Mean Tear Break-up Time Research Articles

The ablation depth effect on dry eye after LASIK treatment for myopia

Purpose The aim was to investigate the effect of ablation depth on the incidence and severity of the dry eye after laser-assisted in-situ keratomileusis (LASIK) treatment of myopia. Patients and methods This was a prospective, noncomparative, interventional case series study that included myopic patients who underwent LASIK treatment for myopia ranging from −1.75 to −12.00 D. All patients had a comprehensive preoperative ophthalmologic evaluation. Tear breakup time (TBUT) and Schirmer 1 tests were undertaken for all patients preoperatively and at 1, 3, and 6 months postoperatively. The main outcome measures included the incidence and severity of the dry eye and their correlation with ablation depth at 1, 3, and 6 months postoperatively. Results 104 eyes of 53 myopic patients (14 males and 39 females) with a mean age of 27.4±6.06 years (range: 21–45 years). At the baseline, the mean spherical equivalent was −6.38±2.82 D (range: −1.5 to −12 D), mean TBUT was 12.93±1.60 s (range: 10–17 s), and the mean Schirmer 1 score was 17.9±62.52 mm (range: 14–30 mm). Mean post-LASIK TBUT was 7.58±4.32, 10.22±5.38, and 12.07±4.02 s at 1, 3, and 6 months, respectively (P Conclusions There was moderate to strong negative correlation between ablation depth and the degree of post myopic LASIK dryness assessed objectively by TBUT and Schirmer 1 tests.

Meibography of Eyes With Sequelae of Trachoma.

To study the effect of trachoma on meibomian glands using infrared meibography and to correlate the results with tear film parameters. This is a prospective cohort study in which 86 eyes of healthy volunteers and 90 eyes with trachoma were included. Clinical assessment was performed including the following: slit-lamp examination looking for signs of sequelae of trachoma, tear breakup time (TBUT), superficial punctate keratopathy (SPK), Schirmer II test (with anesthesia), and meibum score. Noncontact meibography was performed on both upper and lower eyelids separately using the meibograde system, which involved distortion of the meibomian gland, shortening, and dropout. Lid margin abnormalities (telangiectasia, lid margin swelling, and hyperemia) were all significantly higher in the trachoma group. The mean SPK (1.36), meibum score (1.76), meibography dropout, distortion, shortening, and total meibography (8.19 for upper eyelids and 3.81 for lower eyelids) were all significantly higher in the trachoma group (P < 0.001) compared with the normal group were SPK (0.88), meibum score (0.16), and total meibography (1.24 for upper eyelids and 0.92 for lower eyelids). Mean TBUT (4.2 s) was significantly shorter in the trachoma group than in the normal group (10.3 s) (P < 0.001). There was no significant difference between both groups in the Schirmer II test. Meibography of patients with sequelae of trachoma was in agreement with the histopathologic studies. Upper eyelids were much more affected than the lower eyelids. TBUT, SPK, and meibum score were correlated with the status of meibomian glands and meibography, which were significantly different in the trachoma group.

Estimation of tear film break up time in normal peoples of Diwaniya,Iraq

Objective: to estimate tear film break- up time , a test of tear film stability in normal Iraqi population.&#x0D; Material and method: 286 normal subjects ( 146 male and 140 female ) age from 12 to 78 years were participated in this study, tear break -up time is estimated using impregnated fluorescein strip wetted with normal saline and the measurement is done in one room with stable temperature and door closed , three readings for each subject and the mean is taken .&#x0D; Results: The&#x0D; Objective: to estimate tear film break- up time , a test of tear film stability in normal Iraqi population.&#x0D; Material and method: 286 normal subjects ( 146 male and 140 female ) age from 12 to 78 years were participated in this study, tear break -up time is estimated using impregnated fluorescein strip wetted with normal saline and the measurement is done in one room with stable temperature and door closed , three readings for each subject and the mean is taken .&#x0D; Results: The mean TBUT in this study was 15.3 second with SD 4.7 ( range from 6-28s), the study show TBUT to be decreased with age, The study show significant difference in result between male and female.&#x0D; Conclusion : The tear break -up time (TBUT)values in this study are comparable to those reported for Asian population but much less than those for western population; there is significant difference between gender and the results tend to decrease with age.&#x0D;

Analysis of treatment results in dry eye syndrome patients after phacoemulsification by preservative-free 0.3% sodium hyaluronate eye drops

Postsurgical dry eye syndrome is found in a substantial proportion of patients after phacoemulsification. Its onset could be explained by surgical trauma and by use of preservative-containing eye drops. In some patients, it causes substantial discomfort that continues unabated after 3-4 weeks after surgery.&#x0D; Purpose. To investigate the results of 0.3% sodium hyaluronate instillation therapy used to treat dry eye syndrome after phacoemulsification.&#x0D; Materials and methods. Basal tear secretion (Schirmer II test) and tear breakup time (TBUT) test were investigated in 33 patients with symptoms characteristic of dry eye syndrome in 1 month after phacoemulsification. These patients received 0.3% preservative-free sodium hyaluronate instillations for 30 days, whereupon Schirmer II and TBUT tests were repeated. Symptom dynamics was estimated according to the OSDI questionnaire scale.&#x0D; Results. Mean values of basal tear secretion and TBUT tests were slightly below normal ones. In one month of treatment, the TBUT index associated with Gilan Ultra Comfort use became somewhat better: mean TBUT value appeared to be 9.8 2.5 sec. OSDI questionnaire patient symptom score evaluation also revealed in patients a mild degree of xerosis severity. Mean score before treatment was 19.6 10.0. Positive disease dynamics after Gilan Ultra Comfort use is confirmed by a significant decrease of OSDI score index up to 12.3 6.3.

Evaluation of the Tear Function Tests and the Ocular Surface in First-Time Users of Silicone Hydrogel Contact Lenses

ABSTRACTPurpose: To evaluate the effects of three different silicone hydrogel contact lenses (SHCL), (balafilcon A, senofilcon A, and comfilcon A) on tear function tests, corneal thickness, and ocular surface cytology in first time contact lens users.Materials and methods: In this prospective study, 120 eyes of 60 subjects were evaluated. Balafilcon A users were designated as group 1, senofilcon A users as group 2, and comfilcon A users as group 3. In all cases, before and after 6 months of contact lens wear, ocular surface disease index score (OSDI), tear breakup time (TBUT), Schirmer 1 test, central corneal thickness (CCT), central corneal epithelium thickness (CCET), and conjunctival impression cytology samples were evaluated.Results: In group 1, 40 eyes of the 20 patients, in group 2, 40 eyes of the 20 patients, and in group 3, 40 eyes of the 20 patients were evaluated. The mean OSDI scores did not differ between the three groups after contact lens wear (p > 0.05). In group 1 and group 2, significant decrease was found in the mean TBUT 6 months after contact lens wear (p = 0.04, p < 0.001, respectively). In group 3, after 6 months of contact lens wear, the mean Schirmer 1 tear test was decreased significantly (p = 0.021). In all 3 groups, no significant change was observed in the mean CCT and CCET after contact lens wear (p > 0.05). After 6 months, the morphological changes in temporal and superior conjunctival epithelial cells were found to be significant in all groups (p < 0.001).Conclusion: Six months after SHCL wear, marked morphological changes occurred in the conjunctival epithelium. Tear function tests were also affected, while corneal thickness did not show any significant difference.

Vitamin B12 deficiency evaluation and treatment in severe dry eye disease with neuropathic ocular pain.

This study aims to understand the effect of vitamin B12 deficiency on neuropathic ocular pain (NOP) and symptoms in patients with dry eye disease (DED). Patients with severe DED (without receiving topical artificial tears treatment) and ocular pain were enrolled (n = 90). Patients with severe DED and vitamin B12 deficiency (group 1, n = 45) received parenteral vitamin B12 supplement + topical treatment (artificial tears treatment + cyclosporine), and patients with severe DED and normal serum vitamin B12 level (group 2, n = 45) received only topical treatment (artificial tears treatment + cyclosporine). Patients were evaluated by the ocular surface disease index (OSDI) questionnaire, 3rd question (have you experienced painful or sore eyes during last week?) score of OSDI as a pain determiner and pain frequency measure), tear break up time (TBUT), and Schirmer's type 1 test. We compared the groups' OSDI, TBUT, and Schirmer's test recordings at the first visit and after 12 weeks retrospectively. The OSDI score, 3rd OSDI question score, TBUT, and Schirmer's test results improved after 12 weeks (p < 0.001 for each group). The mean vitamin B12 level at enrollment was 144.24 ±43.36 pg/ml in group 1 and 417.53 ±87.22 pg/ml in group 2. The mean vitamin B12 level in group 1 reached to 450 ±60.563 pg/ml after 12 weeks of treatment. The mean score changes between the groups were not statistically significant; however, the decrease in the OSDI questionnaire score (-30.80 ±5.24) and 3rd OSDI question score (-2.82 ±0.53) were remarkable in group 1 (Table 2). The mean TBUT increase was +7.98 ±2.90 s and Schirmer's test result increase was +12.16 ±2.01 mm in group 1. The mean TBUT increase was +6.18 ±1.49 s and Schirmer's test result increase was +6.71 ±1.47 mm in group 2. These findings indicate that vitamin B12 deficiency is related with NOP. It may be important to consider measuring the serum vitamin B12 level in patients with severe DED presenting with resistant ocular pain despite taking topical treatment.

Clinical and allergological analysis of ocular manifestations of sick building syndrome.

PurposeThe disease concept of sick building syndrome (SBS) is still unclear. Ocular mucous membrane irritation is one of the major symptoms of SBS. However, the immunological aspects of the ocular complications of SBS are not yet clarified. The clinical and allergological aspects of SBS cases with ocular disorders with special reference to allergic conjunctival diseases (ACD) were analyzed, especially with respect to local immunological features.MethodsTwelve cases of SBS with ocular findings and 49 cases of ACD (allergic conjunctivitis [AC], atopic keratoconjunctivitis [AKC], and vernal keratoconjunctivitis [VKC]) for comparison were evaluated. The clinical findings in SBS and ACD were scored, and tear film breakup time (BUT) was measured. Cytokine (interferon-γ [IFN-γ], interleukin [IL]-2, IL-4, IL-5, IL-6, IL-8, and IL-13) concentrations in tears were analyzed by cytometric bead arrays. Eosinophil count in peripheral blood, total IgE in serum, and multiple allergen simultaneous test (MAST) for antigen-specific IgE were also measured.ResultsIn SBS, conjunctival lesions were observed in all cases, and corneal abnormalities were found in two-thirds of the cases. Limbal lesions were observed in 2 pediatric cases. Mean serum total IgE level in SBS was significantly higher than that in AC; however, it was significantly lower than that in AKC and VKC. Eosinophil count in peripheral blood and number of positive allergens in MAST were significantly lower in SBS than in AKC and VKC. Significant elevation of tear IL-4 was observed in SBS and ACD. However, in contrast to ACD, elevation of other cytokines in tears was not observed in SBS. Mean tear BUT in SBS was in the normal range.ConclusionFrom these results, SBS is thought to be partially induced by an allergic response. However, clinical dissociation of the ocular clinical findings and local immunological features in tear cytokines may suggest that SBS belongs to a different entity from ACD.

Tear and Pterygium: A Clinico-Pathological Study of Conjunctiva for Tear Film Anomaly in Pterygium

Aims: To evaluate the clinical and histological status of tear film in patients with unilateral pterygium. Settings and Design: Cross-sectional, case-control, double-blinded study. Methods and Material: Cross-sectional study of both eyes of 102 patients with unilateral pterygium was conducted between March 2011 to December 2012. Patients were subject to fluorescein lower tear meniscus height (LTMH) evaluation, fluorescein tear break-up time (TBUT), Schirmer’s test (using topical anesthetic), vital staining (viz. fluorescein, Rose Bengal and lissamine staining), LTMH imaging with anterior segment spectral-domain optical coherence tomography (OCT) cornea-anterior module (CAM-L and CAM-S), and conjunctival smear impression cytology. The normal eye acted as control. Statistical analysis used: fisher’s t-test and chi-square test. Results: The study comprised of seventy males and thirty-two females in the age-range 28-76years. The mean fluorescein LTMH, mean TBUT, mean Schirmer’s test value, mean OCT CAM-S and CAM-L values in the normal control eyes were 0.36 ± 0.03 mm, 12.3 ± 1.9s, 13.4 ± 2.5 mm, 0.338 ± 0.082 mm and 0.325 ± 0.088 mm, respectively. The comparable values in eyes with pterygium were 0.24 ± 0.03 mm, 8.2 ± 1.4 sec, 9.2 ± 2.4 mm, 0.212 ± 0.046 mm and 0.204 ± 0.058 mm respectively. Goblet cell count was decreased in impression cytology. Conclusions: Both fluorescein and OCT LTMH were found to be significantly decreased (p<0.01) in eyes with pterygium compared to control eyes. Goblet cell count, TBUT and Schirmer’s test values were also comparatively decreased. This study thus emphasizes that tear film abnormalities play a role in aetiology of pterygium and hence early institution of therapy for tear film stabilization can help prevent the disease.

Conjunctival Cytological Alterations in Ocular Behçet Disease.

To evaluate the ocular surface alterations and tear film functions in patients with ocular Behçet disease (BD). This study included 48 eyes of 48 patients with inactive BD and a control group of 33 age- and sex-matched subjects. Schirmer I and tear break-up time (TBUT) tests were used to evaluate the tear film of the subjects. Impression cytology was used to evaluate morphological changes of the conjunctival surface epithelial cells. The mean Schirmer I test result was 11.6 ± 5.9 mm/5 minutes and 16.1 ± 4.6 mm/5 minutes in the Behçet and control groups, respectively. The mean TBUT test result was 9.8 ± 5.6 seconds and 13.2 ± 5.7 seconds in the study and control groups, respectively. The Schirmer and TBUT test results were significantly lower in the study group than in the controls (P = 0.001 and P = 0.011, respectively). The mean impression cytology score was 1.3 ± 0.9 in the study group and significantly higher than the control group value of 0.4 ± 0.6 (P = 0.001). Tear film functions and conjunctival surface epithelial morphology were significantly altered in patients with ocular BD.

To study the Efficacy and safety of travoprost 0.004% BAK-free versus latanoprost 0.005% in patients with primary open-angle glaucoma or ocular hypertension.

Aim: To study the efficacy, safety, and tolerability of travoprost 0.004% benzalkonium chloride (BAK)-free versus latanoprost 0.005% in patients with primary open-angle glaucoma or ocular hypertension. Settings and Design: Prospective, randomized, comparative study in 30 patients of POAG/ocular hypertension with moderate glaucomatous damage were included. Material and Methods: The patients were randomly assigned to one of the two treatment groups, each having a sample size of 15 patients. All the patients were subjected to the detailed ocular examination at baseline and 12 weeks after starting the study treatment. Results: No significant difference in mean intraocular pressure (IOP) was observed between latanoprost at baseline and travoprost BAK-free after 12 weeks nor were significant differences noted in mean ocular hyperemia, visual acuity, corneal fluorescein staining, or overall scores from the Ocular Surface Disease Index. Patients had a significantly shorter mean tear breakup time while on latanoprost compared with travoprost BAK-free. Conclusion: The results of this study showed that both the groups had similar IOP control with better anterior segment signs in patients treated with travoprost BAK-free monotherapy .

Effect of benzalkonium chloride-free latanoprost ophthalmic solution on ocular surface in patients with glaucoma.

IntroductionBenzalkonium chloride (BAK), included as a preservative in many topical treatments for glaucoma, induces significant toxicity and alters tear breakup time (TBUT). BAK-containing latanoprost, an ester prodrug of prostaglandin F2α, can cause ocular adverse events (AEs) associated with BAK. The purpose of this study was to evaluate the efficacy and safety of BAK-free latanoprost.Patients and methodsA prospective, open-label, single-arm, multicenter, 8-week study in patients with primary open-angle glaucoma or ocular hypertension taking BAK-containing latanoprost for ≥12 months was performed. Patients were switched to BAK-free latanoprost ophthalmic solution 0.005% administered once daily, and eyes were assessed after 28 and 56 days. Primary efficacy and safety variables were TBUT and treatment-emergent AEs, respectively.ResultsAt day 56, 40 eyes were evaluable. Mean TBUT increased significantly from baseline (3.67±1.60 seconds) to 5.03±2.64 and 6.06±3.39 seconds after 28 and 56 days of treatment with BAK-free latanoprost (P<0.0001). Ocular Surface Disease Index© (OSDI©) score also decreased significantly to 12.06±13.40 and 7.06±10.75 at 28 and 56 days, respectively, versus baseline (18.09±18.61, P<0.0001). In addition, inferior corneal staining score decreased significantly to 0.53 from baseline (0.85, P=0.0033). A reduction in conjunctival hyperemia and intraocular pressure was observed at both time points. No treatment-related serious AEs were evident and 12 (26.08%) treatment-emergent AEs occurred in seven patients, with eye pain and irritation being the most frequent. No clinically significant changes in vital signs or slit lamp examinations were observed.ConclusionResults indicate that switching from BAK-containing latanoprost to BAK-free latanoprost resulted in significant improvements in TBUT, OSDI© score, and inferior corneal staining score, and measurable reductions in conjunctival hyperemia score. Furthermore, BAK-free latanoprost was well tolerated with only mild-to-moderate and self-limiting AEs. BAK-free latanoprost appears to be effective in protecting ocular surface integrity in glaucoma patients but further studies are needed to confirm this beneficial effect.

Prevalence and severity of dry eye in candidates for laser in situ keratomileusis for myopia in Russia

To assess the prevalence and severity of dry-eye disease in patients with myopia being evaluated for laser in situ keratomileusis. Nine ophthalmology centers in Russia. Prospective noninterventional cross-sectional study. The assessments included the Schirmer I test, tear breakup time (TBUT), lissamine green and fluorescein staining (Oxford grading scheme), Ocular Surface Disease Index (OSDI) questionnaire, and Dry Eye Workshop (DEWS) dry-eye severity grading. The study comprised 400 patients with myopia (mean age 29.7 years); 145 (36.2%) wore contact lenses, and 81 (20.2%) used topical dry-eye medication. The mean Schirmer test score was 15.2 mm; 36.5% of patients had evidence of tear-volume deficiency (Schirmer score ≤10 mm). The mean TBUT was 11.7 seconds; 10.1% of patients had tear-film instability (TBUT <5 seconds). Conjunctival (lissamine green) staining intensity was categorized as minimal or greater (grade ≥1) in 62.3% of patients and mild or greater (grade ≥2) in 22.8% of patients. The mean OSDI score was 20.4, indicating mild ocular disability. Dry-eye severity (DEWS grading) was mild/episodic in 66.2%, moderate in 29.5%, and severe in 4.3% of patients. No clear correlation was evident between the Schirmer/TBUT scores and the lissamine green/OSDI scores. The prevalence of dry eye in this population was estimated at approximately 10% to 40% (based on clinical signs) and 40% to 55% (based on symptoms); dry-eye severity was predominantly mild/episodic. The proportion of patients requiring dry-eye therapy (based on OSDI and DEWS severity findings) was almost 2 times higher than the proportion receiving treatment.

The Effect of Smoking on Corneal Endothelial Cells

ABSTRACTPurpose: To investigate the effect of chronic cigarette smoking on the endothelial cells of the cornea via non-contact specular microscopy. Method: In this prospective, cross-sectional study, 25 eyes of 25 chronic smokers and 21 eyes of 21 age-matched, healthy non-smokers were enrolled. The Fagerström Test for Nicotine Dependence on Cigarettes was used to determine the nicotine dependency level. The level of cotinine, a major metabolite of nicotine, was measured in urine samples from the control group to detect whether they were passively affected by cigarette smoke. All participants underwent measurement of tear break-up time (TBUT), central corneal thickness (CCT), and axial length. Endothelial cell density and endothelial cell morphology were evaluated by non-contact specular microscopy. Results: On average, the cigarette smokers consumed 19.2 ± 8.3 cigarettes per day and had been smoking for 14.5 ± 6.8 years. The mean TBUT value was significantly lower in the smoker group compared to the non-smoker group (p < 0.05). No statistically significant difference was found in the mean CCT, mean endothelial cell density, or parameters of endothelial cell morphology between smokers and non-smokers. Conclusion: This study showed that cigarette smoking seems to affect the TBUT value but no effects were found on the parameters of corneal endothelial cells.

Comparison of the femtosecond laser and mechanical microkeratome for flap cutting in LASIK.

To compare refractive results, higher-order aberrations (HOAs), contrast sensitivity and dry eye after laser in situ keratomileusis (LASIK) performed with a femtosecond laser versus a mechanical microkeratome for myopia and astigmatism. In this prospective, non-randomized study, 120 eyes with myopia received a LASIK surgery with the VisuMax femtosecond laser for flap cutting, and 120 eyes received a conventional LASIK surgery with a mechanical microkeratome. Flap thickness, visual acuity, manifest refraction, contrast sensitivity function (CSF) curves, HOAs and dry-eye were measured at 1wk; 1, 3, 6mo after surgery. At 6mo postoperatively, the mean central flap thickness in femtosecond laser procedure was 113.05±5.89 µm (attempted thickness 110 µm), and 148.36±21.24 µm (attempted thickness 140 µm) in mechanical microkeratome procedure. An uncorrected distance visual acuity (UDVA) of 4.9 or better was obtained in more than 98% of eyes treated by both methods, a gain in logMAR lines of corrected distance visual acuity (CDVA) occurred in more than 70% of eyes treated by both methods, and no eye lost ≥1 lines of CDVA in both groups. The difference of the mean UDVA and CDVA between two groups at any time post-surgery were not statistically significant (P>0.05). The postoperative changes of spherical equivalent occurred markedly during the first month in both groups. The total root mean square values of HOAs and spherical aberrations in the femtosecond treated eyes were markedly less than those in the microkeratome treated eyes during 6mo visit after surgery (P<0.01). The CSF values of the femtosecond treated eyes were also higher than those of the microkeratome treated eyes at all space frequency (P<0.01). The mean ocular surface disease index scores in both groups were increased at 1wk, and recovered to preoperative level at 1mo after surgery. The mean tear breakup time (TBUT) of the femtosecond treated eyes were markedly longer than those of the microkeratome treated eyes at postoperative 1, 3mo (P<0.01). Both the femtosecond laser and the mechanical microkeratome for LASIK flap cutting are safe and effective to correct myopia, with no statistically significant difference in the UDVA, CDVA during 6mo follow-up. Refractive results remained stable after 1mo post-operation for both groups. The femtosecond laser may have advantages over the microkeratome in the flap thickness predictability, fewer induced HOAs, better CSF, and longer TBUT.

Effect of a hyaluronic acid and carboxymethylcellulose ophthalmic solution on ocular comfort and tear-film instability after cataract surgery

To evaluate the efficacy and safety of using sodium hyaluronate 0.1% and carboxymethylcellulose 0.5% artificial tears for ocular discomfort and tear-film stability in eyes after cataract surgery. Twenty ophthalmic centers in Italy. Prospective randomized case series. This study enrolled patients scheduled for unilateral cataract surgery. After surgery, patients received artificial tears and a topical steroid-antibiotic (study group) or topical steroid-antibiotic alone (control group) and were assessed postoperatively at 1 and 5 weeks. Outcome measures were tear breakup time (TBUT), ocular surface disease index (OSDI), frequency of dry-eye symptoms evaluated using a visual analog scale (VAS), and corneal fluorescein staining. The study comprised 282 patients. At 5 weeks, the mean TBUT was statistically significantly higher in the study group than in the control group (P = .0003). The mean OSDI score statistically significantly improved in both groups from 1 to 5 weeks (P < .0001 for both groups); however, there was no statistically significant difference between the groups at these timepoints. The artificial tears statistically significantly improved VAS-assessed dry-eye symptoms in the study group compared with the control group at 5 weeks (P < .001). The mean corneal fluorescein staining was significantly reduced in the study group compared with the control group at 5 weeks (P = .002 versus P = .05, respectively). No treatment-related adverse events were reported. Sodium hyaluronate 0.1% and carboxymethylcellulose 0.5% ophthalmic solution was effective and well tolerated in reducing dry-eye disease symptoms and improving the clinical outcome after cataract surgery. No author has a financial or proprietary interest in any material or method mentioned.

A comparison of corneal biomechanical properties in patients with psoriasis and healthy subjects.

To evaluate the differences in corneal biomechanical properties between healthy subjects and patients with psoriasis using the ocular response analyzer (ORA). Fifty-nine eyes of 59 psoriasis patients and 66 healthy individuals were included in the study. Corneal biomechanical parameters were obtained using ORA. Ultrasound pachymetry was used to measure central corneal thickness (CCT). The main parameters assessed were corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) measurement and corneal-compensated IOP (IOPcc) through ORA. The dry eye evaluation was performed with tear break-up time (TBUT) and Shirmer test. The mean CH values in psoriasis and healthy subject eyes were 10.75±2.9 mm Hg, 11.97±3.6 mm Hg, respectively (P=0.047). The mean CRF values were 10.14±3.1 mm Hg and 11.61±3.3 mm Hg, respectively (P=0.012). The mean CCT were 539.1±36 μm and 536.3±28 μm, respectively (P=0.643). Mean TBUT values were 8.2±2.9 sec in psoriasis group and 10.4±3.6 sec in healthy subjects (P<0.001). Shirmer test values were less (8.9±3.8 mm/5 min) in psoriasis than in healthy subjects (13.1±3.6 mm) (P<0.001). Psoriasis can influence the corneal biomechanical properties. Patients with psoriasis had lower CH and CRF, but higher IOPg and IOPcc values than healthy controls. These corneal biomechanical changes should be considered when determining IOP values.

Evaluation of dry eye syndrome after LASIK and surface ablation: a comparative study

Aim of the study The aim of the present study was to evaluate the severity of dry eye following laser in-situ keratomileusis (LASIK) and surface ablation (photorefractive keratectomy). Patients and methods This study was designed as a prospective, nonrandomized, comparative clinical study. In total, 40 eyes of 20 patients were divided into two equal groups (group A and B). In group A, 20 eyes underwent LASIK with mechanical microkeratome flap. In group B, 20 eyes underwent surface ablation with mechanical or laser epithelial removal. Dry eye was evaluated by tear breakup time (TBUT) and Schirmer test preoperatively, and then 1 week, 1 month, and 3 months postoperatively. Results Preoperative mean TBUT in LASIK patients was 13 ± 1.87 s and mean TBUT in surface ablation patients was 12.9 ± 1.79 s ( P = 0.435). At 1 week postoperative, the mean TBUT in LASIK patients was 7.6 ± 1.93 s ( P P P P P P P = 0.475). At 1 week postoperative, the mean Schirmer test score in LASIK patients was 9.35 ± 2.37 mm ( P P P P P P < 0.05). Conclusion Both LASIK and surface ablation are associated with postoperative dry eye, which is more severe in LASIK than in surface ablation.

Non-Sjögren Kuru Göz Hastalarında Vitamin D Eksikliği ile Oküler Yüzey Klinik Parametreleri Arasındaki İlişki

Objective: To investigate the effect of vitamin-D deficiency on ocular surface clinical parameters in Non-Sjögren dry eye patients. Material and Methods: Forty patients with serum vitamin D deficiency and 24 control subjects with normal vitamin D levels were included in this study. Ocular surface disease index (OSDI) questionnaire, tear break-up time (TBUT), corneal fluorescein staining and Schirmer 1 test without topical anesthesia were performed to all patients. Results: The median vitamin-D levels were 10.5 (9.5-12.5) ng/mL in study and 24.5 (17.6-35.2) ng/mL in the control group (p<0.001). The median OSDI scores were 27.77(18.75-37.50) in study, 8.33 (6.25-28.41) in control group (p =0.071). The mean TBUT were 5.18±2.15 and 7.36±3.10 seconds and Schirmer scores were 12.18±6.44 and 18.57±8.99 mm in the study and control groups. TBUT scores and Schirmer 1 results of the study group were significantly lower than the control group (p=0.01 and 0.007 respectively). There was also a significant difference in corneal fluorescein staining score between groups (p<0.001). Conclusion: Vitamin-D deficiency seems to have an effect on ocular surface parameters however does not influence OSDI scores in patients with Non-Sjögren dry eye syndrome.

Topical cyclosporine a for mustard gas induced ocular surface disorders.

Purpose:To evaluate the effectiveness of topical cyclosporine A 0.05% for treatment of mustard gas-induced ocular surface disorders with special attention to conjunctival goblet cell density in patients with severe dry eye.Methods:This prospective clinical study included 20 eyes of 20 patients previously exposed to mustard gas with dry eye syndrome unresponsive to artificial tears. Before and after treatment with topical cyclosporine A 0.05% twice daily for 3 months, subjects were evaluated for improvement in symptoms using the ocular surface disease index (OSDI) and signs by tear breakup time (TBUT), Schirmer test and measurement of superior bulbar conjunctival goblet cell density. Limbal stem cell deficiency (LSCD) and the degree of corneal squamous cell metaplasia were also assessed before and after treatment.Results:Before treatment, mean OSDI score, Schirmer test I value and mean TBUT were 42.8 ± 6.1, 4.2 ± 1.2 mm and 2.5 ± 1.3 s, respectively. After 3 months of treatment with topical cyclosporine A, these scores reached 36.4 ± 5.2, 5.8 ± 1.6 mm and 4.9 ± 2.1 s, respectively showing a statistically significant improvement (P < 0.001) in all parameters. Mean goblet cell density was 23.3 ± 17.1/high power field (hpf) at baseline which was significantly increased to 47.7 ± 16.1/hpf at the end of the study (P < 0.001). There was no improvement, however, in corneal conjunctivalization, LSCD and the degree of corneal squamous cell metaplasia based on impression cytology reports (P > 0.05).Conclusion:Treatment with topical cyclosporine A 0.05% in patients with severe dry eye due to mustard gas injury increases goblet cell density in the bulbar conjunctiva and improves symptoms of the disease.

Ocular surface disease in posttrabeculectomy/mitomycin C patients

BackgroundOur aim was to describe the demographics, risk factors, clinical signs, severity, and outcome of ocular surface disease (OSD) in 12 patients who had undergone trabeculectomy augmented with mitomycin C (MMC).MethodsTwelve glaucoma patients were referred to the Dry Eye Clinic (Singapore National Eye Centre) for further management of clinically significant OSD.ResultsOf the 15 eyes from 12 patients, 14 were treated with MMC and one with 5-fluorouracil. Mean age was 69.3±10.6 years and two-thirds were male. The median interval before onset of dry eye symptoms after surgery was 13.5 months. Mean tear breakup time (TBUT) was 5.32 seconds and mean Schirmer score was 6.14 mm/5 min. Possible major risk factors for OSD in the cases include limbal stem cell deficiency occurring from exposure to antimetabolites, chronic use of antiglaucoma medications prior to surgery, and the preoperative status of the ocular surface prior to disease onset. Treatment of OSD resulted in improved best corrected visual acuity (BCVA) in 50% of the patients, with a median gain of two-line improvement in BCVA.ConclusionOSD is a clinical problem often overlooked in patients who undergo antimetabolite-augmented filtration surgery. Recognition of the condition and appropriate treatment can improve patient symptoms and reduce health-care burdens on the economy.