Instillation Of Tears Research Articles

Artificial Tear Instillation-Induced Changes in Corneal Topography.

This study aims to compare changes of corneal topography (Galilei G4) before and after the instillation of artificial tears in patients with dry eye disease (DED). Corneal topography was performed in patients 1 min before and after artificial tear instillation. Two types of artificial tears were used: 1% polysorbate 80 (PSB) and 0.5% carboxymethylcellulose (CMC). Of 135 patients, PSB and CMC were instilled in 101 and 34 eyes, respectively. The average value of Sim K increased significantly after instillation (44.07 ± 2.26 diopter (D)) compared to before (43.90 ± 2.02 D, p = 0.006) the instillation of artificial tears. Mean Sim K astigmatism was statistically increased after PSB instillation (1.48 ± 2.17 D) compared to before instillation (1.31 ± 2.10 D, p = 0.049). An axis change of astigmatism 10° or more after artificial tear instillation was found in 51.9% of patients, and 30° or more in 20.0% of patients. Increased Sim K value and significant changes in the astigmatic axis in the corneal topography were observed after instillation of artificial tears in DED patients. PSB instillation had a greater effect on corneal keratometry values than CMC instillation.

Digital display use and contact lens wear: Effects on dry eye signs and symptoms.

To assess the potential additive effects of short-term display use and contact lens (CL) wear on the ocular surface and tear film. Thirty-four healthy volunteers (20.87±2.33years old) participated in this study. Participants' dry eye symptoms, ocular surface, tear film and pupil size were assessed before and after executing a 20-min reading task on a computer and a smartphone with and without CL wear, or with CL wear and artificial tear instillation. Measurements included the Ocular Surface Disease Index (OSDI) questionnaire; 5-item Dry Eye Questionnaire (DEQ-5); tear meniscus height (TMH); noninvasive keratograph break-up time (NIKBUT); bulbar conjunctival redness (BR) and pupil size. Higher symptoms were reported after reading on both displays with and without CLs (p≤0.001) for short periods. BR was higher and NIKBUT shorter after reading on the computer regardless of wearing CLs (p≤0.02 and p≤0.02, respectively), while TMH increased for all conditions (p≤0.02) except for CL computer reading (p=0.23). Reading with CLs did not lead to greater signs of dry eye (BR, NIKBUT) and symptoms compared with reading unaided (p>0.05), although a smaller increase in TMH was observed when reading on the computer with CLs (p=0.005). Artificial tear instillation during CL wear led to a smaller increase in symptoms (p≤0.02), a smaller increase in BR (p≤0.04) and a decrease in NIKBUT (p=0.02) compared to reading without correction. Disposable CL wear had no additive effects on signs and symptoms of dry eye when using digital devices for short periods. The instillation of artificial tears is an effective strategy for reducing the impact of display use in CL wearers.

Improving Tolerance and Compliance with Topical Immunomodulators Using Micro-Emulsion Lipid Layer Artificial Tears.

PurposeTo investigate the efficacy of a micro-emulsion (ME) lipid layer artificial tear in improving tolerance of immunomodulator eye drops for the treatment of dry eye disease.Patients and MethodsA total of 33 patients with previously diagnosed dry eye disease were given the micro-emulsion lipid layer artificial tear in conjunction with either lifitegrast or cyclosporine. Patients were queried on their tolerance of the regimen by reporting VAS scores before starting the adjunctive eye drop, immediately after starting, and 2–3 weeks later. Tolerance was statistically compared over time and with respect to previous medication compliance, timing of the adjunctive eye drop, age, gender, and ethnicity.ResultsAcross all patients, the VAS pre-treatment score (6.8 ± 0.6) was significantly higher than both the VAS 1-day post ME lipid tear instillation time point (3.0 ± 0.7) (post hoc Bonferroni, p < 0.001) and the VAS 2–3-week post instillation time point (1.7 ± 0.7) (post hoc Bonferroni, p < 0.001), with the mean VAS score improving over time (post hoc Bonferroni, p < 0.028). Average VAS scores did not vary with respect to specific medical therapy or the timing of instillation of this artificial tear. Both the “at-risk” and “conversion” groups independently had significant improvements at both 1-day and 2–3-week time points compared to baseline.ConclusionThe micro-emulsion lipid layer artificial tear was effective as an adjunctive eye drop to improve tolerance of lifitegrast and cyclosporine for patients with dry eye disease who were at risk of failing or had previously failed immunomodulatory therapy.

Dry Eye: The Effect of Chi-Ju-Di-Huang-Wan Plus Si Wu Tang and the Underlying Mechanism.

Objectives: In this pilot study, the effect of 970 mg Chi-Ju-Di-Huang-Wan (CJDHW) plus 30 mg four-substance decoction (Si Wu Tang; CJDHWSWT) was evaluated, in terms of its ability to alleviate dry eye symptoms and its therapeutic mechanism. Methods: This double-masked prospective investigation has recruited dry eye patients who have been randomly selected into two groups, namely treatment (n = 15) versus nontreatment (n = 15). In the treatment group, a daily oral intake of CJDHWSWT plus eye drops systane ultra was given for 90 consecutive days. In the nontreatment group, only defined eye drops were prescribed. The examinations included Schirmer's test, fluorescein-stained superficial punctate keratitis (SPK), artificial tear consumption, tear vascular endothelium growth factor (VEGF) level, and ocular surface disease index. The drug safety tests included liver and kidney functions, and complete blood counts. The candidates were observed during the screening visit and the following three monthly follow-ups. The data were analyzed by unpaired Student's t-test. Results: Compared to no significance in the nontreatment group, CJDHWSWT significantly (p = 0.03) increased the tear secretion after 3 months of intake. Furthermore, in contrast to no significance in the treatment group, there were significant alterations, including (i) increased fluorescein-stained SPK areas (p = 0.03); (ii) increased artificial tear instillation amount (p = 0.03); (iii) elevated tear VEGF protein levels (p = 0.03) in the nontreatment group; and (iv) significant improvement in clinically relevant phenomenon (e.g., reading limit and uncomfortable feeling in windy conditions), after treatment of artificial tear plus oral intake of CJDHWSWT. As shown by the post-treatment normal defined laboratory data, there were no adverse drug effects. Conclusions: This study has supported that CJDHWSWT is safe and effective in relieving dry eye's clinically relevant symptoms/phenomena. CJDHWSWT avoided the tear VEGF upregulation probably induced by dry eye-associated hypoxia/ischemia.

Alleviating effects of artificial tear instillation on S-1-induced ocular toxicity in dogs.

S-1 is an anticancer agent that consists of tegafur, gimeracil, and oteracil potassium at a molar ratio of 1:0.4:1. S-1 is used to treat metastatic and resectable gastric cancer. However, the extensive use of S-1 in clinical practice results in watery eyes, a serious clinical problem, which worsens patients' quality of life. Although repeated instillation of artificial tears is recommended, therapy or prophylaxis against S-1-induced ocular toxicity has not been established. In the present study, we evaluated the alleviating effects of repeated artificial tear instillation on S-1-induced ocular toxicity in dogs. Ten beagle dogs (5 males and 5 females) were orally administered 3 mg/kg/day of S-1 for up to 21 days. Five drops of artificial tears were instilled to the left eye, eight times daily, within 6 hr after S-1 administration. The mean cornea staining score tended to be low in the left eye with repeated artificial tear instillation. In 4 out of 10 dogs, the corneal staining score of the left eye was more than 2-fold lower than that of the right eye. The incidence of dogs indicating normal tear drainage increased and stenosed tear drainage decreased by repeated artificial tear instillation. In conclusion, we demonstrated that artificial tear instillation can alleviate corneal surface damage induced by S-1 in dogs.

A Study of the Short-Term Effect of Artificial Tears on Contrast Sensitivity in Patients With Sjögren's Syndrome

Primary Sjögren's syndrome often includes dry eye manifestations, including a reduction in optical quality from the compromised ocular surface. This study was designed to measure the effect of different artificial tears on the contrast sensitivity of Sjögren's syndrome patients from 5 minutes to 4 hours after instillation. Ten normal subjects and 10 subjects with ocular manifestations of Sjögren's syndrome were compared at baseline, including staining scores, a dry eye questionnaire, and contrast sensitivity testing. Changes in contrast sensitivity in the Sjögren's syndrome group were measured over a 4-hour period after instillation of a variety of artificial tears. Statistically significant differences in staining, subjective questionnaire scores, and contrast sensitivity were measured between the normal and Sjögren's syndrome groups. Statistically significant changes in contrast sensitivity were measured over time after artificial tear instillation, with the greatest effect at 3 to 6 cycles/deg. The more mucoadhesive artificial tears demonstrated a significantly greater effect. The effects of artificial tears on measured contrast sensitivity in dry eye patients in the postinstillation period of 5 minutes to 4 hours appear limited, but an artificial tear with more mucoadhesive properties showed more benefit than those that do not. Modest effects on contrast sensitivity, primarily at medium spatial frequencies, were observed with the more mucoadhesive formulations.

Effectiveness of Nonpharmacologic Treatments for Acute Seasonal Allergic Conjunctivitis

To investigate whether artificial tears and cold compress alone or in combination provide a treatment benefit and whether they were as effective as or could enhance topical antiallergic medication. Randomized, masked clinical trial. Eighteen subjects (mean age, 29.5±11.0 years) allergic to grass pollen. Controlled exposure to grass pollen using an environmental chamber to stimulate an ocular allergic reaction followed by application of artificial tears (ATs), 5 minutes of cold compress (CC), ATs combined with CC, or no treatment applied at each separate visit in random order. A subset of 11 subjects also had epinastine hydrochloride (EH) applied alone and combined with CC in random order or instillation of a volume-matched saline control. Bulbar conjunctival hyperemia, ocular surface temperature, and ocular symptoms repeated before and every 10 minutes after treatment for 1 hour. Bulbar conjunctival hyperemia and ocular symptoms decreased and temperature recovered to baseline faster with nonpharmaceutical treatments compared with no treatment (P <0.05). Artificial tears combined with CC reduced hyperemia more than other treatments (P <0.05). The treatment effect of EH was enhanced by combining it with a CC (P <0.001). Cold compress combined with ATs or EH lowered the antigen-raised ocular surface temperature to less than the pre-exposure baseline. Artificial tear instillation alone or CC combined with ATs or EH significantly reduced the temperature (P <0.05). Cold compress combined with ATs or EH had a similar cooling effect (P >0.05). At all measurement intervals, symptoms were reduced for both EH and EH combined with CC than CC or ATs alone or in combination (P <0.014). After controlled exposure to grass pollen, CC and AT treatment showed a therapeutic effect on the signs and symptoms of allergic conjunctivitis. A CC enhanced the use of EH alone and was the only treatment to reduce symptoms to baseline within 1 hour of antigenic challenge. Signs of allergic conjunctivitis generally were reduced most by a combination of a CC in combination with ATs or EH.

The Tear Film and the optical Quality of the Eye

The stability of the tear film plays an important role in the optical quality of the eye. Various methods have been developed to quantify the contribution of the tear film to optical quality, including the double-pass optical method, Hartmann-Shack wavefront sensing, videokeratoscopy, retroillumination analysis, and interferometry. In addition to assessing the effect of tear film irregularities, these methods can aid in the diagnosis of dry-eye related conditions and the monitoring of therapy. This review describes the methodologies used to assess the relationship between the tear film and optical quality of the eye and summarizes the most important findings obtained with these methods with regard to the healthy human eye, the dry eye, and the effect of artificial tear instillation.

Optical quality after instillation of eyedrops in dry-eye syndrome

To study the effect of eyedrop instillation on the optical quality of the air-tear film interface at the anterior cornea in cases of dry eye. University of Valencia, Valencia, Spain. Corneal aberrations (total, spherical-like, and coma-like) were determined from corneal elevation maps and purpose-designed software in cases of dry eye before, immediately after, and 10 minutes after lubricating eyedrop instillation (Blink Intensive Tears). All data were decomposed using Zernike polynomials to yield the root-mean-square wavefront deviations for pupil diameters of 3.0 mm and 5.5 mm. Outcome measures included comparison with clinical tear breakup time (TBUT). Wavefront higher-order aberrations (HOAs) decreased significantly, by a factor of 2.5 on average, after artificial tear instillation with both pupil diameters (P<.01). The reduction was maintained 10 minutes after eyedrops instillation (P>.2). The mean TBUT was 3.6 seconds +/- 1.7 (SD). Eyedrop instillation increased the TBUT values significantly (by approximately 60%) from baseline (P<.01). This method of air-tear film interface analysis facilitated evaluation of optical quality improvement after eyedrop instillation in patients with dry eye. After eyedrops were given, the increasingly regular tear film decreased HOAs, improving optical quality.

Repeated Measurements of Dynamic Tear Distribution on the Ocular Surface after Instillation of Artificial Tears

To determine the repeatability of real-time optical coherence tomography (OCT) measurements of tear film thickness (TFT) and variables of tear film menisci. Forty eyes were imaged with a custom-built, real-time OCT to obtain heights, curvatures, and cross-sectional areas of upper and lower tear menisci simultaneously. The central TFT was indirectly determined as the difference between the combined thickness of the central cornea and tear film and the true corneal thickness obtained after instillation of artificial tears. Dynamic tear distribution was determined by OCT imaging immediately and 5, 20, 40, and 60 minutes after tear instillation. Measurements taken after two blinks of one eye at each visit were repeated on the next day. Measurements from the companion eye were made on separate days. There were no significant differences between the two measurements of each variable made on consecutive days. At baseline, upper tear meniscus variables were strongly correlated with the comparable lower meniscus variables. However, there were no significant correlations between TFT and any tear meniscus variable. Immediately after instillation of artificial tears, all measured variables increased significantly. TFT, upper and lower menisci heights, and upper meniscus area remained elevated for at least 5 minutes. In addition there were significant correlations between TFT and the lower tear meniscus height and area. The custom-built OCT showed good repeatability and holds promise in measuring the dynamic distribution of artificial tears on the ocular surface.

Changes in ocular aberrations after instillation of artificial tears in dry-eye patients

Purpose: To study the effect of artificial tear instillation on ocular aberrations in dry-eye patients. Setting: Research, Development and Innovation Department, Instituto Oftalmológico de Alicante, Alicante, Spain. Methods: Ocular aberrations (total, spherical-like, and coma-like) were measured with a Hartmann-Shack aberrometer before and after artificial tear instillation (immediately and 10 minutes later) in 15 eyes of 15 dry-eye patients. Results: Optical aberrations showed a statistically significant reduction after artificial tear instillation ( P<.01). Total aberrations decreased on average by a factor of 2 to 3 times immediately after instillation; the reduction was maintained after 10 minutes ( P>.01). Conclusions: After artificial tear instillation, the reduction in optical aberrations associated with an increasingly irregular tear film may cause an improvement in the optical quality of dry eyes. Wavefront analysis facilitates the evaluation of improvement in optical quality after artificial tear instillation in patients with dry eye.

Effect of artificial tears on corneal surface regularity, contrast sensitivity, and glare disability in dry eyes

Objective To investigate the effects of artificial tears on corneal surface regularity and visual function in dry eyes. Design Nonrandomized, comparative trial. Participants Forty patients (40 eyes) with dry eyes with (group 1, n = 15 eyes) or without (group 2, n = 25 eyes) punctate epithelial keratopathy and a normal control group of 20 individuals (20 eyes) with no ocular abnormalities (group 3). Methods In both dry and normal eyes, the surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) were measured by computer-assisted videokeratography (TMS-1; Computed Anatomy, New York, NY). Spatial-contrast sensitivity and glare disability were also measured before and 1 minute after instillation of artificial tears. Main outcome measures Differences in SRI, SAI, PVA, spatial-contrast sensitivity, and glare disability between groups, before instillation of tears, and within groups, after instillation of tears. Results Compared with group 3, eyes in group 1 had significantly worse SRI, SAI, PVA, and contrast sensitivity (incomplete glare disability data precluded analysis) before instillation of artificial tears. Differences in corneal surface regularity and visual function between groups 2 and 3 were not significant except for a significantly increased glare disability at low spatial frequency (1.5 cycles per degree [cpd]) in group 2. Significant improvement in SRI, SAI, PVA, and contrast sensitivity were observed after instillation of artificial tears in group 1. In groups 2 and 3, the only significant changes were improvement in glare disability at 1.5 cpd and worsening of the SRI, respectively. Conclusions Tear film changes in dry eye patients may lead to irregularities on the corneal surfaces, causing glare disability. However, these changes may be too subtle in the early stages of dry eyes to be detected by corneal topography or contrast sensitivity measurements. Significant improvement in SRI, SAI, PVA, and contrast sensitivity were found after instillation of artificial tears in dry eyes with punctate epithelial keratopathy.

The Effect of Artificial Tears on Computer-assisted Corneal Topography in Normal Eyes and After Penetrating Keratoplasty

To examine the effect of adding artificial tears for one minute to normal eyes and eyes that have undergone keratoplasty by using computer-assisted videokeratography. We prospectively analyzed 24 normal corneas (24 patients) chosen by random number table (reproducibility section [10 eyes], tear section [14 eyes]) as well as 14 postkeratoplasty corneas. The parametric descriptors analyzed statistically included the simulated keratometry value, surface asymmetry index, surface regularity index, power at the vertex normal, and the pupil offsets from the visual axis. Vectoral analysis was used to calculate the difference in power and axis between the simulated keratometry values before and after tear instillation. In normal eyes, tear instillation increased the surface asymmetry index (0.28 +/- 0.34, P = .01), changed the simulated keratometry value (0.23 diopter by 27.8 degrees), and power (0.79 +/- 0.82 diopters, P = .004) and location (0.91 +/- 0.76 mm) of the steepest point of the cornea changed. In postkeratoplasty eyes, the surface regularity index decreased (0.49 +/- 0.80, P = .04), surface asymmetry index decreased (0.37 +/- 1.03, P = .21), mean simulated keratometry value changed (1.04 diopters by 1.01 degrees), and power (0.70 +/- 2.34 diopters, P = .28) and location (1.04 +/- 1.17 mm) of the steepest point of the cornea changed. Changes were greater than the variability of the surface regularity index (0.07 +/- 0.05), surface asymmetry index (0.04 +/- 0.03), simulated keratometry value power (0.08 +/- 0.06 diopter), and axis (4.6 +/- 5 degrees). The addition of artificial tears to normal or regular and symmetric eyes that have undergone keratoplasty worsened symmetry and changed the power and location of the steepest point. However, the addition of artificial tears to irregular eyes that have undergone penetrating keratoplasty created a more regular and symmetric surface and significantly altered the simulated keratometry values. We recommend that corneal topography be performed before the application of artificial tears.