Incidence Of Dry Eye Syndrome Research Articles

Prevalence of dry eye syndrome in a South African diabetic paediatric population

BackgroundDiabetes mellitus (DM) can be defined as a metabolic disorder that results from either the inability of insulin to perform its normal functions or decreased insulin secretion. Dry eye disease is a complex ailment of the tear film resulting in discomfort characterised by pain, a feeling of heavy eyes, grittiness, burning, dryness, itchiness, foreign body sensation, and visual disturbances. Patients with chronic conditions, i.e. DM, are more susceptible to developing dry eye due to various complications that may arise, such as, peripheral neuropathy, inflammatory alterations and reduced lacrimal gland function. AimTo identify the prevalence of dry eye syndrome in paediatric patients diagnosed with Diabetes Mellitus (Type 1/2). Method37 children with diabetes and 40 healthy, age group matched controls were enrolled in this study. Participants underwent a complete dry eye assessment in the following order: Ocular Surface Disease Index (OSDI) and McMonnies questionnaire, meibomian gland evaluation using white light, Tear Break-up Test (TBUT), Phenol Red Thread (PRT) test and Tear film Osmolarity test. Duration of diabetes was used as the parameter. ResultsThe incidence of dry eye syndrome was found to be higher among diabetics, with 15 (40.5 %) from the diabetic population compared to 4 (10.0 %) from the control group. TBUT and PRT test values were significantly reduced in children with diabetes (p < 0.001). TFO values were higher in the diabetics. No statistically significant differences were found the questionnaire scores, of the two groups, however the diabetic group appeared to be less symptomatic. ConclusionDry eye is more common in the diabetic paediatric population. TBUT and PRT results were found to be lower in diabetics. Results showed a strong correlation between duration of diabetes and TBUT values. Healthcare practitioners, working with children diagnosed with diabetes, should raise awareness as well as encourage early dry eye screening and intervention. Clinical significanceDue to the steady increase in the number of children and adolescents with diabetes, the characteristics and prevalence of dry eye syndrome in this population has become more valuable.

Identification Of Dry Eye Syndrome Risk Factors In Workers Who Use Visual Display Terminals (VDT)

Dry eye syndrome is a multifactorial disease of the eye air and eye surface which causes symptoms of discomfort, visual disturbances, and instability of the eye air layer which has the potential to damage the eye surface. This condition has an impact on productivity, activities in the work environment, apart from that it also has an impact on lower employment opportunities, decreased working hours and increases a person's inability to work. Using visual display terminals for 5-7 hours/day can significantly increase the incidence of dry eye syndrome. Therefore, paying attention to the risk factors of visual display terminal workers is very important in preventing the occurrence of dry eye syndrome. The research method uses literature studies from several national and international journals obtained from 18 reference sources through searches on PubMed and Google Scholar published in the last 5 years. There were 18 articles with full text that met the inclusion criteria and contained several risk factors associated with the incidence of dry eye syndrome. Risk factors for dry eye syndrome in workers who use visual display terminals include age, gender, screen exposure time, psychological stress, work environment, use of contact lenses, use of drugs and history of surgery, refractive disorders, and length of work. Identification of risk factors for dry eye syndrome in workers who use visual display terminals can reduce the incidence and morbidity associated with this disease. So it can improve the quality of life of workers

THE RELATIONSHIP BETWEEN DRY EYE SYNDROME AND THE USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) IN HOSPITAL MEDICAL WORKERS)

Introduction &amp; Objectives : Background: The need to wear personal protective equipment (PPE) during a pandemic can cause dry eye syndrome. It will increase sweating so reduce tear production and the use of masks increase air flow to the eye area so that tear evaporation increases. Objective: To determine the relationship between the incidence of dry eye syndrome and the use of PPE in hospital medical personnel.&#x0D; Methods : Methods: This was an analytic observational study with a cross-sectional design using the OSDI (Ocular Surface Disease Index) questionnaire. The research was carried out at the Cilacap Hospital in 2021. There were 49 samples (51% male and 49% female), with an age range of 20-50 years. The data was analyzed by using the Spearmans test.&#x0D; Results : Results: The incidence of dry eye syndrome was 69.5% (mild 18.4%, moderate 18.4%, severe 32.7%). As many as 53.1% of the incidence of dry eye syndrome occurred in wearing PPE for more than 4 hours and was more common in the use of PPE level 1 (40.8%), followed by level 3 (36.7%) and level 2 (22.5%). In the Spearman's test, it was found that there was a significant association between the incidence of dry eyes syndrome and the use of PPE (duration and level of PPE) (p&lt;0.05) but had a weak relationship strength (r=0.3).&#x0D; Conclusion : Conclusion: There is a significant relationship between the incidence of dry eyes syndrome and the use of PPE (duration and level of PPE use) but has a weak relationship strength.

Incidence of Dry Eye Syndrome After Cataract Surgery with Phacoemulsification Technique in Padang Eye Center Hospital

Introduction &amp; Objectives : Dry eyes is one of the most common ophthalmological problems. The etiology of dry eyes is usually multifactorial, such as medication, aging, systemic disease, allergy, computer usage, environmental factors, meibomian gland dysfunction and ophthalmic surgery. Cataract is still one of the leading causes of vision impairment globally. No medical treatment is effective to remove cataract. Thus, the only option is cataract removal surgery. The most common technique of cataract surgery in Padang Eye Center Hospital is phacoemulsification. This study aims to assess the incidence of dry eye syndrome after phacoemulsification surgery without complication in patients with no previous history of dry eye syndrome.&#x0D; Methods : This study was conducted using a prospective study. The evaluation uses Ocular Surface Disease Index ( OSDI ) questionnaire and tear break-up time ( TBUT ) test performed preoperatively and three times postoperatively at one week, one month and three months follow-up after surgery.&#x0D; Results : 110 eyes of 96 patients diagnosed with cataracts who had undergone phacoemulsification surgery were enrolled in this study. The mean age of patients is 62.46 ± 6.14 years, and 59,09% were men. After one week of surgery, only 9,09% had results 0-12 on the OSDI scale, and 43,63% represented moderate dry eye disease ( OSDI score 23-32 ) and TBUT test results from 61,82% of patients had dry eyes, which improved gradually after time.&#x0D; Conclusion : The incidence of dry eye syndrome significantly increased after one-week post-surgery. But after one month postoperative, the patients’ condition gradually improved and returned to normal after three months postoperatively.

Subjective Assessment of the Dry Eye Syndrome According to the OSDI Questionnaire in Patients Using Various Options for Correcting Ametropia

Purpose: to study the severity of dry eye symptoms in patients who wear contact lenses and in those who underwent laser keratomileusis a long period ago according to OSDI questionnaire.Methods. 88 patients with various refractive disorders were included in the study, there were 33 men and 55 women. Mean age was 30,11 y.o. All patients were divided into 3 groups according to method of refractive disorder correction. Groups were equal in age and gender. The first included 27 patients wearing soft contact lenses for more than 5 years. The second group contained 33 patients who didn’t use contact lenses. The third one included 32 patients who underwent refractive surgery (LASIK, Femto-LASIK) more than a year ago. Assessment of severity of dry eye symptoms was performed according to questionnaire data (patients’ subjective feelings), objective data was not taken into account. Survey was performed with the use of OSDI questionnaire.Results. According to the symptoms presented the incidence of dry eye syndrome was 73.91 % in patients of the first group and it was 56.25 % and 66.66 % in the second and third one, moreover, the prevalence of DES in each of the groups was higher among women and amounted to 94.11% in the first group; 63.63% — in the second and 61.11% — in the third group. Mean OSDI in the first group was 31.48 ± 22.17; and it was 18,83 ± 14,00 and 22,25 ± 15,53 in the second and third group respectively. The obtained data corresponded to moderate severity of dry eye syndrome in all groups. DES was more prevalent among women in each group.Conclusion. The prevalence of DES according to the severity of symptoms was 65.6 %, the severity of DES was predominantly moderate. There was definite connection of symptoms and such risk factors as female sex and contact lens wear. Despite the connection with underlying pathogenetic mechanisms, the spread and severity of dry eye symptoms in patients a year after refractive surgery were significantly lower compared to those who didn’t undergo any refractive surgical procedures.

Mask associated Dry Eye (MADE) during Covid-19 pandemic

The widespread use of protective masks in the COVID-19 era has led to an increasing incidence of dry eye syndrome. In connection with this, a new disease unit emerged, called the “mask-associated dry eye” (MADE). The term was first used in June 2020. by American ophthalmologist Darrell E. White. There is a simple physical mechanism involved in the pathogenesis of mask-associated dry eye. When the protective mask is not placed correctly, the exhaled air is directed in the form of an air jet to the eye surface, creating conditions for destabilization of the tear film. As a result, irritation and discomfort occur, and patients with MADE begin to rub their eyes frequently for temporary relief, increasing the chance of contracting the Sars CoV-2 virus. MADE may aggravate symptoms in patients with pre-existing dry eye syndrome, postmenopausal dry eye syndrome in women, people using smart devices for more than 2 hours a day, and lead to more severe discomfort in patients after cataract or refractive surgery. Key words: MADE, protective masks, COVID-19

Comparing Objective Conjunctival Hyperemia Grading and the Ocular Surface Disease Index Score in Dry Eye Syndrome During COVID-19.

The incidence of dry eye syndrome (DES) has increased due to wearing masks, utilizing digital devices, and working remotely during the pandemic. A survey was conducted during the COVID-19 pandemic to determine the prevalence of dry eye syndrome. A cross-sectional study investigated how prevalent DES is during COVID-19 in healthy patients aged 20-45 in the United States. An Ocular Surface Disease Index (OSDI) questionnaire was given to 40 individuals remotely from October 31, 2021, to December 1, 2021. The AOS and the OSDI survey were used to evaluate DES. The subjects were 29 years old on average (SD 14.14), with 23 males (57.5%) and 17 females (42.5%). According to the OSDI survey, low DES, moderate DES, and severe DES had prevalence rates of 15%, 77.5%, and 7.5%, respectively. White (W) people represent 50% of the population, while African Americans (AA) represent 35%, Asians represent 7.5%, and Hispanics represent 7.5%. Mild DES affected 77.5% of subjects, with 64.50% males and 35.50% females. According to the AOS objective grading system, mild (M) DES, moderate (MO) DES, and severe (S) DES had prevalence rates of 40%, 12.5%, and 15%, respectively. Linear regression was used to compare the two grading systems, and it demonstrated a strong relationship between the two grading systems.

Comparative antioxidant activity of various ophthalmic product types for artificial tears under different experimental conditions.

Artificial tears or lubricants is a developing category in pharmaceutical research, due to the permanent increasing incidence of dry eye syndrome caused by the extensive use of personal computers and other gadget screens, associated with global warming and pollution. Considering the role of inflammation in dry eye syndrome, characterized by the production of free radicals, it is imperative to determine which elements are more significant in forming an artificial tear more effectively and more comfortably for the eye state and for the quality of life. Thus, the aim of the present study was to examine the evolution of the total antioxidant capacity of some frequently commercialized artificial tears via the photochemiluminescence method, using an antioxidant capacity of lipid soluble substances procedure, prior and subsequent to the exposure of these therapy agents to some physical agents. This is a preliminary research aiming to evaluate the impact of various environmental factors on these ophthalmic products, to be continued by evaluating whether the effectiveness of these products, in terms of objective examination and patient preference and adherence criteria, is impacted by the conditions of use and storage. Thus, the total antioxidant capacity of the evaluated artificial tear samples after UVC irradiation at 254 nm wavelength was studied, in order to investigate whether their status suffered any change in terms of antioxidant potential. In addition to the findings obtained in the study, some recommendations were also made.

Частота формирования синдрома «сухого глаза» в зависимости от длительности применения гипотензивных капель у пациентов с первичной открытоугольной глаукомой

Aim. To conduct a clinical assessment of the incidence of dry eye syndrome (DES) in patients with primary open-angle glaucoma (POAG), depending on the timing of the use of local antihypertensive therapy. Methods. The main group included 45 patients (45 eyes) with POAG. Inclusion criteria - use of local antihypertensive therapy for at least one month; absence of previous laser and microsurgery operations, systemic pathology that can cause DES (thyroid lesions, diabetes mellitus, autoimmune and rheumatoid diseases). The patients’ age averaged 61.2±8.7 years (from 47 to 82 years). There were 29 men and 16 women. The design of the work consisted of a comparative assessment of the frequency of DES formation in the studied groups and subgroups, as well as the degree of its severity. Results. The results of the study showed that with an increase in the duration of the use of local antihypertensive drugs by patients with POAG the incidence of DES development increases. Moderate changes in the studied functional parameters of the ocular surface were recorded as early as 1-3 years from the start of antihypertensive therapy. Especially often DES was formed in the 3rd subgroup and proceeded in more severe clinical forms. Conclusion. The initial statistically insignificant changes in the indicators of the state of the ocular surface in patients with POAG using local antihypertensive therapy took place at the time of their instillation from 1 to 3 years. Most often, according to our data, DES developed in patients with POAG after three years of using antihypertensive drugs (9 out of 15 patients). Key words: dry eye syndrome; glaucoma; antihypertensive therapy.

Взаимосвязь длительности применения гипотензивного режима и частоты случаев развития синдрома «сухого глаза» у пациентов с первичной открытоугольной глаукомой

Purpose. To study the incidence of dry eye syndrome (DES) in patients with primary open-angle glaucoma (POAG), depending on the duration of the use of local antihypertensive therapy. Material and methods. The material for the study was patients who were examined in the treatment and diagnostic department of the Khabarovsk branch the S. Fyodorov Eye Microsurgery Federal State Institution with a confirmed clinical diagnosis of POAG. The main group included 45 patients with a duration of antihypertensive therapy of 1 month or more. The comparison group consisted of 15 patients with newly diagnosed POAG. The period of use of antihypertensive therapy in them did not exceed one month. Depending on the experience of using antihypertensive therapy, the patients of the main group were divided into 3 subgroups. All were questioned using the DEQ-5 dry eye questionnaire, Schirmer I, II and Norn's tests, objective examination of the anterior segment of the eyes. The analysis of the detection and severity of DES among patients with POAG was carried out, taking into account the experience of using the antihypertensive regimen. Results. According to the questionnaire, 26 patients (58%) of the main group presented complaints typical of DES, while in the comparison group only 3 patients (20%) presented them (p&lt;0.05). There was also a tendency towards a decrease in the total and main type of tear production in the main group according to the results of Schirmer's tests I and II – 10.9±1.04 mm and 7.7±0.48 mm versus 13.9±2.5 mm and 10, 2±2.1 mm in the comparison group (p&gt;0.05). The stability of the tear film, according to Norn's test, also differed: 8.2±0.35 sec. and 9.5±1.8 sec. in the main and comparison group, respectively (p&gt; 0.05). Conclusion. The initial symptoms of xerosis of the ocular surface are recorded in the period from 1 to 3 years from the beginning of the use of antihypertensive drugs and increase in proportion to the increase in the length of the disease. Key words: dry eye syndrome, glaucoma, antihypertensive therapy.

Prevalence of dry eye syndrome in association with the use of contact lenses in Saudi Arabia

BackgroundDry eye disease is a tear film disorder which can cause discomfort to patients and negatively affect vision acuity. A number of risk factors has been reported to affect the incidence and severity of dry eye syndrome (DES). The aim is to study the prevalence of DES in Saudi Arabia and the factors affecting the severity of DES in relation to the use of contact lenses.MethodsA cross-sectional questionnaire-based study was conducted on 310 participants using the ocular surface disease index (OSDI) questionnaire and the eye dryness part from contact lens questionnaire-8 (CLDEQ-8). Dry eye OSDI scores were compared across different epidemiological and risk factors with focus on the use of contact lenses. Pearson and Spearman’s correlation coefficients were used to analyze the frequency of contact lenses usage in relation to OSDI scores. Student’s t-test and one-way analysis of variance (ANOVA) tests were used to compare means of two or more than two groups, respectively.ResultsForty eight (15.5%) of participants did not have any degree of DES, achieving an OSDI score between 0 and 12. Forty participants (12.9%) scored from 13 to 22, (mild DES), 44 (14.2%) were moderate, scoring 23–32 on the OSDI, while those who scored above 33 were 178 (57.4%) had severe DES. The mean score for all participants was 37.8. A high percentage of participants (84.5%) had some degree of DES. There was a strong positive correlation between OSDI score and the frequency of the feeling of dry eye and a moderate positive correlation between OSDI score and the intensity of dryness feeling. Out of 310 participants, 136 (43.9%) indicated using contact lenses. There was no significant association between the use of contact lenses per se and DES, however, those who used contact lenses more frequently had significantly higher OSDI scores.ConclusionsDry eye syndrome is a widespread, underdiagnosed condition in Saudi Arabia. The frequency of contact lenses use may contribute to the incidence of DES.

Chemical Quality of Pool Water and Correlation Between Swimmers Behaviour with Dry Eyes Syndrome in Tws Swimming Pool Padangan, Bojonegoro

Supervision and management of pool water quality need special attention to prevent health disorders. There are chemical substances in pool water that categorized as irritant and will cause Dry Eyes Syndrome if being used excessively. The purpose of this study was to analyze pool water chemical quality as well as swimmers behaviour and its correlation with Dry Eyes Syndrome. This was an observational research with cross sectional study design. The population in this study was swimmer within 16 - 45 years old age range in 1 time chlorination period, with the sample of 75 respondents. Statistic analysis process was done by using Chi-Square Test. The results showed that in chlor remnant level measurement, some results were indicating that the level of chlor exceeded the maximum allowed threshold (&gt; 0.5mg / l) while the rest less than the minimum threshold (&lt;0.2 mg / l). Hardness meausrement results (CaCO3) pointed out that the average outcome was exceeding maximum allowed threshold (&gt; 500 mg / l). Statistic test result indicated that there were 2 variables related to the incidence of Dry Eye Syndrome, knowledge (p = 0,037) and action (p = 0,035). In the conclusion, the result of pool water chemical quality measurement showed that some of pool water had not met the requirement in accordance to Ministry of Health Regulation Number 416 in 1990. Therefore it is important to conduct management and routine supervision of the swimming pool also perform health promotion to prevent Dry Eyes Syndrome in swimming pool surroundings.

PERBEDAAN KADAR PM2,5 DI TEMPAT PEMBAKARAN BATU BATA DAN KEJADIAN SINDROMA MATA KERING

Brick cumbustion in Kaloran Village uses firewood and corncob as main fuel. Combustion using firewood and corncobs in burning bricks produce PM2.5 pollutants that can cause health problem including the eyes. Dry eye is a multifactorial disease of ocular surface in symptoms that include discomfort, visual disturbance and tear film instability with potential damage to the ocular surface. This study aims to describe PM2.5 levels in brick combustion and dry eye syndrome events in brick workers in Kaloran Village Ngronggot Nganjuk District in 2017. This research was an observational study with cross sectional design, conducted in May 2017, Using questionnaires, interviews and observations with a large sample of 42 respondents. The PM2.5 measurements use the Haz-Dust EPAM 5000 model for 30 minutes, which is performed three times a day at each point of location. Data collection on the incidence of dry eye syndrome was diagnosed using an OSDI questionnaire. All measurements of PM2.5 exceed the ambient air quality standard of government regulation number 41 of 1999 of (0.065 mg/m3) and There are three measurement result of PM2.5 that exceed the Threshold Limit No 13 of 2011 about Threshold Value of Physical Factors and Chemical Factors in the Work Environment. There are 71.6% workers experience dry eye syndrome. In the results of this study, PM2.5 levels are in place. The advantages and disadvantages of some places that exceed the Threshold Limit and there are workers who experience dry eye syndrome. Keywords: burning bricks, dry eye syndrome, level of PM2,5

Can artificial tears prevent Acanthamoeba keratitis? An in vitro approach

BackgroundThe use of contact lenses has increased in recent years as has the incidence of Dry Eye Syndrome, partly due to their use. Artificial tears are the most common treatment option. Since these changes can facilitate Acanthamoeba infection, the present study has been designed to evaluate the effect of three artificial tears treatments in the viability of Acanthamoeba genotype T4 trophozoites. Optava Fusion™, Oculotect®, and Artelac® Splash were selected due to their formulation.MethodsViability was assessed using two staining methods, Trypan Blue stain and CTC stain at different time intervals (2, 4, 6, 8 and 24 h). Trypan Blue viability was obtained by manual count with light microscopy while the CTC stain was determined using flow cytometry.ResultsTrypan Blue staining results demonstrated a decrease in viability for Optava Fusion™ and Artelac® Splash during the first 4 h of incubation. After, this effect seems to lose strength. In the case of Oculotect®, complete cell death was observed after 2 h. Using flow cytometry analysis, Optava Fusion™ and Oculotect® exhibited the same effect observed with Trypan Blue staining. However, Artelac® Splash revealed decreasing cell respiratory activity after four hours, with no damage to the cell membrane.ConclusionsThe present study uses, for the first time, CTC stain analyzed by flow cytometry to establish Acanthamoeba viability demonstrating its usefulness and complementarity with the traditional stain, Trypan Blue. Artelac® Splash, with no preservatives, and Optava Fusion TM, with Purite®, have not shown any useful amoebicidal activity. On the contrary, promising results presented by Ocultect®, with BAK, open up a new possibility for Acanthamoeba keratitis prophylaxis and treatment although in vivo studies should be carried out.

Hydroxypropyl methylcellulose 2% for dry eye prevention during phacoemulsification in senile and diabetic patients.

To assess the effect of hydroxypropyl methylcellulose (HPMC) 2% to prevent dry eye during phacoemulsification in senile and diabetic patients. This prospective interventional case series comprised 60 eyes (44 patients) with age-related cataract scheduled for standardized phacoemulsification surgery. The patients were assigned to receive either balanced saline solution (BSS, 30 eyes) or HPMC 2% (30 eyes) during surgery. Preoperative and postoperative examinations (1, 3, 7 and 30days) included measurements of automatic noninvasive tear film breakup time (NITBUT), fluorescein staining, Schirmer I test, tear meniscus height, depth and area and subjective symptoms. Intraoperative application frequency was also assessed. The mean age of patients was 68.7±2.3years. The application frequency of BSS during surgery was significantly reduced in HPMC group (P=0.001). The incidence of dry eye syndrome (DES) was significantly reduced in HPMC group in both senile and diabetic patients. Scores of subjective symptoms were significantly higher in the BSS group in 1day (P=0.003) and 3days (P=0.043) postoperatively. The first and average NITBUT were significantly higher in HPMC group in 1day and 3days after surgery, respectively (P=0.012 and P=0.024, respectively). NITBUT values did not significantly change postoperatively in the HPMC group (P>0.05), while they were significantly lower postoperatively in the BSS group. Application of HPMC 2% during phacoemulsification reduced the incidence of DES and improved patients' satisfaction in both senile and diabetic cataract patients. It was also effective in maintaining corneal hydration and was able to significantly reduce the application frequency intraoperatively.

Study on the influences of lacrimal secretion and tear film after interferon-alpha therapy in patients with chronic viral hepatitis

Objective To analyze the influences of lacrimal secretion and tear film after interferon-alpha therapy in patients with chronic viral hepatitis. Methods Sixty patients with chronic viral hepatitis who would accept the interferon-alpha therapy,including 30 cases of hepatitis B and 30 chronic viral hepatitis C, visited our department of ophthalmology and were enrolled in this study.All cases received eye examination,including medical history,slit lamp examination,corneal fluorescein staining(FL),tear film break-up time (BUT)and schirmer test before interferon-alpha therapy and two months after the therapy. Results In the 60 cases of chronic viral hepatitis,there were 19 dry eye cases(31.67%)and 41 non-dry eye cases(68.33%). In dry eyes group,9 of them(47.37%) were hepatitis B patients and 10 of them were hepatitis C patients(52.63%).There was significant difference in FL grade(t=-5.288,P< 0.05),BUT(t= 5.799,P< 0.05), SchirmerⅠ(t= 5.319,P< 0.05)test in hepatitis B before and two months after interferon-alpha therapy.Statistical significance had been found before and two months after therapy in FL grade(t=-9.103,P< 0.05), BUT(t= 5.682,P<0.05),SchirmerⅠtest(t= 4.592,P<0.05).The incidence of dry eye syndrome in hepatitis B patients increased from 26.70% to 53.30% two months after treated with interferon-alpha,while the incidence of dry eye syndrome in hepatitis C patients increased from 33.30% to 60.00% two months after treated with interferon-alpha. Conclusion Dry eye syndrome is one of common complications in patients with chronic viral hepatitis.Interferon-alpha therapy would influence the lacrimal secretion and damage tear film, which increased the dry symptoms in patients.We should pay attention to the side effects of interferon-alpha therapy. Key words: Hepatitis,Viral,Human; Interferon-alpha; Keratoconjunctivitis Sicca

Effect of Pterygium Surgery on Tear Osmolarity

Purpose. To investigate changes of dry eye test results in patients who underwent pterygium surgery. Methods. Seventy-four patients who underwent primary pterygium surgery were enrolled in this study. At the baseline, 3-, 12-, and 18-month visits, measurements of tear osmolarity, BUT, and Schirmer test were performed. The patients were divided into 2 groups: Group 1, which consisted of patients in whom pterygium did not recur, and Group 2, which consisted of patients in whom pterygium recurred after surgery. Results. The patients in Group 1 had lower tear osmolarity levels after surgery than those at baseline (all P < 0.001). In Group 2 the tear osmolarity levels did not differ from baseline after 18 months (P = 0.057). The prevalence rates of dry eye syndrome (DES) were lower than that at baseline and 18 months after surgery in Group 1 (P = 0.002). In Group 2, the incidence of DES was lower after 3 months than at baseline (P = 0.03) but was similar to the baseline rate after 12 and 18 months (both P > 0.05). Conclusions. Anormal tear film function associated with pterygium. Pterygium excision improved tear osmolarity and tear film function. However, tear osmolarity deteriorated again with the recurrence of pterygium.

Longitudinal Evidence on Punctal Plug Use in an Elderly Population

The purpose of this study was to determine whether changes in Medicare reimbursement for punctal plug insertion were associated with a decrease in the incidence of insertion and dry eye diagnosis. Incident cases of dry eye syndrome (DES) diagnoses and punctal plug insertions among Medicare beneficiaries were identified from Medicare 5% Part B from 1994 to 2008, using a 3-year look-back. Dry eye syndrome diagnoses and punctal plug insertion codes were ascertained from the international classification of diseases and current procedural terminology codes. Medicare payment data were obtained from the Centers for Medicare and Medicaid Services from 1994 to 2008 for punctal plug insertion. Rates were calculated for both the incidence of DES and the use of punctal plugs. From 2001 to 2008, inflation-adjusted Medicare reimbursement for punctal plug insertion decreased 55.1%, whereas the Medicare population-adjusted incidence of dry eye diagnosis increased 23.3%. Nine percent of individuals diagnosed with DES between 1991 and 2008 underwent punctal plug placement with a mean of 2.0 plugs placed per patient. Total punctal plug placement increased 322.2% between 1994 and 2003, and then reached a plateau. First-time punctal plug insertion rates within 365 days of DES diagnosis increased 111.8% from 1994 to 2002, and then declined 47.0% from 2002 to 2008. Although the frequency of DES diagnosis in the Medicare population has increased over time, first-time punctal plug insertion rates, especially within the first year following DES diagnosis, have declined coincidently with the increasing presence of a medical alternative and declining Medicare payment. Choice of therapies may have cost and care implications.

Blepharoplasty, Laser In Situ Keratomileusis, and the Corneal Reflex Arc

Sir: We applaud Korn et al.1 for their article in the July 2007 issue of the Journal. Prior studies in the literature have reported dry eye syndrome as a complication of either blepharoplasty or laser in situ keratomileusis (LASIK). The current study by Korn et al. provides insight into the combined effect of blepharoplasty and LASIK on the incidence of dry eye. In their retrospective study, the authors examined six patients who underwent both blepharoplasty and LASIK. Of particular interest are the two patients who underwent monocular LASIK and subsequent bilateral upper and lower blepharoplasty. After blepharoplasty, these patients manifested the symptoms of dry eye syndrome. However, the symptoms were confined only to the LASIK-treated eye. The authors hypothesize that the dry eye symptoms (in the LASIK eye) were the result of a blunted corneal reflex arc on that side (secondary to LASIK)1 and that the lack of dry eye in the opposite eye (with blepharoplasty alone) was due to the preservation of the blink response on that side. To examine the validity of this hypothesis, we wish to elaborate on the neurophysiology of the corneal reflex. It is known that blunting of the corneal reflex arc does in fact occur when raising a corneal flap and transecting the afferent nerves in the cornea during a LASIK procedure.2–4 However, the authors should note that the corneal reflex arc comprises an afferent pathway from each eye and a consensual efferent response that is bilateral.5 In the case of the two patients treated with LASIK in only one eye, the intact afferent arc in the opposite eye (with the blepharoplasty only) would preserve the blink response bilaterally, thus preventing a possible dry eye in the LASIK-treated eye. Taken together, the eye with blepharoplasty alone will have an uninterrupted afferent reflex arc and both eyes will have fully intact efferent motor nerves, resulting in a preserved blink response. Barring disruption of lid mechanics, the impulse for normal bilateral closure remains unaffected; thus, sweeping and lubrication of the corneal surfaces should theoretically be unchanged. In this regard, we ask the authors to reconsider their hypothesis in these patients. We appreciate the reporting of an association between LASIK and blepharoplasty in inducing dry eye syndrome. Further studies should aim to examine the incidence of dry eye syndrome in each eye after monocular LASIK and subsequent bilateral upper and lower blepharoplasty in a larger patient population. If dry eye symptoms consistently occur only in the LASIK-treated eye, causes other than the corneal reflex arc will need to be explored and elucidated. Paul N. Afrooz, M.D. Vijay S. Gorantla, M.D., Ph.D. Division of Plastic and Reconstructive Surgery University of Pittsburgh Medical Center Pittsburgh, Pa. DISCLOSURE Neither author has any financial interest in any of the products, drugs, or devices described in this communication.