Non-invasive Tear Break-up Time Research Articles

Prevalence of Dry Eye Disease in Laser-Assisted In Situ Keratomileusis Candidates

Objective: To evaluate the prevalence of dry eye disease (DED) in laser-assisted in situ keratomileusis (LASIK) candidates. Methods: A chart review of consecutive LASIK candidates who underwent full ocular surface work-up was performed, including ocular surface disease index (OSDI), noninvasive tests (noninvasive tear breakup time [ni-TBUT], tear meniscus height, lipid layer thickness, and meibography), and invasive tests (Schirmer test I, fluorescein TBUT, corneal staining, and meibomian gland [MG] expressibility). The prevalence of DED was calculated according to the Dry Eye Workshop II (DEWS II), and Japanese and Asia Dry Eye Society (JDES/ADES) criteria. Results: In total, 135 patients (270 eyes) were evaluated. The mean age was 32.6±8.3 years, and 62.9% were women (n=85); 19 patients (15.4%) wore contact lenses, and 31 patients (23.8%) used artificial tears. The mean OSDI was 18.2±16.9, which was abnormal in 54.1% (n=62). Inferior lid MG dropout was the sign with the highest percentage of abnormal results (61.5%; n=83). There were no differences between men and women in any test except for ni-TBUT (6.3±0.3 and 7.2±0.2, respectively; P=0.002). Dry eye disease prevalence was 25.9% and 53.3%, according to JDES/ADES and DEWS II criteria, respectively. The only significant risk factor for DED was artificial tear use for both DEWS II (odds ratio [OR]=3.5, confidence interval [CI] [1.35–9.39]) and JDES/ADES (OR=2.58, CI [1.03–6.48]). Conclusions: This study found a high prevalence of DED and abnormalities in LASIK candidates and highlights the importance of ocular surface evaluation before photorefractive surgery.

Meibography-Guided Electroepilation for Congenital Distichiasis: A Novel Surgical Technique.

Congenital distichiasis is managed either by ablation, using laser, cryotherapy, or electroepilation, or by surgical excision with mucous membrane grafting. Ablative procedures are usually blind as the exact depth of distichiatic eyelashes is unknown. The described surgical technique utilizes meibography for imaging the root and depth of distichiatic eyelashes that aided in performing electroepilation. Six patients (n = 24 eyelids; mean age 15.5 ± 12.2 years) underwent infrared meibography (Oculus Keratograph 5 M) and noninvasive tear breakup time prospectively. Eyelashes were electroepilated using a premarked needle inserted at a depth based on meibography findings in 4 patients. Surgical success was defined as no distichiatic eyelash regrowth and functional success was defined as the resolution of symptoms at a minimum of 3 months of follow-up. All 6 patients had all 4 eyelids involved to varying degrees, with a total of 230 distichiatic eyelashes. The median number of distichiatic eyelashes was 9 in the upper eyelids and 4.5 in the lower eyelids. Meibography revealed visible distichiatic eyelash roots in 70% of eyelashes in the upper eyelid and 87.8% in the lower eyelid, respectively. The median eyelash root depth was 2.7 mm (mean 2.9 mm, range 1.8-5.4 mm). The mean noninvasive tear breakup time was 12.2 seconds despite absent or rudimentary meibomian gland segments seen on meibography. The anatomical success was 75% (12/16 eyelids), and functional success was 87.5% (7/8 eyes) at a median follow-up of 5.5 months. Preoperative infrared meibography in eyelids with congenital distichiasis helps estimate the eyelash depth and can be used to guide eyelash ablation procedures.

Assessment of tear film parameters post-treatment with commercial eyelid cleaning wipes: a pilot study.

To investigate the short-term effects of commercially available eyelid-cleaning wipes on film parameters. This study enrolled 48 healthy participants aged 20-35y (both males and females). Clinical assessment included the Ocular Surface Disease Index (OSDI) questionnaire, non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), and lipid layer pattern (LLP). Based on these initial results, participants were categorized as either non-dry eye or dry eye. Participants in each group were randomly allocated to either Blephaclean® or Systane® treatments. Changes in NITBUT, TMH, and LLP levels before and after lid wipe treatment were assessed. The dry eye group exhibited significantly higher OSDI scores and lower NITBUT and TMH levels than in the non-dry eye group (P<0.001). Following the application of eyelid wipes (Systane® wipes), dry eye subjects experienced a significant improvement in NITBUT levels (P=0.0014) compared to the non-dry eye individuals. Although the remaining participants showed a marginal increase in TMH and NITBUT levels, these changes did not achieve statistical significance (P>0.05). Similarly, the LLP levels were significantly improved with Systane® (P<0.001) post-treatment compared to individuals in the non-dry eye group. However, the dry eye subjects showed higher post-treatment LLP levels than the untreated group (P<0.02). The short-term effects of Systane® eyelid wipes on tear film parameters suggest their effectiveness in dry eye disease. Nonetheless, further exploration of their long-term impact is essential to justify their cost effectiveness and efficacy in treating both aqueous deficiency and evaporative dryness.

Differential Impact of 0.01% and 0.05% Atropine Eyedrops on Ocular Surface in Young Adults.

To evaluate the effect of low-concentration (0.01% and 0.05%) atropine eyedrops on ocular surface characteristics in young adults. Twenty-six myopic students aged 18 to 30 years were randomly assigned to receive either 0.01% or 0.05% atropine once nightly for 14 days, followed by cessation, with a ≥14-day interval between each administration. Assessments were conducted one, two, seven, and 14 days after using atropine with corresponding timepoints after atropine cessation. Tear meniscus height and first and average noninvasive keratograph tear film breakup time (NIKBUT-first, NIKBUT-average) were measured using Keratograph 5M, whereas the objective scatter index (OSI) was measured by OQAS II devices; the ocular surface disease index (OSDI) score was also obtained. The mean OSI peaked after two days of administration of 0.05% atropine (β = 0.51, P = 0.001), accompanied by significant decreases in NIKBUT-first (β = -7.73, P < 0.001) and NIKBUT-average (β = -8.10, P < 0.001); the OSDI peaked after 14 days (β = 15.41, P < 0.001). The above parameters returned to baseline one week after atropine discontinuation (all P > 0.05). NIKBUT-first and NIKBUT-average reached their lowest points after 14 days of 0.01% atropine administration (NIKBUT-first: β = -4.46, P = 0.005; NIKBUT-average: β = -4.42, P = 0.001), but those significant changes were diminished once atropine treatment stopped. Young adult myopes experienced a significant but temporary impact on the ocular surface with 0.05% atropine administration, whereas 0.01% atropine had a minimal effect. The investigation of the ocular surface effects of different concentrations of atropine may inform evidence-based clinical decisions regarding myopia control in young adults.

A novel method of evaluating the non-invasive tear film break-up time and progression of corneal opacification in dogs using imaging video.

This study aimed to determine the correlation of the parameters that indicate the status of the ocular surface with the prognosis of corneal opacification. Fifty dogs (96 eyes) were examined using a grid-line illuminator (non-invasive tear film break-up time (NIBUT)). Thirty dogs (54 eyes) were included in the final analysis based on the criteria. The NIBUT and tear film break-up time (TFBUT) results of the eyes included in the study were divided into three groups: Group 1 (< 5 s), Group 2 (5 to <10 s), and Group 3 (≥ 10 s). The Schirmer's tear Test 1 (STT-1) results of the included patients were also divided into three groups: Group 1 (< 5 mm/min), Group 2 (5 to <10 mm/min), and Group 3 (≥ 10 mm/min). The corneal opacity grades are divided into four scores, ranging from 0 to 3. The corneal opacity grade score (COS) of 0 indicates a completely clear cornea or only a trace of opacity. COS of 1, 2, 3 indicate the presence of a prominent corneal opacity that does not interfere with the visualization of the fine iris details, the opacity obscures the visibility of the iris and lens details and severe obstruction of the intraocular structure visibility, respectively. The mean difference in COS during the follow-ups for each group of NIBUT were 0.61 ± 0.92 (n = 28), 0.10 ± 0.32 (n = 10), 0.19 ± 0.40 (n = 16). The NIBUT groups were significantly correlated with COS (p-value = 0.073) at a 10% level of significance. Post-hoc test at a 10% level of significance revealed significant correlations between Groups 1 and 2 (p-value = 0.041) and between Groups 1 and 3 (p-value 0.104). Although the TFBUT and STT-1 groups did not show any significant correlation with COS. Eyes with NIBUT of <5 s were found to have a significantly higher chance of increased COS compared with eyes with NIBUT of >5 s in the grid-line illumination plate NIBUT test. Among NIBUT, STT-1, and TFBUT, NIBUT was the only test that showed significant associations with the changes in COS.

End-of-day assessment of asymptomatic versus highly symptomatic soft contact lens wearers.

To investigate differences in key clinical parameters between asymptomatic and highly symptomatic soft contact lens (CL) wearers after 14 h of wear. In this pilot investigation, Phase 1 identified asymptomatic (CLDEQ-8 score ≤ 7) and highly symptomatic (CLDEQ-8 score ≥ 20) subjects after fitting with nelfilcon A CLs. Phase 2 investigated the following over a single nelfilcon A CL-wearing day (14 ± 2 h): blinking characteristics, tear meniscus height (TMH), non-invasive tear break-up time (NIBUT), tear film osmolarity and eyelid margin staining. Parameters for the two groups were compared using linear mixed models and post-hoc testing. The relationship between comfort scores and the clinical parameters was also investigated. Overall, 161 and 42 subjects were enrolled into Phase 1 and 2, respectively. Twenty-five asymptomatic and 17 symptomatic subjects completed Phase 2. Lower eyelid TMH was decreased after 14 h in symptomatic compared with asymptomatic subjects (least square mean [LSM] difference -0.04 mm, 95% CI: -0.07, -0.01). Osmolarity was lower in symptomatic than in asymptomatic subjects at fitting (LSM difference -9.89, 95% CI: -18.91, -0.86). Upper eyelid margin staining was greater after 14 h in symptomatic than in asymptomatic subjects (LSM difference 0.53, 95% CI: 0.01, 1.05) and greater after 14 h than baseline in the symptomatic group (LSM difference 0.61, 95% CI: 0.16, 1.07). There was a significant relationship between comfort and upper eyelid margin staining (r = -0.40, 95% CI: -0.63, -0.11) and blink rate (r = -0.31, 95% CI: -0.57, -0.003). The potential parameters most effective in differentiating asymptomatic from symptomatic wearers were upper eyelid margin staining and lower TMH. The parameter with the strongest relationship to comfort was upper eyelid margin staining, where higher comfort scores were associated with lower levels of staining.

Effect of Regulated Type-2 Diabetes Mellitus on the Ocular Surface

The aim of this study was to see whether well-regulated Type-2 diabetes mellitus (DM) under than 10 years impacted meibography and tear film break-up time. DM (n=45) and normal subjects (n=45) were recruited. Two years’ mean glycated hemoglobin data were calculated as the regulation indicator. Eye examination followed by noninvasive tear break‑up time (NTBUT) measurement and then meibography were conducted. Regression analyses corrected for age and gender were used for comparisons between groups. Pearson correlation analysis was used to examine the linear relationship between NTBUT and meibomian gland loss to mean glycated hemoglobin. A value of p&lt;0.05 was considered statistically significant. The meiboscale comparisons within groups did not show any statistical difference. The mean meibomian gland loss comparisons between groups for the right lower eyelid (r=0.017, p=0.69), right upper eyelid (r=0.04 p=0.24), left lower eyelid (r=0.009, p=0.68) and left upper eyelid (r=0.027, p=0.13) were all similar. NTBUT for right and left eye were similar between groups (p=0.69 and p=0.36 respectively). Pearson’s correlation did not show any significant correlation between glycated hemoglobin, NTBUT and gland loss. In conclusion, it was found that patients with less than 10-year disease duration under DM regulation had similar ocular surfaces to normal subjects.

Machine learning-based prediction of tear osmolarity for contact lens practice.

This study addressed the utilisation of machine learning techniques to estimate tear osmolarity, a clinically significant yet challenging parameter to measure accurately. Elevated tear osmolarity has been observed in contact lens wearers and is associated with contact lens-induced dry eye, a common cause of discomfort leading to discontinuation of lens wear. The study explored machine learning, regression and classification techniques to predict tear osmolarity using routine clinical parameters. The data set consisted of 175 participants, primarily healthy subjects eligible for soft contact lens wear. Various clinical assessments were performed, including symptom assessment with the Ocular Surface Disease Index and 5-Item Dry Eye Questionnaire (DEQ-5), tear meniscus height (TMH), tear osmolarity, non-invasive keratometric tear film break-up time (NIKBUT), ocular redness, corneal and conjunctival fluorescein staining and Meibomian glands loss. The results revealed that simple linear regression was insufficient for accurate osmolarity prediction. Instead, more advanced regression models achieved a moderate level of predictive power, explaining approximately 32% of the osmolarity variability. Notably, key predictors for osmolarity included NIKBUT, TMH, ocular redness, Meibomian gland coverage and the DEQ-5 questionnaire. In classification tasks, distinguishing between low (<299 mOsmol/L), medium (300-307 mOsmol/L) and high osmolarity (>308 mOsmol/L) levels yielded an accuracy of approximately 80%. Key parameters for classification were similar to those in regression models, emphasising the importance of NIKBUT, TMH, ocular redness, Meibomian glands coverage and the DEQ-5 questionnaire. This study highlights the potential benefits of integrating machine learning into contact lens research and practice. It suggests the clinical utility of assessing Meibomian glands and NIKBUT in contact lens fitting and follow-up visits. Machine learning models can optimise contact lens prescriptions and aid in early detection of conditions like dry eye, ultimately enhancing ocular health and the contact lens wearing experience.

Improvement of Clinical Findings, Meibography and Tear Film Parameters in Pediatric Ocular Rosacea Patients After a Standard Treatment Protocol

ABSTRACT Purpose The objective of this study was to illustrate the changes in ocular findings, meibography, and tear break-up time (TBUT) values in pediatric patients with ocular rosacea following a standardized treatment. Methods The study included consecutive patients diagnosed with ocular rosacea, referred to a tertiary hospital between 2021 and 2023. Each patient underwent biomicroscopic examinations, non-invasive TBUT assessments, corneal fluorescein staining (evaluated using the Oxford scoring system), and meibography. The standard treatment protocol involved warm compresses, eyelid hygiene, preservative-free sodium hyaluronate eye drops (administered four times daily), topical azithromycin 1.5% (twice daily for 3 days), topical steroids (loteprednol 0.5%, four times daily for 2 weeks), and either doxycycline 100 mg/day for 14 days or oral suspension of azithromycin 10 mg/kg for 3 days followed by an additional three-day course of treatment administered 10 days later (for patients above and below 14 years of age, respectively). Results The study included 18 patients, with 10 (55.5%) being female and 8 (44.4%) being male, with a mean age of 9.7 ± 4.5 years (range: 3–18). Four patients displayed cutaneous involvement. The treatments resulted in significant improvements in the Oxford scores, reduction in corneal neovascularization, and increased TBUT (p < 0.001, p = 0.016, p < 0.001, respectively). Meibomian gland loss area also significantly improved post-treatment (27.4 ± 6.7% vs 39.2 ± 13.4%, p = 0.001). Conclusion This study demonstrated that pediatric ocular rosacea patients may exhibit improved meibomian gland function, regression of corneal neovascularization, and enhanced tear film parameters following a standardized treatment protocol that includes both topical and systemic approaches.

Comparison of comfort and tear stability with two novel silicone-hydrogel daily disposable contact lenses.

The surface wettability of soft contact lenses (SCLs) affects the wearing comfort. Verofilcon A is a daily disposable silicone hydrogel contact lens with SMARTSURFACE® technology, ensuring high surface wettability. To evaluate tear stability on the surface of verofilcon A and narafilcon A SCLs and correlate these findings with clinical parameters and patients' discomfort. Sixty-two SCL wearers (124 eyes) with SCL discomfort were randomly assigned to use narafilcon A (control SCL) and verofilcon A for 2weeks each by crossover. The noninvasive tear break-up time (NIBUT) of the naked eye at baseline and pre-lens NIBUT (PL-NIBUT) of the SCL surface after 2weeks of using each SCL were measured using the DR-1α® dry eye observation device. Corneal superficial punctate keratopathy (SPK) (0-3) and conjunctival hyperemia (0-3), and comfort level of SCL wear (1-10) were also evaluated. NIBUT and PL-NIBUT values were 4.6 ± 2.3s for the naked eye, 6.6 ± 6.6s for narafilcon A, and 11.3 ± 3.5s for verofilcon A. verofilcon A had significantly higher PL-NIBUT than the naked eye and narafilcon A (p < 0.05). SPK (0.16 ± 0.48 vs. 0.00 ± 0.00, p < 0.01) and conjunctival hyperemia (1.15 ± 0.82 vs. 0.49 ± 0.50, p < 0.01) scores were lower when wearing verofilcon A than narafilcon A. The ocular comfort score of wearing SCLs was higher with verofilcon A than with narafilcon A (8.7 ± 1.8 vs. 9.8 ± 0.5, p < 0.01). The ocular comfort score for wearing verofilcon A was higher, regardless of the baseline NIBUT. The results of this study showed a consistent surface-wetting advantage of verofilcon A in patients with ocular discomfort. verofilcon A was used comfortably in patients with low NIBUT scores at baseline. The findings suggest that verofilcon A is recommended for SCL wearers experiencing SCL-related dry eye symptoms and discomfort.

Diamond Bur Microblepharoexfoliation Combined with Intense Pulse Light and Meibomian Gland Expression for Evaporative Dry Eye: A Short-term Controlled Clinical Trial.

To assess the efficacy and safety of the combination of microblepharoexfoliation (MBE), intense pulse light (IPL) and meibomian gland expression (MGX) for treatment of meibomian gland dysfunction (MGD). This was a prospective, parallel-control trial conducted from April 2022 to January 2023. Participants were assigned to receive either three sessions of MBE-IPL-MGX treatment and home-based therapy (treatment group) or home-based therapy alone (control group). Outcome measures were assessed at baseline and after 2-month follow-up. Seventy eyes of 70 patients were enrolled. MBE-IPL-MGX treatment achieved better improvements than home-based therapy in ocular surface disease index (OSDI) and symptom assessment in dry eye (SANDE) scores, noninvasive tear film break-up time (NIBUT), lipid layer grade (LLG), loss area meibomian gland (LAMG) and meibomian gland yielding secretion score (MGYSS). The mean differences between the two groups were as follows: OSDI (- 11.23 ± 4.68 points, P < 0.001), SANDE (- 24.63 ± 13.41 points, P < 0.001), NIBUT (1.3 ± 1.57s, P = 0.033), LLG (0.4 ± 0.04 points, P = 0.003), LAMG (- 2.85 ± 1.69%, P = 0.023) and MGYSS (7.5 ± 2.32 points, P < 0.001). In addition, the increment (Δ) of MGYSS after MBE-IPL-MGX treatment was significantly higher in MGD grades 2 and 3 (all P < 0.001). MBE-IPL-MGX treatment is an effective and well-tolerated procedure that improves dry eye symptoms and signs as well as meibomian gland secretions in patients with MGD. In addition, this treatment is recommended for MGD grades 2 and 3.

Ocular Surface Analysis of Dry Eye Disease After Cataract Surgery

Purpose: We aimed to compare the efficacy and safety of 0.3% hydroxypropyl methylcellulose/dextran (HPMC/Dextran) and 0.3% sodium hyaluronate (SH) in the treatment of dry eye disease (DED) in postcataract surgery patients by analyzing the presurgery and postsurgery ocular surface. Methods: This double-blinded, randomized, parallel-group study enrolled 96 patients with ocular surface dysfunction, specifically DED, after phacoemulsification. Patients were randomized to receive either HPMC/Dextran (n = 56) or 0.3% SH (n = 40). All patients received 1 drop per eye, 4 times per day. Data from OCULUS Keratograph 5M and Schirmer I tests without anesthesia were collected at baseline and 1 week, 1 month, and 3 months postoperatively. Results: Three months postsurgery, the ocular surface, Schirmer I test, tear meniscus height (TMH), noninvasive tear film break-up time (NITBUT), meibography, redness, and Ocular Surface Disease Index were significantly improved. The Schirmer I test, TMH, and NITBUT improved significantly (P = 0.07, 0.17, and 0.43, respectively; analysis of variance, P &lt; 0.05) in the SH group compared with the HPMC/Dextran group. In a subgroup analysis of patients with severe dry eye, Schirmer I test ≤ 5 mm/5 minutes and NITBUT &lt; 5 significantly improved (P = 0.00 and 0.001, respectively) at 3 months in the SH group compared with the HPMC/Dextran group. Thus, 0.3% SH gave significantly superior tear secretion and tear film instability outcomes. Conclusions: Both types of preservative-free artificial tears are effective in treating postsurgery DED. Compared with HPMC/Dextran, 0.3% SH artificial tears showed more improvements in Schirmer I test and NITBUT postsurgery.

Comparison of non-pharmaceutical treatments for evaporative dry eye: a randomised controlled study protocol

IntroductionThe lipid layer of the tear film is critical to maintaining the integrity of the tear film and absence in the tear film lipid layer (TFLL) is one of the...

Analysis on the changes of objective indicators of dry eye after implantable collamer lens (ICL) implantation surgery.

To explore whether implantable collamer lens implantation has any effect on the postoperative objective indicators of dry eye and to determine the severity of its influence on each indicator. This prospective observational trial was performed in the Department of Ophthalmology of West China Hospital and was approved by the Biomedical Ethics Sub-Committee of the West China Hospital of Sichuan University. A total of 89 non-dry eye patients (178 eyes in total) who received ICL implantation surgery at West China Hospital of Sichuan University were enrolled. The noninvasive keratograph tear film breakup time (NIKBUT), noninvasive keratograph tear meniscus height (NIKTMH), score of lipid layer, score of meibomian gland function, and hyperemia index were obtained via the OCULUS Keratograph for all subjects before surgery and at 1week, 1month, and 3months after surgery. The fluorescein tear film breakup time (FBUT), corneal fluorescein staining score (CFS), and Schirmer test I were also measured at the same time. A total of 178 eyes completed the 1-week and 1-month follow-up, and 40 eyes completed the 3-month follow-up. Compared with the preoperative baseline, there was no significant difference in the NIKBUT or the corneal fluorescein staining score at each follow-up time point (P > 0.05, P > 0.05, P > 0.05). The FBUT and Schirmer test I at 1week, 1month, and 3months after surgery were significantly higher than the preoperative baseline (P < 0.01, P < 0.01, P < 0.01). The NIKTMH and the score of lipid layer were significantly lower than the preoperative baseline at 1week, 1month, and 3months after surgery (P < 0.01, P < 0.01, P < 0.05). The score of meibomian gland function and hyperemia index were significantly lower than the preoperative baseline 1week after surgery (P < 0.01). ICL implantation has no adverse effect on the occurrence of postoperative dry eye, but it reduces the basal tear secretion of patients after surgery and has adverse effects on the indices of meibomian gland function in the short term postoperatively.

CONSISTENCY OF TBUT VS NIBUT MEASUREMENT FOR ASSESSMENT OF DRY EYE DISEASE IN COMPUTER VISION SYNDROME

Abstract&#x0D; Introduction &amp; Objectives : The coronavirus disease (COVID-19) pandemic requires medical faculty students to attend distance lectures using computers for long periods of time which directly has an impact of computer vision syndrome (CVS) which can progress to dry eye disease (DED). One of the tear film stability tests is the Tear Break Up Time, both with the invasive tear break up time (TBUT) technique and the non- invasive tear break up time (NIBUT) technique. This study aims to determine the consistency of tear film stability measurements using these two techniques in medical faculty students who suffer from CVS with and without DED.&#x0D; Methods : 62 medical students of Udayana University were enrolled in this study and devided into two groups namely CVS with DED symptoms and CVS without DED symptoms. Both groups were underwent TBUT examination using fluorescein strips and cobalt blue filter with slitlamp biomicroscopic and NIBUT examination with the tear film analysis software from Medmont E300 corneal topography.&#x0D; Results : There was no significant difference between TBUT and NIBUT measurements in the DED group (p=0.1985) and in the Non-DED group (p=0.9336). There was no difference in the consistency of TBUT and NIBUT in the two groups (p=0.4550).&#x0D; Conclusion : Both techniques provide consistent results in assessing DED. NIBUT technique is faster and more convenient for patients also can be an alternative for practitioners to diagnose DED if it is not possible to use TBUT due to allergies or the unavailability of fluorescein at the clinic.

Changes in Ocular Surface Parameter After Intense Pulsed Light Therapy in Ocular Demodicosis: A Case Report

Introduction : Demodex infestation may manifest as blepharitis and dry eye syndrome. Intense Pulsed Light (IPL) therapy is an emerging option for managing ocular demodicosis.&#x0D; Case Illustration : A 77-years-old woman complained of itch and watery eyes since four years ago. Meibomian pouting, telangiectasias, foamy secretions, and sleeves were identified in both eyelids. Right eye examination showed 52% and 42% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer test 6 mm, lipid layer thickness (LLT) 43 nm, tear meniscus height (TMH) 0.36 mm, and non-invasive tear break-up time (NIBUT) 9.6 seconds. Left eye examination showed 65% and 56% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer test 5 mm, LLT 66 nm, TMH 0.16 mm, and NIBUT 5.8 seconds. Demodex mites were identified during eyelash wet mount examination. She underwent four sessions of IPL. At the two-month follow-up, complaints were alleviated. Signs of blepharitis were subsided. Right eye examination showed 36% and 34% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer's test 9 mm, LLT 68 nm, TMH 0.49 mm, and NIBUT 10.7 seconds. Left eye examination showed 25% and 35% meibomian dropout in the superior and inferior eyelid, respectively, Schirmer's test 9 mm, LLT &gt;100 nm, TMH 0.9 mm, and NIBUT 6.2 seconds.&#x0D; Discussion : IPL has a role in managing ocular demodicosis by local inflammation control, meibum liquefaction, and meibomian glands photomodulation. IPL is also thought to directly eradicate Demodex mites.&#x0D; Conclusion : Improvement of ocular surface parameters was observed after IPL therapy in ocular demodicosis.

Understanding Ocular Surface Disease in Glaucoma: A Comparative Analysis of Symptoms and Objective Parameters.

Background Glaucoma is a progressive optic neuropathy that may result in irreversible visual impairment and can diminish quality of life. Lowering intraocular pressure (IOP) through topical eyedrops is usually the primary approach to managing glaucoma. However, long-term treatment poses a risk to ocular surface health, leading to ocular surface disease (OSD). Preservative-containing eyedrops are implicated in OSD development due to their detrimental effects on the tear film and goblet cell density. OSD symptoms may impact patient compliance due to local side effects. This study aims to assess OSD in glaucoma patients receiving topical treatment, quantify symptoms and objective ocular surface parameters, and compare them to a control group not using topical glaucoma medications. Methodology Patients diagnosed with primary open-angle glaucoma receiving topical treatment and a control group were included in this study. To assess OSD, patients completed the Ocular Surface Disease Index (OSDI) questionnaire to evaluate symptoms and underwent objective measurements of ocular surface parameters using a keratograph. These parameters included assessments of bulbar redness and non-invasive keratograph tear break-up time (NIKTBUT). Results A cohort of 92 patients was subjected to examination, comprising 66 individuals diagnosed with glaucoma and 26 controls. Within the glaucoma patient subset, the mean number of IOP-lowering drugs administered was 2.42 ± 0.18, with 22.7% exclusively utilizing preservative-free eye drops. Our investigations unveiled a substantial prevalence of OSD symptoms, manifesting not only within the glaucoma cohort but also among the control group, with 72.7% and 53.8%, respectively (p = 0.224), reporting moderate-to-severe symptoms (OSDI > 23). Remarkably, OSDI scores exhibited higher values among female participants (p = 0.039) and glaucoma patients using prostaglandins (p<0.001) and were negatively correlated to the number of IOP-lowering drugs used (-0.448; p < 0.001). Furthermore, employing keratograph assessment, we discerned heightened bulbar redness (1.86 ± 0.07) in the glaucoma group compared to the control group (1.58 ± 0.07; p = 0.008). Glaucoma subgroup analyses further unveiled higher bulbar redness among glaucoma patients employing carbonic anhydrase inhibitors (p = 0.035) and applying medication preservatives (p = 0.045) but lower among individuals using beta-blockers (p = 0.018). However, the NIKTBUT did not show significant variance between the two groups (glaucoma group: 10.19 ± 0.85 seconds; control group: 10.96 ± 1.37 seconds; p = 0.499). Conclusions Our study revealed a significant prevalence of OSD in our sample, with the OSDI questionnaire showing limited specificity. The notable increase in bulbar redness pointed to an elevated prevalence of OSD among glaucoma patients, emphasizing the considerable impact of preservatives on ocular surface damage. Recognizing the potential damage to the tear film and ocular surface is crucial for glaucoma experts, who must employ comprehensive therapeutic strategies to mitigate symptoms, advocating for the preferential use of preservative-free medications, when possible, for optimizing long-term treatment.

Evaluation of dry eye disease and corneal epithelial mapping in patients with lower eyelid ectropion.

To evaluate the corneal epithelial mapping, ocular surface parameters and their relationship with each other in lower eyelid ectropion patients according to severity. This retrospective study included 48 lower eyelid ectropion patients and 63 healthy individuals as control group. Ocular surface and tear functions were evaluated with ocular surface staining score, tear film break-up time (BUT), non-invasive tear break-up time (NIBUT) and ocular surface disease index (OSDI). Meibography scores and corneal epithelial thickness (CET) mapping were evaluated. The lower eyelid ectropion was classified and divided into subgroups as follows: mild, moderate and severe. There was no significant differences between the groups for age and gender. Compared to controls, CET was significantly thinner at inferior (p = 0.047) and inferior nasal quadrants (p = 0.023) in the ectropion patients. Lower BUT and NIBUT, higher OSDI scores and higher ocular surface staining were observed in the ectropion patients. In the subgroups determined according to the severity of ectropion, ocular surface damage was found to be significantly higher as the severity of ectropion increased (p < 0.05). Patients with lower eyelid ectropion had worse ocular surface findings and more ocular complaints. Furthermore, the inferior and inferior nasal CETs were thinner in patients with lower ectropion.

Evaluation of tear film in patients with AIDS without opportunistic ocular infections in the era of COVID-19: A case-control study.

The assessment of tear film and ocular surface conditions in patients with acquired immunodeficiency syndrome (AIDS) has been poorly studied thus far. We aim to assess tear film parameters, ocular surface characteristics, and dry eye disease (DED) symptoms of patients with AIDS who did not undergo highly active antiretroviral treatment (HAART). This case-control study included 154 age-, sex-, and ethnicity-matched healthy controls and patients with AIDS. All participants underwent comprehensive ocular surface assessment and subjective DED symptomology evaluation. Data were collected between March 2022 and July 2022. HAART-naïve patients with AIDS had a shorter noninvasive tear film breakup time (median 3.76 vs. 8.54 s), thinner tear film lipid layer thickness (median 73.00 vs. 91.00 nm), and lower Schirmer I test values (median 5.00 mm/5 min vs. 12.00 mm/5 min) (all P < 0.001). Moreover, higher corneal fluorescein staining scores (median 1.00 vs. 0.00) and higher upper, lower, and total meibomian gland grades were observed in AIDS patients (all P < 0.05). Negative correlations between the blood viral load and the Ocular Surface Disease Index score ( r = -3.50, P = 0.027) and the Schirmer I test score ( r = -0.374, P = 0.017) were detected in patients with AIDS. Altered tear film status was observed in individuals with HAART-naïve AIDS, even when there were no other ocular symptoms present. Therefore, patients with AIDS should be encouraged to undergo comprehensive ocular surface examinations to detect any subclinical tear film alterations occurring.

Complex therapy of the evaporative form of dry eye syndrome in patients after keratorefractive surgery

Introduction. Meibomian gland dysfunction (MGD) is considered as the leading cause of the evaporative dry eye syndrome (DES). At the same time the standard methods of DES treatment often allow to achieve only a short-term effect and the search of alternative methods to achieve remission for a longer period is required.Aim. To evaluate the effectiveness of a combined treatment of DES with MGD using transdermal Intense Pulsed Light (IPL) method combined with preservative-free sodium hyaluronate 0.18% eyedrops.Materials and methods. The study involved 60 patients (120 eyes) after refractive surgery (femtoLASIK) with DES and MGD aged 20 to 40 years with a follow-up period of 3 months. The patients were divided into two groups: main (30 patients) and control (30 patients). Patients of both groups were administered a preservative-free form of 0.18% sodium hyaluronate four times a day for 3 months. All studied patients underwent standard examination methods, indicators of DES were assessed along with an objective valuation of tear film parameters and the meibomian glands condition by mean of digital biomicroscopy using a MediWorks slit lamp before surgery and 7 days, 1, 2 and 3 months after refractive surgery.Results and discussion. A comparative analysis of therapy effectiveness in the main and control groups showed that OSDI scores (ocular surface disease index), non-invasive tear breakup time (NITBUT) and meibomian gland function improved after treatment in both groups, but in the main group (IPL) positive dynamics of indicators were more pronounced with a cumulative increase of effectiveness after subsequent sessions.Conclusion. A course of IPL therapy in combination with a course of sodium hyaluronate 0.18% for dry eye syndrome due to MGD reduces the time, allows for longer-term results of therapy and promotes earlier elimination of discomfort.