BackgroundExtranasal neurostimulation is a promising therapy for aqueous-deficient dry eye (ADDE), but neural adaptation and optimal treatment duration remain poorly characterized. This study investigated duration-dependent neural sensitivity dynamics to formulate an optimized cyclic treatment regimen.MethodsIn this prospective, randomized, open-label trial, 50 ADDE patients (Schirmer test: 2–5 mm) were assigned to 2-week or 4-week bilateral extranasal neurostimulation (twice daily). Participants were followed for 6 weeks post-treatment. The primary outcomes were neural sensitivity changes (Δ Schirmer) and short-term recovery (6 weeks after stimulation cessation). Secondary endpoints included subjective symptoms and objective signs.ResultsDistinct neural adaptation patterns were observed. The 4-week group exhibited reversible neural adaptation, with an attenuated stimulation response at treatment completion (Δ Schirmer: 1.18 ± 4.17 mm, P = 0.051, Cohen's d = 0.28) that fully recovered after the 6-week intermission (post-stimulation Schirmer: 10.90 ± 7.29 mm vs. initial 12.42 ± 6.67 mm, P = 0.90, η2p = 0.092). This reversible adaptation was associated with sustained improvements in tear film stability [fluorescent tear film break-up time (FBUT): 6.27 ± 2.49 s vs. baseline 3.18 ± 1.36 s, P < 0.001, η2p = 0.235] and tear volume [tear meniscus height (TMH): 0.25 ± 0.05 mm vs. 0.19 ± 0.02 mm, P < 0.001, η2p = 0.26]. Critically, this reversible adaptation pattern was exclusive to the 4-week protocol. The 2-week protocol showed preserved stimulation responses during treatment (Δ Schirmer: 3.22 ± 6.54 mm, P < 0.001, Cohen's d = 0.49) but developed persistent neural hyposensitivity (8.76 ± 5.95 mm vs. initial 14.88 ± 8.69 mm, P < 0.001, η2p = 0.24). Its clinical benefits, though significant for FBUT (5.20 ± 2.81 s vs. baseline 2.86 ± 1.01 s, P < 0.001, η2p = 0.109), were less pronounced than in the 4-week group, and TMH showed no sustained increase (0.21 ± 0.04 mm vs. baseline 0.19 ± 0.03 mm, P = 0.11, η2p = 0.112). Both protocols demonstrated excellent safety and high patient satisfaction.ConclusionsBased on neural adaptation and recovery characteristics, a cyclic regimen of 4-week extranasal neurostimulation followed by a 6-week intermission is proposed as a potentially effective and sustainable clinical strategy for managing ADDE. This approach synchronizes treatment with the nervous system's intrinsic recovery cycles, addressing limitations of continuous stimulation paradigms.Trial registrationChinese Clinical Trial Registry (ChiCTR2500100816). Registered on 15 April 2025 (retrospectively registered), https://www.chictr.org.cn/bin/project/edit?pid=265888.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40662-025-00466-w.

BackgroundTo investigate the relationship between tear film thickness, corneal epithelial thickness, tear film breakup location, and dry eye in patients with high- and low-myopia undergoing femtosecond-assisted laser in situ keratomileusis (FS-LASIK).MethodsA total of 52 patients (52 eyes) were enrolled and divided into a low-myopia group (LMG; spherical equivalent ≤−3.00 D; 26 eyes) and a high-myopia group (HMG; spherical equivalent ≥−6.00 D; 26 eyes). The Ocular Surface Disease Index (OSDI), fluorescein tear film breakup time (FBUT), corneal epithelial thickness (CET), tear film thickness (TFT), and other tear film stability markers were evaluated preoperatively. Each parameter was evaluated preoperatively at 1 and 3 months postoperatively.ResultsAt 1 month postoperatively, the HMG showed significantly higher OSDI scores and CET compared to the LMG (p < 0.05). Conversely, the FBUT and TFT were significantly lower in the HMG at the same time point (p < 0.05). Within a 6- to 7-mm corneal diameter, the TFT was significantly lower in the HMG than in the LMG (p < 0.05). Furthermore, the change in CET from baseline at 1 and 3 months postoperatively was significantly greater in the HMG, especially within the 5-mm corneal diameter (p < 0.05). There were no significant differences in spherical equivalent (SE) or uncorrected distance visual acuity (UDVA) between 1 and 3 months postoperatively within either group (p > 0.05).ConclusionThe observed alterations in tear film thickness, tear film distribution, FBUT, and tear film breakup location, affected by varying corneal stromal ablation depths, contribute to the development of dry eye disease following FS-LASIK. The extent of corneal epithelial remodeling after FS-LASIK correlates with the degree of refractive correction but not with refractive regression, and may play a role in tear film stability recovery.

Identification of microplastics in human tear fluid and meibum: Implications for dry eye disease pathogenesis.

This consensus aims to establish a practical severity classification for applying a tailored stepladder treatment algorithm helpful to any clinician. A modified Delphi methodology was used to establish a consensus on the definition, diagnosis, severity classification, and treatment algorithms for dry eye disease (DED) adapted to the needs of Latin America. The consensus focused on promoting the effective use of lubricants and providing straightforward, practical guidance for ophthalmologists treating dry eyes. Twenty-eight corneal specialists from representative Latin American countries reviewed the scientific evidence and drew on their expertise to answer specifically designed open-ended questions. A simple diagnostic algorithm (clinical history, DED questionnaire, and dry eye clinical tests) identified patients with the disease. A practical severity classification system of four grades: mild, moderate, severe, and LUBOS plus DED was based on four criteria: OSDI, film break-up time, Sjögren International Collaborative Clinical Alliance ocular surface staining score, and international workshop on meibomian gland dysfunction meibomian gland functionality test. For classification, ≥2 criteria of the highest severity grade from the worse eye were considered. A stepladder therapeutic algorithm aligned with disease severity consisted of 5 steps, each with proposed and recommended treatment alternatives. Patient education, lifestyle recommendations, adverse environment avoidance, lubricants, and eyelid therapy were reinforced during the therapy period. The LUBOS expert panel consensus considered the diverse geoenvironmental, socioeconomic, cultural, and ethnic factors pertinent to Latin America. This consensus offers an accessible and cost-effective tool, enabling professionals to detect, evaluate, and grade the severity of dry eye disease effectively for planning adequate therapeutic strategies that can be monitored with confidence.

INTRODUCTION: The aims of the study were to assess the prevalence and severity of dry eye in autoimmune disorders. The objectives included studying the prevalence of dry eye in patients with autoimmune disorders and assessing the severity of dry eye in each individual with an autoimmune disorder.AIM: To assess the prevalence and severity of dry eye in patients newly diagnosed with Autoimmune disorders.OBJECTIVES: • To study the prevalence of dry eye in patients newly diagnosed with Autoimmune disorders.• To assess the severity of dry eye in each patient with an Autoimmune disorder.MATERIAL AND METHODS: The study design is a cross-sectional study. The study population included hospital-based population newly diagnosed with autoimmune disorders. The study was conducted in the state of Tamil Nadu, with the study setting being the Ophthalmology Outpatient Department at SBMCH. The study period was 11/2 years from Jan 2023 to June 2024. Ethical considerations include obtaining approval from the Medical Ethical Committee of Sree Balaji Medical College and Hospital before commencing the study. The resources and funding for the study was self-funded.RESULTS: The mean age of the study participants were 32.34±9.05 years. Gender-wise, 43.8% were males, and 56.2% were females, indicating a female preponderance. Among the autoimmune disorders studied, Rheumatoid arthritis (32.9%), Psoriasis (27.4%),and Sjogren’s syndrome (12.3%) were the most prevalent. Tear film meniscus height results revealed that 80.8% had TFMH &lt;0.25% and 19.17% had TFMH 0.25-0.50mm.Tear film breakup time (TBUT) results revealed that 64.4% had TBUT more than 10 seconds, and 35.6% had 5 to 10 seconds. The Rose Bengal test showed positive results in 43.8% and was negative in 56.1% of patients. Schirmer’s test 1 showed 35.6% had moderate dry eye followed by 32.8% had mild dry eye and 17.8% had severe dry eye. Schirmer’s test 2 also showed 36.9% of patients had moderate dry eye,31.5% had mild dry eye and 20.5% had severe dry eye. Ocular surface disease index questionnaire (OSDI) indicated 38.4% had mild dry eye,30.1% had moderate dry eye,15.1% had severe dry eye and 16.4% had normal tear function.CONCLUSION: The study provides a valuable understanding of the prevalence and characteristics of dry eye syndrome in a diverse population with various autoimmune conditions. The findings highlight important demographic patterns, ocular manifestations, and tear function parameters among individuals with autoimmune diseases.

Purpose To evaluate the effect of punctal plugs combined with cyclosporine eye drops on dry eye disease (DED) and ocular surface inflammation. Methods In a clinical trial, 73 patients were randomly allocated into three groups: punctal plug group, combination therapy group, and cyclosporine group. At the baseline and four weeks after treatment, the Schirmer I test score, fluorescein tear film break-up time (FBUT), ocular surface staining score and dry eye symptoms were assessed. Tear samples were collected to detect the level of inflammatory factors (interleukins, matrix metalloproteinase 9 (MMP-9) and tumor necrosis factor alpha (TNF-α)). In an animal experiment, a New Zealand rabbit dry eye model was induced. The rabbits were randomly divided into control group, punctal plug group, and combination therapy group (n = 6). Conjunctival goblet cell density, protein level of MMP-9 in conjunctiva and mRNA levels of inflammatory factors in conjunctiva and cornea were measured before and after treatment. Results In combination therapy group of the clinical trial, the following results were observed: significant improvement in Schirmer I test scores and FBUT compared to the cyclosporine group and punctal plug group, respectively; a decrease in the tear levels of IL-6, IL-1, and MMP-9 compared to the punctal plug group; and a decrease in the tear levels of IL-1α, IL-6, and IL-17 compared to the baseline (all p < 0.05). In the animal experiment, rabbits in combination therapy group had a higher goblet cell density (p < 0.01) and lower mRNA levels of IL-16 (p < 0.05), IL-17 (p < 0.05), and MMP-9 (p < 0.01) in conjunctiva and that of MMP-9 (p < 0.01) in cornea compared to punctal plug group. Conclusion Cyclosporine eye drops combined with degradable punctal plugs is a more optimized clinical treatment strategy for DED compared with degradable punctal plugs or cyclosporine eye drops alone, considering the influence of comprehensive clinical efficacy and ocular surface inflammation.

PurposeTo examine the effectiveness and identify clinical response predictors of a short corticosteroid‐based regimen consisting of topical preservative‐free 0.1% dexamethasone (Monopex®, Théa Laboratories) in conjunction with artificial tears (AT) for dry eyes in a real‐life clinical setting.MethodsPatients were recruited from the Norwegian Dry Eye Clinic and were allowed to use ATs of their own choice in addition to the prescribed 14‐day topical dexamethasone course. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ‐5), Schirmer test (ST), fluorescein tear film break‐up time (FBUT), ocular surface staining (OSS), meibum expressibility (ME), meibum quality (MQ), number of expressible meibomian glands among the central eight glands in the lower lids (NMG) and intraocular pressure (IOP) were measured at baseline and at 1‐month follow‐up. The average values of clinical parameters from both eyes were used for analyses. A paired t‐test and a significance value of p < 0.05 were used for statistical analyses. Associations between sex, age, baseline values and the changes after the intervention (Δ) were explored using linear regression.ResultsA total of 167 patients (124 women, mean age 54 years ±17 (standard deviation)) were included. One month after initiation of intervention, OSDI and DEQ5 scores improved from 39.5 ± 22.1 to 31.4 ± 21.3 (p < 0.001) and from 12.6 ± 4.2 to 11.0 ± 4.6 (p < 0.001), respectively. OSS improved from 2.2 ± 1.4 to 1.8 ± 1.5 (p < 0.001), NMG increased from 4.8 ± 2.2 to 5.1 ± 2.2 (p < 0.05), while IOP decreased from 12.9 ± 3.3 to 12.4 ± 3.5 mmHg (p < 0.05). Significant associations were found between the change in symptoms and objective measures of DED (ΔOSDI, ΔDEQ5, ΔOSS, ΔFBUT, ΔNMG, ΔMQ) and their respective baseline values (OSDI, DEQ5, OSS, FBUT, NMG, MQ). The remaining tests did not show statistically significant changes.ConclusionImprovement in dry eye symptoms and signs were observed following a short course of topical, preservative‐free 0.1% dexamethasone treatment in combination with AT. Individuals exhibiting more pronounced symptoms and signs witnessed the most profound improvements with the treatment regimen, suggesting that poor baseline parameters may serve as response predictors of the treatment regimen. While the real‐life data presented herein are valuable, the conclusions are limited by the inherent biases of a non‐controlled study.

BackgroundA cross-sectional population-based survey in the Beichen district of Tianjin was conducted to estimate the prevalence of dry eye disease (DED) among the population over 50 years old with Dry Eye Workshop (DEWS) II and Chinese expert consensus (CEC) criteria.MethodsA total of 5791 subjects over 50 years old were enrolled. Ocular surface disease index (OSDI) questionnaire, lipid layer thickness (LLT), partial blink ratio (PBR), fluorescein tear film breakup time (FBUT), Schirmer I test (SIT), fluorescein staining, meibomian gland dropout, meibomian gland expression scores (MES) and quantity scores (MQS) was assessed. Additionally, basic information, weight, disease history, living habits, anxiety, and depression condition were collected.ResultsAccording to the CEC, the prevalence of DED was 39.0%, whereas 44.0% based on DEWS II. The prevalence of DED increased with age and was substantially greater among women (41.1%, 95% CI, 39.5-42.6%) than males (35.1%, 95% CI, 33.1 -37.2%) (p < 0.001). Furthermore, the severity of DED was more severe in women (p = 0.006). The associated risk factors were age, female, depression, smoking, insomnia, and glaucoma. On the other hand, 53.6% of these populations were diagnosed as asymptomatic DED, and the morbidity was higher in males (p = 0.007).ConclusionsThe prevalence of DED in China was relatively high, which was associated with aging, female(sex), depression, smoking and sleep problems. Hence, it is crucial for clinicians and caregivers to be aware of the existence of asymptomatic DED within the susceptible population.

To explore whether implantable collamer lens implantation has any effect on the postoperative objective indicators of dry eye and to determine the severity of its influence on each indicator. This prospective observational trial was performed in the Department of Ophthalmology of West China Hospital and was approved by the Biomedical Ethics Sub-Committee of the West China Hospital of Sichuan University. A total of 89 non-dry eye patients (178 eyes in total) who received ICL implantation surgery at West China Hospital of Sichuan University were enrolled. The noninvasive keratograph tear film breakup time (NIKBUT), noninvasive keratograph tear meniscus height (NIKTMH), score of lipid layer, score of meibomian gland function, and hyperemia index were obtained via the OCULUS Keratograph for all subjects before surgery and at 1week, 1month, and 3months after surgery. The fluorescein tear film breakup time (FBUT), corneal fluorescein staining score (CFS), and Schirmer test I were also measured at the same time. A total of 178 eyes completed the 1-week and 1-month follow-up, and 40 eyes completed the 3-month follow-up. Compared with the preoperative baseline, there was no significant difference in the NIKBUT or the corneal fluorescein staining score at each follow-up time point (P > 0.05, P > 0.05, P > 0.05). The FBUT and Schirmer test I at 1week, 1month, and 3months after surgery were significantly higher than the preoperative baseline (P < 0.01, P < 0.01, P < 0.01). The NIKTMH and the score of lipid layer were significantly lower than the preoperative baseline at 1week, 1month, and 3months after surgery (P < 0.01, P < 0.01, P < 0.05). The score of meibomian gland function and hyperemia index were significantly lower than the preoperative baseline 1week after surgery (P < 0.01). ICL implantation has no adverse effect on the occurrence of postoperative dry eye, but it reduces the basal tear secretion of patients after surgery and has adverse effects on the indices of meibomian gland function in the short term postoperatively.

Dry eye (DE) is a multifactorial ocular surface disease characterised by an imbalance in tear homeostasis. The pathogenesis of DE is complex and related to environmental, immunological (e.g., T helper 17 cells) and other factors. However, the DE disease pathogenesis remains unclear, thereby affecting its clinical treatment. This study aimed to explore the mechanism through which prostaglandin E2 (PGE2) affects DE inflammation by regulating Th17. The DE mouse model was established through subcutaneous injection of scopolamine hydrobromide. The tear secretion test and break-up time (BUT) method were used to detect tear secretion and tear film BUT, respectively. Enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of PGE2, interleukin (IL)-17, IL-6 and tumour necrosis factor (TNF-α) in tear fluid and those of PGE2 and IL-17 in the serum. RT-qPCR and western blotting were used to test the mRNA and protein expression levels of IL-17 and retinoid-related orphan receptor-γt (RORγt). PGE2 was highly expressed in the DE mouse model. The mRNA and protein levels of IL-17 and the key Th17 transcription factor RORγt were increased in tissues of the DE mice. Moreover, PGE2 promoted tear secretion, reduced the BUT, increased the IL-17 concentration in tears and increased the Th17 cell proportion in DE, whereas the PGE2 receptor inhibitor AH6809 reversed the effects of PGE2 on tear secretion, BUT, and the Th17 cell proportion in draining lymph node (DLN) cells. Taken together, the study findings indicate that PGE2 could induce DE-related symptoms by promoting Th17 differentiation.

BackgroundThis study aimed to explore the associations between Demodex infestation and the ocular surface characteristics of meibomian gland dysfunction (MGD) in different age groups, to further understand the effect of Demodex on MGD.MethodsA total of 202 consecutive MGD patients aged 18 to 70 years were randomly recruited. All patients were divided into two groups based on their age: young patients (18–40 years) and elderly patients (41–70 years). The main observations were the different relationship between Demodex infestation and ocular surface and meibomian gland (MG) parameters in two age groups. We also compared ocular surface and MG parameters between the young and the elderly groups. Demodex infestation was diagnosed based on expert consensus in China.ResultsOur results indicated significant differences among young Demodex-positive, suspicious-positive, and negative patients in MG dropout (P = 0.000), plugging of MG orifices (P = 0.000), lid margin abnormality (P = 0.000), and meibum quality (P = 0.000). In elderly patients, there were significant differences among the Demodex-positive, suspicious-positive, and negative groups in terms of ocular surface disease index (OSDI) (P = 0.037), fluorescein tear film break-up time (FBUT) (P = 0.002), corneal fluorescein staining (CFS) (P = 0.036), MG dropout (P = 0.000), plugging of MG orifices (P = 0.008), lid margin abnormality (P = 0.000), and MG expression (P = 0.037). The mean number of mites in elderly Demodex-positive patients (10.64 ± 7.50) was greater than that of in young patients (7.60 ± 4.71) (P = 0.014). MG dropout (P = 0.000), plugging of MG orifices (P = 0.006), lid margin abnormality (P = 0.000), MG expression(P = 0.001), and meibum quality (P = 0.032) were more severe in elderly Demodex-positive patients. Additionally, FBUT (P = 0.005) was lower and tear film lipid layer thickness (LLT) (P = 0.001) was higher in the elderly.ConclusionThe effect of Demodex infestation on the ocular surface and MG parameters of MGD was different in patients of different ages. It is necessary to pay more attention to the diagnosis and treatment of Demodex infestation in MGD.

Objectives:To determine if patients treated with multiple intravitreal injections for neovascular age-related macular degeneration are more likely to suffer from dry eye and meibomian gland dysfunction.Materials and Methods:Sixty eyes of 30 patients were enrolled. One eye of each patient was treated with multiple monthly intravitreal injections for neovascular AMD (Group 1) and the fellow healthy eye received no treatment (Group 2). The presence of dry eye was evaluated using tear film break-up time, Schirmer 1 test, the Oxford scale, and Ocular Surface Disease Index (OSDI). The loss rate of meibomian glands was evaluated by meibography and was graded and scored (meiboscore) from grade 0 (no loss of glands) to grade 3 (loss of >2/3 of total meibomian glands) for each eyelid.Results:Group 1 had lower mean Schirmer 1 and tear film break up-time measurements and higher mean OSDI score than Group 2, but the differences were not statistically significant (p=0.257, p=0.113, and p=0.212, respectively). Mean Oxford scale scores and meiboscore of the upper eyelids showed no statistically significant difference between the groups (p=0.594, p=0.663, respectively). The meiboscore of the lower eyelids was significantly higher in Group 1 (p=0.048).Conclusion:Multiple factors such as povidone-iodine and the preservatives in topical eye drops may cause inflammation leading to ocular surface damage in patients treated with multiple intravitreal injections. As the treatment requires repeated injections, exposure to these factors might worsen the ocular surface inflammation. The possibility of dry eye and meibomian gland dysfunction should be considered in these patients.

PurposeTo assess the effects of the preoperative application of artificial tearscombined with recombinant bovine basic fibroblast growth factor on theocular surface function and inflammatory factor levels after operation incataract patients complicated with dry eyes.MethodsA total of 118 cataract patients (118 eyes) complicated with dry eyes treatedfrom February 2019 to February2020 were assigned to control and observationgroups (n=59 eyes/group) using a random number table. One week before theoperation, the control group was administered 0.1% sodium hyaluronate eyedrops (artificial tears), based on which the observation group receivedBeifushu eye drops (recombinant bovine basic fibroblast growth factor), both6 times daily for 1 week. A comparison was made between the scores ofclinical symptoms and the indices of ocular surface function, inflammatoryfactors in tears, and oxidative stress indices before and after theoperation. The ocular surface function was evaluated by an ocular surfacedisease index questionnaire, tear film breakup-time assay, Schirmer’s Itest, and corneal fluorescein stain test. The inflammatory factors in tearswere measured.ResultsNo significant differences were noted in the general data and clinicalsymptom score, ocular surface disease index, tear film breakup-time,Schirmer’s I test score, fluorescein stain score, interleukin-6, tumornecrosis factor-alpha, malondialdehyde, superoxide dismutase, lipidperoxide, and total antioxidant capacity before treatment between the 2groups (p>0.05). After treatment, the clinical symptom score, ocularsurface disease index, fluorescein stain score, tumor necrosis factor-alpha,interleukin-6, malondial-dehyde and lipid peroxide declined significantly,and tear film breakup-time, Schirmer’s I test score, superoxide dismutase,and total antioxidant capacity increased in both the groups. Theimprovements in the clinical symptom score as well as in the indices ofocular surface function, inflammatory factors, and oxidative stress weremore prominent in the observation group than in the control group(p<0.05).ConclusionsArtificial tears combined with recombinant bovine basic fibroblast growthfactor before operation. significantly improved the ocular surface function,reduced inflammatory factors in tears, and alleviated dry eye symptoms afteroperation in cataract patients.

PurposeThis study aimed to screen the ocular surface of children with attentiondeficit hyperactivity disorder and identify the adverse effects ofmethylphenidate related to dry eye disease.MethodsThis cross-sectional study included children with attention deficithyperactivity disorder and healthy children (all aged 5-18 years). They wererandomized into Group A (without methylphenidate treatment), Group B (withmethylphenidate treatment), and Group C (healthy children). Tear filmbreak-up time, Ocular Surface Disease Index questionnaire, tear meniscusheight, tear meniscus area, and Schirmer test results were evaluated.Furthermore, symptom severity in attention deficit hyperactivity disorderwas assessed by Turgay DSM-IV-based Child and Adolescent BehavioralDisorders Screening and Rating Scale and Conners Parent Rating Scale-48.ResultsGroups A, B, and C consisted of 34, 40, and 60 individuals (n=34, 40, and 60eyes; age=11.44 ± 2.79, 11.70 ± 2.83, and 11.96 ± 3.63years, median age=12, 12, and 11.5 years), respectively. Tear film break-uptime, Ocular Surface Disease Index, tear meniscus height, tear meniscusarea, and Schirmer test results were not significantly different betweenGroups A and C (p=0.964, 0.336, 0.445, 0.439, and 0.759, respectively).However, Group B showed a significant decrease in tear film break-up time(10.50 ± 3.39 vs. 12.52 ± 2.46 s; p=0.005), tear meniscusheight (307.40 ± 5.53 vs. 310.82 ± 7.30 µm; p=0.025),tear meniscus area (0.024 ± 0.0037 vs. 0.026 ± 0.0046mm2; p=0.010) and Schirmer test (12.75 ± 3.96 vs.15.41 ± 3.75 mm; p=0.004) results compared with Group A.ConclusionCompared with healthy children, children with attention deficit hyperactivitydisorder showed ocular surface parameters suggestive of dry eye diseasedespite taking methylphenidate. Thus, they require close ophthalmologicfollow-up to prevent sight-threatening dry eye complications.

Objectives: To investigate the changes of dry eye-related clinical manifestations, ocular surface parameters, and tear inflammatory cytokines after upper blepharoplasty.Methods: Forty eyes of 20 who underwent upper blepharoplasty were divided into either the group with or the group without preexisting dry eye before upper blepharoplasty. Ocular Surface Disease Index (OSDI), Schirmer I test, tear meniscus height, lipid layer thickness, non-invasive tear break-up time (NIKBUT), fluorescein tear film break-up time (FBUT), corneal fluorescein staining, meibum expression, lid margin changes, and tear inflammatory cytokines were assessed preoperatively and at 1, 3, and 6 months postoperatively. Correlations between inflammatory cytokines and dry eye-related parameters were determined.Results: The OSDI scores increased significantly at 1 month (p = 0.040) and subsequently decreased to the preoperative levels at 6 months postoperatively in subjects with dry eye. First (f)-NIKBUT and FBUT were significantly shortened at 1, 3, and 6 months postoperatively in subjects with dry eye (f-NIKBUT: p <0.001, p = 0.010, p = 0.042; FBUT: p = 0.002, p = 0.005, p = 0.037, respectively), but were only shortened at 1 month (p = 0.028, p = 0.005) and returned to baseline levels at 6 months postoperatively in subjects without preexisting dry eye. A significant increasing trend of interleukin (IL)-6 was found in both dry eye and subjects without preexisting dry eye (p = 0.016, p = 0.008), while IL-8 and tumor necrosis factor alpha (TNF-α) were only found to be increased in subjects with dry eye postoperatively (p = 0.031, p = 0.031). The levels of IL-8 and TNF-α were positively correlated with OSDI scores (p = 0.046, p = 0.043, respectively) and negatively correlated with f-NIKBUT and FBUT (p = 0.026, p = 0.006, respectively).Conclusions: Upper blepharoplasty might increase the release of tear inflammatory cytokines and tear film instability that contribute to the development of postoperative dry eye in the early postoperative period and the changes most relieved in 6 months. Preexisting dry eye is a higher risk factor for worse and persistent ocular surface damage after upper blepharoplasty.

Purpose:To observe the effect of demodex infection on the ocular surface changes of patients with meibomian gland dysfunction (MGD) and analyze the correlation between the number of demodex and the changes of the ocular surface.Methods:Hundred patients with MGD aged 18–70 years who visited the dry eye center of Shanghai Aier Eye Hospital were recruited. All patients were examined with in vivo confocal microscopy to quantify the demodex and divided them into two groups (demodex negative group and demodex positive group) according to the number of demodex mites. The subjects underwent questionnaires of ocular surface disease index (OSDI) and a series of examinations. Parameters including the OSDI score, fluorescein tear film break-up time (FBUT), meibum quality, meibum gland expressibility, meibomian gland dropout (MG dropout), and ocular redness were recorded and compared between the two groups. The correlation between the number of demodex and the ocular surface changes was further analyzed.Results:Among 100 patients, 51 were positive for demodex. The demodex-positive group showed significantly increased scores of OSDI (24.41 ± 3.43 vs 20.98 ± 2.31, P = 0.00), ocular redness score (1.38 ± 0.46 vs 1.00 ± 0.30, P = 0.00), and MG dropout (3.00 ± 1.13 vs 2.18 ± 0.64, P = 0.00) and decreased FBUT (6.40 ± 1.63 vs 6.54 ± 1.83, P = 0.00), compared to the demodex-negative group. A significant correlation was noted between the number of demodex and OSDI, ocular redness, and FBUT.Conclusion:Ocular demodex infestation might play a role in the ocular surface discomfort, inflammation, and meibomian gland dropout in MGD patients. It is necessary to pay attention to the examination and treatment of demodex mite in patients with MGD.

As reported previously, tear film surface quality (TFSQ) should be considered in contact lens (CL) fitting. This study followed noninvasive keratograph tear film break-up time (NIKBUT) in CL wearers for 12 months to validate its clinical utility in predicting CL performance. Fifty-five subjects (M/F=17/38) aged 26±4 years were prescribed silicone hydrogel or hydrogel CLs. The study included baseline measurements without CLs; 2 visits for CL fitting and control; follow-up after 3, 6, and 12 months of CL wear; and postwear visit without CLs. Ocular Surface Disease Index (OSDI), 8-Item Contact Lens Dry Eye Questionnaire (CLDEQ-8), first and mean NIKBUT (F/M-NIKBUT), fluorescein tear film break-up time (FBUT), and ocular surface staining were evaluated. Post hoc analysis of each pair of visits showed differences between baseline and all CL visits for F-NIKBUT, M-NIKBUT, FBUT, and corneal staining. No difference was reported in symptoms. In addition, differences between baseline and postwear visits were noted in OSDI, M-NIKBUT, FBUT, and corneal staining, with three of the latter parameters showing a downward trend. No changes in TFSQ and symptoms were reported over 12 months. Introducing NIKBUT as part of routine CL fitting is advised to improve CL fit and predict success.

This study aimed to evaluate the efficacy of hyaluronic acid/trehalose drop for corneal epithelial and stromal healing after phacoemulsification surgery at Maltepe University, Department of Ophthalmology, Istanbul, Turkey. It is a retrospective randomized comparative study.The patients had phacoemulsification surgery divided into two groups. These patients received either a mixture of sodium hyaluronate and trehalose (HT, Thealoz Duo®, Thea)(Group 1) or sodium hyaluronate 0.15% (Eye Still®; Teka) (Group 2) postoperatively. Effect on corneal epithelial and stromal healing was evaluated using Oxford staining and the vertical scar length measured by optic coherence tomography (OCT) respectively. Preoperative and postoperative findings for Oxford staining, Schirmer’s test, tear film break-uptime (TBUT) and ocular surface disease index(OSDI) scores were also evaluated. The correlation between scar length and tear film parameters was examined. The effect of trehalose on the epithelial healing and stromal scar formation was evaluated. Group 1 and 2 each had 30 eyes. The two groups were similar according to age and sex distribution. In terms of epithelial healing, it was faster in the trehalose group, although there was no statistical difference between the two groups. The length of the stromal scar was not significantly different between groups, though a smaller scar formation was observed in group 1 compared to those in group 2 at both 1 week and 1 month postoperatively. There was also no significant difference between the groups in tear film parameters. The stromal scar length was correlated with the Schirmer test on the 15th day. Although it was not statistically significant, the hyaluronic acid/trehalose may affect epithelial healing and stromal scar formation in a positive way after phacoemulsification surgery. Larger and longer studies are needed.

ABSTRACT Purpose: To analyze the clinical and regional distribution characteristics of obstructive meibomian gland dysfunction (OMGD) in China. Methods: A total of 2900 patients (2900 eyes) diagnosed with OMGD were enrolled in this multicenter, cross-sectional, observational study. The Ocular Surface Disease Index (OSDI), tear film breakup time (FBUT), Schirmer test (SI), lipid layer thickness (LLT), OMGD grade, meibomian gland loss score (Meiboscore), meibum expressibility score (MES), meibum quality score (MQS), Lid margin abnormality score(LMS) and other tear film stability markers were evaluated. Results: The prevalence of dry eye in OMGD patients was 89%. There were gender differences among OMGD patients in the 30–39 and 50–59 years age groups (p < .05), and FBUT, Meiboscore, MES and MQS were significantly different among different OMGD grades (p < .05). There were significant differences in the detection indexes of OMGD patients in the six regions (p < .05), except LLT (p = .329). According to the Qinling-Huaihe River in China, OMGD patients were divided into the North Group (Shenyang and Beijing) and South Group (Wuhan, Changsha, Chongqing, and Chengdu). There was a significant difference in the detection indexes, except LLT (p = .600), between the two groups (p < .05). FBUT was significantly correlated with the OSDI (r = −0.131; p < .000). Meiboscore and LLT were significantly correlated with the OMGD grade (r = 0.299 and r = 0.106; p < .001). Age, LMS and MQS were significantly correlated with Meiboscore (r = 0.415, r = 0.256 and r = 0.328; p < .001). Conclusions: The prevalence of dry eye was high among OMGD patients. OMGD patients in different age groups may show different gender distributions. The symptoms of patients showed variation among subgroups with different OMGD grades and among different regions.

ObjectiveTo elucidate the relationship between lipid layer thickness (LLT), incomplete blinking rate and tear film stability in patients with different myopia degrees after small-incision lenticule extraction (SMILE) and to determine whether there is a difference in the prevalence of dry eye disease (DED) after SMILE among patients with different myopia degrees.MethodsFifty patients (100 eyes) were enrolled in this study; they were divided into 3 groups according to the degree of spherical refraction: a low-myopia group (LMG; spherical refraction ≤-3.00 D, 20 eyes), a moderate-myopia group (MMG; -3.00 D < spherical refraction <-6.00 D, 40 eyes), and a high-myopia group (HMG; spherical refraction ≧-6.00 D, 40 eyes). Testing indicators included the ocular surface disease index (OSDI), fluorescein tear film breakup time (FBUT), corneal fluorescence staining (CFS), the Schirmer test (SI), lipid layer thickness (LLT), blink rate (BR) per 20 seconds, incomplete blinking rate, noninvasive keratograph assessment of first and average tear film breakup time (NIKBUTf, NIKBUTav), and tear meniscus height (TMH). Each indicator was evaluated preoperatively and postoperatively at 1 w, 1 mo and 3 mo.ResultsThe mean age was 29.12±5.95 years. There were no significant differences among the three groups (p>0.05), except preoperative age (p = 0.006). There were significant differences in the FBUT among the three groups at postoperative 1 w and 1 mo (p<0.05). There were significant differences in the incomplete blinking rate and FBUT between the LMG and the HMG at postoperative 1 mo (p<0.05). The number of first tear film breakup points located beyond the 6 mm diameter of the cornea was higher in the HMG than in the other groups. The prevalence of DED in the LMG, the MMG, the HMG was 15%, 8% and 23%, respectively, at 1 w postoperative and 30%, 45% and 53%, respectively, at postoperative 1 mo. The change in LLT was significantly correlated with the changes in FBUT (r = 0.408, p<0.001) and incomplete blinking rate (r = -0.266, p = 0.007). The change in OSDI was negatively correlated with the change in SI (r = -0.502, p = 0.000).ConclusionsThe changes in LLT and incomplete blinking rate decreased the stability of the tear film. The changes in LLT, FBUT and incomplete blinking rate differed postoperatively with different myopia degrees. The prevalence of DED was higher in the HMG than in the other two groups.