Non-invasive Tear Break-up Time Research Articles

Ocular Surface Changes in Treatment-Naive Thyroid Eye Disease.

To investigate the association of meibomian gland dysfunction (MGD) and ocular surface exposure with tear film instability in untreated thyroid eye disease (TED) patients. A cross-sectional study of TED patients from September 2020 to September 2022 was conducted. Ocular surface parameters included ocular surface disease index (OSDI), tear meniscus height (TMH), non-invasive tear break-up time (NITBUT), partial blinking rate, lipid layer thickness (LLT), meibomian gland dropout (meiboscore), Schirmer's test, and corneal punctate epithelial erosions (PEE). Ocular surface exposure was assessed by the margin reflex distances of the upper and lower eyelid (MRD1 and MRD2), the amount of exophthalmos, lateral flare, and lagophthalmos. In total, 152 eyes from 76 TED patients (64 females and 12 males, age 42.99 ± 12.28 years) and 93 eyes from 61 healthy controls (51 females and 10 males, age 43.52 ± 17.93 years) were examined. Compared with control eyes, TED eyes had higher OSDI, TMH, LLT, and PEE; shorter NITBUT; and worse meiboscore (all p < 0.05). They also had larger amounts of exophthalmos, longer MRD1, more lateral flare, and lagophthalmos. Multivariate analysis identified an association of the tear film instability with lagophthalmos (β = -1.13, 95%CI: -2.08, -0.18) and severe MGD in the lower eyelid (β = -5.01, 95%CI = -7.59, -2.43). Dry eye in TED is mainly manifested as evaporative dry eye disease. Severe lower eyelid MGD and worse lagophthalmos were significantly associated with tear film instability in treatment-naive TED patients.

Combination therapy with 3% diquafosol tetrasodium ophthalmic solution and sodium hyaluronate: an effective therapy for patients with dry eye after femtosecond laser-assisted in situ keratomileusis.

To assess the effect of combination therapy with 3% diquafosol tetrasodium (DQS) and sodium hyaluronate (HA) for dry eye after femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Prospective nonrandomized comparative trial. The prospective study included 80 eyes of 40 patients who underwent FS-LASIK with or without preoperative dry eye. Patients were divided into a combination group and a HA group according to their willingness and the doctor's advice. The combination group was treated with DQS six times a day and HA four times a day, and the HA group was treated with HA four times a day after FS-LASIK. Ocular surface disease index (OSDI), ocular symptom score, vision-related score, environmental score, tear meniscus height (TMH), first non-invasive tear breakup time (NIBUT-First), average non-invasive tear breakup time (NIBUT-Ave), tear breakup time (TBUT), Schirmer I test (SIT), corneal fluorescein staining score (CFS), bulbar redness score, limbal redness score, lipid layer grade (LLG), meiboscore, lid margin abnormality, corneal sensitivity, and corneal nerve parameters were examined before surgery and at 1 week and 1 month after surgery. Surface regularity index (SRI) was also examined before surgery and at 1 month postoperatively. OSDI score (p = 0.024) and vision-related score (p = 0.026) were significantly lower in the combination group than in the HA group at 1 month after FS-LASIK, especially in patients with preoperative dry eye symptoms. The increasements of CFS (p = 0.018), bulbar redness score (p = 0.021), and limbal redness score (p = 0.009) were significantly lower in the combination group than in the HA group at 1 week after FS-LASIK. But other ocular surface parameters showed no difference between both groups at 1 week and 1 month after FS-LASIK. LLG was significantly higher in the combination group than in the HA group at 1 week (p = 0.004) and 1 month (p < 0.001) after surgery, especially in patients with high meiboscore. Additional DQS significantly improved corneal sensitivity in patients without preoperative dry eye symptoms at 1 month after FS-LASIK (p = 0.041). The combination therapy with DQS and HA significantly relieved subjective symptoms, improved ocular surface status, and had the potential to promote corneal nerve growth in patients after FS-LASIK.

The influence of overnight orthokeratology and soft contact lens on the meibomian gland evaluated using an artificial intelligence analytic system

PurposeTo test the changes of meibomian gland (MG) morphology using an artificial intelligence (AI) analytic system in asymptomatic children wearing overnight orthokeratology (OOK) and soft contact lens (SCL). MethodsA retrospective study was conducted including 89 participants treated with OOK and 70 participants with SCL. Tear meniscus height (TMH), noninvasive tear breakup time (NIBUT), and meibography were obtained using Keratograph 5 M. MG tortuosity, height, width, density, and vagueness value were measured using an artificial intelligence (AI) analytic system. ResultsIn an average of 20.80 ± 10.83 months follow-up, MG width of the upper eyelid significantly increased and MG vagueness value significantly decreased after OOK and SCL treatment (all P < 0.05). MG tortuosity of the upper eyelid significantly increased after OOK treatment (P < 0.05). TMH and NIBUT did not differ significantly pre- and post- OOK and SCL treatment (all P > 0.05). The results from the GEE model demonstrated that OOK treatment positively affected MG tortuosity of both upper and lower eyelids (P < 0.001; P = 0.041, respectively) and MG width of the upper eyelid (P = 0.038), while it negatively affected MG density of the upper eyelid (P = 0.036) and MG vagueness value of both upper and lower eyelids (P < 0.001; P < 0.001, respectively). SCL treatment positively affected MG width of both upper and lower eyelids (P < 0.001; P = 0.049, respectively) as well as MG height of the lower eyelid (P = 0.009) and tortuosity of the upper eyelid, (P = 0.034) while it negatively affected MG vagueness value of both upper and lower eyelids (P < 0.001; P < 0.001, respectively). However, no significant relationship was found between the treatment duration and TMH, NIBUT, MG morphological parameters in OOK group. SCL treatment duration negatively affected MG height of the lower eyelid (P = 0.002). ConclusionsOOK and SCL treatment in asymptomatic children can influence MG morphology. The AI analytic system may be an effective method to facilitate the quantitative detection of MG morphological changes.

Influence of overnight orthokeratology on tear film and meibomian glands in myopic children: a prospective study

BackgroundOrthokeratology lenses, which are worn overnight, are recommended for reducing myopia progression. They lie on the cornea and can influence the ocular surface by temporarily reshaping the corneal surface through a reverse geometry design. This study investigated the effect of overnight orthokeratology lenses on tear film stability and meibomian gland status in children aged 8–15 years.MethodsThis prospective, self-controlled study included 33 children with monocular myopia who were prescribed orthokeratology lenses for at least one year. The experimental group (ortho-k group) comprised 33 myopic eyes. The control group comprised the emmetropic eyes of the same participants. Tear film stability and meibomian gland status were measured using a Keratograph 5M (Oculus, Wetzlar, Germany). Paired t-tests and Wilcoxon signed-rank tests were used to compare the data between the two groups.ResultsAt the one-year visit, the non-invasive first tear film break-up time (NIBUTf) values were 6.15 ± 2.56 s and 6.18 ± 2.61 s in the experimental and control groups, respectively. The lower tear meniscus height was 18.74 ± 0.05 μm and 18.65 ± 0.04 μm in these groups, respectively. No significant difference was observed in loss of meibomian glands or non-invasive average tear film break-up time between the experimental and control groups using Wilcoxon signed-rank tests.ConclusionsThe stability of the tear film and meibomian gland status were not significantly affected by wearing orthokeratology lenses overnight, indicating that continuous use of orthokeratology lenses for 12 months has a minimal effect on the ocular surface. This finding can help guide the clinical management of tear film quality with respect to the use of orthokeratology contact lenses.

Diagnostic accuracy of non-invasive tear film break-up time assessed by the simple manual interferometric device.

To determine the diagnostic accuracy of non-invasive tear film break-up time (NIBUT) measured by the handheld lipid layer examination instrument. 108 patients were enrolled in this cross-sectional study and divided into two groups: patients with dry eye (n=57) categorized by the presence of dry eye symptoms obtained by Schein Questionnaire and minimally-one objective dry eye sign (tear film break-up time <10s or corneal, conjunctival and lid margin fluorescein staining), and healthy subjects (n=51). Dry eye subjects had significantly shorter NIBUT than healthy subjects (6s vs 20s, p<0.001). Logistic regression analysis showed that shorter NIBUT values were excellent indicators of dry eye disease (p<0.001), with consistency and no significant difference between measurements, even after standardizing the results for age and sex. NIBUT cut-off point to distinguish dry eye from healthy subjects was 12s (sensitivity 90.2%, specificity 88.5%, PPV 92.5%, NPV 85.2%, LR +7.82, LR- 0.11, DOR 70.92, DE 89.6%). Good, but lower accuracy was observed at cut-off value of 10s (sensitivity 87.8%, specificity 88.5%, PPV 92.3%, NPV 82.1%, LR+ 7.61, LR- 0.14, DOR 55.2, DE 88.1%). The area under the ROC curve (AUC) of 0.944 classified NIBUT as a diagnostic test with very high accuracy. This study showed a high diagnostic accuracy of NIBUT measured by the handheld lipid layer examination instrument. This simple, reliable, objective and available instrument might regularly take place in routine, standard dry eye diagnostic and can be used by almost every eye specialist.

Dry eye parameters measured with an ocular surface analyzer in eyes after vitrectomy for vitreomacular interface disorders.

Dry eye disease (DED) might be caused by multiple ocular surgical interventions. The aim of the study was to estimate the extent of DED in patients undergoing core vitrectomy for vitreoretinal interface disorders. In this prospective observational study, we included patients with 12 months of follow-up after vitrectomy. The following data were collected as controls: age, sex, best-corrected visual acuity before and after surgery, and phakic status. In OSA (ocular surface analysis), the following parameters were evaluated: NIBUT (non-invasive tear break-up time), sltDear (thickness of the lipid layer), Meibomian gland (MGD) loss, and the height of tear meniscus. Shapiro-Wilk test, Wilcoxon rank-sum test, and Mann-Whitney U tests were used for statistical analysis. We evaluated 48 eyes of 24 patients (10 men, 14 women; 64.63 ± 14.10 years) 1 year after vitrectomy. From the analyzed ocular surface parameters, NIBUT was significantly lower in operated versus non-operated eyes (P = 0.048). The higher the level of difference in MGD loss between both eyes, the higher the level of difference in NIBUT between both eyes (rs = 0.47, P = 0.032). NIBUT levels were still decreased 12 months after vitrectomy. Patients with more pronounced MGD loss or decreased NIBUT levels in the fellow eye were more likely to experience such disorders. The tear meniscus height was lower in patients undergoing surgery for retinal detachment than in those with vitreoretinal disorders. This might allow the suggestion to include artificial tears in pre- and post-operative care in vitrectomized eyes.

Prevalence of Dry Eye Disease Among Individuals Scheduled for Cataract Surgery in a Norwegian Cataract Clinic.

To determine the prevalence of dry eye disease (DED) in patients scheduled for cataract surgery in a Norwegian eye clinic. 218 patients scheduled for cataract surgery were examined for DED in one randomly selected eye and questioned regarding symptoms and risk factors. Patients were diagnosed with DED if they fulfilled the DEWS II criteria with symptom score >12/100 with Ocular Surface Disease Index (OSDI) questionnaire, and the presence of any of the three signs: tear osmolarity >307 mOsm/L in either eye or a difference in osmolarity between the two eyes of >8 mOsm/L, corneal fluorescein staining (CSF) ≥ grade 2 and non-invasive tear film breakup time (NIKBUT) of <10 seconds. Additional tests were the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear meniscus height (TMH), Schirmer 1, tear film thickness (TFT), corneal sensitivity and meibography (meiboscore). Dry eye test outcomes were correlated with risk factors for DED. The prevalence of DED was 55.5% according to the DEWS II criteria. The abnormal osmolarity percentage was 66.5, while 29.8% had shortened NIKBUT and 19.7% exhibited CFS ≥2. 57% had Schirmer 1 ≤ 10 mm/5 min, and 81.1% had a meiboscore of ≥1. 71.2% of subjects scored positive for DED symptoms using the OSDI questionnaire and 69.3% using SPEED. Logistic regression analysis showed that higher age correlated with a lower OSDI symptom score, reduced corneal sensitivity and increased meibomian gland atrophy. Female sex was associated with higher odds of having DED, abnormal NIKBUT and abnormal CFS. Ocular tests for DED did not correlate with OSDI symptom scores when assessed with Spearman`s rank analysis. The prevalence of DED in an elderly Norwegian population scheduled for cataract surgery is high and associated with female sex. There was a lack of correlation between signs and symptoms of DED.

Evaluation of the effects of electronic cigarettes on the tear film of Smokers using Keratograph and SM Tube

Purpose: To evaluate the effects of e-cigarettes on tear film by comparing the tear film parameters of smokers and non-smokers using Keratograph and SM Tube. Study Design: Cross sectional study. Place and Duration of Study: Qasim University, from Saudi Arabia. Methods: A total of 60 males of age group 20 – 38 years were divided into three groups (Twenty non-smokers, 20 tobacco smokers and 20 vapor users). After consent, dry eye symptoms questionnaire was given to the participants. Four different test parameters through the Keratograph (5M JENVIS). Tear meniscus height, non-invasive tear break-up time, ocular redness and lipid layer thickness were measured. The new strip menis cometry tube (SM Tube) was used to test tear production. Data were analyzed using Statistical Package for Social Sciences (SPSS) with p value of less than 0.05 considered as significant. Results: The average tear breakup time was significantly decreased in both smokers and vapors group (10.15 ± 1.92 and 10.25 ± 2.65 respectively) than in nonsmokers (13.35 ± 2.36). There was also statistically significant difference in tear meniscus height, redness and lipid layer thickness between e-smokers and non-smokers(p &gt; 0.05). The difference in these parameters was statistically non-significant between smokers and e-cigarette users. Conclusion: E-cigarettes cause low tear breakup time, less tear volume and other dry eye parameters, which leads to dry eye. There is a need for strict checks and balances on E-cigarette consumption for controlling cases of vision impairments related with e-cigarettes.

The epidemiology of dry eye disease in the UK: The Aston dry eye study

PurposeCross-sectional studies on dry eye disease (DED) have relied on different diagnoses hindering conclusions about the disease epidemiology. This study offers an insight into DED epidemiology in the UK using prior and recent diagnostic recommendations. MethodsStudy participants comprised 282 volunteers from Birmingham, UK (median 40 years, range 18–88 years, 56% females). DED was defined by the Tear Film Ocular Surface Dry Eye Workshop II (TFOS DEWS II) criteria, based on a positive symptom score with the Dry Eye Questionnaire (DEQ-5) and Ocular Surface Disease Index (OSDI), and one of the following homeostasis markers: non-invasive tear break-up time of < 10 s (Oculus Keratograph 5M); the highest osmolarity value of ≥ 308 mOsm/L among eyes or an interocular osmolarity difference of > 8 mOsm/L (TearLab Osmolarity System); or > 5 corneal spots, >9 conjunctival spots or lower/upper lid-wiper-epitheliopathy staining of ≥ 2 mm length and ≥ 25% width (Oculus Keratograph 5 M). In addition, the Women’s Health Study (WHS) criteria, based on symptoms or a prior dry eye diagnosis, was assessed. DED risk factors were gathered using a self-administered questionnaire. ResultsDED prevalence by the TFOS DEWS II criteria was 32.1% (95% confidence interval 25.5–37.7% and 29.5% (95% confidence interval 24.4–35.1% by the WHS criteria. Female sex, systemic and/or ocular health conditions, short sleep duration and prolonged outdoor leisure time spent were significant DED risk factors (p ≤ 0.05). ConclusionsApproximately one-third of the adult UK population have DED, aligning with the prevalence reported in multiple counties globally. Female sex, systemic/ocular health conditions, short sleep duration and prolonged outdoor leisure time are positive predictors of DED.

Skin-Only Versus Skin-Plus-Orbicularis Resection Blepharoplasty: An Elaborated Analysis of Early- and Long-Term Effects on Corneal Nerves, Meibomian Glands, Dry Eye Parameters, and Eyebrow Position.

To evaluate the early- and long-term effects of 2 different blepharoplasty techniques on corneal nerves, meibomian gland morphology, clinical parameters of dry eye disease (DED), and eyebrow position. This prospective, interventional study included age-sex-matched blepharoplasty patients who had a skin-only resection (24 eyes of 12 patients; Group-S) or a skin-plus-orbicularis muscle resection (24 eyes of 12 patients; Group-M) procedure. Preoperative and postoperative parameters of in vivo corneal confocal microscopy (IVCCM; corneal nerve fiber density [CNFD], nerve branch density [CNBD], and nerve fiber length), meibomian gland area loss (MGAL), DED (Schirmer I test and noninvasive tear breakup time), and eyebrow heights (lateral [LBH] and central [CBH]) were evaluated and compared between the intervention groups ( ClinicalTrials.gov , NCT05528016). Compared with baseline, the CNBD of Group-S (19.91 ± 7.66 vs. 16.05 ± 7.28 branches/mm 2 , p = 0.049) and CNFD of Group-M (19.52 ± 7.45 vs. 16.80 ± 6.95 fibers/mm 2 , p = 0.028) was significantly decreased at postoperative first week. However, in both groups, IVCCM parameters returned to baseline values at postoperative first month and first year ( p > 0.05). A significant MGAL increase was observed in Group-S (18.47 ± 5.43 vs. 19.94 ± 5.31, p = 0.030) and Group-M (18.86 ± 7.06 vs. 20.12 ± 7.01, p = 0.023) at the postoperative first year, demonstrating meibomian gland atrophy. Only significant changes were observed in Group-M in LBH (16.17 ± 2.45 vs. 16.67 ± 2.28 mm, p = 0.044) and CBH (17.33 ± 2.35 vs. 17.96 ± 2.31 mm, p = 0.004) at postoperative first year. Blepharoplasty with or without orbicularis resection seems to have similar effects on IVCCM, DED, and MGAL parameters. However, incorporating an orbicularis muscle resection in a blepharoplasty operation could slightly elevate the eyebrow position.

Non-invasive and objective tear film breakup detection on interference color images using convolutional neural networks.

Dry eye disease affects hundreds of millions of people worldwide and is one of the most common causes for visits to eye care practitioners. The fluorescein tear breakup time test is currently widely used to diagnose dry eye disease, but it is an invasive and subjective method, thus resulting in variability in diagnostic results. This study aimed to develop an objective method to detect tear breakup using the convolutional neural networks on the tear film images taken by the non-invasive device KOWA DR-1α. The image classification models for detecting characteristics of tear film images were constructed using transfer learning of the pre-trained ResNet50 model. The models were trained using a total of 9,089 image patches extracted from video data of 350 eyes of 178 subjects taken by the KOWA DR-1α. The trained models were evaluated based on the classification results for each class and overall accuracy of the test data in the six-fold cross validation. The performance of the tear breakup detection method using the models was evaluated by calculating the area under curve (AUC) of receiver operating characteristic, sensitivity, and specificity using the detection results of 13,471 frame images with breakup presence/absence labels. The performance of the trained models was 92.3%, 83.4%, and 95.2% for accuracy, sensitivity, and specificity, respectively in classifying the test data into the tear breakup or non-breakup group. Our method using the trained models achieved an AUC of 0.898, a sensitivity of 84.3%, and a specificity of 83.3% in detecting tear breakup for a frame image. We were able to develop a method to detect tear breakup on images taken by the KOWA DR-1α. This method could be applied to the clinical use of non-invasive and objective tear breakup time test.

The effects of facial mask use on ocular surface parameters and tear film cytokine profile in prolonged use.

To compare tear fluid levels of matrix metalloproteinase 9 (MMP-9) and IL-1ß cytokines between healthcare workers wearing facial masks and controls with correlations in clinical findings. In a prospective, controlled clinical trial tear fluid was analyzed for MMP-9 and IL-1ß levels using a commercially available test (Invitrogen; Thermo Fisher Scientific Inc. Waltham, Massachusetts, USA). Symptoms and signs of dry eye disease (DED) were evaluated using the ocular surface disease index (OSDI), noninvasive tear break-up time (NIBUT), tear meniscus height (TMH), Oxford corneal staining, meibomiography, and clinical findings of meibomian gland dysfunction (MGD). In the 38 eyes of healthcare workers and 30 eyes of controls, there was no statistically significant difference between the groups in terms of age and sex (p > 0.05). The mean OSDI score, daily mask wear time, meibomiography degree, and rate of positive clinical findings of MGD were higher in group 1 than in group 2, and the mean NIBUT was higher in group 2. (p > 0.05). The mean values of IL-1ß and MMP-9 were higher in group 1 (p = 0.036 and p = 0.001, respectively). The TMH and Oxford score percentages were similar between the two groups (p > 0.05). Elevated levels of IL-1ß and MMP-9 in the basal tear fluid reveal increased ocular inflammation in healthcare professionals. Lower NIBUT values with higher OSDI and meibomian gland loss scores support ocular surface disturbance depending on regular mask use.

Evaluation of corneal topographic parameters in patients with psoriasis.

To evaluate corneal topographic parameters in patients with psoriasis. This prospective, cross-sectional study included 50 right eyes of 50 patients with psoriasis and 50 right eyes of 50 age- and sex-matched healthy individuals. Detailed dermatological and ophthalmological examinations were performed in all cases. Noninvasive tear break-up time (NIBUT), meibography, keratometry values, and high-order corneal aberrations (HOAs) were obtained using corneal topography and compared to healthy subjects. These values were also evaluated according to anti-tumor necrosis factor alpha (anti-TNF-α) use, the Psoriasis Area and Severity Index (PASI) score, psoriasis duration, and patient age. The chi-square test, Mann-Whitney U test, and Pearson correlation test were used for statistical assessment. Lower NIBUT and higher meibomian gland loss (MGL) were detected in psoriasis patients compared to healthy controls. There were no significant differences between the groups in terms of corneal HOAs. Higher MGL was detected in patients using anti-TNF-α than in patients not using it. A positive correlation was found among topographic parameters, especially between PASI score and the patient's age. No correlations were found between the disease duration and the other parameters. NIBUT and MGL are more common in psoriasis patients than in healthy subjects. The relationship between anti-TNF-α use, PASI score, patient age, and corneal parameters should be considered in the follow-up and treatment of ocular findings in psoriasis patients.

Comparison of changes in visual fatigue and ocular surface after 3D and 2D viewing with augmented reality glasses

The extensive use of electronic devices commonly results in visual discomfort, particularly in stereoscopic display. Augmented Reality (AR) is a mixed technology that superimposes three-dimensional (3D) digital data onto an image of reality. Even though the visual health evaluation of 3D contents has been widely concerned, the difference between 3D and two-dimensional (2D) viewing using AR display was rarely studied. We aimed to compare the changes in visual fatigue and ocular surface parameters after 3D and 2D viewing with optical waveguide AR glasses for one hour (1hr). In the experiment, thirty young healthy participants watched the same film in 2D and 3D mode separately using AR glasses with one week interval. Subjective visual fatigue questionnaire and ocular examinations were evaluated at 3 time points: pre-watching, post-2D and post-3D visual task for 1hr. Lipid layer thickness (LLT) and total blink (TB) were evaluated with the LipiView interferometer. Tear meniscus height (TMH) and noninvasive tear breakup time (NIBUT) were measured using Keratograph 5M. The effect of viewing 2D and 3D videos for 1hr with AR glasses suggested slight visual discomfort except the symptom of pain and dullness. The lipid layer thickness and total blink showed increasing trends in both post-visual task but more obvious after 2D viewing. Blinking patterns and tear film stability are meaningful for video display terminal users in visual health education. Ocular parameters are needed to be considered in the design and usage of future AR applications.

Efficacy of pyridostigmine (Mestinon) in the relief of patients with epiphora.

Although the mechanism is not clear, the inability of the orbicularis oculi muscle, especially the deeper segment (Horner muscle), is thought to be responsible in epiphora. This study evaluates the effect of the anticholinergic drug pyridostigmine (Mestinon) in patients with patent but dysfunctional lacrimal drainage system. Twenty patients with bilateral epiphora (mean age:60.78±6.49 yrs) were included in this study. Patients with a patent lacrimal irrigation test based on persistent and symptomatic epiphora, wiping >10 times daily or continuous tearing and grade 4-5 epiphora according to Munk scale, showing neuropathic involvement in the orbicularis oculi muscle by the quantitative motor unit potential (MUP) analysis method were evaluated prospectively. Fluorescein dye disappearance test (a semi-quantitative assessment of delayed tear outflow) together with a Schirmer test reading were performed in order to detect dry eye. The patients were evaluated for tear meniscus measurements by anterior segment optical coherence topography (OCT) and non-invasive tear break-up time (NI-BUT) was measured by Oculus Keratograph 5 M. Those with a NI-BUT value above 10s, without eyelid laxity, previous ocular surgery or ocular surface disease, or nasolacrimal duct obstruction, and who agreed to use the drug were included in the study. Each subject underwent OCT measurements of the lower tear meniscus of both eyes before and 15mins after taking Mestinon (1×60mg tablet). Upon measurement of the positive effect of the drug on tear meniscus height (TMH), the patients were asked to continue this regime daily for 1 month and then evaluated for relief in their epiphora complaints and any systemic drug side effects. A total of 20 patients (40 eyes) with bilateral epiphora were included in the study. All eyes had grade 4 Munk-score epiphora, Schirmer's test was within the normal range in all eyes (mean, 14±4mm), and patent lacrimal irrigation test. The lower mean TMH reductions 15min after Mestinon in the right and left eyes were 135.41±85.47 and 55.44±61.56mm, respectively, a statistically significant decrease in both eyes (p=0.001, p<0.01). The mean tear meniscus area (TMA) in the right and left eyes was 131.83±68.27mm2 and 62.72±50.57mm2, respectively; 15 mins after administration of Mestinon, the mean TMA in the right and left eyes was 77.27±48.34 and 59.18±44.74mm2, respectively (p=0.001, p<0.01). The mean decreases of 54.56±39.34mm2 in the right eye area and 3.53±42.32mm2 in the left eye area were statistically significant (p=0.041, p<0.05). Symptomatic relief for epiphora cannot be achieved with known treatment options due to lacrimal pump dysfunction. We found that pyridostigmine (Mestinon) provided relief in patients' complaints of epiphora consistent with a significant reduction in TMH levels.

Evaluation of the Effect of İnfection and İmmunity on the Tear Film by Scheimpflug-Placido Disc Topography- A Case Control Study.

We aimed to compare the tear film stability of individuals who had recovered from coronavirus disease (COVID-19), that of individuals vaccinated against COVID-19 and that of healthy individuals in a control group. This study included 61 eyes of 61 post-COVID-19 patients, 63 eyes of 63 participants who had received at least two doses of the SARS-CoV-2 mRNA BNT162b2 (Pfizer-BioNTech) vaccine, and 57 eyes of healthy individuals in a control group. We compared the groups' tear film stability. The mean non-invasive first tear break-up time (NIF-BUT) value was 4.1±2.7 seconds in the post-COVID-19 group, 4.7±2.9 seconds in the vaccinated group, and 5.8±2.8 seconds in the control group. This value was statistically significantly lower in the post-COVID-19 and vaccinated groups than in the control group (p= 0.007). The rate of superotemporal (ST) quadrant breakup, statistically significantly higher in the vaccinated group than in the other two groups (p=0.001). According to a qualitative examination of the results, at least one breakup occurred in 47 (77%) of the post-COVID-19 participants' eyes, 50 (79.4%) of the vaccinated group's eyes, and 33 (57.9%) of the control group's eyes. In terms of this qualitative value, the post-COVID-19 and vaccinated groups had significantly higher breakup rates than the control group (p=0.018). Destabilization in the tear film was more common in both the post covid group and the vaccinated group. In addition to individuals who have post-Covid, we think that post-vaccination individuals should be followed closely in terms of ocular surface diseases.

Conjunctival T Cell Profile in Allogeneic Hematopoietic Stem Cell Transplant Patients after Instilling Topical Cyclosporine-A 0.1% Cationic Emulsion.

To profile conjunctival T cell populations in allogeneic hematopoietic stem cell transplant (HSCT) patients after instillation of daily topical cyclosporine-A (CsA) 0.1% cationic emulsion (Ikervis), and to evaluate patients' tolerance to these eye drops. Nineteen participants were prescribed Ikervis prophylaxis once daily to both eyes from 3-5weeks pre-HSCT to 12months post-HSCT. The outcome measure was conjunctival T cell proportions from flow cytometry after impression cytology. Covariates included visual acuity, intraocular pressure, slit lamp and fundal examination, dry eye (SPEED) and quality of life questionnaires, non-invasive keratograph tear break-up time (NIKBUT), conjunctival redness, meibography, lipid thickness, Schirmer test, tear cytokines, fluorescein staining, tear osmolarity, and meibomian gland expressibility. The conjunctival T cell analysis showed either stable or decreased proportions of conjunctival CD4 T cells at the last visit from baseline in compliant patients. CD4 proportions were increased in non-compliant patients and in the single patient who developed ocular graft-versus-host disease (GVHD). All patients were tolerant to Ikervis but 6/19 were not compliant. In the majority of patients, vision did not affect activities of daily living. Pre- and post-HSCT up to the last study visit, there was no statistically significant change in clinical covariates. Only one participant developed ocular GVHD at 9months post-HSCT. Superficial conjunctival T cell profile reflects compliance to daily topical Ikervis eye drops and clinical ocular surface parameters in allogenic HSCT patients. Tolerance is comparable to other formulations of topical CsA in the first 12months. NCT04636918. URL: https://clinicaltrials.gov/ct2/show/NCT04636918?cond=ocular+Graft+Versus+Host+Disease&cntry=SG&draw=2&rank=2 .

Evaluation of meibomian gland dysfunction in type 2 diabetes with dry eye disease: a non-randomized controlled trial

BackgroundThe purpose of this investigation was to evaluate the morphology and physiological function of the meibomian glands between type 2 diabetics with dry eye disease (DED) and control subjects. Doing so will help to better reveal the pathologic mechanisms of meibomian gland dysfunction (MGD) and DED in type 2 diabetes mellitus (T2DM).MethodsNinety subjects were divided into the following four groups: DM-DED group: T2DM patients with DED (n = 30); DM control group: DM patients without DED (n = 18); DED group: DED patients without DM (n = 26); and normal control group: normal subjects (n = 16). All participants administered the ocular surface disease index (OSDI) questionnaire, tear meniscus height (TMH), noninvasive Keratograph tear film break-up time (NIKBUT), Schirmer I test (SIT), corneal fluorescein staining (CFS), eyelid margin abnormality examinations, meibum quality and meibomian gland (MG) dropout evaluations. ResultsThe percentage of MG dropout in the upper and lower lids was significantly higher in the DM-DED group than the DED group (P < 0.05 or P < 0.01). However, there was no significant difference in other MG parameters between these two groups. Oppositely, Significant difference was observed in all of MG parameters except MG dropout in the lower lids comparing DM group with normal controls (P < 0.05 or P < 0.01). While the SIT values decreased in the DM-DED group compared to the DED group (P < 0.05), no significant differences were found in the values of other tear parameters. ConclusionsThe higher prevalence and increased severity of MGD was found in patients with both T2DM and DED compared to those only with DED. Trial registrationChinese Clinical Trial Registry ChiCTR1800019939, date of registration December 9, 2018, prospectively registered.

Managing Severe Evaporative Dry Eye with Intense Pulsed Light Therapy.

This study assessed the efficacy and safety of intense pulsed light (IPL) therapy in participants with severe evaporative dry eye disease (DED). This randomized, controlled, single-center study included 49 adult participants (≥ 18years) with severe evaporative DED who received either IPL therapy (n = 56 eyes) or sham therapy (n = 42 eyes) three times. The primary efficacy parameters were ocular surface disease index (OSDI) score, non-invasive tear breakup time (NITBUT), tear film lipid layer (TFLL), conjunctivocorneal staining score (CS), MG Score, meibomian gland (MG) quality, and MG expression score. The mean ages for the IPL group and the control group were 28.05 ± 3.41years (57.1% female) and 28.14 ± 3.53years (52.4% female), respectively. Comparison between the IPL group and the control group found significant differences in the mean OSDI score (22.16 ± 6.08 vs. 42.38 ± 6.60; P < 00.01), NITBUT (6.27 ± 0.84 vs. 3.86 ± 0.68; P < 0.001), TFLL (2.14 ± 0.44 vs. 3.45 ± 0.50; P < 0.001), MG Score (1.34 ± 0.55 vs. 1.88 ± 0.33; P < 0.001), MG quality (1.59 ± 0.07 vs. 2.67 ± 0.08), and MG expression (1.54 ± 0.57 vs. 2.45 ± 0.55) at 12weeks follow-up; however, there was no significant difference in CS (3.32 ± 1.11 vs. 3.74 ± 1.04; P = 0.063). The findings suggest that IPL therapy is clinically beneficial in ameliorating the signs and symptoms of severe evaporative dry eye disease.

Associations between Serial Intravitreal Injections and Dry Eye

To investigate the effects of serial intravitreal injections (IVI) on the ocular surface and meibomian glands (MG) in patients treated with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD). Retrospective controlled observational study. Patients with nAMD receiving unilateral IVI with anti-VEGF agents. The fellow eye was used as control. Tear film and ocular surface examinations were performed on a single occasion at a minimum of four weeks after IVI. A pre-IVI asepsis protocol with povidone-iodine was applied. Upper and lower MG loss, tear meniscus height (TMH), bulbar redness score (BR), non-invasive tear break-up time (NIBUT), tear film osmolarity (TOsm), Schirmer test, corneal staining, fluorescein tear film break-up time (TBUT), meibomian gland expressibility (ME) and meibum quality (MQ). Ninety patients with a mean age of 77.5 years (SD 8.4; range 54-95) were included. The median number of IVI in treated eyes was 19.5 (range 2-132). Mean MG loss in the upper eyelid was 19.1 (SD 11.3) % in treated eyes and 25.5 (SD 14.6) % in untreated fellow eyes (P=0.001). For the lower eyelid, median MG loss was 17.4 (IQR 9.4-29.9) % in treated eyes and 24.5 (IQR 14.2-35.2) % in fellow eyes (P<0.001). Mean BR was 1.32 (SD 0.46) in treated eyes versus 1.44 (SD 0.45) in fellow eyes (P=0.017). Median TMH was 0.36 (IQR 0.28-0.52) mm in treated eyes and 0.32 (IQR 0.24-0.49) mm in fellow eyes (P=0.02). There were no differences between treated and fellow eyes regarding NIBUT, TOsm, Schirmer test, corneal staining, fluorescein TBUT, meibomian gland expressibility ME or MQ. Repeated IVI with anti-VEGF with preoperative povidone-iodine application was associated with reduced meibomian gland loss, increased tear volume and reduced signs of inflammation compared to fellow non-treated eyes in patients with nAMD. This regimen may thus have a beneficial effect on the ocular surface.