Non-invasive Tear Break Research Articles

Efficacy and safety of a lipid-containing artificial tear compared with a non-lipid containing tear: a randomized clinical trial.

Dry eye disease (DED) is a prevalent condition affecting over 16 million patients in the USA. DED and the symptoms of ocular discomfort are debilitating and a significant burden on patients. If left untreated, DED can progress to cause severe pathology. Treatment is often initiated by patients without consulting a healthcare professional. This study investigated the safety and efficacy of a novel lipid-containing eye drop (BTC), which might better mimic the components of natural tears. This was a multicenter, randomized, double-masked, active control, two arm, parallel group study of eye drops in adult subjects with self-reported DED. Subjects were randomly assigned to BTC or control (commercially available non-lipid eye drops; NLED) arm and were followed for 30 days. Assessments using visual analog scale and patient-reported outcomes (PRO) questionnaires, non-invasive tear break up time, slit-lamp examination, and subject-reported ocular symptoms were conducted at baseline and at days 7 and 30. The primary endpoint was change in overall ocular comfort score from baseline to day 30. 158 subjects were randomized, of whom 130 completed the study per protocol (PP). Mean (SD) age was 47.8 (14.14) years. The mean (95% CI) change in overall comfort scores at the 30-day follow-up in the PP population was 21.4 (15.1, 27.7) for the test drop and 10.0 (3.9, 16.1) for the comparator. The mean (95% CI) treatment difference was 11.3 (2.6, 20.1); this met the pre-defined requirements for non-inferiority. There was no significant difference in the proportion of eyes with reported ocular symptoms between the groups. At day 7, the OR (95% CI) was 0.967 (0.528, 1.770) and at day 30 was 1.160 (0.610, 2.203). There were no Grade 3 or higher corneal edema, corneal neovascularization, corneal staining, conjunctival injection, tarsal abnormalities or any other biomicroscopy findings, and no corneal infiltrates observed during the study. The investigational lipid eye drop BTC was noninferior to the commercially available non-lipid comparator in all parameters measured and has the potential to provide an effective therapy for subjects with symptoms of dry eye who would benefit from a lipid-based artificial tear. NCT03995355 ( http://www. gov ), registered June 24, 2019.

Effect of laughter exercise versus 0.1% sodium hyaluronic acid on ocular surface discomfort in dry eye disease: non-inferiority randomised controlled trial

ObjectiveTo assess efficacy and safety of laughter exercise in patients with symptomatic dry eye disease.DesignNon-inferiority randomised controlled trial.SettingRecruitment was from clinics and community and the trial took place at Zhongshan...

The impact of systemic isotretinoin treatment on the tear film, meibomian glands, and corneal endothelium

Purpose The study aims to investigate changes in tear function, meibomian glands and corneal endothelium in patients receiving systemic isotretinoin therapy. Materials and methods This prospective study included 38 eyes from 38 patients (23 females and 15 males) treated with systemic isotretinoin (0.5–1 mg/kg/day) following the diagnosis of acne vulgaris. All patients underwent a comprehensive ophthalmologic examination at baseline, 1st month, and third month of treatment. Subjective complaints were assessed using the Ocular Surface Disease Index (OSDI). Tear functions were evaluated through non-invasive tear break up time (NIBUT) and Schirmer I test. Meibomian gland (MG) changes were examined using meibography. Corneal parameters, including endothelial cell density (ECD), coefficient of variation (CV), the number of cells with a hexagonal shape (6A), average cell area (AVG), and central corneal thickness (CCT) were assessed using non-contact specular microscopy. Results The mean age of the patients was 19.29 ± 2.83 years. Ocular surface-related discomfort, measured with OSDI scores, significantly worsened at the third month measurements compared to the pre-treatment values (p < 0.001). In the 1st month of treatment, there was a significant decrease in NIBUT (p < 0.05). No statistically significant difference was found in the Schirmer test results at each visit. According to the 1st and third-month analysis, there was a significant increase in MG loss compared to the pre-treatment period (p < 0.001). ECD, CV, 6 A, AVG measurements at the first and third months showed a significant change compared to the pre-treatment values (p < 0.001). No significant difference was observed in the CCT measurements during the treatment. Conclusion Systemic isotretinoin disrupted tear stability, caused MG loss, deterioration in corneal endothelium, and led to symptomatic complaints in patients.

Analysis of Factors Associated with Anterior Location of Marx’s Line

Purpose The study aimed to investigate the factors associated with anterior location of Marx’s line in ocular surface and living habits, especially in tear film. Materials and methods This cross-sectional study enlisted 483 participants with meibomian gland dysfunction, who were divided into two groups: 160 participants with mild anterior location of Marx’s line and 323 participants with moderate-to-severe anterior location. Participants completed a survey of demographic characteristics (sex, age, length of visual terminal use, sleep duration, skin property), and the Ocular Surface Disease Index and Standard Patient Evaluation of Eye Dryness questionnaires. They also underwent slit-lamp examinations of the lids, and measurements of non-invasive tear break up time, tear meniscus height, fluorescein tear break up time, lipid layer thickness, partial blink rate, lid wiper epitheliopathy, and meibomian gland dropout. Results The tear meniscus height (mild:0.21(0.18–0.25), moderate-to-severe:0.19(0.16–0.23), p = 0.004), fluorescein tear break up time(mild:3(2–4),moderate to severe:2(1–3), p = 0.000), max LLT(mild:87(62–100), moderate-to-severe:99(69–100), p = 0.04), average LLT(mild:64.5(47.5–96.75), moderate-to-severe:74(53–100), p = 0.012), min LLT(mild:52(38–75), moderate-to-severe:59(41–85), p = 0.029) differed significantly between mild and moderate-to-severe anterior location of Marx’s line, and associated to the anterior location of Marx’s line(r=-0.134, p = 0.03; r=-0.194, p = 0.000; r = 0.093, p = 0.041; r = 0.119, p = 0.009; r = 0.105, p = 0.022) However, no statistical significance was observed in the OSDI, SPEED, partial blink rate, non-invasive tear breakup time, lipid layer thickness, meibomian gland dropout and lid wiper epitheliopathy(p > 0.05). Meanwhile, in the demographic characteristics, statistically significant correlations were associated with skin property(r = 0.154, p = 0.001) and sleep duration(r=-0.124, p = 0.006), but not with age, sex, and the length of visual terminal use (p > 0.05). Conclusions Lower TMH and shorter TBUT positively correlated with anterior location of the Marx’s line, and were risk factors. Meanwhile, participants with oily skin and shorter sleep duration were more likely to exhibit anterior location of Marx’s line.

Perioperative intense pulsed light to prevent and improve symptoms of post-laser corneal refractive surgery dry eye. A randomized clinical trial

PurposeTo evaluate the efficacy of perioperative IPL therapy in preventing postoperative ocular surface disorders in patients undergoing corneal laser refractive surgery. Designrandomized, controlled, clinical trial with triple-blinding. MethodsSetting: Vissum Miranza - Alicante; Study population: 61 patients randomized in two groups: 31 study patients (perioperative IPL + laser refractive surgery) and 30 control patients (perioperative placebo + laser refractive surgery). Follow-up was conducted over a 6-month period; Intervention: Each participants underwent three IPL sessions with a two-week interval between each session (pre-surgery, post-surgery week-one, and post-surgery week-three). For controls, placebo was administered following the same protocol. Main outcomes measures: visual outcomes and refraction, slit-lamp examination, corneal topography, visual analogue scale questionnaire and Oculus Keratograph 5 M including tear meniscus height, non-invasive tear break- up time, ocular redness, infrared meibography and Ocular Surface Disease Index (OSDI) questionnaire. Results61 randomized eyes were included. No significant differences were observed in terms of uncorrected and corrected distance visual acuity (UDVA, CDVA), refractive error or corneal aberrations. A statistically significant improvement in OSDI score (change −8.47, p = 0.043), tear meniscus (change 0.05 mm, p = 0.004) and Meibography (change −0.42, p = 0.012) was observed at the third postoperative month in the study group. Additionally, at the sixth postoperative month, there were statistically significant improvements in tear meniscus (change 0.06 mm, p = 0.018), tear break-up-time (change 1.68 s, p = 0.039) and Meibography (change −0.37, p = 0.030). ConclusionsResults suggest that perioperative IPL therapy applied to laser corneal refractive surgery improves objective and subjective ocular surface parameters over non-IPL-treated control patients and early postoperative dry eye symptoms.

Lacrimal gland activity in lacrimal drainage obstruction: exploring the potential cross-talk between the tear secretion and outflow

PurposeTo investigate the effects of lacrimal drainage obstructions on the lacrimal gland activity and if there exists a potential link between the two.MethodsDirect assessment of the lacrimal gland activity from...

Impact of Dry Eye Disease on Visual Function and Quality after Femtosecond LaserAssisted In-Situ Keratomileusis

Purpose: The purpose of this study was to determine how objective and subjective parameters of dry eye disease correlate with objective vision quality changes following femtosecond laser in-situ keratomileusis (FS-LASIK) surgery in low and high myopes. Methods and Materials: This prospective, observational case series recruited patients undergoing bilateral FS-LASIK. Patients were divided into low/moderate and high myopia groups based on pre-operative assessment. Objective and subjective measurements of dry eye, as well as measurements of vision quality were obtained pre-operatively, 1-week, 1 month, and 3 months post-operatively. Thirty patients were included. The low/moderate and high myopia groups each contained 15 patients. Results: Non-invasive keratography tear break up time (NIKBUT) decreased after FS-LASIK in both groups. Objective scatter index (OSI) improved in the L/M myopia group but worsened in the H myopia group post-operatively. Modulation transfer function (MTF) cutoff improved in both groups post-operatively. A negative correlation was identified between the NIKBUT and both the OSI and MTF results. Changes in ocular surface disease index (OSDI) scores support these objective findings. Conclusion: The results of our study provide evidence that ocular surface changes associated with dry eye contribute to reduced subjective vision quality after FS-LASIK. Refractive surgeons should address dry eye pre-operatively and manage its sequalae post-operatively

Repeatability, reproducibility and agreement between three different diagnostic imaging platforms for tear film evaluation of normal and dry eye disease.

To assess the repeatability and reliability of different commercially available diagnostic platforms in the objective assessment of tear film parameters and if there exists any agreement between them. Thirty healthy individuals (N = 60 eyes) and fifteen DED patients (N = 30 eyes) had their tear film parameters (Lipid layer thickness (LLT), Tear meniscus height (TMH), Non-invasive tear break up time (NIBUT)) assessed using three instruments - LipiView® II, IDRA ocular surface analyser (IDRA-OSA) and Oculus keratograph 5 M (K5M). Bland-Altman analysis and linear mixed effects modelling & Generalized Linear Hypothesis Test were used for analysis and coefficient of variation (CoV). There is poor repeatability but good reproducibility of LLT values measured with Lipiview, or IDRA. NIBUT using K5M & IDRA-OSA shows good repeatability and reproducibility in control group but poor repeatability in DED patients. TMH values obtained with K5M or IDRA-OSA had poor repeatability with high CoV. Between two observers, good reproducibility is observed for TMH and NIBUT values using both K5M & IDRA-OSA but not for LLT values. Between instruments, all the measurements (LLT, NIBUT and TMH) were significantly different on Bland Altman analysis. No two dry eye diagnostic platforms can be used interchangeably andnon-invasivetear film values should be interpreted keeping in mind the individual machine's variability. The high coefficient of variation in DED patients compared to normalreflectsinherent variability in tear film irrespective of the device used.

Comparison of the Pre-Lens Tear Film Stability and Visual Performance of a Novel and Two Other Daily Disposable Contact Lenses in Healthcare Professionals Wearing Facial Masks for Prolonged Time.

ObjectiveTo compare a novel daily disposable contact lens (DDCL) verofilcon A with other DDCL materials in terms of pre-lens tear film (PLTF) stabilization and visual performance for prolonged use in healthcare professionals with the use of masks.MethodsSubjects aged 20–40 years old were prospectively randomized into three study groups. Group 1: verofilcon A, group 2: nesofilcon A and group 3: senofilcon A. The subjects were evaluated at baseline with best corrected visual acuity (BCVA), non-invasive tear break up time (NIBUT) of pre-lens tear film, and high order aberrations (HoAs). After 28 days of CL use, NIBUT at 1, 4, 8, and 12 h, HoAs, contrast sensitivity (CS) with CVS100-E and contact lens dry eye questionnaire-8 (CLDEQ-8) were evaluated.ResultsBetween August and September 2021, 147 eyes of 77 subjects were included in the three study groups. At day 28, the CS scores at 18 cycles per degree, spatial frequencies, and the mean NIBUT scores at 4, 8, and 12 h were higher in the verofilcon A group compared to the nesofilcon A and at 12 h were higher compared to the senofilcon A (p < 0.05). The mean HoAs and CLDEQ-8 test scores were higher in the nesofilcon A group (p < 0.001).ConclusionThe results of this study suggest the superiority of the PLTF stabilization ability of verofilcon A in healthcare professionals with prolonged use of mask. The improved CS and NIBUT scores of this lens could be explained by a new and unique surface technology with greater than 80% water content.

Prospective evaluation of intense pulsed light treatment for meibomian gland dysfunction and blepharitis due to ocular rosacea

Ocular rosacea is a common skin condition leading to dry eye that is difficult to manage. To estimate the efficacy and safety of a new intense pulsed light device, Thermaeye Plus, for meibomian gland dysfunction and blepharitis due to ocular rosacea. This prospective, longitudinal study included 74 eyes of 37 consecutive patients with ocular rosacea, with mean age of 45.6±11.7 years. Four consecutive sessions were undertaken, including14 flashes with 10 J/cm²on the periocular area and facial cheeks on Day 1, 14, 28, and 49. Clinical evaluation was based on: ocular surface disease index (OSDI) and symptom score questionnaires, quality of live and facial severity degree, non-invasive tear meniscus height, non-invasive tear break up time, corneal fluorescein staining and eyelid margin and meibomian gland assessment. Adverse effects on the eye and periocular area, and systemic complications were evaluated. The OSDI questionnaire showed a decrease in symptoms, achieving normal values in 91.9% of patients. The symptom score showed amelioration, with the most significant changes relating to dryness, foreign body sensation, light sensitivity, and pain. Longitudinal analysis showed the most significant improvement between baseline at Day 1 and 49. All eyelid signs improved, most significantly for telangiectasia/vascularity and blepharitis, leading to a 78% clearance of facial rosacea and 81.1% reduction of flushing. In total, 100% of the patients reported an improvement in their quality of life after treatment and 94.6% a very significant improvement (p<0.001). These results demonstrate that Thermaeye Plus is an effective and safe treatment for ocular rosacea.

Influence of pars plana vitrectomy on ocular surface using noninvasive Keratograph 5M

AIM: To evaluate the influence of pars plana vitrectomy (PPV) on ocular surface using Keratograph 5M. METHODS: Totally 30 consecutive patients (30 eyes) undergoing primary 23-gauge PPV were recruited in the study. Ocular Surface Disease Index (OSDI) questionnaire was performed. Ocular surface parameters, including tear meniscus height (TMH), noninvasive tear break up time (NITBUT) and bulbar redness score were obtained preoperatively, in 1, 2, 4, 8 and 12wk postoperatively by Keratograph 5M. Correlations between all the clinical parameters were analyzed further. RESULTS: The percentages of both photophobia and gritty within 4wk after PPV were significantly higher than pre-operation, while they decreased to the preoperative levels in both 8wk and 12wk postoperatively. The percentage of sore eyes in the first week postoperatively was significantly higher than pre-operation, but there were no significant differences between the percentages of pre-operation and 2, 4, 8, and 12wk postoperatively. OSDI score increased significantly within 4wk postoperatively, but it returned to the preoperative level in 8 and 12wk. TMH increased with 2wk postoperatively, but there were no significant differences compared with preoperation. Both NITBUT-first and NITBUT-average shortened significantly within 8 weeks postoperatively, but they gradually improved to the preoperative levels in 12wk. Bulbar redness score was significantly higher than the preoperative level within 4wk postoperatively, but it returned to the preoperative level in 8wk. NITBUT-first and NITBUT-average had a significant positive correlation at each visit. TMH had a significant positive correlation with NITBUT-average in the first week postoperatively. CONCLUSION: Keratograph 5M can provide a reliable noninvasive method to assess the influence of PPV on the ocular surface. PPV may cause various changes in both symptoms and signs of ocular surface damages at the early stage, while all these changes will return to preoperative levels gradually in 12wk postoperatively.

The Presence of Dry Eye Syndrome in Patients with Fibromyalgia: A Cross-sectional Controlled Study

Our aim is to investigate the presence of dry eye in fibromyalgia (FM) patients with using a self-reported questionnaire and objective tests. This study included 20 patients who were newly diagnosed FM and 20 healthy controls. Both groups were evaluated with ocular surface disease scale (OSDI), non-anesthetized Schirmer-I test, meibography, tear meniscus assessment, fluorescein tear break time (FBUT), non-invasive tear break time (NITBUT) and corneal fluorescein staining (CFS) tests. OSDI questions were significantly higher, FBUT values were significantly lower and FBUT values were significantly correlated with OSDI in FM patients. (p&amp;lt;0.05, p=0.007). There was no significant difference in other parameters.In this context, it was observed in this study that FM patients had significantly more ocular discomfort than healthy controls. Early recognition of comorbidities by physicians ensures the success of FM treatment with comorbidities.

Effect of ocular demodicosis on the stability of the tear film and the tear break up time

The aim of the study was to analyze the correlation between the presence of Demodex mites in the hair follicles of patients' eyelashes and the stability and break up time of the tear film assessed with the Non-Invasive Tear Break Up Times (NIBUT) method. 319 patients were included in the study (195 women, 124 men). The patients were divided into two groups: those with Demodex infestation and without visible symptoms of eyelid or eye surface diseases, and asymptomatic non-infested patients. The NIBUT analysis was performed with a 5 M keratograph (oculus). Non-invasive tests were performed to identify the first and mean values of the tear break up time. The first and mean tear break up time in the Demodex-infested group was lower than in the non-infested subjects. The difference was a highly statistically significant. There was a significant correlation with the age of the patients for the first break up time. The first break up time in both eyes decreased with the age of the Demodex-infested and non-infested patients. The NIBUT analyses indicate the impact of Demodex mites on the tear film stability. This may suggest possible association of demodicosis with dry eye syndrome.

Efficacy of five-flash intense pulsed light therapy technique in patients with meibomian gland dysfunction

ABSTRACT Clinical relevance Meibomian gland dysfunction is the main cause of evaporative dry eye disease and can lead to ocular discomfort and ocular surface damage. Early diagnosis and management of this condition can prevent its impact on patients ‘visual health and quality of life. Background In the last decade, intense pulsed light therapy (IPL) has been introduced as a therapeutic option for patients with meibomian gland dysfunction (MGD). Various treatment modalities and protocols have been reported to increase the efficacy of this technique. This study aimed to assess the efficacy of a novel five-flash IPL technique in combination with home-based therapy and to compare it with conventional home care alone in patients with MGD. Methods In a randomised controlled trial, 100 symptomatic MGD patients were enrolled. The treatment group underwent three sessions of a five-flash IPL therapy. For all participants, eyelid warming, lid hygiene and lubricant therapy was prescribed. Ocular surface parameters were compared for control and treatment groups. Results Ocular Surface Disease Index (OSDI), non-invasive keratograph tear break up time (NIKBUT), fluorescein TBUT, MG expressibility, meibum quality and tear osmolarity were improved at follow up visits in both groups (p < 0.05). On day 75, NIKBUT was significantly higher in the IPL group (p = 0.045). The IPL treatment effect was not statistically significant (p > 0.05), except for bulbar and limbal hyperaemia (p = 0.02 and p = 0.02). In both groups, younger patients showed more improvement in NIKBUT (p = 0.02, r = −0.32; p < 0.001, r = −0.52). Conclusion IPL therapy combined with conventional home-based therapy, and home care alone are both effective for patients with MGD. IPL may have an additional role in the improvement of ocular hyperaemia.

Comparison of efficacy of trehalose-based eye drops versus topical 0.1% Hyaluronic Acid for management of clinically significant dry eye using non-invasive investigational modalities.

To compare the efficacy of trehalose-HA eye drops versus 0.1% hyaluronic acid for the treatment of dry eye. This prospective, comparative, contralateral eye study included sixty eligible patients (mean age 44.13 ± 14.53years). Patients having a SPEED questionnaire score of 16 or above, objective scatter index (OSI) > 1 and non-invasive tear break up time (NIBUT) of 10s or less were included in the study. Eyes were randomized to receive 0.1% hyaluronic acid (HA) in one eye and trehalose-HA eye drops in the contralateral eye. At baseline, 1- and 3-month follow-ups, OSI, NIBUT, MG loss, tear meniscus height (TMH) and tear film osmolarity (TFO) were evaluated using non-invasive modalities RESULTS: There was a statistically significant improvement in NIBUT, TMH, OSI, SPEED questionnaire score in the trehalose-HA compared to the 0.1% HA group at both 1- and 3-month visits (p < 0.05). In both the study groups, compared to the baseline, the mean values of TFO, MG loss, OSI and SPEED questionnaire score significantly reduced at 3months (p < 0.05). The mean values of NIBUT and tear meniscus height on the other hand showed a significant increase compared to the baseline values (p < 0.05). Both drugs were well tolerated by the study participants without any significant ocular side effects. Trehalose-HA was found to be more effective than 0.1% HA eye drops in the management of symptomatic dry eye, as shown by significant reduction in NIBUT, TMH and OSI, when evaluated using non-invasive modalities of dry eye evaluation.

Non-invasive tear break-up time on six types of daily disposable contact lenses after 10 hours of wear

Purpose: Maintaining a persistent tear film over the surface of a contact lens is an important factor for successful contact lens wear. The chemistry of the lens material can play an important role in stabilizing tears. This study aims to evaluate the Non-invasive tear break up time (NIBUT) of 6 types of daily disposable contact lenses commonly available in the market after 10 h of wear.

High Level of Inflammatory Cytokines in the Tears: A Bridge of Patients with Concomitant Exotropia and Dry Eye.

Concomitant exotropia have obvious symptoms of eye discomfort in adults, and the presence of ocular surface inflammation in patients may be important mediators between concomitant exotropia and dry eye. Oculus Keratograph eye comprehensive analyzer was performed to detect noninvasive tear break time, noninvasive tear height, and eye red index, while the ocular surface disease index and schirmer I testing were made. The levels of IL-6, IL-10, IL-17A, IL-12P70, INF-γ, and TNF-α were detected in tears in patients with concomitant exotropia and healthy controls matched by age and gender through the Simoa technology. IL-6 was significantly higher in patients with concomitant exotropia (4.683 ± 1.329) pg/mL than that in normal group (1.455 ± 0.391) pg/mL, p = 0.0304. TNF-α was also significantly higher in patients (0.2095 ± 0.0703) pg/mL than normal group (0.0513 ± 0.0149) pg/mL, p = 0.0397. The levels of inflammatory factors in strabismic patients vs. normal controls were as follows: IL-17A (0.1551 pg/mL︰0.0793 pg/mL), IL-10 (0.3358 pg/mL︰0.0513 pg/mL), IL-12p70 (0.0253 pg/mL︰0.0099 pg/mL), and INF-γ (0.0284 pg/mL︰0.009 pg/mL) were detected, and the median of them in concomitant strabismus was 1.96-6.55-fold as much as the control group. High levels of inflammatory cytokines in tears of patients with concomitant exotropia, which may be a potentially factor promoted the occurrence of dry eye in the patients with concomitant exotropia.

Dry eye prevalence and main risk factors among undergraduate students

Introduction: Dry Eye (DE) is a common, complex, and multifactorial disease of the ocular surface and tear film that results in discomfort and visual disturbance. Prevalence varies from 5 to 50%, according to criteria, age, sex, and population studied. A meta-analysis was conducted to determine the prevalence of DE for different diagnostic criteria stratified by age and sex and reported by the TFOS DEWS II (Tear Film Ocular Surface Dry Eye Workshop) epidemiology committee showing relevant higher n umber among youth. The prevalence of symptomatic and clinically diagnosed DE varied by age, and sex, but only one study included young participants. Objective: This study aims to evaluate DE among a sample of undergraduate students from 2 major universities in Brazil, to comprehend symptoms, clinical signs presentation and most associated risk factors. Methodology: Cross-sectional survey that included 2,140 students (1,649 from UNICAMP and 491 from UNIFESP). Three fields of knowledge were included:1,128 from biological; 699 from exact; and 313 from human area. All participants completed 2 self-applicable questionnaires about dry eye symptoms: Ocular Surface Disease Index (OSDI) and short questionnaire used in the Women Heath Study (WHS), both previously translated and validated to Portuguese. DE symptoms were considered positive if OSDI score &gt;22 or reported severe symptoms and/or previous history of clinical diagnosis at WHS questionnaire. Indeed, a list of risk factors such as contact lens wear, medications, ocular surgery, and systemic disease associated to DE was presented. Participants who fulfilled criteria for DE symptoms underwent a complete clinical evaluation for signs of the disease evaporative and aqueous deficient DE: such as tear meniscus height, hyperemia, non-invasive tear break up time, ocular surface staining with fluorescein and lisamine green and Schimmer test. Results: 2,140 participants aged 23.4±5.2 years old, 56.1% female and 43.9% male were enrolled. OSDI score was 19.4±16.2; 34.4% had OSDI had &gt;22 and according to WHS 23.5% presented severe symptoms and/or previous history of clinical diagnosis. DE prevalence showed consistent sex differences, according OSDI scores 69.29% (510/736) female and 30.71% (226/736) male and with WHS questionnaire 64.8% (326/503) were female and 35.2% (177/503) were male (p&lt;.0001). Most common risk factors were visual display use (50.1%), less than 6 hours of sleep/day (37.0%), oral contraceptive use (21.9%), contact lens wear (16.3%) and antiallergic use (15.1%). Univariate and multivariate analysis demonstrated that female sex, contact lens wear, ocular surgery, use of electronic devices over 6 hours/day, oral contraceptive, anti-depressant, anti-allergic, sleep less than 6 hours/day as relevant related factors. Clinical evaluation demonstrated mild signs of ocular surface dysfunction, normal tear volume, tear film instability and evaporative DE, such as tear film instability: Schimer test &lt;10mm 14.8%; TBUT &lt;10sec 61.1%; Fluorescein &gt;4 5.6%; and Lisamine green &gt;3 1.9%.Conclusion: Dry eye is prevalent condition among undergraduate students. In this Brazilian youth sample, rates were higher than data recently published, that showed in the general Brazilian population over 40 years old, the overall rate was 12.8%. However, further investigation might be addressed to better understand related risk factors and clinical presentation.

Short-Term Changes in Tear Lipid Layer Thickness After Instillation of Lipid Containing Eye Drops.

PurposeLipid-containing eye drops is increasingly popular in eye clinics to treat dry eye. Tear lipid layer thickness (LLT) changes after instillation of lipid eye drops have not been characterized. We aim to evaluate these changes of LLT using a noninvasive interferometry-based method.MethodsThis prospective clinical study was conducted on staff and patients from Singapore National Eye Centre with ad hoc recruitment. Noninvasive tear break up time was measured using the Keratographer 5M. LLTs were measured using a tear interferometer machine before and at 1, 5, and 15 minutes after instillation of lipid-containing drops, either Cationorm unidose or Artelac Lipids. Fluorescein clearance (tear clearance rate) and Schirmer tests were conducted. The tear clearance rate of fluorescein dye was based on the visual examination of the color of a Schirmer strip after 5 minutes, compared against color standards.ResultsThis study included a total of 84 participants aged ≥21 years. Many were female (92.8%) and Chinese (89.2%). A tear clearance rate of 1/16 was most common (35.7%), whereas 1/128 and 1/32 were uncommon (3.57% each). Schirmer results were 6.5 ± 8.1 mm, and noninvasive tear break up times were 8.12 ± 6.25 mm. Participants with baseline LLT <60 nm had greater changes in LLT after Cationorm instillation, compared with those with an LLT of >60 nm. LLT changes over 15 minutes were not associated with tear clearance rate. Similar results were obtained when using Artelac Lipids.ConclusionsOur results showed that participants' initial LLT affected their responsiveness to lipid-containing eye drops more than other factors.Translational RelevanceDoctors may choose to measure the baseline LLT of patients before deciding whether to prescribe lipid eye drops to patients.

Ocular surface assessment in maturity-onset diabetes of the young

To examine ocular surface changes in patients with maturity-onset diabetes of young (MODY). Fifty patients with MODY who were transferred to Genetic Diagnosis Department of Diskapi Yildirim Beyazit Training and Research Hospital have been included. All patients were subjected to Ocular Surface Illness Index (OSDI) survey, shirmer test, invasive and non-invasive tear break up time (TBUT), cornea fluorescein, and Lissamine green dye tests. Lastly, meibography measurements have been completed using Sirius Scheimpflug camera (Sirius, CSO, Florence, Italy). All 50 patients had a glucokinase (GCK) mutation. MODY diagnosis time was 5.0 ± 5.5 years (range: 0–20 years) on an average. While the average HBa1c levels were 5.5 (range: 4.8–6.5, reference range: 4–6), none of the patients were diagnosed with diabetic retinopathy in fundus examination. There was no significant difference between MODY and control group in terms of OSDI score, Schirmer 1 test, meibomian gland loss, average BUT, TBUT ((p)0.05). Our work is the first one which specifically evaluates ocular surface in MODY patients. Contrary to the common concept that “dry eye is frequently seen in type 1 and type 2 DM,” we did not come across any significant difference between MODY and control group in ocular surface tests. It might be linked to the fact that not enough time had passed for DR or DES symptoms to be detected. Our patients’ average diabetes diagnosis length might be a short time span for clinical symptoms like DR and DES to show up.