Ocular Discomfort Research Articles

Morphological aberration of corneal nerves in hyposecretory dry eye guinea pigs.

Dry eye, a common ocular surface disease associated with tear film instability and corneal impairment, is frequently accompanied by ocular discomfort and pain. Recent research has shown that corneal nerve dysfunction may play a role in certain pathologies of dry eye; however, the details remain unclear. To clarify the aberration in corneal nerves underlying sensory abnormalities, in addition to corneal impairment in dry eye, we examined the morphological alterations of nerve fibers in the corneas excised from guinea pigs with dry eye, where the lacrimal glands were surgically excised. Guinea pigs with dry eye exhibited reduced tear volume, increased spontaneous blink frequency, and corneal epithelial damage. Simultaneously, the subbasal nerve plexus in the cornea visualized using an anti-tubulin βIII antibody partially outgrew and became convoluted. The morphology of peptidergic nerves containing calcitonin gene-related peptide, which may function as a polymodal nociceptor, was also altered. These results indicate that guinea pigs with excised lacrimal glands can serve as useful tools for investigating the neuronal mechanisms underlying corneal pathology in dry eyes. Additionally, chronic tear deficiency may considerably alter nerve structure, including peptidergic nerves in the cornea, accompanied by epithelial damage and increased blink frequency.

Effect of Subconjunctival Injection of Canine Adipose-Derived Mesenchymal Stem Cells on Canine Spontaneous Corneal Epithelial Defects

Spontaneous chronic corneal epithelial defects (SCCEDs) are characterized by nonadherent corneal epithelium leading to poor attachment to the corneal stroma. The objective of this study was to characterize corneal outcomes concurrently with the quantification of tumor necrosis factor-alpha (TNF-α) and vascular endothelial growth factor-A (VEGF-A) in tear fluid after the subconjunctival injection of canine adipose-derived mesenchymal stem cells (cAD-MSCs) in canine SCCEDs. Ten eyes with SCCEDs, which were nonresponsive to two rounds of diamond burr debridement, were included in this study. All eyes received a single subconjunctival injection of 1 × 106 cAD-MSCs. Ophthalmic examinations were performed before treatment and on day 7, 14, and 21 after treatment. Tear samples were collected for the quantification of TNF-α and VEGF-A concentrations by a canine multiplex immunoassay. Nine out of ten eyes revealed complete healing by day 21. The mean healing time was 10.89 ± 1.7 days. All eyes showed a decreased degree of ocular discomfort, in accordance with the degree of corneal characteristics. The concentrations of VEGF-A significantly reduced from pre-treatment (4334.91 ± 1275.92 pg/mL) to day 21 post-treatment (3064.61 ± 1028.66 pg/mL). No significant difference in TNF-α concentration was observed before/after treatment. In conclusion, the single use of a subconjunctival injection of cAD-MSCs could be used as an alternative treatment for canine SCCEDs.

Influence of Lifestyle Factors on Ocular Surface Parameters in Relation to Age

Purpose: To evaluate how Video Display Terminal (VDT) use, Contact Lens (CL) wear, and eyedrop use affect ocular surface parameters in participants with ocular discomfort and how these factors may vary across different age groups. Methods: The current cross-sectional study initially involved a total of 252 participants who completed a self-administered survey to collect information about ocular discomfort and lifestyle factors. This online survey was composed of an Ocular Surface Disease Index (OSDI) questionnaire and three extra questions regarding lifestyle factors (VDT use, CL wear, and eyedrop use). Only 185 symptomatic participants, those with OSDI values > 12, were scheduled to undergo a comprehensive ocular examination that included tear film osmolarity, Fluorescein Break-Up Time (FBUT), Maximum Blink Interval (MBI), and corneal staining. Results: Differences in ocular parameters and lifestyle factors across age groups (<40 years, 40–60 years, >60 years) were analyzed, along with their correlations and regression. Significant age group differences were found in OSDI, osmolarity, FBUT, and MBI (One-way ANOVA, all p ≤ 0.029). Correlations were observed between CL wear and osmolarity and MBI (Pearson’s correlation, both p ≤ 0.049). Multiple regression confirmed age associations with OSDI, osmolarity, FBUT, and MBI (Multiple linear regression, all p ≤ 0.040) and found links between VDT use and osmolarity and MBI (Multiple linear regression, both p ≤ 0.038) and between eyedrop use and OSDI (Multiple linear regression, p = 0.040). Conclusion: Aging is a primary factor affecting ocular homeostasis, with older adults showing lower FBUT and MBI values and higher osmolarity. Prolonged use of VDTs exacerbates this effect, further contributing to ocular discomfort and destabilized tear film. No associations between CL wear and any of the ocular parameters were found. Eyedrop use shows varied effects on ocular comfort across age groups, emphasizing the need for age-specific ocular care. Overall, these findings confirm that aging and extended VDT use play a significant role in ocular surface discomfort.

Phospholipid Nanoemulsion-Based Ocular Lubricant for the Treatment of Dry Eye Subtypes: A Multicenter and Prospective Study.

Dry eye disease (DED) is a multifactorial condition of the ocular surface (OS) characterized by loss of tear film homeostasis, ocular discomfort, and vision disturbances. Most available ocular lubricants target the aqueous deficiency of the tear, restoring only this layer, leaving the tear lipid stratum deficient, as occurs in most patients with evaporative DED. An innovative propylene glycol-hydroxypropyl guar enriched with a phospholipid nanoemulsion (PG-HPG-PH-N) is indicated to restore deficiencies in both the lipid and aqueous layers of the tear film, and its composition was designed to increase lubricant retention on the OS. The purpose of this study was to evaluate, through the Ocular Surface Disease Index (OSDI) and clinical assessment, the treatment of patients who had DED due to aqueous deficiency arising from mixed or evaporative DED subtypes with a PG-HPG-PH-N ocular lubricant at a reduced frequency of twice a day, in a prospective, multicenter, and single-arm study. Patients were screened from days - 7 to 0, and from day 1 (baseline and first day of treatment) to day 28 of treatment with this lubricant. After visit 1 (screening visit, days - 7 to 0), designed as pre-treatment OS assessment, patients returned to their research center on days 14 and 28 of treatment for a complete assessment, including anamnesis, the OSDI, corrected visual acuity, tear breakup time (TFBUT), OS staining evaluation, tolerability index, and environmental exposure questionnaire. Seventy patients were enrolled in this study (60 women, 10 men), with a mean age of 45 (range 27-64) years. TFBUT results showed an improvement in tear film stability as vital dyes sodium fluorescein and lysamine green showed a decrease in corneal staining after 14 and 28days of treatment. No significant adverse events were reported, demonstrating the good tolerability of the lubricant. The PG-HPG-PH-N nanoemulsion can be considered to be a safe and effective ocular lubricant for treating DED due to aqueous deficiency, both mixed and evaporative subtypes. Brazilian National Research Ethics Commission (ReBEC registration number 16055).

Cell Death Pathways in Dry Eye Disease: Insights into Ocular Surface Inflammation.

Dry eye disease (DED) is increasingly prevalent, with inflammation playing a crucial role in its pathogenesis. Severe cases of DED result in significant ocular discomfort and visual impairment due to damage and loss of ocular surface epithelial cells. The precise mechanisms underlying the loss of these epithelial cells remain a subject of ongoing research and debate. Programmed cell death (PCD) mechanisms, including pyroptosis, apoptosis, and necroptosis, are known to be critical in maintaining ocular surface homeostasis and responding to stressors in DED. The concept of PANoptosis, which integrates elements of various PCD pathways, has been implicated in the development of numerous systemic diseases, including infections, cancer, neurodegenerative, and inflammatory conditions. It also provides novel insights into the inflammatory processes underlying DED. This review highlights the crosstalk of PCD pathways in DED, particularly the significance of PANoptosis in ocular inflammation and its potential as a therapeutic target for more effective interventions.

A Preservative-Free Combination of Sodium Hyaluronate and Trehalose Improves Dry Eye Signs and Symptoms and Increases Patient Satisfaction in Real-Life Settings: The TEARS Study.

Dry eye disease (DED) is a frequently observed condition characterized by ocular discomfort and visual disturbance. It is highly prevalent and impairs patients' quality of life (QoL). This study assessed the benefit of a preservative-free bioprotectant eye drop formulation containing sodium hyaluronate and trehalose (SH-trehalose) with regards to DED, as well as patient satisfaction, through a large-scale real-life survey. In a multi-center, international, prospective observational study, subjects with DED received SH-trehalose for 84 days. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire-5 items (DEQ-5), and patient satisfaction were assessed at baseline, day 28, and day 84, and clinical evaluations included ocular surface staining, Schirmer test, tear film break-up time (TBUT), and conjunctival hyperemia at baseline and day 84. A total of 312 patients were evaluated, of whom 82.4% were women. The mean age was 57.9±15.2 years. The mean OSDI score at baseline was 41.7 ± 20.6. After 84 days, the mean OSDI score was 27.3 ± 19.8 (p < 0.001). The percentage of patients with a severe OSDI score decreased from 60.3 to 34.5%. The DEQ-5 score significantly (p < 0.001) improved after 28 and 84 days, as did patient satisfaction. Ocular surface staining, Schirmer test, TBUT, and conjunctival hyperemia scores improved significantly (all p < 0.001) for both eyes with SH-trehalose between baseline and day 84. Tolerance of SH-trehalose was good. SH-trehalose significantly improved the clinical signs and symptoms of DED after 84 days. Moreover, it significantly increased patient satisfaction and was well tolerated. NCT04803240.

Targeting Nrf2 signaling in dry eye.

Dry eye, the most common ocular surface disease, can cause ocular surface tissue damage and discomfort symptoms and seriously affect people's quality of life. The etiology of dry eye is diverse, and its pathogenesis is complex. The oxidative stress reaction is considered to be among the important factors in the pathogenesis of dry eye. Therefore, activating the antioxidant system has a potential therapeutic effect on dry eye. Nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway is considered the most important antioxidant pathway in the body. The activation of the Nrf2 signaling pathway and its interaction with other pathways are important mechanisms to prevent the occurrence and development of dry eye. This review describes the structure and function of Nrf2, summarizes the changes in the oxidative stress response in dry eye, focuses on the potential mechanism of the Nrf2 signaling pathway in the treatment of dry eye, and, finally, summarizes the drugs that activate the Nrf2 signaling pathway in the treatment of dry eye.

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.

8640 Thyroid Orbitopathy in Pregnancy

Abstract Disclosure: Z. Maisonet -Feliciano: None. M. Alvarado: None. L.A. Gonzalez-Rodriguez: None. M. Ramirez: None. L. El Musa Penna: None. J. Segarra-Villafane: None. I.C. Arroyo: None. W. Medina-Torres: None. L.R. Sepulveda-Garcia: None. Thyroid orbitopathy, often associated with Graves' disease, is characterized by the inflammation and swelling of ocular tissues. Its occurrence or exacerbation during pregnancy is infrequent, primarily due to the immunosuppressive state inherent in pregnancy. In most instances, the immunosuppression associated with pregnancy leads to a reduction in TRAb levels, although they continue to be present in women who have an active form of the disease. The course and severity of ocular manifestation do not always correlate with thyroid hormone levels. Strict control of thyroid function is crucial in patients with thyroid eye disease. This report sheds light on the rare occurrence of thyroid orbitopathy during pregnancy, a condition that complicates treatment due to potential risks to both the mother and the child. In this case, a 35-year-old pregnant woman with no prior history of thyroid issues exhibited symptoms of hyperthyroidism in her first trimester, including unintended weight loss, anxiety, and tremors in the upper limbs. She also presented with ocular discomfort, diplopia, and eyelid lag. Thyroid tests confirmed Graves Disease, with a significant elevation in Thyroid Stimulating Immunoglobulin (TSI): 243 %, Free thyroxine (T4): 1.08 ng/dl and Triiodothyronine (T3): &amp;gt;1.89 units and decreased Thyroid Stimulation Hormone (TSH): 0.001 uIU/ml. Ophthalmic examination revealed mild Graves orbitopathy due to bilateral exophthalmos (measured by Hertel’s exophthalmometer) 21mm on both sides, Marginal reflex distance (MDR) 1: right eye 9 mm and left 7mm. MDR 2: right eye 6mm and left eye 7mm. Right upper eyelid retraction, lagophthalmos of the right eye, limitation in the upward movement of the left eye, and vertical diplopia on extreme gazes without signs of orbital compression. Considering her normal FT4 levels and the mild nature of her hyperthyroidism, the decision was made to prioritize the mother's treatment while minimizing fetal risk, thus opting not to initiate antithyroid medication but to closely monitor her thyroid function. Symptomatic management of her orbitopathy was provided including lubricating eye drops and an eye patch. Throughout the progression of her pregnancy, her TSI levels exhibited a decreasing trend while FT4 remained within normal limits. Following delivery, there was a notable improvement in her ocular symptoms, and her TSH started increasing up to normal values of 1.29 uIU/ml and FT4 remained in range. This report underscores the importance of recognizing uncommon presentations of autoimmune thyroid conditions, such as thyroid orbitopathy, during pregnancy. It emphasizes the complexities and necessary considerations in treating these cases. A collaborative approach involving endocrinology, ophthalmology, and obstetrics is essential to safeguard the health of both the mother and the fetus. Presentation: 6/1/2024

Assessing Prevalence and Severity of Dry Eye Disease Across Various Types of Allergic Conjunctivitis

Background: Allergic conjunctivitis (AC) is a prevalent ocular condition triggered by environmental allergens, causing significant discomfort and reduced quality of life. Dry Eye Disease (DED), marked by ocular discomfort and visual disturbances, frequently overlaps with AC symptoms. This study examines the prevalence of DED in AC patients and explores the relationship between different AC types and DED severity. Method: A cross-sectional, observational study was conducted from June to September 2023 in the Department of Ophthalmology at a tertiary center in North India. A total of 264 AC patients aged 18 years and older with itchy eyes were included. Patients with contact lens use, recent ocular surgery, trauma, corneal pathology, or certain systemic diseases were excluded. DED was assessed using the Ocular Surface Disease Index (OSDI), Schirmer’s test, and Tear Film Break-Up Time (TFBUT). Results: DED was found in 70% of AC patients, with 20% mild, 19% moderate, and 32% severe cases. Females were more affected (64%). VKC patients showed higher tear production and better TFBUT scores. PAC patients had the most severe DED. Conclusion: DED is common in AC patients, with PAC associated with more severe DED, while VKC shows milder symptoms. Tailored treatment approaches are needed for managing AC and DED.

Immune-mediated meibomian gland dysfunction and dry eye disease related to trastuzumab emtansine chemotherapy in HER2 breast cancer: A case report

One of the most commonly administered drugs for human epidermal growth factor receptor 2 (HER2) breast cancer is trastuzumab emtansine (TDM-1). Unfortunately, this drug causes ocular surface disease as an adverse effect. This case report describes the diagnosis and management of meibomian gland dysfunction (MGD) and dry eye related to TDM-1 in HER2 a breast cancer patient. Our patient was a 43-year-old female diagnosed with HER2 breast cancer with metastasis to the peritoneum and liver. After a cycle of TDM-1 chemotherapy, she complained of recurrent hordeolum, ocular discomfort, and blurry vision. We initially prescribed topical and oral medications and gradually combined them with hordeolum incision and drainage, in-office meibomian gland expression, and intense pulse light therapy to improve symptoms. Ocular adverse effects due to anticancer agents are not preventable. Ophthalmologists must be aware of them and instigate needed therapy to ensure patients’ compliance with cancer treatment and improve quality of life.

Reconstruction of deep and perforating corneal defects in dogs-A review (Part III/III): The use of corneal sutures and reporting of ocular discomfort.

The surgical reconstruction of severe corneal disease is a common and crucial component of the clinical practice of veterinary ophthalmology. The first part of the present review described procedures that utilize autogenous ocular tissues, homologous donor tissues, and heterologous donor tissues in dogs, while the second part reviewed the use of biomaterials and keratoprosthetics in this species. This third part is dedicated to the review of the use of corneal sutures including suture type and suture pattern in corneal reconstruction of small animals including dogs and cats. The review also focused on the way studies report postoperative ocular discomfort/pain and how this is treated. Lastly, the author briefly presents the simple but effective techniques available to bury corneal knots for corneal reconstructive surgery in small animal patients, such as the "tugging" and "deep-superficial-superficial-deep" methods for simple interrupted sutures, and the adaptation of the latter for simple continuous sutures.

Dry Eye Disease Prevalence and Associated Risk Factors Among the Middle East Population: A Systematic Review and Meta-Analysis.

Dry eye disease (DED) is a common condition characterized by a loss of the tear film function, leading to symptoms of ocular discomfort and damage to the ocular surface. The prevalence and associated risk factors of DED may vary by region due to environmental, cultural, and genetic differences. The aim of the present study is to systematically review and analyze the prevalence and risk factors of DED in the Middle East (ME) region. This study adhered to the PRISMA 2020 guidelines. A comprehensive literature search was conducted using databases such as Web of Science, Scopus, Google Scholar, and PubMed to identify relevant studies published from January 2004 to July 2024. Studies included in the review were those that provided data on the prevalence and risk factors of DED in Middle Eastern populations. Data were extracted and analyzed to determine overall pooled prevalence and associated risk factors using a random-effects model. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42024583897. The meta-analysis included 17 studies from 10 countries with a total of 22,087 subjects. The estimated pooled prevalence of DED in the ME region was 28.33% (95% CI: 27.74-28.93). The primary risk factors include age, female gender, and smoking. Other risks are contact lens use, prolongedscreen time (over six hours daily), diabetes, glaucoma medications, allergies, autoimmune diseases, refractive surgery, arthritis, high cholesterol, acne treatments, antihistamines, antidepressants, thyroid disease, and a history of conjunctival infections or corneal abrasions. The prevalence of DED in Middle Eastern countries was higher than the global estimate, highlighting significant regional variation. Common risk factors for DED include older age, female gender, and smoking. These findings underscore the need for targeted prevention and management strategies that address the specific risk factors prevalent in the Middle Eastern population.

Modified Transepithelial Phototherapeutic Keratectomy for Band Keratopathy.

Objectives: To report the outcomes of novel modified transepithelial phototherapeutic keratectomy (PTK) in treating band keratopathy (BK). Methods: A retrospective analysis was performed on patients who underwent PTK for BK at the Sussex Eye Laser Clinic, Nuffield Health, Brighton. Patients with BK obscuring the visual axis, affecting visual acuity, or causing discomfort were considered for PTK. All the patients underwent preoperative evaluation, including preoperative corneal topography and optical coherence tomography. Modified transepithelial PTK was performed without using EDTA for chelation or alcohol for epithelium debridement. Patients were followed up for one week and then every two weeks after that until two months. Preoperative and postoperative best corrected visual acuities (BCVA) were compared using a paired t-test. Results: We studied 15 eyes of nine patients undergoing novel PTK for BK. The mean age was 80 ± 5.73 years. The mean pre-treatment visual acuity was 0.68 ± 0.17 logMAR (range: 0.6 logMAR to 1 logMAR) and improved to 0.22 ± 0.09 logMAR (p < 0.05), ranging from 0.18 to 0.48 logMAR at two months following PTK. None of the patients complained of ocular discomfort following the procedure. A repeat procedure was not required for any of these patients. Conclusions: Modified transepithelial PTK is an effective procedure for improving visual outcomes in patients with band keratopathy and should be considered for the treatment of band keratopathy.

Spontaneous filtering bleb: Diagnosis and treatment

Abstract: A 72-year-old patient presented with decreased visual acuity and ocular discomfort. The patient had not undergone previous ocular surgery or had a history of ocular trauma. Physical examination revealed decreased intraocular pressure (IOP) (9 mmHg), a subconjunctival filtering bleb, and hypotonic maculopathy. Ultrasound biomicroscopy revealed a fistula between the anterior chamber and the subconjunctival space at Schwalbe’s line. The patient presented no findings suggestive of systemic disease or dysmorphic facial features. Surgical closure of the fistula was attempted using multiple transconjunctival 10-0 nylon sutures and staining using trypan blue 0.06%. Although the fistula was not sealed, the bleb became flatter, IOP increased (18 mmHg), and hypotonic maculopathy resolved. Spontaneous formation of subconjunctival filtering blebs is exceedingly rare; most reported cases are associated with concomitant systemic or local disease. Our novel surgical approach successfully treated the hypotony and revealed that intraoperative use of trypan blue 0.06% in phakic patients causes temporary capsular staining.

Visual Performance of School-age Children Wearing Dual-Focus Soft Contact Lenses: A Randomized Controlled Trial

To investigate the effect of wearing dual-focus soft contact lenses (DFSCL) on the visual performance of school-age children. In this randomized controlled clinical trial, 64 children aged 8 to 12 years with spherical equivalent refraction between -0.75 D and -4.00 D were recruited in our hospital in October 2022. Using the envelope method, the subjects were evenly and randomly assigned to the control group wearing single vision spectacles (SVS) or the intervention group wearing MiSight dual-focus soft contact lenses (DFSCL) from CooperVision. Follow-up examinations were conducted once every 3 months. The corrected visual acuity, contrast sensitivity function (CSF), and the scores for National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI-RQL-42) were compared between the control and intervention groups. By December 2023, a total of 58 subjects completed follow-up (30 in the SVS group and 28 in the DFSCL group). No significant difference in corrected visual acuity was observed between subjects wearing DFSCL and those wearing SVS. The CSF of the DFSCL group was comparable to that of the SVS group across the spatial frequencies of 3, 6, 12, and 18 cpd (P>0.05). According to the results of the NEI-RQL-42 survey at the 6-month follow-up, the score for ocular discomfort symptoms was 89±14 in the SVS group and 79±16 in the DFSCL group (P=0.008), reflecting that the DFSCL group had a 12.66% higher level of discomfort. For appearance, the score was 70±32 in the SVS group and 92±22 in the DFSCL group (P=0.002), showing a 31.43% improvement in the DFSCL group. In addition to providing the normal visual acuity and CSF, wearing MiSight DFSCL also leads to better satisfaction with the appearance.

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...

Primary Conjunctival Molluscum Contagiosum in a Patient With Ocular Graft-Versus-Host Disease.

Primary conjunctival molluscum contagiosum (MC) is rare and usually reported in patients with acquired immunodeficiency syndrome. In this study, we present a case of bilateral primary conjunctival MC in a patient with ocular graft-versus-host disease (oGVHD). This is a case report study. Clinical evaluation, in vivo confocal microscopy imaging, and histopathology were used to confirm the diagnosis. A 38-year-old woman with a history of allogeneic bone marrow transplant and secondary chronic oGVHD presented with ocular discomfort, redness, and dryness. On examination, clusters of white gelatinous nodular lesions, stained with fluorescein and Lissamine green, were observed on the bulbar conjunctiva, along with similar solitary nodular lesions in all quadrants of both eyes. In vivo confocal microscopy revealed nests of epithelial cells with bright inclusions measuring approximately 30-35 μm. Excisional biopsy confirmed the diagnosis of MC. A 6-month post-operative follow-up showed healed conjunctiva with no recurrence and improved ocular comfort. Molluscum contagiosum should be considered in the differential diagnosis of conjunctival lesions in patients with impaired immunity such as oGVHD. In diagnosing MC lesions, in vivo confocal microscopy proves to be valuable. In the absence of topical antiviral treatment, surgical excision is warranted.

Ocular thermography and clinical measurements in symptomatic and asymptomatic soft contact lens wearers.

Symptoms of dryness and discomfort are the main reasons for contact lens dropout. Clinical tests for this purpose are invasive or subjective. Ocular thermography may help to assess the ocular discomfort and dryness in noninvasive and objective manner. This study aimed to investigate the relationship of ocular thermography with clinical measurements in habitual symptomatic and asymptomatic soft contact lens wearers. Forty habitual contact lens wearers were evaluated in two age- and gender-matched asymptomatic and symptomatic groups (Contact Lens Discomfort Questionnaire scores ≤8 and ≥14, respectively). Clinical measurements took place during visit 1 (with contact lens in situ and after contact lens removal) and at baseline after a 2-week washout period (visit 2). The Ocular Surface Disease Index (OSDI) questionnaire, noninvasive tear breakup time, bulbar conjunctival hyperemia, and corneal staining were assessed. Thermal cooling rate was computed in the central and lower cornea during natural blinking (30 s) and sustained eye opening (10 s). Dry eye symptoms (OSDI score) were significantly higher in the symptomatic group during contact lens wear (p<0.001) and at baseline (p = 0.001). Thermal cooling rate was significantly higher in the symptomatic group in the lower cornea (10 s, p=0.013) with the contact lens in situ and in the central cornea (30 s, p=0.045) after contact lens removal. At baseline, dry eye symptoms (OSDI score) significantly correlated with cooling rate in the central cornea region for the symptomatic group (30 s: r = -0.5, p=0.03; 10 s: r = -0.63, p=0.005). Noninvasive tear breakup time correlated with cooling rate in the central cornea region at baseline in the symptomatic group (30 s, r = 0.6, p=0.005; 10 s, r = 0.55, p=0.018). Cooling rate in the central cornea region (10-s duration, p<0.0001) and noninvasive tear breakup time (p<0.0001) were identified as significant predictor variables for dry eye symptoms at baseline. Noninvasive tear breakup time and thermal cooling rate were identified as significant predictor variables for contact lens-induced dry eye. These findings may suggest the potential for the additional application of ocular thermography in the evaluation of contact lens discomfort.

Corneal hypersensitivity to cold stimuli in symptomatic computer users.

Prolonged computer use may result in repeated stimulation of the ocular surface due to ocular dryness, potentially leading to alterations in its sensitivity. This study aimed to evaluate the relationship between ocular symptoms and corneal sensitivity to cold and mechanical stimuli in computer users. Fifty-two young (31 ± 6 years), frequent computer users, including symptomatic and asymptomatic users, participated in this study. Mechanical and cold sensation thresholds were determined at the central cornea of one randomly selected eye of each participant using the UNSW Liquid Jet Aesthesiometer. Ocular surface symptoms and digital eye strain were assessed using the Ocular Surface Disease Index, Ocular Comfort Index, Instant Ocular Symptom Survey, and Computer Vision Syndrome Questionnaire (CVS-Q). Associations between central corneal sensation thresholds and demographic variables, patterns of digital device use, and symptom scores were analyzed using Pearson (r) or Spearman (ρ) correlations and linear regression models. Age (ρ = 0.24), CVS-Q score (ρ = -0.33), CVS-Q dry eye score (ρ = -0.28), and mechanical sensation threshold (ρ = 0.63) were significantly associated with cold sensation threshold (p≤0.04). Conversely, there were no significant relationships with Ocular Surface Disease Index, Ocular Comfort Index, or Instant Ocular Symptom Survey or with other demographic variables (p≥0.34). In multiple linear regression models, age and mechanical sensation threshold were significant predictors of cold sensitivity (p=0.04 and p<0.001, respectively) (adjusted R2 = 0.459). There were no significant correlations between mechanical sensitivity and symptom scores (p≥0.09). Symptoms of digital eye strain, particularly those related to dry eye, were associated with higher corneal cold sensitivity. Corneal hypersensitivity to cold stimuli as a marker of ocular discomfort during computer use requires further investigation.