Ocular Discomfort Research Articles

Efficacy and Safety of 1% Progesterone Gel to the Forehead for Ocular Chronic Graft-versus-Host Disease

There is no Food and Drug Administration-approved treatments for ocular chronic graft-versus-host disease (oGVHD) to date, and current therapeutic options are limited. Forehead application of 1% progesterone gel provides corneal antinociception in preclinical models, suggesting it may be useful in alleviating ocular irritations. This study was conducted to evaluate the efficacy and safety of 1% progesterone gel in treating moderate to severe symptomatic oGVHD. Thirty-three patients with oGVHD following allogeneic stem cell transplantation were enrolled in this single-center, sponsor-initiated, prospective exploratory randomized double-masked placebo-controlled phase II clinical trial. The inclusion criteria included a National Institutes of Health consensus score of ≥2, moderate to severe ocular discomfort level, and receipt of a stable immunosuppression regimen. Twenty-one of the 22 patients in the progesterone arm and all 11 patients in the placebo arm completed the course of twice-daily forehead drug application for 10 weeks. The changes from baseline of self-reported ocular symptom scores and physician-recorded cornea fluorescein staining scores were analyzed using mixed-model repeated-measures regression model in an intention-to-treat population. The 33 patients included 12 women and 21 men, with a median age of 66 years (range, 24 to 75 years). At 10 weeks, there was a significant reduction in ocular symptoms from baseline in the progesterone group compared with the placebo group in symptom frequency (-30.7 versus -2.2; P < .001) and severity (-19.8 versus +1.6; P=.005). At 10 weeks, there was also greater reduction of cornea fluorescein staining centrally (-1.2 versus +.1; P=.001) and inferiorly (-1.4 versus -0.2; P=.005). No difference was noted in superior cornea staining. There were no severe adverse events in the progesterone group. Foreheadapplicationof 1% progesterone gelsignificantlyimproved ocular signs and symptoms within 10 weeks. It appears to be a safe and effective new therapy for oGVHD, and a novel mechanism for neuroaxis drug delivery. A multicenter phase III clinical trial is planned for further validation.

Anti-demodectic effects of okra eyelid patch in Demodex blepharitis compared with tea tree oil.

Demodex infection gradually develops to Demodex blepharitis, which is characterized as chronic inflammation of the eyelid and meibomian gland (MG) and ultimately leads to MG dysfunction. In the present prospective study, the anti-demodectic effects of an okra eyelid patch in patients Demodex blepharitis were investigated. A total of 52 patients with Demodex blepharitis with ocular discomfort were recruited. Patients were randomized to receive either an okra eyelid patch treatment (treatment group, n=27) or tea tree oil (TTO) eye care patch treatment (control group, n=25) for three months. The Demodex count, the ocular surface disease index (OSDI) score, MG expressibility (MGE) and meibum quality, Schirmer I test (SIT), tear break-up time (TBUT) and corneal fluorescein staining (CFS) were determined prior to treatment and after 1 and 3 months of treatment. Changes in the parameters were compared between the treatment group and control group after 1 and 3 months of treatment. The average survival time in the okra group was 115.25±11.87 min, which was significantly lower compared with the average ST of 378.75±37.94 min in the blank group (P<0.01). After 3 months of okra eyelid patch treatment, the Demodex count was significantly reduced from 10.15±4.53 to 1.30±1.41 (P<0.01) and the OSDI score of the patients was reduced by 16.84±10.17 (P<0.01). There was no significant difference in the Demodex count (P=0.716) and OSDI (P=0.873) between the treatment and control groups. The rate of complete Demodex eradication in the treatment group (11/27, 40.74%) was slightly lower than that in the control group (12/25, 48%), but there was no significant difference between the two groups (χ2=0.277, P=0.598). Regarding the other ocular parameters, no significant difference was observed in the TBUT, meibum quality and MGE between the two groups (P<0.05). TTO group has a significantly improvement compared with Okra group in terms of SIT (P=0.035) and CFS (P=0.023). In conclusion, okra eyelid patch treatment is able to significantly eradicate ocular Demodex as well as markedly alleviate ocular symptoms. Due to causing less irritation than TTO, the okra eyelid patch may be more suitable for sensitive patients with Demodex blepharitis, such as the elderly and children. The study was registered as a clinical trial in the Chinese Clinical Trial Registry (ChiCTR) in November 2018 (registration no. ChiCTR-1,800,019,466).

Evidence of Polyphenols Efficacy against Dry Eye Disease.

Dry eye disease is a multifactorial pathology compromising the quality of life of patients, resulting in significant damage of the ocular surface and discomfort. The current therapeutical strategies are not able to definitively resolve the underlying causes and stop the symptoms. Polyphenols are promising natural molecules that are receiving increasing attention for their activity/effects in counteracting the main pathologic mechanisms of dry eye disease and reducing its symptoms. In the present review, a deep literature search focusing on the main polyphenols tested against dry eye disease was conducted, analyzing related in vitro, in vivo, and clinical studies to provide a comprehensive and current review on the state of the art. Polyphenols present multiple effects against dry eye diseases-related ocular surface injury. In particular, the observed beneficial effects of polyphenols on corneal cells are the reduction of the pathological processes of inflammation, oxidative stress, and apoptosis and modulation of the tear film. Due to numerous studies reporting that polyphenols are effective and safe for treating the pathological mechanisms of this ocular surface disease, we believe that future studies should confirm and extend the evidence of polyphenols efficacy in clinical practice against dry eye disease and help to develop new ophthalmic drug(s).

Self-reported symptoms of mask-associated dry eye: A survey study of 3,605 people

PurposeDuring the COVID-19 pandemic, the widespread use of face masks was recommended as a key measure against the spread of SARS-CoV-2. A marked increase in dry eye symptoms among regular mask users was reported, but the prevalence of this condition has not been described in the literature yet. The aim of this observational, descriptive, and cross-sectional study was to measure self-reported symptoms of mask-associated dry eye in the general population and to identify factors influencing this condition. MethodsAn anonymous online survey was distributed using Google Forms through different social media platforms. ResultsA total of 3,605 surveys were analysed. Of the 2,447 having symptoms, 658 (26.9 %) participants reported their symptoms were exacerbated when wearing a mask, thus 18.3 % of all participants experienced mask-associated dry eye. There was no significant association between perceived mask-associated dry eye and age, refractive correction, and pre-existing ocular discomfort, while a positive association was observed with female sex and retail work. ConclusionsAlthough the results of this survey showed that most people reported no change in ocular symptoms while wearing a face mask, a significant proportion reported an increase in ocular discomfort when wearing a face mask. As face masks are necessary to slow down the spread of COVID-19, it is important not to underestimate all symptoms that could discourage the population from using them. Eye care professionals should verify the presence of clinical signs in all patients complaining about mask-induced eye discomfort, and suggest methods to mitigate this condition.

A cross-sectional study of ocular surface discomfort and corneal nerve dysfunction after paclitaxel treatment for cancer

Ocular surface dysfunction is common in patients receiving anti-cancer drug treatment. The effects of paclitaxel, a neurotoxic chemotherapeutic drug, on ocular surface discomfort associated with dry eye disease was investigated. Patients with cancer who had completed paclitaxel treatment between 3 and 24 months prior to assessment (n = 29) and age- and sex-matched healthy control subjects (n = 29) were recruited and assessed with the Ocular Surface Disease Index (OSDI) to measure ocular surface discomfort. In-vivo corneal confocal microscopy was used to evaluate corneal nerve parameters in the right eye. Peripheral neurotoxicity was assessed using patient-reported outcomes and clinical grading scales. The paclitaxel group had significantly worse OSDI total scores compared with controls (Median, Md = 19.3 and Md = 0, p = 0.007, respectively). Corneal nerve fiber and inferior whorl lengths were reduced in the paclitaxel group compared with controls (14.2 ± 4.0 and 14.4 ± 4.0 mm/mm2 vs. 16.4 ± 4.0 and 16.9 ± 4.9 mm/mm2, respectively, p = 0.04). When analyzed by presence of peripheral neuropathy, paclitaxel-treated patients with neuropathy showed worse OSDI total scores compared to those without peripheral neuropathy post-treatment (p = 0.001) and healthy controls (p < 0.001). More severe ocular discomfort and worse visual function was associated with greater peripheral neurotoxicity symptoms (r = 0.60, p = 0.001) and neuropathy severity (r = 0.49, p = 0.008), respectively. Patients who have been treated with paclitaxel have a higher risk of ocular surface discomfort associated with dry eye disease, particularly those with peripheral neuropathy. Future longitudinal studies should investigate the clinical impact of corneal nerve reduction in dry eye disease.

A comparison of accommodation and ocular discomfort change according to display size of smart devices

BackgroundTo evaluate the change of accommodation and ocular discomfort according to the display size, using quantitative measurements of accommodation and ocular discomfort through subjective and objective metrics.MethodsForty six subjects without any ophthalmic disease history were asked to watch the documentary movie, using two different sizes of smart devices; smartphones and tablets. Before and after using devices, the near point accommodation (NPA) and the near point convergence (NPC) were measured, and objective accommodation was measured using an auto refractometer/keratometer. The subjective ocular discomfort was assessed through a survey.ResultsBoth devices showed a decrease in post-use NPA and NPC, and the change after use of the smartphone was significantly severe, 1.8 and 2.5 folds respectively, compared to tablet (p = 0.044, p = 0.033, respectively). Neither smartphone nor tablet showed significant changes in the accommodative response induced by dynamic accommodative stimulus of auto refractometer/keratometer (p = 0.240 and p = 0.199, respectively). Subjects showed a more severe increase in ocular discomfort after using smartphones (p = 0.035) and reported feeling tired even with shorter use times (p = 0.012).ConclusionsBoth devices showed significant decreases in NPA and NPC, and the larger changes were seen when using the small display smartphone. Even within 20minutes of using, subjects start to feel ocular discomfort, and it was more severe and faster after smartphones than tablets. Therefore, the smaller the display size, the greater the adverse impact on eyes, and thus, appropriate display size will need to be selected depending on the time and purpose of use.

Investigating the Synergistic Interactions of Surface Immobilized and Free Natural Ocular Lubricants for Contact Lens Applications: A Comparative Study between Hyaluronic Acid and Proteoglycan 4 (Lubricin).

The main reasons for the discontinuation of contact lens wear are ocular dryness and discomfort. Proteoglycan 4 (PRG4), a mucinous glycoprotein, and hyaluronic acid (HA), a nonsulfated linear glycosaminoglycan, are naturally present in the eye and contribute to ocular hydration and lubrication. This study aimed to investigate the impact of the structure of the recombinant human PRG4 (rhPRG4)/HA complex on contact lens properties, when one agent is grafted and the counterpart is physisorbed on the surface of model conventional or silicone contact lens materials. Investigation of the wettability, water retention, antifouling, and boundary lubricant properties of the prepared hydrogels showed that the rhPRG4/HA interactions varied with the rhPRG/HA configuration on the hydrogel surface as well as the composition of the underlying substrate used. The rhPRG4-physisorbed/HA-grafted sample was characterized by better antifouling and boundary lubricant properties on the model conventional hydrogels, while the HA-physisorbed/rhPRG4-grafted sample exhibited improved surface wettability, antifouling, and water-retentive properties on the model silicone hydrogels. The results of this study contribute to the design of biomimetic contact lens surfaces that work synergistically with ocular fluid-phase biological agents to enhance compatibility between the contact lens and the ocular environment, alleviating dry eye symptoms and improving comfort.

Detection of SARS-CoV-2 in the ocular surface in different phases of COVID-19 patients in Shanghai, China.

BackgroundTo investigate the temporal pattern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presence on ocular surfaces using conjunctival swabs in coronavirus disease 2019 (COVID-19) patients.MethodsThis study included 59 patients (32 newly admitted and 27 hospitalized for ≥2 weeks) with a COVID-19-confirmed diagnosis at the Shanghai Public Health Clinical Center from March 3, 2020, to March 21, 2020. Conjunctival swab samples were collected from both eyes of all the 59 patients and were tested by reverse transcription polymerase chain reaction (RT-PCR) assay. The range of sampling time lies widely between 1 and 50 days since symptom onset.ResultsAmong the 32 newly admitted patients, positive RT-PCR results for SARS-CoV-2 in conjunctival swab samples were reported in 2 patients (one eye for each) without ocular discomfort, but 1 positive case had conjunctival congestion. The positive results were detected on Day 5 for 1 patient and Day 7 for the other, but repeated tests after 1 week were negative for both patients. All 27 patients who had been hospitalized for ≥2 weeks had negative test results. The mean time from symptom onset to sampling of 2 positive cases was significantly less than that of 57 negative cases (P<0.001).ConclusionsSARS-CoV-2 on the ocular surface can be detected in the early phase of COVID-19. The risk of ocular transmission remains and might be higher in the early phase.

An Overview on Dry Eye Disease Evaluation and Management Approach in Primary Health Care Centre

Dry eye disease (DED) was previously characterized as a tear film disease caused by tear deficit or extreme evaporation, caused injury to the inter-palpebral ocular surface and ocular discomfort. Due to ocular discomfort, difficulties completing everyday tasks, and depression, patients with moderate-to-severe DED may have a worse quality of life. DED is a rapidly developing health concern with an increasing global prevalence. Therefore, the physician needs to acquire adequate knowledge about thi

Impact of Acceleration on Human Visual Acuity and Stereopsis

Purpose: To assess the impact of horizontal acceleration on human visual acuity and stereopsis. Methods: The written consent of 60 subjects (36 females and 24 males) aged between 18-24 years was taken after proper explanations. History taking followed by VA measurement, refraction, slit lamp examination, Ophthalmoscopy was performed to rule out the exclusion criteria. Measurements of near visual acuity and stereopsis was done in 3 speeds, slow, moderate and high speed of tread mill for all subjects. Static and dynamic VA measurements was noted. Dynamic VA was measured in tread mill with examiner holding the VA chart. After completing the near visual acuity examination, participant was subjected to stereopsis test using the stereo-test circles with both eyes. Duration of each test was noted. Results: The ANNOVA test analysis revealed no significant difference in visual acuity and stereopsis measured in slow and moderate speed in comparison with static visual acuity and stereopsis (p>0.05). However, a highly significant difference was found in visual acuity and stereopsis measured during high speed (p<0.01). Also, it was observed that time taken to read visual acuity and stereopsis chart increased with increasing speed (p<0.01). It was also found that majority of subjects experienced different level of dizziness, headache, ocular discomfort during acceleration. Conclusion: High acceleration had a highly significant effect on visual acuity and stereopsis.

A hybrid ocular delivery system of cyclosporine-A comprising nanomicelle-laden polymeric inserts with improved efficacy and tolerability.

We report on hybrid nanomicelle-polymer inserts for improved delivery of cyclosporine A (CyA) to the surface of the eye. Hybrid inserts containing a nanomicellar formulation were prepared by the solvent casting method; their characteristics, in vitro release of CyA, eye irritation potential, nanomicelle distribution inside the insert, and in vivo pharmacokinetics of the most promising solid formulation (F3) were investigated. Nanomicelles capable of accommodating a therapeutically relevant amount of CyA (57.22 ± 5.90-68.52 ± 1.4 μg) were incorporated into five different polymeric formulations (F1-F5). The developed inserts displayed promising characteristics (size, weight, surface pH, and contact angle) that fulfill ocular tolerability requirements. Considering the technological properties and CyA in vitro release, F3 and F5 were the most promising formulations. SEM analysis suggested the F3 formulation as the potential prototype for CyA ocular delivery. The F3 formulation (CyA: 60.08 ± 2.85 μg) did not induce conjunctival irritation when HET-CAM assay was performed and was hence considered suitable for further study in a rabbit eye. The AUC value for CyA loaded in the F3 insert was about 2-fold greater than that obtained with the Ikervis® used as a control formulation. F3 produced a significant reduction (of about 7-folds) in the rate of CyA elimination from the tear fluid relative to Ikervis® and about 4-fold greater reduction than Nano-CyA (p = 0.0187). The ability of F3 to delay the elimination of the drug from the precorneal area is particularly desirable when treating dry eye syndrome. Furthermore, F3 did not induce ocular discomfort, a typical characteristic of solid ocular inserts, including commercially available ones.

Commentary: Impact of COVID-19 on ocular surface health

Commentary: Impact of COVID-19 on ocular surface health

Crossover randomized study comparing the efficacy and tolerability of preservative-free Tafluprost 0.0015% to Latanoprost 0.005% in patients with primary open-angle glaucoma.

Purpose:To compare the efficacy and the tolerability of preservative-free Tafluprost 0.0015% (TP) vs Latanoprost 0.005% (LP) in patients with primary open-angle glaucoma (POAG).Methods:Prospective, randomized, crossover study included patients with early POAG attending the outpatient clinic from July 2019 to February 2020. Patients were divided into 2 groups: group A included patients receiving TP and group B receiving LP. After 2 months, treatment was stopped for 1 month (washout period) then drops were switched between the groups for further 2 months. Intraocular pressure (IOP) was recorded at baseline and monthly until 5 months. Efficacy was measured by the IOP reduction at the end of each treatment period. Tolerability was assessed both subjectively (questionnaire on ocular comfort) and objectively (ocular findings) at the end of each period.Results:A total of 30 patients were allocated into two groups (15 patients each). There was no statistically significant difference between the 2 groups in baseline clinical examinations. All the eyes in both groups achieved IOP reduction >20% compared to baseline values, with no statistically significant difference in between. Corneal erosions and conjunctival hyperemia were significantly higher in LP-treated eyes throughout the study, regardless of the sequence. Tear break-up time scores significantly worsened after LP at the 2nd and 5th month (P < 0.001and P = 0.026 respectively) but not after TP treatment (P = 0.719 and P = 0.164). Significant exacerbation in all patients’ symptoms was noticed on switching from TP to LP.Conclusion:Tafluprost was proved to exhibit a comparable effect on IOP control in POAG patients, as Latanoprost drops resulted in marked alleviation in both subjective and objective ocular discomfort manifestations.

Comparison of ocular discomfort after three different epithelial debridement techniques for corneal collagen cross-linking in keratoconus treatment.

Purpose:To compare the severity and duration of ocular discomfort after three different epithelial debridement techniques for corneal collagen cross-linking in the treatment of keratoconus.Methods:Fifty-five patients (65 eyes) known to have keratoconus were enrolled in this retrospective study. The eyes were divided into three groups based on the technique used for epithelial debridement for corneal collagen cross-linking procedure; excimer laser transepithelial phototherapeutic keratectomy was used in group 1 (18 eyes), alcohol-assisted epithelial removal was used in group 2 (27 eyes), and mechanical epithelial debridement was used in group 3 (20 eyes). Preoperative and postoperative (third month) best-corrected visual acuity (BCVA) using Snellen chart, objective refraction, and keratometry results were recorded. The results of the questionnaire obtained from the patient’s medical records were reviewed regarding their subjective evaluation of postoperative symptoms including foreign body sensation, tearing, photophobia, and burning at the end of the first postoperative week. Paired-samples t test was used to compare preoperative and postoperative clinical findings. One-way analysis of variance (ANOVA) was used to analyze the differences between three independent groups.Results:BCVA improved from 0.51 ± 0.27 to 0.58 ± 0.21 (p = 0.05). Objective mean spherical and cylindrical refraction decreased from −5.08 ± 2.78D to −4.46 ± 2.91D (p = 0.22) and from −3.45 ± 2.73D to −3.03 ± 1.97D (p = 0.25). Mean maximum keratometry reading (Kmax) decreased from 57.63 ± 4.73D to 56.13 ± 4.47D (p = 0.001). The mean score for foreign body sensation was the highest in group 3 (4.50 ± 0.53) and the lowest in group 1 (2.10 ± 1.85) (p = 0.01). The mean scores for tearing, photophobia, and burning sensation were comparable in three groups (p = 0.84, p = 0.13, and p = 0.61, respectively). The duration of photophobia was the shortest in group 1 (1.50 ± 2.37 days), followed by group 3 (2.00 ± 1.31 days) and group 2 (4.00 ± 1.83 days) (p = 0.04).Conclusions:The severity and duration of adverse subjective symptoms during the first postoperative week after corneal collagen cross-linking appear to be milder with epithelial debridement using excimer laser transepithelial technique compared with -assisted debridement and mechanical debridement.

Ocular Problems among Video Display Terminal Users in a Software Company of Sector V, Kolkata

Background: Video Display Unit use and Information Technology creates a host of problems like Ocular Problems and Work Related Musculo Skeletal Problems. Many experience visual symptoms including eyestrain, headaches, ocular discomfort, dry eye, diplopia and blurred vision either at near or when looking into the distance after prolonged computer use. Very few and sporadic studies have been done in this part of the world especially in India, to address the issue in all its scope. Aim &amp; Objective: To find out the proportion of different ocular problems among the study population and to find out the association of their ocular problems with the socio-demographic, work related and ergonomic factors. Materials and methods: It was an institution based, cross sectional, analytical epidemiological study and was conducted over one-year period. The study population comprised of persons working with Video Display Terminals. A predesigned, semi-structured instrument for elaborating the socio-economic, lifestyle related and a few job-related health behaviors were used. Combination of few instruments to elicit different morbidities like and many ergonomic checklists to evaluate office workspace were also used. Results: Of the total 79.1 % had any kind of ocular problems currently, with around 65% of them reporting to be having problem constantly in the last 12 months. Headache (63.6%) seemed to be the most important problem, followed by Eye fatigue (52.4%). Repetition of work and poor ergonomic practices turned out to be the statistically significant factors. Increased Years of working and female sex were also found to be important factors. Screen Character was found to be the most important risk factor of eye problems. Conclusion: A simple model was proposed where interaction of Individual factors and factors related to workstation was identified as the main culprit, which exaggerated by the repetition of work.

Frontal bone fracture- A case report

Frontal bone fractures are rare as it is well protected due to prominence of the nasal pyramid and may present with facial deformity and compromised asthetics. It occurs with high impact maxillo facial trauma, maybe associated with ocular discomfort. A three dimensional computed tomography scan may be useful in diagnosing the case and treatment planning. While treating the frontal sinus fracture, patency of the fronto nasal duct is important to avoid formation of mucocele as a late complication. Keywords: Frontal bone fractures, Supra orbital fractures, Frontal sinus fractures, Three dimensional imaging.

The association of comfort and vision in soft toric contact lens wear

PurposeThis work set out to investigate if there was an association between subjective comfort and both subjective and measured vision during the use of contemporary daily disposable soft toric contact lenses. MethodsThirty-eight habitual soft contact lens wearers wore each of three daily disposable toric lenses for one week in a prospective, crossover, randomised, single-masked study. The following clinical measures were recorded at dispensing and follow-up visits: biomicroscopy scores, lens fitting (including rotation and rotational stability), high and low contrast visual acuity, subjective vision quality and subjective ocular surface comfort. Subjective scores were collected using 0–10 numerical grading scales. Comfort scores were analysed using a linear regression model with age, sex, visit, phase of crossover (‘phase’), lens type, lens rotation, lens rotational stability, visual acuity, cylinder power and subjective vision quality as factors of interest and then refined using backward stepwise regression. ResultsThirty six participants (31.1 ± 13.5 years) completed the study. Comfort scores were found to be associated with subjective vision quality (F = 127.0 ; p < 0.0001), phase (F = 7.2; p = 0.001) and lens type (F = 4.9; p = 0.009). Greater comfort scores were observed with greater subjective vision quality scores. Visual acuity was not statistically significant in the model. ConclusionThis work suggests that symptoms of ocular discomfort may be more intense if there is also perceived visual compromise in daily disposable soft toric lenses. There was a stronger positive correlation between comfort and subjective vision quality compared with comfort and measured visual acuity.

Intense Pulse Light for Treating Post-LASIK Refractory Dry Eye.

Objective: Optimal pulse technology-intense pulse light (OPT-IPL) treatment on patients with post-LASIK refractory dry eye (DE). Background: The prevalence of dry eye disease is common and can lead to ocular discomfort, reduced visual acuity, lowered quality of vision and life. Materials and methods: A prospective study was conducted on 72 eyes of 36 patients (treatment group, n = 42 eyes; control group, n = 30 eyes) who had previously undergone myopic LASIK correction with subsequent refractory DE. All eyes fulfilled the Japanese DE criteria and had not responded to conventional DE treatment. The treatment group underwent two OPT-IPL treatment sessions at 2-week intervals, while the control group received no treatment. Best-corrected visual acuity (BCVA), ocular surface disease index (OSDI), noninvasive breakup time (NITBUT), tear film lipid layer (TFLL) quality, corneal fluorescein staining, meibum gland (MG), endothelial cell count (ECC), and intraocular pressure (IOP) were assessed at baseline (D0), day-14 (D14) and day-28 (D28) after OPT-IPL treatment. Results: The mean age of treatment group and control group was 30.48 ± 5.16 years (12 females, 57%) and 31.00 ± 4.33 years (8 females, 53%), respectively. Treatment group had clinically and statistically significant improvement in NITBUT and was observed at D14 (p < 0.001) and D28 (p < 0.001). OSDI, TFLL score, and MG quality and expressibility improved significantly (p < 0.05) at D28, whereas BCVA, ECC, and IOP showed no significant changes at D14 and D28 between the groups. Conclusions: Our results suggest that post-LASIK refractory DE is safely treated with OPT-IPL treatment. OPT-IPL treatment reduced the severity of symptoms and improved the overall tear film stability in patients with severe refractory DE post-LASIK surgery. In addition, the frequency of artificial tears usage was significantly less and can be attributed to the reduction in OSDI scores due to improved TFLL and tear film stability.

Defining Dry Eye from a Clinical Perspective.

Over the past decades, the number of patients with dry eye disease (DED) has increased dramatically. The incidence of DED is higher in Asia than in Europe and North America, suggesting the involvement of cultural or racial factors in DED etiology. Although many definitions of DED have been used, discrepancies exist between the various definitions of dry eye disease (DED) used across the globe. This article presents a clinical consensus on the definition of DED, as formulated in four meetings with global DED experts. The proposed new definition is as follows: “Dry eye is a multifactorial disease characterized by a persistently unstable and/or deficient tear film (TF) causing discomfort and/or visual impairment, accompanied by variable degrees of ocular surface epitheliopathy, inflammation and neurosensory abnormalities.” The key criteria for the diagnosis of DED are unstable TF, inflammation, ocular discomfort and visual impairment. This definition also recommends the assessment of ocular surface epitheliopathy and neurosensory abnormalities in each patient with suspected DED. It is easily applicable in clinical practice and should help practitioners diagnose DED consistently. This consensus definition of DED should also help to guide research and clinical trials that, to date, have been hampered by the lack of an established surrogate endpoint.

Ocular Features in a Large Cohort of Indians With Xeroderma Pigmentosum.

Xeroderma pigmentosum (XP) is an extreme hypersensitivity to sunlight causing skin freckling and pigmentary changes because of defective DNA repair mechanisms. The purpose of this article is to evaluate the spectrum of ocular and systemic features in XP at a tertiary eye care center in India over 32 years. Data from 418 eyes of 209 patients diagnosed with XP from 1987 to 2018 were reviewed retrospectively for demographics, complaints, ocular features, systemic associations, and their management. Median age at diagnosis was 2 years (interquartile range, 0.5-5 years). A total of 124 patients (59.3%) were men. There was parental consanguinity in 74.4% cases. Common ocular complaints were photophobia (47.1%), ocular discomfort (45%), defective vision (36.6%), redness (13.4%), tissue growth (12%), white spot (11.2%), and pain (10.5%). At presentation, 43.5% had corneal scars (45.5% were located inferiorly and 70.9% covered visual axis). Corneal vascularization and limbal stem cell deficiency were noted in 37.4%. A total of 56% of patients had at least 1 tumor, and 6.7% had neurological abnormalities. At least 1 ocular surgery was performed in 37.8% of patients. Ophthalmic surgical interventions included tumor excision (23%), keratoplasty (13.4%), and nontumor ocular surface surgery (3.4%). XP is a disorder that has high ocular morbidity in Indian patients. The recognition of common signs and symptoms and relative frequency of various ocular complications with time trends will help in managing and reducing the sequelae of this otherwise untreatable and progressive disease.