast, the levator resection alone group showed stable dry eye parameters, with preoperative TBUT, Schirmer’s test, and OSDI scores remaining consistent at 1 and 3 months. Conclusion: Upper eyelid blepharoplasty with levator resection temporarily exacerbates dry eye symptoms and reduces tear film stability, with partial recovery by 3 months. Levator resection alone did not significantly impact dry eye parameters, underscoring the role of blepharoplasty-specific interventions in these changes. Proactive patient counseling and early postoperative management are essential for mitigating transient discomfort.

Enhancing Corneal Sensitivity in Diabetic Patients Through an Innovative Ophthalmic Solution: In Vivo and Vitro Results.

Background/Objectives: Diabetes is a well-recognised factor inducing a plethora of corneal alterations ranging from dry eye to reduced corneal sensibility, epithelial defects, and reduced cicatrisation. This cohort study aimed to assess the efficacy of a novel ophthalmic solution combining cross-linked hyaluronic acid (CHA), chondroitin sulfate (CS), and inositol (INS) in managing diabetes-induced corneal alterations. Specifically, it evaluated the solution's impact on the tear breakup time (TBUT), the ocular surface disease index (OSDI), and corneal sensitivity after three months of treatment. Additionally, the solution's potential to promote wound healing was examined. Methods: Two different populations were retrieved from the database; the first one was composed of 20 diabetic subjects treated for three months with the ophthalmic CAH-CS (OPHTAGON srl, Rome, Italy), while the second group was composed of 20 diabetic subjects who did not want to use any eye lubricant or other treatment. The outcome measures were the TBUT, the OSDI score, and the corneal sensitivity measured using a Cochet-Bonnet aesthesiometer. To investigate the wound-healing properties, in vitro tests were conducted using two cell lines, comparing the results of scratch tests with and without the solution. Results: The results indicate that CHA-CS significantly improved the tear film stability, as evidenced by an increased TBUT and a reduction in dry eye symptoms reflected by lower OSDI scores. Moreover, the solution was associated with an enhanced corneal sensitivity in treated patients. In wound-healing assays, CHA-CS promoted cell motility, suggesting a supportive role in tissue repair compared to untreated cells. Conclusions: Collectively, the results suggest that CHA-CS could serve as an innovative tool for the treatment of diabetic patients with corneal alterations and delayed corneal sensitivity. Clinical trial registration number: Clinical Trial.gov NCT06573606.

Is Thermal Pulsation Therapy Effective for Dry Eyes Before and After Cataract Surgery? A Systematic Review and Meta-Analysis.

Meibomian gland dysfunction (MGD) is a primary cause of evaporative dry eye disease (DED), which is often exacerbated by cataract surgery due to surgical trauma and inflammation. Thermal pulsation therapy (TPT) aims to enhance meibomian gland function and relieve dry eye symptoms. We conducted a systematic review and meta-analysis to evaluate the effectiveness of TPT in managing dry eye symptoms associated with cataract surgery. A systematic search was performed in December 2024 across PubMed, ScienceDirect, CINAHL, and the Cochrane Central Register of Controlled Trials to identify original research on the efficacy of TPT in addressing cataract surgery-related dry eye symptoms. The quality of the included studies was evaluated using the Risk of Bias in Non-Randomized Studies of Interventions tool, with results visualized through the Robvis 2.0 tool developed by the Cochrane Collaboration. The search yielded 365 records, of which seven studies met the inclusion criteria for this meta-analysis. Key outcomes analyzed included the meibomian gland yielding liquid secretion (MGYLS) score, tear break-up time (TBUT), ocular surface disease index (OSDI) score, and lipid layer thickness (LLT). The meta-analysis revealed a moderate effect of TPT, with a small but clinically significant improvement observed in MGYLS scores (Cohen's d = 0.29, p = 0.033) and TBUT (Cohen's d = 0.15, p = 0.029). However, the effects on OSDI scores and LLT were not statistically significant. Study heterogeneity varied, with some outcomes exhibiting considerable variability. TPT provides moderate and clinically meaningful improvements in MGYLS scores and TBUT for patients experiencing dry eye symptoms after cataract surgery, although improvements in OSDI scores and LLT did not achieve statistical significance. The variability in study quality and heterogeneity highlights the need for well-designed, high-quality research to confirm these findings and evaluate the durability of TPT's therapeutic effects both before and after cataract surgery.

Real-World Treatment Outcomes of an Artificial Tear Containing Arabinogalactan, Hyaluronic Acid and Trehalose Among Subjects with Dry Eye.

To assess the efficacy, adherence, and tolerability of a new artificial tear based on arabinogalactan, hyaluronic acid, and trehalose in a population with dry eye disease (DED). A retrospective, real-world, post-marketing study identified 96 adult patients (aged 18-80 years) with signs and symptoms of dry eye. These patients received fixed combination therapy with eye drops containing arabinogalactan, hyaluronic acid, and trehalose at various dosing schedules. The data for this study were collected from April 2022 to June 2023. Patients underwent evaluation at baseline (T0) and after a follow-up period of two-three months (T1) using a patient-reported questionnaire. In 96 adult patients (71 women and 25 men) with dry eye due to various conditions, the results indicated a 98% positive response to therapy. This response included improvements in vision (13%), comfort (39%), redness (13%), itching (16%), photophobia (4%), and tearing (14%). Additionally, 61% of the patients experienced 1-2hours of comfort following instillation. This real-life post-marketing study demonstrated clinical improvement of signs and symptoms in patients with dry eye disease using a new artificial tear medical device based on arabinogalactan, hyaluronic acid, and trehalose.

Effect of Refractive Error Correction on Dry Eye Disease among Computer Operators of Hayatabad Medical Complex Peshawar

Purpose: To determine the frequency of dry eye disease and association of refractive error correction on dry eye disease among computer operators. Study Design: Cross-sectional. Place and Duration of Study: Hayatabad Medical complex, Peshawar from June 2022 till December 2022. Methods: This study recruited 93 computer operators in Hayatabad Medical Complex. Data collection began after approval from hospital ethical and research committee. Symptoms of dry eye were recorded in a pre-designed proforma after obtaining written informed consent. The Schirmer test was used to measure tears volume.Data was analyzed using SPSS version 23. Quantitative variables were described as mean + standard deviation and categorical values in frequency and percentages. Post stratification chi square test was utilized. A p value of less than 0.05 was considered statistically significant Results: The mean age of the subjects was 38.7 + 8.5 years. There were 75.3% males. The mean duration of the job was 8.1 + 3.5 years and mean daily computer use was 8 + 2.2 hours. Use of spectacles was reported by 30.1% participants and contact lenses by 17.2%. Dry eye disease (on Shirmer’s test) was recorded in 24.7%. Refractive errors correction had no statistically significant effecton dry eye disease (for glasses p=0.313 and contact lens p=0.193). Conclusion: Dry eye disease is significantly high in our population among avid screen users, but the refractive error correction has no effect on dry eye disease.

Comparison of the Effect of and Compliance With Cyclosporine 0.1% After Various Pretreatments in Dry Eye Disease.

Purpose: We sought to compare the effect of cyclosporine 0.1% after various pretreatments in patients with dry eye disease. Methods: Two hundred seventy-four eyes of 137 patients diagnosed with dry eye disease were retrospectively enrolled. Thirty patients (Group 1, 60 eyes) were not pretreated, while 68 patients (Group 2, 136 eyes) were pretreated with fluorometholone 0.1%, and 39 patients (Group 3, 78 eyes) were pretreated with cyclosporine 0.05% before treatment with cyclosporine 0.1%. The Ocular Surface Disease Index Questionnaire (OSDI) score, Schirmer I test result, noninvasive tear film break-up time (NItBUT), corneal staining score, matrix metalloproteinase-9 (MMP-9) grade, meibography result, meibum quality and expressibility scores, and tear meniscus height were examined before treatment and at 1, 2, and 3 months after treatment. Results: All dry eye signs and symptoms of all Groups at 1, 2, and 3 months were significantly improved compared to those before treatment with cyclosporine 0.1% (p < 0.05). Notably, the OSDI score, Schirmer I test result, NItBUT, corneal and conjunctival fluorescein score, and MMP-9 grade in Group 3 were significantly improved compared to those in Groups 1 and 2 at 1, 2, and 3 months after treatment with cyclosporine 0.1% (p < 0.05). The percentages of cases with treatment discontinuation in Groups 1, 2, and 3 were 20.0%, 7.4%, and 10.0%, respectively. Conclusion: Pretreatment with cyclosporine 0.05% can augment the anti-inflammatory effect of cyclosporine 0.1%. Pretreatment with a steroid or a lower concentration of cyclosporine can increase compliance in patients using a cyclosporine 0.1% eye drop.

Post-COVID-19 dry eye negatively impacts the patient's quality of life.

To describe the ophthalmological findings of dry eye disease and its relation to the quality of life of COVID-19 survivors. COVID-19 survivors who had previously been hospitalized at Hospital das Clínicas de Ribeirão Preto complex underwent an ophthalmological evaluation, which included a dry eye disease questionnaire, break-up time, fluorescein staining, and Schirmer test. We collected the presenting and best-corrected visual acuity, sociodemographic data, personal medical history, and scores from a self-reported quality of life questionnaire (WHOQOL-bref). According to the severity of the acute phase of the disease, the patients were classified into mild-to-moderate, severe, and critical groups. Ninety-five patients (190 eyes) were evaluated 100 ± 44 days after the onset of COVID-19 symptoms. Of these, 83 patients (87.3%) completed the WHOQOL-bref questionnaire. Ten patients (12.0%) had mild-to-moderate COVID-19, 41 (49.4%) had severe COVID-19, and 32 (38.6%) had critical COVID-19. The median best-corrected visual acuity was logMAR 0 (0-1). Approximately 26.3% patients had a history of dry eye disease or severe dry eye symptoms (frequent or constant ocular dryness and irritation). There was an association between the proportion of patients with dry eye disease and the quality of life (p=0.014) and health (p=0.001). Furthermore, there was a significant trend between the proportion of patients with dry eye disease and how they rated their health and quality of life (p=0.0004 and 0.0027, respectively. There is a significant negative correlation between the proportion of patients with dry eye disease and their self-reported quality of life.

Effects of Tisochrysis lutea on Dry Eye Symptoms

Purpose: Tisochrysis lutea is a marine microalga known for its anticancer and antioxidant properties. This study aimed to investigate the efficacy and safety of T. lutea in adults with dry eye symptoms.Methods: One hundred participants with dry eye symptoms were enrolled and divided into two groups: one received T. lutea powder (test group), and the other received control food (placebo, control group) for 12 weeks. Subsequently, the measurements of ocular surface disease index (OSDI), tear secretion (Schirmer’s test), tear break-up time (TBUT), corneoconjunctival staining, and safety assessments were compared between the test and control groups.Results: In terms of the OSDI score, the value for the test group decreased by 6.51 points after 12 weeks of T. lutea powder intake, compared with baseline, whereas that in the control group decreased by 2.88 points, demonstrating a significant difference between the two groups (p = 0.002). The results of Schirmer's test also showed significant improvements: in the test group, the result for the right eye increased by 1.33 ± 3.71 after 12 weeks (p = 0.020), and that for the left eye increased by 1.93 ± 3.33 (p = 0.0003). However, no significant increases in the results were observed in the control group. Additionally, TBUT showed a significant increase from baseline in the right eye of the test group after 6 weeks of T. lutea powder intake (p = 0.043).Conclusions: After 12 weeks of consumption in the powdered form, T. lutea improved the symptoms of dry eye and increased tear production. Therefore, T. lutea can be used as an eye supplement for adults with dry eye symptoms.

Refrigeration reduces instillation discomfort of a 0.09% cyclosporine A solution.

Topical cyclosporine A (CsA) for the treatment of dry eye disease is often associated with instillation discomfort, which may negatively influence patient adherence to therapy. This study found that refrigerating topical CsA reduced instillation discomfort compared with instillation of warm CsA. Thus, refrigerating CsA prior to instillation may improve patient experience when using CsA to manage dry eye disease. This study aimed to quantify instillation discomfort associated with cold or warm instillation of a 0.09% CsA. Forty participants with symptomatic aqueous deficient dry eye were enrolled. A drop of cold (4°C) CsA was instilled in one eye, and a drop of warm (23°C) CsA was instilled in the other eye. The order and eye receiving the cold drop were randomized. Participants rated the discomfort of each eye (0, no discomfort; 10, maximal discomfort) prior to drop instillation, immediately post-instillation, and at each subsequent minute for 10 minutes. Area under the curve was used to quantify cumulative discomfort. Forty participants (39.6 ± 18.9 years old, 82% female) completed the study. A majority of participants (n = 24, 60%) experienced reduced cumulative discomfort with cold CsA, whereas the remainder experienced minimal difference (n = 10, 25%) or increased cumulative discomfort (n = 6, 15%). For those with reduced discomfort (n = 24), cumulative discomfort associated with cold instillation (median, 11.5 [2.2, 20.0]) was significantly lower (p<0.01) than cumulative discomfort associated with warm instillation (median, 17.5 [11.2, 32.2]). Cold instillation was associated with a median reduction of 1 discomfort point immediately post-instillation and at all subsequent time points (all p≤0.04, but not significant at t = 10), compared with warm instillation. Up to 60% of participants found that cold instillation of CsA solution induced less discomfort than warm instillation, lasting up to 9 minutes post-instillation. In contrast, although 15% of participants found reduced discomfort with warm instillation, the magnitude of discomfort associated with warm instillation was not significantly different than cold instillation.

A study to correlate over the counter drugs and ophthalmologists prescribed osmoprotective drugs among prolonged visual display terminal users

To find out the drug instillation behaviour, the relationship between drug instillation behaviour and subjective symptoms &amp; compliance rate of OTC purchased Osmoprotective drugs and to find the correlation between OTC drugs and Ophthalmologist prescribed drugs among VDT users. A prospective, cross-sectional study included 100 subjects who use OTC-purchased Osmoprotective drugs and have not visited Ophthalmologist recently. The study data were collected by asking one sutured questionnaire to find out the complete scenario of OTC drug usage patterns. Subjects were tested for Schirmer’s II test and according to the diagnosis, Osmoprotective drugs were prescribed. In our study, out of 100 subjects a significant majority (86%) did not visit ophthalmologists in the recent past, therefore the prevalence of OTC drugs has increased. Schirmer’s-II test indicated that most participants experienced mild dry eye symptoms in both eyes (14.26 + 4.21 &amp; 14.37 +4.20). CarboxymethylCellulose emerged as the most commonly used OTC drug (64%). A significant association was observed between the dry eye severity levels before and after treatment (p &amp;#60; 0.000). Only 2 drugs CarboxymethylCellulose (p &amp;#60; 0.003) and Polyethylene glycol and polypropylene glycol (p &amp;#60; 0.000) are commonly given in both OTC and ophthalmologist prescriptions. This work gives a detailed insight into drug usage patterns purchased from OTC and also found the correlation between OTC drugs and Ophthalmologist prescribed drugs.

Combined Effect of Rebamipide 2% and Hyaluronic Acid 0.15% on Dry Eye after Cataract Surgery

Purpose: To assess the combined therapeutic effects of topical rebamipide 2% and hyaluronic acid 0.15% in managing dry eye symptoms following cataract surgery.Methods: Patients who underwent cataract surgery (phacoemulsification with intraocular lens insertion) were assessed for dry eye one week following the procedure. Dry eye patients were randomly assigned to two groups: a treatment group receiving rebamipide 2% and hyaluronic acid 0.15% eye drops, and a control group who did not receive these treatments. Various dry eye tests, including Schirmer’s test, tear break up time (TBUT), ocular surface staining, tear film osmolarity, tear lipid layer thickness, and the ocular surface disease index, were conducted at one and two months after surgery.Results: Significant improvements in TBUT (1 month: &lt;i&gt;p&lt;/i&gt; &lt; 0.001; 2 months: &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and ocular surface staining scores (1 month: &lt;i&gt;p&lt;/i&gt; = 0.001; 2 months: &lt;i&gt;p&lt;/i&gt; &lt; 0.001) were observed in the treatment group at both one and two months after surgery compared to baseline. During the follow-up period, the treatment group consistently showed significantly longer TBUT (&lt;i&gt;p&lt;/i&gt; &lt; 0.001 at both intervals) and lower ocular surface staining scores (1 month: &lt;i&gt;p&lt;/i&gt; = 0.007; 2 months: &lt;i&gt;p&lt;/i&gt; &lt; 0.001) when compared to the control group.Conclusions: The combined application of rebamipide and hyaluronic acid eye drops following cataract surgery effectively improved TBUT and ocular surface staining scores.

Safety and Efficacy of Hydroxypropyl Guar-Hyaluronic Acid Dual-Polymer Lubricating Eye Drops in Indian Subjects with Dry Eye: A Phase IV Study.

This work aimed to evaluate the safety and efficacy of hydroxypropyl guar-hyaluronic acid (HPG-HA) dual-polymer lubricating drops in Indian subjects with dry eye disease (DED). This prospective, open-label, single-arm, phase IV study was conducted in India. Adults (18-65 years) with an average total ocular surface staining (TOSS) score ≥ 4, best-corrected visual acuity of ≥ 20/40 in each eye, tear break-up time (TBUT) ≤ 10 s, and dry eye questionnaire (DEQ-5) score ≥ 6. Subjects received the first dose of HPG-HA eye drops on day 1 and self-administered 1-2 drops four times daily for 90 ± 5 days. Frequency and characteristics of treatment-emergent adverse events (TEAEs) throughout the study and TOSS score at day 90. Secondary/other endpoints: Dry eye symptoms score (through dry eye questionnaire [DEQ-5]) and TBUT. Of 175 subjects, 36 (20.6%) had ≥ 1 TEAE, and 27 (15.4%) of this reported ≥ 1 mild drug-related TEAE (eye irritation [n = 9], eye pruritus [n = 8], blurred vision [n = 6], increased lacrimation [n = 4], ocular hyperemia [n = 3], and ocular discomfort [n = 1]). One subject discontinued due to TEAEs, and none led to drug interruptions. No serious adverse events were reported. The mean TOSS score reduced from day 1 (6.12 ± 1.69, OU [both eyes]) to day 90 (2.40 ± 1.97, OU). The mean DEQ-5 score reduced from day 1 (11.50 ± 2.27) to day 90 (5.50 ± 2.50). TBUT increased from day 1 (right eye [OD], 5.70 ± 1.94; left eye [OS], 5.70 ± 1.96) to day 90 (OD, 9.51 ± 3.08; OS, 9.63 ± 3.01). HPG-HA dual-polymer eye drop was safe and effective in relieving signs and symptoms of DED over 90 days in Indian subjects. Clinical Trial Registry India, CTRI/2022/03/041175.

Randomized clinical trial: MGrx versus standard debridement and expression for meibomian gland dysfunction.

Evaporative dry eye disease, due to meibomian gland dysfunction, causes significant suffering for millions of people globally, yet satisfactory long-term treatment remains elusive for many. Investigation of potential therapies for meibomian gland dysfunction is therefore of high importance to clinicians and their patients. This study aimed to compare the efficacy of a new device for meibomian gland debridement and expression to that of the conventional way of providing this treatment. Thirty participants (mean age, 36.4 ± 15.4 years; 77% female) fulfilling current Tear Film & Ocular Surface Society diagnostic criteria for dry eye disease and meibomian gland dysfunction were recruited (Research Registry, 10340). Fifteen participants each were randomized to receive a single treatment with either traditional debridement (using a golf-club spud), heating (10 minutes of Blepha EyeBag, Théa Laboratories, Clermont-Ferrand, France) and expression (with forceps), or the multimodal MGrx, which comprises a handheld device with heated debridement, massage, and expression attachments. Symptomatology, tear film, and ocular surface measures were assessed at baseline and at 4 and 8 weeks post-treatment. Ocular Surface Disease Index, 5-Item Dry Eye Questionnaire, and Symptom Assessment in Dry Eye symptom questionnaire scores all improved significantly with both treatments (all p<0.001), with no subsequent deterioration for at least 8 weeks. The improvement was similar between treatment groups (all p>0.05). Clinical signs, of blink rate, tear film quality and quantity, ocular surface characteristics, and meibomian gland expressibility, were all unchanged with both treatments (all p>0.05) except for noninvasive tear breakup time, which deteriorated in the conventional treatment group (p=0.006) between 4 and 8 weeks post-treatment. No adverse reactions were reported, and all participants were able to tolerate treatment. A single application of meibomian gland debridement and expression resulted in sustained improvements in the symptoms of dry eye disease, in both treatment groups. The MGrx device provides a safe and effective in-office treatment for evaporative dry eye disease, and has time and space advantages compared with conventional treatment.

Long-Term Evaluation of Ocular Surface and Meibomian Gland Function after Laser Assisted in Situ Keratomileusis surgery.

Laser-assisted in Situ Keratomileusis (LASIK) is a common refractive surgery. But it may lead to temporary dry eye due to reversible damage to the corneal sub-basal nerve plexus. However, chronic ocular surface changes are unclear. This study reports the ocular surface changes, partial blinking rate, and meibomian gland status in eyes that underwent LASIK for at least 48 months. Cross-sectional, matched case-control comparison study, including 48 post-LASIK patients and 48 sex-, age-, smoking-, and axial length-matched healthy controls, recruited from a community eye screening program. Outcome measures include anterior segment clinical findings, keratographic and meibographic imagings. Totally 48 right eyes of 48 post-LASIK Chinese patients (39 females, 2 smokers) were analyzed with 48 right eyes of 48 matched healthy controls. The age on ocular surface examination was 50±11 years, and the axial length 26±1mm. Post-LASIK eyes had a lower quality of meibum (P=0.008) compared to healthy controls. Post-LASIK eyes were associated with a shorter Schimer test (P=0.03). The ocular surface disease index (OSDI) score was higher in post-LASIK patients (P=0.00001). Other anterior segment examination parameters, partial blinking rate, meibomian gland dropout, lipid layer thickness, non-invasive tear break-up time, and tear meniscus height were comparable between the 2 groups. Up to 75% of post-LASIK patients complained of chronic dry eye symptoms. Post-LASIK eyes were associated with a reduced aqueous tear production. Post-LASIK patients with chronic dry eye symptoms should have comprehensive ocular surface evaluation. Treatment should be commenced in patients with poor tear film stability.

Rebuilding the autoimmune-damaged corneal stroma through topical lubrication.

Corneal lubrication is the most common treatment for relieving the signs and symptoms of dry eye and is considered to be largely palliative with no regenerative functions. Here we challenge this notion by demonstrating that wetting the desiccated cornea of an aqueous-deficient mouse model with the simplest form of lubrication, a saline-based solution, is sufficient to rescue the severely disrupted collagen-rich architecture of the stroma, the largest corneal compartment that is essential to transparency and vision. At the single cell level we show that stromal keratocytes responsible for maintaining stromal integrity are converted from an inflammatory state into unique reparative cell states by lubrication alone, thus revealing the extensive plasticity of these cells and the regenerative function of lubricating the surface. We further show that the generation of a reparative phenotype is due, in part, to disruption of an IL1β autocrine amplification loop promoting chronic inflammation. Thus, our study uncovers the regenerative potential of topical lubrication in dry eye and represents a paradigm shift in our understanding of its therapeutic impact.

Corneal Epithelial Thickness Correlation with Dry Eye Symptom Severity: A Cross-Sectional Study [Response to Letter

Corneal Epithelial Thickness Correlation with Dry Eye Symptom Severity: A Cross-Sectional Study [Response to Letter

Efficacy of indirect intense pulsed light irradiation on meibomian gland dysfunction: a randomized controlled study.

To investigate the efficacy and mechanisms of indirect intense pulsed light (IPL) irradiation on meibomian gland dysfunction (MGD). A total of 60 MGD patients was included in this prospective randomized controlled trial. Patients were randomly assigned 1:1 into two groups (3-mm group and 10-mm group) in which IPL was applied at distances from the lower eyelid margin of 3 and 10 mm, respectively. Both groups received three times treatment with 3-week interval. Meibomian gland yield secretion score (MGYSS), standard patient evaluation of eye dryness (SPEED) questionnaire, tear break-up time (TBUT), corneal fluorescein staining (CFS), and in vivo confocal microscopy were performed at baseline and after every treatment. After three IPL treatments, both groups had significant improvement in MGYSS (both P<0.05). The non-inferiority test showed that improvement in 10-mm group was not inferior to that in 3-mm group (P<0.001). In both groups, temporal regions of both upper and lower eyelids showed significant improvement in MGYSS. Scores of SPEED questionnaire in both groups declined significantly (both P<0.001) and changes of SPEED had no difference between two groups (P=0.57). Density of central corneal subepithelial nerves and TBUTs showed no statistically significant changes. The 3-mm group had improvement on corneal fluorescein staining (P=0.048) and meibomian gland morphology (acini wall thickness P=0.003, hyperreflective points P=0.024) while the 10-mm group had not. The efficacy of IPL indirect irradiation in improving meibomian gland secretion and alleviating dry eye symptoms remains unchanged with increase in treatment distance. IPL may primarily act on the functional improvement of the meibomian glands and corneal nerves.