Ocular Protection Index Research Articles

Meibomian gland dysfunction in people who have been in the refuge for a long time during the hostilities in Ukraine

Aims/Purpose: To study the indicators of the eye surface in people who have been in the refuge for a long time during the hostilities in Ukraine.Methods: We recruited 58 patients (main group) aged 32–75 years, who have been in the basement or underground from 3 to 5 month during the hostilities in Ukraine. The control group – 42 patients, aged – 32–72 years, who have been in their houses or flats. Each patients underwent additional examination: the Schirmer's test, the Norn's test, determination of the ocular protection index (OPI), contact meibography (Pult et al., 2012), compression test for evaluation of excretory capacity (Korb, 2005) and quality of the secretion (The International Workshop on Meibomian Gland Dysfunction, 2011) of meibomian gland, and Ocular Surface Disease Index Questionnaire (OSDI). The International Workshop's Classification of Meibomian Gland Dysfunction, 2011 was used to evaluate the severity of MGD.Results: In 75.8% patients of the main group Schirmer test was 4.8 ± 0.7 mm, Norn test was 4.1 ± 0.8 s, OPI test was 0.54 ± 0.8, test for evaluation of excretory capacity and quality of the secretion of meibomian glands was 2 stage, the mean of OSDI was 56.6 ± 3.4 (p < 0.05). In 71.4% patients of the control group Schirmer test was 14.1 ± 1.6 mm, Norn test was 9.7 ± 0.8 s, OPI test was 0.69 ± 0.1, test for evaluation of excretory capacity and quality of the secretion of meibomian glands was 1 stage, the mean of OSDI was 11.2 ± 1.7 (p < 0.05).Conclusions: Our findings suggest that 75.8% of all patients who have been in the refuge from 3 to 5 month, have significant changes in the indicators of the eye surface, which corresponds to Meibomian Gland Dysfunction stage 3 and 4 (p < 0.05). 71.4% patients of the control group who have been in their houses or flats have changes in the indicators of the eye surface, which corresponds to Meibomian Gland Dysfunction stage 1 and 2 (p < 0.05). Long stays in the refuge caused significant changes in the surface of the eye, which required treatment for 75.8% of all patients (p < 0.001, respectively).

Non-invasive assessment of the tear film after LASIK.

The aim of the study was to compare the assessment of the ocular surface using classic methods with the newly developed keratoscopy-based MYAH (Topcon EU, Visia Imaging, Japan) device after femtosecond laser-assisted in situ keratomileusis (LASIK). This cross-sectional and observational study analyzed 80 eyes of 40 patients. Tear film and ocular surface evaluation were performed at baseline, postoperative week 1, and month 1. Measurements obtained using the Schirmer I test and invasive tear-film breakup time (I-TBT) were compared with non-invasive evaluation of the tear break-up time (NI-TBT), tear meniscus height (TMH) and blink analysis obtained using the MYAH device. Findings were correlated with the Ocular Surface Disease Index (OSDI) questionnaire in all subjects. The study included 80 eyes of 40 consecutive patients (21 males and 19 females) with a mean age of 26.6 ± 5.9 years (18-40 years) and a mean spherical equivalent value of -3.64 D (-9.63 to -0.25 D). There was a significant decrease in Schirmer I test (19.21 ± 8.4 vs. 16.61 ± 9.1 vs. 14.69 ± 9.86, p= 0.02, respectively) and I-TBT values (8.59 ± 3.4 vs. 7.4 ± 3.25 vs. 6.17 ± 3.01, p=0.03 respectively). OSDI values showed a significant increase after LASIK (11.56 ± 6.3 vs. 17.24 ± 7.5 vs. 14.71 ± 9.6, p=0.03, respectively). 5% level NI-TBT was significantly lower at 1 week 6.75 and 1 month 7.45 than baseline 13.2 at follow-up (p=0.037). Ocular protection index (6.6 vs. 2.3 vs. 2.6, p=0.009, respectively) and blink/minutes (18 vs. 17 vs. 15, p=0.002, respectively) values showed a statistically significant decrease. Our data detected a weak correlation between I-TBT and noninvasive first TBT, 5% level TBT parameters at month 1 follow-up. This study also found no correlation between contact lens use, older age, female gender, and pre-operative refractive error with the noninvasive MYAH dry eye parameters. This study demonstrated the ability of the new keratoscopy-based MYAH device to detect changes in the short term after LASIK surgery.

PREVALENCE OF MEIBOMIAN GLAND DYSFUNCTION IN PATIENTS UNDERGOING CATARACT SURGERY IN A TERTIARY CARE CENTER IN BARABANKI

Introduction- Modern cataract surgery despite having favourable outcome in most of the aspects, comes with an unavoidable complication i.e. dry eye. Dry eye syndrome is an ocular surface disease either due to lacrimal undersecretion or overevaporation. Obstructive meibomian gland dysfunction (MGD) is the most common cause of evaporative dry eye disease, characterized by stagnation of meibomian gland lipids with or without qualitative/quantitative changes in meibum. Hyposecretion of lipids may result in tear lm instability, ocular irritation, and ultimately ocular surface disease. To study the prevalence of meibomian gland dysfunction in pa Aim: tients undergoing cataract surgery in A Tertiary Care Center in Barabanki. The present study was Cross sectional and was conducted from Materials and method: September 2021 to November 2022. It included 130 patients presented to ophthalmology department with the chief complaint of diminution of vision and was evaluated thoroughly under slit lamp for cataract and MGD and underwent a series of tests like Schirmer's Test, TFBUT, Ocular Protection index, MGD grading and DEQS. After examining 130 patients with varying cataract status, MGD (Dry Result: eye) was found to have a prevalence of 49.2% (59 out of 120). The mean age of the study participants was 57.54 (7.67) years. Among the patients, 30 (25.0%) were of aged 40-50 years, 45 (37.5%) were aged 51- 60 years, 43 (35.8%) were aged 61-70 years and rest 2 (1.7%) were of aged more than 70 years. Among the study participants, 65 (54.2%) were males and 55 (45.8%) were females. Addressing MGD and DED before cataract sur Conclusion: gery is important to achieving the best visual outcomes.To achieve optimum patient compliance and quality of life post-operatively, screening for dry eye should be made part of the protocol for pre-operative evaluations

Safety and Performance of an Artificial Tear Containing Arabinogalactan, Trehalose and Hyaluronic Acid in the Treatment of Dry Eye in Subjects with Signs of Inflammation of the Ocular Surface

Background: In this study it has been evaluated the safety and the clinical performance of a new combination of topical solution based on arabinogalactan, trehalose and hyaluronic acid, in reducing symptoms and signs of inflammation in a selected population affected by dry eye disease. Methods: The study enrolled 25 patients (ranging from 57 to 71 years) with signs and symptoms of dry eye disease. They received a combination therapy with arabinogalactan, trehalose and hyaluronic acid one drop three times a day for the first week and subsequently according to their symptoms. Ocular surface disease index score, tolerability and adherence were used to evaluate subjective symptoms of dry eye disease at enrolment (T0), week 1 (T1) and week 4 (T2). Clinical signs were assessed at T0 and T2. The assessment plan included: slit-lamp examination of the anterior segment, uncorrected and corrected visual acuity, ocular protection index, tear film break up time, osmolarity, meniscometry, evaluation of conjunctival hyperemia according to Efron’s classification, the presence of MMP-9, conjunctival and corneal staining and intraocular pressure. Results: The study group showed significant improvement in several clinical parameters after treatment. Ocular surface disease index score was significantly lower at the end of the follow up period, also evaluation of tolerability (ocular burning, ocular itching and blurred vision), before and after instillation, showed a statistically significant improvement at T0 and T1. Improvements in tear film break up time, meniscometry results and conjunctival and corneal hyperemia were statistically significant in the study group (p <0.05). A statistically significant, decrease in MMP-9 levels was also observed. Conclusions: Preliminary findings suggest that the new combination of topical solution based on arabinogalactan, trehalose and hyaluronic acid, could be effective in reducing early inflammatory markers, symptoms and signs, associated with the progression of dry eye disease.

Early ocular surface and tear film status in congenital aniridia indicates a supportive treatment window

AimTo evaluate changes in the ocular surface and tear film with age and mutational status in congenital aniridia.Methods45 participants with congenital aniridia (89 eyes) in a prospective, cross-sectional study. Whole-exome...

Video display terminal use and other risk factors for abnormal blinking in children: gender differences

ObjectiveTo explore the risk factors for abnormal blinking in children and compare these between boys and girls.MethodsChildren attending the Children's Optometry Clinic between June 2019 and June 2020 were recruited for the study. The time they had spent viewing video displays (VDTt) over the past 6 months was recorded. Incomplete blinking (IB) and blinking rate were measured and all participants were allocated to groups based on their blink rate (<20 times/min = normal blinking group, NBG; ≥20 times/min = abnormal blinking group, ABG). Tear film (TF) stability was also evaluated. The corresponding statistical methods are used to analyze the data.ResultsA total of 87 boys and 80 girls were enrolled in the study. No significant difference in age was found between the 2 groups. There was a significant difference in TF stability between the two groups (P<0.05). According to binary logistic analysis, VDTt and ocular protection index (OPI) are important risk factors for abnormal blinking, with cut-off values of 1.75 hours and 1.014 respectively in boys; and 1.25 hours and 1.770 respectively in girls. The average of lipid layer thickness was an important protective factor for children using VDT for long periods, with a cut-off value of 58.5 nm in boys and 53.5nm in girls.ConclusionRisk factors for abnormal blinking in both boys and girls include VDTt and OPI.

Dry eye, its clinical subtypes and associated factors in healthy pregnancy: A cross-sectional study.

The study determined the frequency of dry eye, its clinical subtypes and risk factors among pregnant women. This study was a hospital-based cross-sectional study of pregnant women visiting the antenatal clinic of the University of Cape Coast hospital. Clinical dry eye tests were performed along with the administration of a symptom questionnaire. Frequencies, chi-square analysis and logistic regression analyses were conducted to determine the frequency of dry eye disease, its clinical subtypes and associated factors. The prevalence of dry eye disease among the cohort of pregnant women was 82/201 (40.8% 95% confidence interval 34.3%-47.3%). Among the 82 pregnant women with dry eye disease, the frequencies of the clinical subtypes of dry eye were: evaporative dry eye [15/82(18.3%; 95% CI, 12.2%–25.2%)], aqueous deficient dry eye [10/82(12.2.%; 95% CI, 7.3%–18.3)], mixed dry eye [6/82(7.3%; 95% CI, 3.7%–11.0%)], and unclassified dry eye [51/82(62.2%; 95% CI, 52.4%–72.0%)]. Binary logistic regression analysis showed that the following factors were not significantly associated with dry eye: age, BMI, lipid profile, prolactin level, testosterone level, ocular protection index and blink rate. Only gestational age was significantly associated with dry eye disease in pregnancy. In conclusion, the current study showed that dry eye disease occurs frequently in pregnant women ranging from the first to the third trimester and it is associated with increasing gestational age. The evaporative dry eye was more common compared to the aqueous deficient dry eye, but most dry eye could not be classified.

Tear Film Break-Up Time and Dry Eye Disease Severity in a Large Norwegian Cohort.

This study evaluated to what extent tear film break-up time (TFBUT) could discriminate pathological scores for other clinical tests and explore the associations between them. Dry eye patients (n = 2094) were examined for ocular surface disease index (OSDI), tear film osmolarity (Osm), TFBUT, blink interval, ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test, meibomian expressibility, meibomian quality, and meibomian gland dysfunction. The results were grouped into eight levels of break-up time (≤2, ≥3, ≤5, ≥6, ≤10, ≥11, ≤15, and ≥16) with or without sex stratification. Receiver-operating characteristic curve (ROC) analysis and Pearson’s correlation coefficients were used to study TFBUT’s discriminative power and the associations among the tests, respectively. Above and below each TFBUT’s cut-off, all of the parameters indicated significant difference between groups, except OSDI (cut-off 15 s) and Osm (cut-offs 5 s–15 s). At TFBUT cut-off of 2 s, sex difference could be detected for OSDI, Osm, and OSS. OPI presented the strongest discriminative power and association with TFBUT in sharp contrast to Osm, holding the poorest discriminative power with no significant correlation. The remaining parameters were within the poor to very poor categories, both with regard to discrimination and correlation. In conclusion, patients with lower TFBUT presented with more severe DED parameters at all four defined cut-off values.

Efficacy of Cathionic Emulsion and Carboxymethyl-Cellulose 0,5% for Dry Eye Treatment in Post Menopausal Women

Purpose : To evaluate the efficacy and safety of cationic emulsion and Carboxymethyl-Cellulose (CMC) 0,5% eye drops in post-menopausal women with dry eyeMethods : A randomized, double-masked clinical trial was conducted in polyclinic Ophthalmology Department during March-April 2009. Forty-six post menopausal women with dry eye were included in the study. The subjects were randomized into two groups. Group 1 received cationic emulsion and group 2 received CMC 0,5%. Tear Film Break-Up Time (TFBUT), Inter-Blink Interval (IBI) and Ocular Protection Index (OPI) were evaluated before treatment, day 1, 7 and 14 after treatment. The dry eye symptom severity score was evaluated before treatment, day 7 and 14 after treatment with Ocular Surface Disease Index (OSDI) questionnaire Results : The cationic emulsion had significantly better OPI score and TFBUT value on day 1, 7 and 14 compared to CMC 0,5% group (p&lt;0,001). There were no significant differences between groups on IBI value between groups on day 7 and 14 (p&gt;0,05). The severity symptom score on cationic emulsion group was significantly lower compared to CMC 0,5% on day 14 (p&lt;0,001). The subjective complaints after using both eye drops were visual disturbance, foreign body sensation, and itchy eyes. All complaints were only reported first follow-up (day 7). Conclusion : Cationic emulsion in this study had a clearly beneficial effect both in increasing OPI score and lowering subjective symptom score in the treatment of dry eye for post menopausal women.

Utility of Tear Osmolarity Measurement in Diagnosis of Dry Eye Disease

The prevalence of dry eye disease is high worldwide and poses a great burden on patients’ daily lives. Accurate diagnosis of the disease is important, and it requires application of various methods. Hyperosmolarity is believed to be the disease marker and thus measuring it provides useful information. In this study we investigated utility of tear osmolarity measured with TearLab osmometer, along with other diagnostic tests (Ocular Surface Disease Index questionnaire, Tear film break-up time, Ocular Protection Index, Ocular Surface Staining, Schirmer I test, Meibomian gland functionality in 757 patients (1514 eyes) with dry eye disease and 29 healthy controls (58 eyes). Statistical differences between the patient group and the control group were observed for all the tests apart from tear osmolarity, regardless of cut-off value (>308 mOsm/L, >316 mOsm/L, and inter-eye difference >8 mOsm/L). Moreover, in the receiver operating characteristics curve analyses tear osmolarity measurement could not discriminate dry eye disease pathological scores. Therefore, our study suggests that tear osmolarity measured with TearLab osmometer cannot be used as a key indicator of DED.

Disease etiology‐based design of multifunctional trehalose emulsion eye drops for moderate or severe dry eye: a randomised, quadruple‐masked and active‐controlled clinical trial

AbstractPurposeTo assess the safety and efficacy of multi‐ingredient trehalose emulsion eye drops (TEED) designed to target (1) tear film instability, (2) tear hyperosmolarity, and (3) ocular surface damage and inflammation in moderate or severe dry eye.MethodsThis randomised, quadruple‐masked, active‐controlled parallel study in 64 adult patients comprised three parts. Part 1 (n = 3): One eye was treated with TEED for one day. Part 2 (n = 9): Randomised eyes were treated with TEED and 0.2% hyaluronic acid (HA) control eye drops 3 times a day for 10 days. Part 3 (n = 26 + 26): Randomised treatment was applied on both eyes 3 times a day for 30 days. Ocular assessments were performed at baseline and after the last dose.ResultsBoth treatments were well tolerated without adverse device effects. Tear film break‐up time (p = 0.0025) and ocular protection index (p = 0.0026; change vs. HA, p = 0.047) increased significantly with TEED after 30 days. Tear osmolarity decreased more in TEED than in HA group and significantly with both eye drops in hyperosmolar subgroups. Corneal (p = 0.014) and nasal conjunctival staining (p = 0.043) were reduced with TEED in per‐protocol patients (n = 24). Conjunctival (p = 0.001) and lid redness (p = 0.012) decreased with TEED in all patients (n = 26). Symptoms decreased by about 25 OSDI units with both treatments (p &lt; 0.0001).ConclusionsTEED proved safe and efficacious in improving each etiologic factor for dry eye. Hyperosmolar stress dominating blink cycles must be disrupted by biophysical protection of the ocular surface to facilitate resolution of cellular damage and inflammation, and relief of ocular symptoms.

Disease aetiology-based design of multifunctional microemulsion eye drops for moderate or severe dry eye: a randomized, quadruple-masked and active-controlled clinical trial.

PurposeTo assess the safety and efficacy of multi‐ingredient sacha inchi microemulsion (SIME) eye drops designed to target (1) tear film instability, (2) tear hyperosmolarity, and (3) ocular surface damage and inflammation in moderate or severe dry eye.MethodsThis randomized, quadruple‐masked, active‐controlled parallel study in 64 adult patients comprised three parts. Part 1 (n = 3): one eye was treated with SIME for one day. Part 2 (n = 9): randomized eyes were treated with SIME and 0.2% hyaluronic acid (HA) control eye drops 3 times a day for 10 days. Part 3 (n = 26 + 26): randomized treatment was applied on both eyes 3 times a day for 30 days. OSDI change was tested for superiority of SIME over HA. Ocular assessments were performed at baseline and after the last dose.ResultsBoth treatments were well tolerated without adverse device effects. Tear film break‐up time (p = 0.0025) and ocular protection index (p = 0.0026; change vs. HA, p = 0.047) increased significantly with SIME after 30 days. Tear osmolarity decreased more in SIME than in the HA group and significantly with both eye drops in hyperosmolar subgroups. Corneal (p = 0.014) and nasal conjunctival staining (p = 0.043) were reduced with SIME in per‐protocol patients (n = 24). Conjunctival (p = 0.001) and lid redness (p = 0.012) decreased with SIME in all patients (n = 26). Symptoms decreased by about 25 OSDI units with both treatments (p < 0.0001) and with nonsignificant difference between treatments.ConclusionsSacha inchi microemulsion (SIME) proved safe and efficacious in improving each aetiologic factor for dry eye as revealed through objective tests. Hyperosmolar stress dominating blink cycles must be disrupted by biophysical protection of the ocular surface to facilitate resolution of cellular damage and inflammation, and relief of ocular symptoms.

Evaluation of the Ocular Surface Disease Index Questionnaire as a Discriminative Test for Clinical Findings in Dry Eye Disease Patients

ABSTRACT Purpose To investigate to what extent the OSDI can be utilized as a discriminative test for clinical findings. Methods One thousand and ninety patients with dry eye disease (DED) were consecutively included and examined for osmolarity, tear film break-up time (TFBUT), ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test (ST), meibum expressibility (ME), meibum quality (MQ), and diagnosis of meibomian gland dysfunction (MGD). Receiver-operating characteristic curve (ROC) analysis considering optimum balanced sensitivity and specificity (close to 50%) was used for assessment. Results The present study on more than 1,000 patients indicates that the OSDI in the ROC curve analysis is a poor discriminator of pathological scores for TFBUT ≤ 5 (AUC = 0.553; p = .012) and ≤10 s (AUC = 0.608; p = .002), OSS ≥ 3 (AUC = 0.54; p = .043), ST ≤ 5 (AUC = 0.550; p = .032) and ≤10 mm/5 min (AUC = 0.544; p = .016), and ME ≥ 1 (AUC = 0.594; p = <0.001). Pathological scores for osmolarity >308 and >316 mOsm/L, OPI, OSS > 1, MQ, and MGD could not be discriminated by OSDI (p > .05). Conclusion Cut-off values for the OSDI can be defined to discriminate pathological TFBUT (≤5 and ≤10), OSS (≥3), ST (≤5 and ≤10) and ME, however, the discriminability was low. Our comprehensive study emphasises the importance of taking both symptoms and signs into account in DED management.

Tear Production Levels and Dry Eye Disease Severity in a Large Norwegian Cohort

ABSTRACT Purpose To determine if the Schirmer I test (without anesthesia) cut-off value is a predictor of dry eye severity in a large Norwegian cohort of dry eye disease (DED) patients, which are grouped into six levels of tear production. Methods Patients (n = 1090) with DED of different etiologies received an extensive dry eye work-up: osmolarity (Osm), tear meniscus height (TMH), tear film break-up time (TFBUT), ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test (ST), meibum expressibility (ME), and meibum quality (MQ). Classification of dry eye severity level (DESL) and diagnosis of meibomian gland dysfunction (MGD) were also included. The cohort was divided into six groups: below and above cut-off values of 5 (groups 1 and 2), 10 (groups 3 and 4), and 15 mm (groups 5 and 6) of ST. Mann-Whitney test and Chi-Square test were used for group comparison of parameters (p ≤ 0.05). Results The groups 1, 3, and 5 had values indicating more severe DED than the groups 2, 4, 6 with significant difference in DESL, Osm, TFBUT, OPI, OSS, and TMH. Regardless of the choice of cut-off values, there was no statistically significant difference in ME, MQ, and MGD between groups below and above selected cut-off value. When gender difference was considered in each group, significant difference was only observed for DESL (groups 2, 4, and 5), TFBUT (groups 2, 4, and 5), OPI (groups 2 and 6), and ME (group1). Conclusions Schirmer I is a robust discriminator for DESL, Osm, TFBUT, OPI, OSS, and TMH, but not for ME, MQ, and MGD. Patients with lower tear production levels presented with more severe DED at all three defined cut-off values. Interestingly, the differences in the mean values of DESL were minimal although statistically significant. Thus, the clinical value of different Schirmer levels appears to be limited.

Comparison of the goblet cells’ density and the quality of tears in treatment with sodium hyaluronate 0.1% benzalkonium chloride preservative-free eye drops for patients with glaucoma and dry-eye syndrome: A double-blind randomized clinical trial

This study aims to compare the efficacy of benzalkonium chloride (BAK) on different goblet cells densities and to enhance the quality of tears in patients with glaucoma and dry-eye syndrome treated with preservative-free and preserved sodium hyaluronate (SH) 0.1% eye drops. In this double-blind, randomized clinical trial, we randomly assigned patients with glaucoma and dry-eye syndrome into two groups: group I, treated with SH 0.1% eye drops comprising BAK preservative (a positive comparator group); group II, treated with preservative-free SH 0.1% eye drops. We followed patients for 3 months after enrollment and assessed the quality of tears by examining symptoms and signs, including the Schirmer’s test, tear film break-up time (TFBUT), Ocular Protection Index (OPI), and conjunctival impression cytology pre- and post-treatment. Any ocular discomfort was assessed by using the Ora Calibra Ocular. We enrolled 40 eyes from 20 patients with glaucoma and dry-eye syndrome. Each group comprised 20 eyes of 10 patients. We observed increased values of the mean TFBUT, OPI, and Schirmer’s test pre- and post-treatment, with no significant difference between both groups. While the conjunctival impression cytology revealed similar results of goblet cells in both groups, we observed lower scale of the Ora Calibra Ocular. Both groups elicit a comparable improvement in the quality of tears as demonstrated by augmented results of the Schirmer’s test, TFBUT, OPI, and Ora Calibra Ocular Score of patients with glaucoma and dry-eye syndrome

The Relationship between Symptomatic Assessment and Clinical Signs of Dryness in Dry Eye Subjects

Introduction: There was no previous study to assess relationship between dry eye symptoms and signs in the local population. The purpose of this study is to evaluate the relationship of symptomatic assessment and clinical signs of dryness in dry eye subjects. Materials and method: A Cross-sectional study with convenient sampling involving 321 subjects with 642 eyes was done. Subjects were divided into non-dry eye (NDE) and dry eye (DE) groups. The division of NDE and DE groups were done using two types of classification. In Classification 1(symptoms-based), DE was defined if the score of Ocular Surface Disease Index (OSDI) score was more than 33. The value of tear film break-up time (TFBUT) less than 5 seconds and Schirmer test with anaesthesia (STA) less than 5mm/5 minutes were considered as DE for Classification 2 (signs based). Results: There were poor correlations between OSDI and clinical signs of dryness in all subjects involved (p &gt; 0.05). Similar findings were also noted within NDE subjects in Classification 1 and Classification 2. OSDI score was also not significantly correlated with the signs of dryness within DE subjects except with ocular protection index (OPI) (r = - 0.14, p = 0.047) in Classification 1 and with conjunctival lissamine green staining (CLGS) (r = 0.23, p = 0.040) in Classification 2. Conclusion: There were no significant correlation between the symptoms of dry eye and the clinical signs of dry eye. Therefore, the clinical diagnosis of dry eye can be made based on either just on the symptoms or the signs.

Pollen count compared with severity of symptoms and signs of dry eye disease in Norway

PurposeTo investigate whether pollen counts are associated with severity of symptoms and signs of dry eye disease (DED) in Oslo, Norway.MethodsThe mean daily number of birch or grass pollen grains per cubic meter of air (pollen count) in Oslo from 2012 to 2015 between March and September were provided by The Norwegian University of Science and Technology and The Norwegian Asthma‐ and Allergy Association. Four hundred and twelve DED patients that were examined for the first time on the same day as pollen data were available were included. Symptoms of DED were measured by the Ocular Surface Disease Index (OSDI) self‐report questionnaire and signs of DED included measurements of tear osmolarity, tear film break‐up time, blink interval, ocular protection index, Schirmer I, staining, meibum expressibility and meibum quality from the right eye. Symptoms and signs, as well as the composite score for dry eye severity level (DESL), were compared with pollen count using Pearson's and Spearman's correlations, Chi square test and Mann‐Whitney U‐test.ResultsBirch pollen was generally only detectable during April and May, whereas grass pollen was normally detectable during June. Neither birch (rs = −0.13; p = 0.81) nor grass (rs = 0.06; p = 0.38) pollen were associated with symptoms of DED as measured by the OSDI. Except Schemer I test, which surprisingly was negatively related to grass pollen count (rs = −0.15; p = 0.02), neither pollen types correlated with DESL or any signs of DED. Only 5.6% of the patients reported the use of systemic prescription drugs against allergy, thus the weak association between pollen counts and severity of DED appear not to have been confounded by concomitant use of anti‐allergy medications.ConclusionsThe severity of symptoms and signs of DED in Oslo, Norway does not seem to be strongly associated with either birch or grass pollen count.

Advancing age does not strongly correlate with symptoms and signs of Dry Eye Disease in a large Norwegian cohort

PurposeTo evaluate the relationship between age and signs and symptoms of dry eye disease (DED) in a Norwegian cohort of patients with DEDMethodsClinical signs and symptoms were evaluated for 957 subjects at the Norwegian Dry Eye Clinic. All patients received an extensive ophthalmological work‐up, including tear meniscus height, blink rate, corneal sensibility, tear film break‐up time, Ocular Protection Index, vital staining, Schirmer I, meibum quality and meibum expressibility [CJ1], and in many cases osmolarity measurements. Pearson correlations between signs and symptoms were performed. P values below 0.05 were considered significant. [CJ1] This is not a real word, but may be in ophthalmology it is commonResultsNo correlations above r2 = 0.28 were found between age and signs or symptoms. Increasing age was only correlated with lower protection index (0.13), lower Schirmer I values (0.22), lower corneal sensibility (0.15) and higher Meibum expressibility (0.28)ConclusionsAdvancing age did not correlate strongly with any parameters of dry eye disease. This is particularly interesting as advancing age is regarded as a considerable risk factor for the development of dry eye disease.

Correlation of Osmolarity Measurements with Signs and Symptoms in the Norwegian Dry Eye Clinic

PurposeTo evaluate the relationship between osmolarity and signs and symptoms of dry eye disease (DED) in a Norwegian cohort of patients with DED.MethodsClinical signs and symptoms were evaluated for 365 subjects at the Norwegian Dry Eye Clinic. All patients received an extensive ophthalmological work‐up, including tear meniscus height, blink rate, corneal sensibility, tear film break‐up time, Ocular Protection Index, vital staining, Schirmer I, meibum quality and meibum expressibility. Pearson correlations between signs and symptoms were performed. P values below 0.05 were considered significant.ResultsHigh osmolarity correlated with lower ocular protection index (0.32) and higher blink interval (0.12), but no other parameters.ConclusionsOsmolarity did not correlate strongly with any parameters of dry eye disease.

The Four Seasons of Dry Eye Disease Seasonal Variations in Presenting Symptoms and Signs of Dry Eye Disease in Norway

PurposeTo investigate the seasonal variations of presenting symptoms and signs of dry eye disease (DED) in NorwayMethods930 DED patients examined between August 2012 and May 2015 at the Norwegian Dry Eye Disease Clinic in Oslo, Norway, were consecutively included. All patients underwent a comprehensive ophthalmological examination. Presenting symptoms and signs were related to the season according to when each patient had been examined. Weather report data from the exact day of examination in Oslo, including mean temperature, relative humidity, hours of sunshine, and mean wind, from the Norwegian Meteorological Institute, were also compared with the presenting symptoms and signs.ResultsMean seasonal temperatures for Oslo during spring, summer, fall and winter were 7°C, 16°C, 7°C, and −2°C, respectively. Compared to the rest of the year, tear film break‐up time (TFBUT) was highest during summer (P &lt; 0.001), ocular protection index (OPI) lowest during winter (P = 0.013), Schirmer I lowest during summer (P = 0.004), tear meniscus height was highest during winter (P = 0.004), meibum quality least pathological during winter (P = 0.001), the percentage of patients being diagnosed with meibomian gland dysfunction lowest during winter (P &lt; 0.001), and intraocular pressure highest during winter (P = 0.001). Weather report data correlated the strongest with meibum quality and intraocular pressure, which both were associated with mean temperature (r = 0.24; P &lt; 0.001 and r = −0.21; P &lt; 0.001). Self‐reported symptom load and dry eye severity level (DESL) did not differ between seasons.ConclusionsParameters for assessing DED show seasonal variations, which are important to consider when examining patients with DED. Moreover, contrary to common belief, our results suggest that meibomian gland function appears to improve during winter and with low temperatures.