Lacrimal Film Research Articles

Research progress on the pathogenesis of diabetes-related dry eye

In recent years, with the further understanding of medical circles on diabetic ocular complications, the ocular surface abnormalities of diabetes has drawn increasing concerns. Nearly 50% of diabetic patients suffer from dry eye symptoms. The main manifestations of diabetes related dry eye were abnormal lacrimal secretion, poor lacrimal stability, decreased corneal sensitivity, persistent corneal epithelial defect and even corneal ulcer, which were mainly related to the changes of structure and function of lacrimal gland, the decrease of goblet cells in conjunctiva, the abnormality of meibomian gland function and the degeneration of corneal nerve caused by diabetes. In this paper, we summarized and analyzed the recent research progress on the effect of diabetes on lacrimal film, corneal innervation and lacrimal gland innervation, and the correlation between oxidative stress, advanced glycation end products and diabetes-related dry eye, to explore the pathogenesis of diabetes-related dry eye and to provide reference for clinical diagnosis, treatment and research.

Acupuncture mitigates ocular surface inflammatory response via α7nAChR/NF-κB p65 signaling in dry eye guinea pigs

To observe the effect of electroacupuncture (EA) on the ocular surface inflammation and α7 nicotinic acetylcholine receptor (α7nAChR) / nuclear factor kappa-B (NF-κB) p65 signal pathway in guinea pigs with dry eye, so as to explore its underlying mechanism. A total of 32 male British tricolor short haired guinea pigs were randomized into blank control, model, EA and sham acupuncture groups, with 8 guinea pigs in each group. The dry eye model was established by subcutaneous injection of scopolamine hydrobromide solution (0.6 mg/0.2 mL each time, 4 times a day for 10 days). Guinea pigs of the EA group was treated with EA at bilateral "Cuanzhu" (BL2) and "Taiyang" (HN5), and manual acupuncture at bilateral "Jingming" (BL1), "Sizhukong" (SJ23), "Tongziliao" (GB1) for 15 min, once daily for 14 days. For animals of the sham acupuncture group, a blunt needle was used to prick the skin surface of the acupoints, the acupoint selection and stimulation time were the same as those in the EA group. Before and after modeling and after the intervention, the breakup time (BUT) of lacrimal film, sodium fluorescein coloring (Fl) state of corneal epithelium and phenol red thread (PRT) moist length were recorded for assessing the severity of dry eye. The density of activated immune cells around the corneal epithelial stromal cells was determined by corneal confocal microscopy. The contents of interleukin-4 (IL-4), IL-6, IL-10, tumor necrosis factor α (TNF-α) in the cornea and lacri-mal gland tissues were determined by ELISA, and the expression levels of α7nAChR and NF-κB p65 in the cornea and lacrimal gland were detected by immunohistochemistry and Western blot, separately. Compared with the blank control group, the corneal Fl, density of activated immune cells of corneal epithelium, contents of IL-6, IL-10 and TNF-α in both corneal and lacrimal gland tissues, NF-κB p65 cell positive rate and protein expression of lacrimal gland and corneal tissues were significantly increased (P<0.01, P<0.05), while the BUT, PRT and lacrimal gland α7nAChR cell positive rate considerably decreased (P<0.01) in the model group. In comparison with the model group, the level of corneal Fl, density of the activated immune cells of corneal epithelium, contents of corneal and lacrimal IL-6 and TNF-α, and corneal and lacrimal NF-κB p65 cell positive rates and protein expressions were remarkably down-regulated in the EA group (P<0.01, P<0.05), rather than in the sham acupuncture group (P>0.05) except content of corneal IL-10, lacrimal NF-κB p65 cell positive rate and lacrimal α7nAChR protein expression, whereas the levels of BUT, PRT, corneal and lacrimal IL-10 and corneal and lacrimal α7nAChR cell positive rates and protein expressions significantly up-regulated in the EA group (P<0.01, P<0.05), rather than in the sham acupuncture group (P>0.05) except corneal TNF-α and corneal NF-κB p65 protein expression. EA can improve corneal and lacrimal function in dry eye guinea pigs, which may be associated with its actions in increasing the expression of α7nAChR, inhibiting the nuclear translocation of NF-κB, and reducing the activated immune cells and inflammatory reaction.

DETERMINATION OF SCREEN TIME FOR USING DIGITAL DEVICES WITHOUT DAMAGING EFFECT ON LACRIMAL FILM

Introduction. The changes in the thickness of lipid layer of lacrimal film, the height of the lacrimal meniscus, and non-invasive time of the lacrimal film rupture under the exposure to digital devices up to 60 minutes are requiring in-depth investigation. This justifies the needs for extensive research to determine the safe continuous time spent in front of the screen of digital devices. The aim of this study is to determine the safe time for work with digital devices that does not result in significant changes in the tear film indices. Materials and methods. We examined 335 people (670 eyes) aged from 18 to 48 years, an average age is 28 ± 0.74 years. The study was conducted in two stages: during I stage we analyzed the tear film without the exposure to digital devices; during II stage we analyzed changes in the tear film after the work with digital devices. The analysis of the tear film composition after the exposure to digital devices for 20; 30; 40 and 60 minutes was carried out. Results. Following 20 minute exposure, the thickness of the lipid layer did not differ from the initial data obtained in the subjects (p&gt;0.05); NIBUT also did not change and was similar to the initial indicators (p&gt;0.05); the frequency of blinking began to decrease by 3% of subjects compared with the initial data, however, the difference was not reliable (p&gt;0.05). After 30 minute exposure, there was no significant change in the lipid layer of the tear film, the height of the lacrimal meniscus and the tear film rupture (p&gt; 0.05). Only the frequency of blinking decreased down by 12% of all participants compared with the initial data (p &lt;0.05). After 40 minute exposure, the number of subjects with moderate lipid layer thinning went up to 13% (p&lt;0.05); the number of subjects with pathological indices of tear meniscus increased by 11% (p&lt;0.05); there was no significant change in tear film rupture found (p&gt; 0.05); the blinking frequency decreased by 26% of all participants compared to the initial data (p &lt;0.01). After 60 minute exposure, the number of those examined with a thinning of the lipid layer increased to 16% (p &lt;0.01), of which 3% had a significant thinning of the lipid layer; the number of examined patients with pathological indices of the lacrimal meniscus increased by 16% (p &lt;0.01); the number of patients with NIBUT changes increased by 14% (p &lt;0.01); the frequency of blinking decreased in 50% of all subjects compared to the initial data (p &lt;0.01). Conclusion. The influence of computer devices for 20 minutes does not significantly affect the qualitative composition of the tear film.

Usage of 0.4% sodium hyaluronate in complex treatment of pediatric patients with dry eye syndrome against the background of allergic diseases of the organ of vision

Background. In recent years, the prevalence of allergic diseases of the anterior chamber of the eye has increased. They are often accompanied by the development of dry eye syndrome, which can complicate their course. Therefore, it is important to take a comprehensive approach to their diagnosis and treatment. The purpose was to study the effectiveness of 0.4% sodium hyaluronate (Gilays) in children with dry eye syndrome on the background of allergic diseases of the conjunctiva. Materials and methods. The study involved 42 patients (84 eyes) aged 3 to 18 years, who were examined and treated on the basis of Regional Eye Clinic. Patients were treated with local H-1 histamine blockers twice a day for 14 days, f necessary — with topical glucocorticoids by the scheme for 12 days. In the first group (21 patients, 42 eyes), the main treatment was added with the drugs containing 0.2% sodium hyaluronate, used topically 4 times a day for 14 days. In the second group (21 patients/42 eyes), 0.4% sodium hyaluronate (Gilays) was added to the treatment regimen. H-1 histamine blockers were not used systemically. Before starting therapy and 2 weeks later, the following values were evaluated: the changes in the anterior chamber of the eye using biomicroscopy, determination of lacrimal film rupture time, Schirmer 1 test, questionnaire. Conclusions. The use of sodium hyaluronate in the complex therapy of dry eye syndrome in allergic eye diseases is quite effective. The use of 0.4% sodium hyaluronate was more effective compared to the control group. It is advisable to use a questionnaire to communicate with the child, but it is necessary to refine the form of questions to eliminate as much as possible the subjectivity of the data.

Mass spectrometry-based tear proteomics for noninvasive biomarker discovery.

The lacrimal film has attracted increasing interest in the last decades as a potential source of biomarkers of physiopathological states, due to its accessibility, moderate complexity, and responsiveness to ocular and systemic diseases. High‐performance liquid chromatography‐mass spectrometry (LC‐MS) has led to effective approaches to tear proteomics, despite the intrinsic limitations in sample amounts. This review focuses on the recent progress in strategy and technology, with an emphasis on the potential for personalized medicine. After an introduction on lacrimal‐film composition, examples of applications to biomarker discovery are discussed, comparing approaches based on pooled‐sample and single‐tear analysis. Then, the most critical steps of the experimental pipeline, that is, tear collection, sample fractionation, and LC‐MS implementation, are discussed with reference to proteome‐coverage optimization. Advantages and challenges of the alternative procedures are highlighted. Despite the still limited number of studies, tear quantitative proteomics, including single‐tear investigation, could offer unique contributions to the identification of low‐invasiveness, sustained‐accessibility biomarkers, and to the development of personalized approaches to therapy and diagnosis.

Влияние препарата «Катионорм» на слезную пленку при обструктивной дисфункции мейбомиевых желез у пользователей мягких контактных линз

There are more than 80 million users of soft contact lenses in the world - 10-15 % of the population. The prevalence of meibomyus gland dysfunction is 43-61 % with the prevalence of obstructive form and the development of lipodeficiency in lacrimal film. At the same time, the use of traditional tear substitutes based on hyaluronic acid is ineffective and the problem of finding a tear substitute with exposure to all 3 layers of lacrimal film becomes relevant. Nanoemulsion “Cationorm” is created as a means of pathogenetic therapy of dry eye syndrome against the background of lipodeficiency, however, there weren't any studies of its effectiveness in obstructive form of meibomyus gland dysfunction among users of soft contact lenses. We examined 3 layers of lacrimal film with the help of Norn's sample with determination of time of lacrimal film break, bio-measurement of lacrimal meniscus and biomicoscopy of eyelid edge region at painting of lissamino-om green. The study involved 28 young carriers of silicone-hydrogel contact lenses with signs of obstructive form of meibomyus gland dysfunction, who we divided into two groups: a control group used to eliminate the symptoms of a hyaluronic acid-based tear substitute, and an experimental group using the drug “Cationorm”. We revealed prolonged effect of nanoemulsion “Cationorm” on all three layers of lacrimal film, which hasn't only symptom lacrimal, but has pathogenetic therapeutic delayed effect among users of soft contact lenses with obstructive form of dysfunction of meibomyum glands, and nanostimer of lipid microspheres provides full compatibility even with material of silicone-hydrogel soft contact lenses. We proved the protective effect of the preparation on ocular epithelium cells.

The effect of the tear film on the results of a direct assessment of the sensitivity of the cornea

To evaluate the influence of the tear film on the results of direct assessment of corneal sensitivity. The study was conducted in a group of 20 healthy volunteers. Criteria for inclusion in the group: absence of any ocular and general systemic diseases in the anamnesis, normal indicators of tear production and stability of the tear film according to Schirmer and Norn tests. The process of testing involved a specially designed device that was used to exert a dosed force by jets of air on the frontal corneal surface and the pressure was recorded at the moment of tactile sensations and at the breakup time of tear film, as an indicator of its biomechanical stability. A strong correlation have been found between the pressure of the air stream at the moment of getting tactile sensations and at the breakup of the tear film (R=0.91, p=0.0094). The obtained data indicate that the biomechanical resistance of the lacrimal film is a significant factor preventing the correct assessment of the results of direct corneal esthesiometry in the range of values close to conditionally normal sensitivity. In this regard, in their current technical implementation, modern esthesiometers can only be used for monitoring (not for diagnosis!) of pathological processes by analyzing relative (compared to each other) - rather than absolute - sensitivity measures (optimally in combination with analysis of the structural changes in the corneal nerves based on laser confocal microscopy).

The assessment of lacrimal film condition in patients with dry eye syndrome during therapy

To evaluate the efficiency of modern imaging methods of meibomian gland ducts and determine the tear film break-up time (TFBUT) during therapy in patients with the secondary dry eye syndrome (SDES) of allergic etiology.Material and methods. 66 patients aged 38.0 ± 1.5 with SDES after allergic conjunctivitis were examined. The patients were divided into 2 groups depending on the therapy administered. The main group (n = 33) received Oftalron as tear replacement therapy for 20 days, 2 drops, 2 times a day. The patients of the comparison group (n = 33) used Super Optic HydroBalance for 20 days, 2 drops 2 times a day. The control group consisted of 25 healthy subjects without eye pathology. All subjects underwent Schirmer’s tests I and II, as well as TFBUT and meibography on an automatic refractokeratometer HRK-9000A (Huvitz, Korea).Results. In both SDES groups, a significant decrease of the OSDI (Ocular Surface Disease Index) in the treatment process was observed (p ≤ 0.05), which corresponded to low intensity of SDES symptoms. In both groups morphofunctional changes of meibomian glands of 1 and 2 stages prevailed. The most significant dynamics was observed in TFBUT results, they were significantly lower in comparison with the similar indexes in the patients of the control group.Conclusion. Specific modes of autorefractokeratometer HRK-9000A allow receiving objective information about the condition of the tear film and high-quality imaging of meibomian glands, which allow expanding possibilities of complex diagnostics of various forms of DES.

Impact of pterygium on the ocular surface and meibomian glands.

PurposeTo analyze how ocular surface parameters correlate to presence of pterygium and investigate the possible impact of pterygia on tear film findings and meibomian glands findings.MethodsWe investigated objective parameters of the ocular surface such as conjunctival hyperemia, tear film stability and volume, meibomian gland dysfunction, dry eye disease, corneal topography comparing healthy individuals and correlating with the pterygium clinical presentation.ResultsA total of 83 patients were included. Corneal astigmatism induction was 2.65 ± 2.52 D (0.4–11.8). The impact of pterygium on the ocular surface parameters compared to matched controls was seen in: conjunctival hyperemia (control 1.55±0.39/pterygium 2.14±0.69; p = 0.0001), tear meniscus height (control 0.24±0.05 mm/pterygium 0.36±0.14mm; p 0.0002), meiboscore lower eyelid (control 0.29±0.64/pterygium 1.38±0.95; p 0.0001) and meiboscore upper eyelid (control 0.53±0.62/pterygium 0.98±0.75; p = 0.0083). We found a high number of pterygium patients (88%) presented meibomian gland alterations. Interestingly, meibomian gland loss was coincident to the localization of the pterygium in 54% of the upper and 77% lower lids.ConclusionPterygium greatly impacts on ocular surface by inducing direct alterations in the pattern of meibomian glands besides corneal irregularities, conjunctival hyperemia and lacrimal film alterations, inducing significant symptoms and potential signs of dysfunction.

Lacrimal gland abnormalities in blepharophimosis, ptosis and epicanthus inversus syndrome

Abstract: Introduction: Blepharophimosis, ptosis and epicanthus inversus syndrome (BPES) is an uncommon autosomal dominant congenital disease caused by a mutation in the FOXL2 gene. Its major features are blepharophimosis, blepharoptosis, epicanthus inversus and telecanthus, and recently there have been some reports linking this disease to lacrimal gland (LG) agenesis. We studied the LG changes in BPES patients of our institution. Material and methods: Six patients with ages between 1 and 39 years old were studied. Lacrimal film evaluation was performed by slit-lamp biomicroscopy and Schirmer I test. LG volume was measured on computed tomography scans. All patients were screened for FOXL2 mutations. Results and discussion: The lacrimal film was abnormal in 2 patients. Both presented a reduced lacrimal meniscus; in one patient the Schirmer I test was decreased and in the second patient a significative superficial keratopathy was visible. An absence of the LG was disclosed on both CT scans. In 2 other patients LG volume was bilaterally reduced and in 1 it was normal. The remaining 1-year-old child had visible LGs and a normal lacrimal status evaluation. In this group of patients, clinical changes found on the lacrimal film evaluation were greatly associated to LG dysgenesis. A FOXL2 gene mutation was found in all cases, one of them not previously described. Conclusion: This study reinforces the recently described association between BPES and alacrimia and the importance of lacrimal evaluation in these patients, mainly if they are surgical candidates. A new FOXL2 mutation not previously described is also reported.

Digital Asthenopia: Portuguese Group of Ergophthalmology Survey.

Given the increasing use of electronic devices, and the increasing number of complaints with its use, we intend to evaluate the prevalence of manifestations of dry eye and ocular fatigue in a population of individuals, who use the computer daily to perform all their professional tasks, as well as to correlate these complaints with the number of hours of digital use as well as their possible improvement with behavioural measures and use of tear drops. A total of 77 individuals (154 eyes) were evaluated on two separate days with a 1-month interval. They completed two questionnaires: OSDI and PEG Eye Fatigue. An objective ocular surface assessment was performed: Schirmer test without anesthetic, DR-1a Dry Eye Monitor™, hyperemia evaluation, lacrimal break up, presence of keratitis and lesions in the conjunctiva, as well as near accommodation point and near convergence point. After the first evaluation, the subjects were divided into two groups: group A (< 2 hours of computer working) and group B (> 2 hours of computer working). Some environmental measures to reduce complaints and recommendation of use of artificial tears were explained to the latter. There was a statistically significant difference in the majority of the parameters evaluated in the group B, in relation to the morning period (group A) - tear film (p = 0.032), hyperemia (p < 0.001), BUT (p < 0.001), keratitis (p < 0.001), conjunctival lesion (p = 0.002) and accommodation point (p < 0.001). In the evaluation - one month later - there were no statistically significant differences in any of the parameters analysed in the group A, and in group B there was a decrease in most parameters at the end of that period - Schirmer test (p = 0.005), lacrimal film (p = 0.022), keratitis (p < 0.001), conjunctival lesion (p = 0.005) and fatigue score (p < 0.001). It was thus possible to show the appearance of ocular fatigue and ocular surface changes with prolonged use of computers (> 2 hours) as well as a significant improvement in symptomatology (subjective assessment) as well as of ocular surface changes (objective evaluation) with the implementation of postural measures, regular breaks and use of lubricants. This is the first study, to the best of our knowledge, of digital asthenopia in which, in addition to the subjective evaluation, the presence of ocular surface modifications (objective assessment) were evaluated and the respective improvement with the aforementioned ergophthalmological measures were evaluated. This survey highlights the increased overall level of awareness that we need to have to face the rapid and wide-scale changes driven by the emergence of digital technology and, more particularly, its impact on user's vision and posture. We concluded that the longer we use the electronic devices (more than two hours) the more severe the complaints and rates of ocular surface changes are. Environmental and ocular strategies can attenuate or even eliminate the discomfort caused by this syndrome, and increase professional performance and quality of life.

PREOPERATIVE ASSESSMENT OF THE INITIAL CONDITION OF THE EYE SURFACE IN PATIENTS WITH MYOPIA

T he purpose is to assess the structural state of the cornea and pre-corneal lacrimal film in patients with myopia before refractive surgery, to identify the relationship with changes in cytokine concentration in the tear. Material and methods. 62 patients (124 eyes) with myopia were examined. The first group included 26 patients, only glasses were used for the correction of myopia, and in the 2nd group, 36 patients who used soft contact lenses during 5 to 15 years. Methods of examination: determination of the thickness of the corneal epithelium, height and width of the lacrimal meniscus, assessment of the biomechanical properties of the cornea, the Norn and Schirmer tests. Content of cytokines in the tear – interleukin 10 and tumor necrosis factor α – was measured using the test set «BEST» by enzyme immunoassay. Results . The decrease in the thickness of the epithelium of the cornea, the height and width of the lacrimal meniscus, the stability of the tear film, and the ratio of interleukin-10 to the tumor-α necrosis factor in patients who use contact lenses for a long time are revealed. The conclusion . Prolonged wearing of contact lenses for correction of myopia is accompanied by signs of symptomatic dry eye syndrome against a background of moderate oppression of the anti-inflammatory activity of tears.

Lactoferrin-loaded contact lenses counteract cytotoxicity caused in vitro by keratoconic tears.

Lactoferrin (LF), an iron-binding protein with antioxidant activity, is significantly reduced in the lacrimal film of patients affected by keratoconus (KC) compared to healthy subjects, and this is supposed to be the cause for tear iron increase and consequent iron deposition and oxygen free radical accumulation in the cornea. We decided to study if LF-loaded contact lenses (LF-CLs) could exert antioxidant activity on epithelial cells incubated in tears collected from two patients affected by keratoconus (KC1 and KC2). Moreover through this model we indirectly estimated iron concentration in the tears of healthy and KC subjects. Reflex tears were collected during the first 2 min of light or onion-induced lacrimation and stored at -20 °C. After incubation in tears for 18 h, mortality of epithelial cells was investigated by trypan blue exclusion test. Successively, LF-CLs were deposed on cells incubated in KC1 tears. For the indirect determination of iron content, cells were incubated with LF 1.2 mg/mL and different FeSO4 concentrations, and for the estimation of iron from the patient's tears, cells were incubated with free serum medium and healthy tears (1:1) and different FeSO4 concentrations. Epithelial cells incubated with reflex tears of KC patients showed increased mortality (27.7 ± 3.9%, p = 0.0003, for KC1 and 17.6 ± 0.95%, p = 0.014, for KC2) compared to epithelial cells maintained in control healthy tears (8.6 ± 1.2%). This difference in mortality was correlated with tear iron concentration, which was estimated at 4.58 μg/mL for the healthy subjects, at 56.28 μg/mL for KC1, and at 8.7 μg/mL for KC2 patient. Application of LF-CLs counteracted KC tear cytotoxicity restoring viability obtained in the presence of control tears. Therapeutic contact lenses obtained by LF loading can reduce oxidative stress induced by patients' tears and might represent an efficient device to arrest the progression of keratoconus.

Desórdenes de la película lagrimal, el mal de la mitad del mundo

El comportamiento de la película lagrimal sobre la superficie ocular depende de factores propios del individuo, hábitos y factores externos. La combinación de estos elementos puede producir alteraciones (ojo seco). El objetivo del estudio fue establecer la incidencia de este en personas residentes en Quito; se ha utilizado técnicas de diagnóstico de bajo costo en consultas optométricas. Se evaluó la cantidad y calidad con el test de Schirmer I y Test de Break Up Time a 493 individuos (44,2 % hombres y 55,8 % mujeres). Las alteraciones de esta se clasificaron en cinco grupos: hiper-lagrimación refleja y evaporación; hiper-lagrimación refleja; hiposecreción lagrimal; alteración de la película lagrimal por evaporación, hiposecreción lagrimal y evaporación. El 86,6 % de la población posee alguna alteración de la misma; hay mayor prevalencia de la alteración por evaporación. El género incide; la cantidad de lágrima es mayor en mujeres. Sin embargo, en el ANOVA, dicha variante fue irrelevante. En cuanto a la edad, se observó una disminución progresiva de la calidad lagrimal con el incremento de la edad. Este estudio demuestra el alto índice de individuos con alguna alteración de la lágrima y, por lo tanto, aboga por el aumento de investigaciones sobre esta afección en poblaciones andinas.

Obesrvation on the ocular surface and corneal endothelial cells in diabetic patients after phacoemulsification

Objective To observe the ocular surface and corneal endothelial cells in diabetic patients after phacoemulsification. Methods Eighty-four eyes of 84 cases of cataract received phacoemulsification. Among them 42 eyes of 42 cases with diabetic mellitus were diabetic group, 42 eyes of 42 cases without diabetes were the pure group. No dry eye symptom before surgery occurred. All patients underwent phacoemulsification with corneal incision by the same doctor. No change of ocular fundus for diabetic patients occurred, and preoperative glycemic control was normal. Dry eye symptoms, corneal endothelial cell density, Schirmer Ⅰ test (SⅠt), corneal fluorescein staining (FL) score and lacrimal film breakup time (BUT) were compared between the two groups at preoperatively and postoperatively 3, 7 days and 1month. Results The difference of dry eye symptoms score, corneal endothelial cell density, SⅠt, FL score and BUT before operation were not statistically significant between 2 groups (P=0.9993, 0.5561, 0.8237, 0.1305, 0.8357). The difference of dry eye symptoms at 3 days after operation was not significant between 2 groups (P=0.1986). The dry eye symptoms score of diabetic group were higher than those in the pure group at 7 days and 1 month after operation (P<0.001). The corneal endothelial cell density after operation in diabetic group was lower than that in pure group. The difference was statistically significant (P<0.001). The SIt and FL scores in diabetic group were significantly higher than those in pure group, the difference was statistically significant (P=0.0001). The difference of BUT was not significant between 2 groups at 3 days after operation (P=0.6397), but the BUT of diabetic group at 7 days and 1 month after operation was significantly lower than that of pure group, the difference was statistically significant (P<0.001). Conclusion There is effect of phacoemulsification on dry eye symptoms, SⅠt and BUT for patients with diabetes mellitus, and which may be related to the impaired repair ability of diabetic patients. Key words: Cataract; Diabetes, mellitus; Phacoemulsification; Surface, ocular; Dry eye

Вклад слезной пленки в показатели толщины роговицы и роговичного эпителия

Вклад слезной пленки в показатели толщины роговицы и роговичного эпителия

The triple classification of dry eye for practical clinical use.

"Dry Eye is a condition produced by the inadequate interrelation between lacrimal film and ocular surface epithelium, and is caused by quantitative and qualitative deficits in one or both of them. It can be produced by one or combined etiologic causes, affecting one or several of the secretions of the glands serving the ocular surface, and producing secondary manifestations of different grades of severity". Clinicians need a practical classification to face diagnosis, prognosis and treatment. Dry eyes have many etiologies and pathogenesis, different affectation of the various dacryoglands and ocular surface epithelium, and diverse grades of severity. The specialists in xero-dacryology must know these three parameters to evaluate any case of dry eye, and to establish an adequate treatment. To facilitate this, an open session in the 8th congress of the International Society of Dacryology and Dry Eye (Madrid, April, 2005) proposed modifying the Triple Classification of dry eye approved in the XIV congress of the European Society of Ophthalmology (Madrid, June, 2003). There was consensus of all conclusions. The following classification has been established: First, a classification of the etio-pathogenesis, distributed in ten groups: age-related, hormonal, pharmacologic, immunopathic, hyponutritional, dysgenic, infectious/inflammatory, traumatic, neurologic and tantalic. Second, a classification of the affected glands and tissues, which under the acronym of ALMEN includes the Aqueo-serousdeficient, Lipodeficient, Mucindeficient and Epitheliopatic dry eyes, and the Non dacryological affected exocrine glands (saliva, nasal secretion, tracheo-pharyngeal secretion, etc). And thirdly, a classification of severity, in three grades: Grade 1 or mild (symptoms without slitlamp signs), grade 2 or moderate (symptoms with reversible signs), and grade 3 or severe (symptoms with permanent signs).

Algorithm for dry eye disease diagnosis in individuals infected with human T-cell lymphotropic virus type 1.

To evaluate the accuracy of lacrimal film tests and propose an algorithm for the diagnosis of dry eye disease in individuals infected with human T-cell lymphotropic virus type 1. Ninety-six patients infected with human T-cell lymphotropic virus type 1 were enrolled in the study. To assess clinical complaints, patients completed the Ocular Surface Disease Index questionnaire. To evaluate lacrimal film quality, patients underwent the tear breakup time test, Schirmer I test, and Rose Bengal staining. Dry eye disease was diagnosed when at least two of the three test results were abnormal. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of the questionnaire as well as of each test alone and combined in parallel and in series were determined. The most sensitive test was the tear breakup time test (98%), whereas the most specific was the Schirmer I test (100%). Rose Bengal staining had the highest overall accuracy (88.64%), whereas the Ocular Surface Disease Index had the lowest overall accuracy (62.65%). The tear breakup time test, Schirmer I test, and Ocular Surface Disease Index combined in parallel showed increased sensitivity and decreased specificity for all tests. In contrast, when combined in series, these tests demonstrated increased specificity and decreased sensitivity. This study shows the need to use multiple tests to evaluate tear film quality and include a symptom questionnaire as part of the diagnostic algorithm for dry eye disease.

Prevalence of dry eye symptoms and its risk factors among patients of King Abdulaziz Specialist Hospital (Taif), Saudi Arabia

Background: The prevalence of dry eye symptoms is estimated to be between 7% and 34% depending on the studies, the diagnostic tests used, or the populations studied. Eye dryness is caused primarily by an aqueous deficiency, excessive lacrimal film evaporation or a combination of both. Besides age, several individual and environmental causes were reported as risk factors of dry eye symptoms. Purpose: The objectives of this study were to assess the prevalence of dry eye symptoms and to determine the most frequent risk factors among patients of King Abdul-Aziz Specialist Hospital (Taif), Saudi Arabia. Methods: An observational cross-sectional study using a valid questionnaire (ocular surface disease index [OSDI]) was used to assess the symptoms of dry eye among patients at King Abdulaziz Specialist Hospital in Taif city from August to September 2017. Statistical data were analyzed using Statistical package for the social sciences version 21.0. Results: Out of 482 patients (mean age = 50.16), 116 patients were normal (0≤ OSDI Score ≤12), 103 patients had mild dry eye (13≤ OSDI Score ≤22), moderate dry eye (23≤ OSDI Score ≤32) was prevalent among 62 patients and 201 patients had severe dry eyes (OSDI Score ≤33). No significant effect of gender (P = 0.71) was observed on symptoms of dry. However, age has significant but weak impact (P = 0.01, r = 0.155). Arthritis (P = 0.021, odds ratio [OR] =1.95%; 95% confidence interval [CI]: 1.1, 3.43) and hypercholesterolemia (OR = 2.24, 95% CI: 1.36, 3.69, P = 0.002) were significant factors for dry eye condition. Conclusion: The dry eye symptoms are highly prevalent among patients of King Abdulaziz Hospital. A lot of factors show no significant difference such as smoking and diabetes between groups exposed and not exposed while others such as arthritis and hypercholesterolemia show statistically significant difference. We must make more effort to know what exactly related to dry eye for early intervention and management.

Ocular lubricants: what is the best choice?

ABSTRACT: Ocular lubricants are used to supplement one or more layers of the lacrimal film. They are often prescribed to treat keratoconjunctivitis sicca (KCS) and other diseases of ocular surface in humans. These lubricants may also protect the ocular surface and promote epithelial regeneration. The active component of ocular lubricants is the lubricating agent. The key properties of different lubricating agents are the electrolyte composition, osmolarity, and addition of preservatives. Although lacrimomimetics are not typically used to treat KCS in dogs, they can be used as an adjunctive therapy. Knowledge of the properties of lacrimomimetics will help in making the appropriate therapeutic choice.