Ocular Surface Changes Research Articles

Case Series: Severe meibomian gland loss in polycystic ovarian syndrome patients on estrogen-progesterone therapy: A case series

Purpose: To report the ocular surface and meibomian gland changes in polycystic ovarian syndrome (PCOS) women taking hormone supplementation. Methods: Case series. Results: Three women (27 ± 11 years) already diagnosed with PCOS presented with dry eye symptoms (mean OSDI, 37.5) for a mean duration of 13 months and were taking hormonal supplements for a mean duration of 60 ± 11 months. The hormonal supplements included oral estrogen (n=3), oral progesterone (n=3), antiandrogen cyproterone (n=1) and isotretinoin (n=1). Ocular surface evaluation revealed mean NIBUT of 9.9 ± 1.6 seconds and mean TMH of 0.27 ± 0.05 mm, assessed non-invasively using Oculus keratograph 5M (K5M). Meibography (K5M) showed near total loss of all meibomian glands (n=8/12 eyelids) with residual ghost glands in all four eyelids of two patients, and gland shortening alone in one patient. The gland morphology did not change following intense thermal pulsation treatment or cessation of hormonal therapy. Conclusions: Near-total irreversible meibomian gland loss was seen in two young PCOS women taking hormonal supplements. Collaboration between ophthalmologists and gynecologists is advisable for early detection and better understanding of dry eye disease (DED) progression in these patients.

Ocular Surface Changes after Phacoemulsification

Ocular Surface Changes after Phacoemulsification

Ocular Surface Changes in Glaucomatous Patients Undergoing Cataract Surgery Combined with Micro Invasive Glaucoma Surgery (2nd Generation Trabecular Stents Istent Inject ®): A Study about 69 Eyes

Introduction: The purpose of this study was to evaluate ocular surface changes and dry eyes symptoms in patients undergoing cataract surgery by phacoemulsification combined with implantation of two trabecular stents (Istent Inject®). Methods: This single-arm prospective interventional clinical trial enrolled 69 patients with mild-to-moderate open-angle glaucoma taking 1 to 4 glaucoma medications that underwent phacoemulsification combined with implantation of two trabecular stents (Istent). We explored several key data about ocular surface and glaucoma evolution throughout the follow-up, including the Ocular Surface Disease Index score, the Oxford score, the Efron conjunctival score, and the Fluorescein Tear Break-up Time (FTBUT). Results: Mean OSDI scores improved from 40.1 ± 21.6 (severe dry eye) preoperatively to 17.5 ± 15.3 (mild dry eye) at 3 months. While 73% of eyes had moderate or severe OSDI scores preoperatively, only 29% had such scores at 3 months. The mean FTBUT increased from 4.3 ±2.4 seconds preoperatively to 6.4 ±2.5 seconds at 3 months; the average Oxford staining score decreased from 1.4 ± 1.0 preoperatively to 0.4 ± 0.6 at 3 months. There was a reduction in the number of glaucoma medications from 1.5 to 0.6 medications. Mean IOP decreased from 17.4 ± 4.2mmHg to 14.5 ± 3.2mmHg at the 3 months follow-up. The safety profile of the surgery was excellent. Conclusion: The implantation of two trabecular stents (Istent inject®) combined with cataract surgery resulted in clinical and functional improvements in ocular surface health, as well as significant reductions in IOP and medications in patients with open-angle glaucoma.

Intense Pulsed Light Therapy for Dry Eye Disease: Analyzing Temporal Changes in Tear Film Stability and Ocular Surface between IPL Sessions.

Dry eye disease (DED), a prevalent condition with a multifactorial etiology, significantly impacts global health by causing discomfort and visual disturbance. This historical cohort study evaluates the efficacy of Intense Pulsed Light (IPL) therapy on meibomian gland dysfunction (MGD)-related evaporative DED. The study involved 110 patients (220 eyes) who underwent IPL therapy. Ethical approval was secured, and informed consent was obtained from all participants. A Tearcheck® (ESWvision, Houdan, France) device was used for ocular surface evaluation, measuring tear film stability (NIFBUT, NIABUT), tear film quantity (CTMH, TTMH), and inflammation (OSIE). The study assessed tear film and ocular surface health across multiple IPL sessions. Significant improvements were observed in subjective symptoms (EFT score increased from 29.10 ± 8.87 to 35.91 ± 7.03, p < 0.01), tear film stability (NIFBUT increased from 9.37 ± 6.04 to 10.78 ± 5.83 s, p < 0.01; NIABUT increased from 11.07 ± 4.98 to 12.34 ± 4.66 s, p < 0.01), and tear film surface evaluation (TFSE score decreased from 337.78 ± 414.08 to 206.02 ± 240.44, p < 0.01). Tear film quantity remained unchanged (CTMH and TTMH, p > 0.05). IPL therapy is a promising treatment for DED, improving symptoms and ocular surface health. Further research is warranted to explore long-term efficacy and optimization.

Developing a model for aqueous deficient dry eye secondary to periglandular cicatrizing conjunctivitis

PurposeThe current study used various techniques to develop a rabbit animal model of lacrimal gland damage caused by scarring conjunctivitis in the periglandular area. MethodsLeft eyes of New Zealand white rabbits were injected with 0.1 ml of 1M NaOH subconjunctivally around superior and inferior lacrimal gland orifices (Group 1, n = 4), touched with 1M NaOH for 100 s to the superior and inferior fornices with conjunctival denuding (Group 2; n = 4), and electrocauterization to the ductal opening area (Group 3; n = 4). The ocular surface staining, Schirmer I, lacrimal gland, and conjunctival changes were observed at baseline,1, 4, 8, and 12 weeks. The degree of glandular inflammation, conjunctival fibrosis (Masson Trichrome), and goblet cell density (PAS) were also assessed. ResultsAt 12 weeks, the lacrimal glands of group 1 rabbits with periglandular injection showed severe inflammation with mean four foci/10HPF and a significant mean reduction in the Schirmer values by 7.6 mm (P = 0.007). Lacrimal glands had diffuse acinar atrophy, loss of myoepithelial cells, and ductular dilatation. The overlying conjunctiva showed fibrosis, goblet cell loss, and corneal vascularization in the inferotemporal quadrant. No lacrimal gland or ocular surface changes were observed in groups 2 and 3 at 12 weeks, except for localized subconjunctival fibrosis. ConclusionPeriglandular injection of 0.1 ml of 1M NaOH induced extensive lacrimal gland damage with reduced secretion and scarring in the subconjunctival plane compared to direct cauterization or direct NaOH contact to the ductal orifices of the rabbit lacrimal gland.

How severe are ocular surface abnormalities 3 months following cataract surgery? An observational study

Aim: The aim of this study was to detect the pattern of ocular surface changes seen 3 months after undergoing phacoemulsification or manual small-incision cataract surgery (SICS) and match them with age-matched normal individuals. Materials and Methods: A prospective observational study was conducted in the ophthalmology outpatient department (OPD) in a tertiary care center. Consecutive patients coming to OPD were grouped into three study groups – Group 1 included 25 patients who had undergone manual SICS, Group 2 included patients who had undergone clear corneal phacoemulsification surgery, and Group 3 included age-matched controls. Patients with ocular and systemic diseases were excluded. All the patients underwent Schirmer’s test, tear film breakup time, ocular surface staining, and ocular surface disease index score. One-way analysis of variance test was used for the comparison of data, and P = 0.05 or less was considered to indicate a significant difference. Results: Significant dry eye changes after 3 months of cataract surgery were present in SICS and Phacoemulsification groups as compared to age-matched normals (p-value &lt; 0.05), but there was no significant difference between SICS and PHACOEMULSIFICATION surgery groups in the incidence of dry eye incidence. Conclusion: Dry eye symptoms are significant following cataract surgery irrespective of the type of surgery either SICS or phacoemulsification.

Conjunctival Chalasis Should Not be Overlooked: Investigation Into Postoperative Ocular Surface Changes in Involutional Blepharoptosis.

Involutional blepharoptosis is common among elderly people. The tightening of eyelids postptosis surgery could potentially increase friction between the eyelid and the ocular surface, but this hypothesis has not yet been substantiated by research. The authors explored the relationship between involutional blepharoptosis surgery and friction-related diseases, namely conjunctivochalasis, lid wiper epitheliopathy, and superior limbic keratoconjunctivitis. We conducted a prospective study involving 31 patients who underwent levator advancement for involutional blepharoptosis. Both preoperatively and 6 weeks postoperatively, the authors assessed a range of outcome measures, including margin reflex distance-1, 2, tear film break-up time, superficial punctate keratopathy, inferior conjunctivochalasis, upper lid wiper epitheliopathy, and superior limbic keratoconjunctivitis. Conjunctivochalasis was detected in 18 eyes preoperatively and 20 eyes postoperatively. Lid wiper epitheliopathy was detected in 2 eyes preoperatively and in no eyes postoperatively. Superior limbic keratoconjunctivitis was detected in 2 eyes preoperatively and 1 eye postoperatively. From preoperative to postoperative assessments, conjunctivochalasis worsened in 11 eyes (17.2%), and there were no eyes with worsening lid wiper epitheliopathy or superior limbic keratoconjunctivitis. There was a significant worsening of superficial punctate keratopathy in the group with exacerbated conjunctivochalasis compared with the unchanged group (0.72 vs. 0.12, P =0.0222). The superficial petechial keratopathy in the 6 cases in which there was worsening of both conjunctivochalasis and superficial petechial keratopathy were all located inferiorly in the cornea. Conjunctivochalasis can worsen following ptosis surgery, potentially leading to an increase in inferior superficial punctate keratopathy. When performing involutional blepharoptosis surgery, surgeons should be mindful of the potential implications of friction-related diseases, particularly conjunctivochalasis.

Ocular surface changes in allergic blepharoconjunctivitis and dry eye syndrome: diagnosis and therapy possibilities

Purpose: to evaluate the ocular surface changes (OSC) in seasonal and chronic allergic blepharoconjunctivitis (ABC) under dry eye (DE) conditions and to consider therapeutic possibilities.Materials and methods. 60 patients with seasonal ABC and mild DE syndrome (group 1) and 50 patients with chronic ABC and moderate DE syndrome (group 2) were tested for lipid deficiency (LD; negative lipid-interference test), aqua-deficiency (AD; inferior tear meniscus height &lt; 250 fim), and mucose deficiency (Bijsterveld`s xerosis index &gt; 3 scores; XI, scores), Ocular surface disease index (OSDI), tear film break-up time (TBUT, seconds), meibomian gland dysfunction (MGD) according to Korb, taking into account the proportion of MGD (%) and its severity (MGDS, scores), and the “lid-wiper” symptom (LWS, scores) Statistics: M ± s; Mann — Whitney U-test; differences were statistically significant at p &lt; 0.05.Results. LD was diagnosed in 65% of the 1st group patients (OSDI 32.3 ± 4.2, TBUT 6.5 ± 0.6, TMH 363.4 ± 43.96, XI 2.1 ± 0.4, MGDproportion — 41.02 %, LWS 1.1 ± 0.2). LD and MD were detected in 35 % of 1st group patients (OSDI 41.3 ± 5.7, TBUT 5.7 ± 0.5, TMH 332.9 ± 29.9, XI 4.2 ± 0.7, MGD proportion — 61.9 %, LWS 1.24 ± 0.4). The differences in OSDI, TBUT and XI values between DE patients with LD and DE patients with LD and MD were statistically significant. LD and AD were diagnosed in 48 % of 2nd group (OSDI 48.5 ± 6.4, TBUT 5.5 ± 0.6, TMH 192.3 ± 20.8, XI 2.5 ± 0.5, MGDS 1.8 ± 0.4, LWS 1.9 ± 0.3). LD, AD and MD were detected in 52 % of the 2nd group patients (OSDI 57.5 ± 5.8, TBUT 4.6 ± 0.6, TMH 177.7 ± 16.9, XI 5.5 ± 0.6, MGD-S 2.2 ± 0.4, LWS 2.3 ± 0.4). The differences in OSDI, TBUT and XI values between DE patients with LD-AD combination and DE patients with LD-AD-MD were statistically significant.Conclusion. OSC included lipid deficiency (65 %) and lipid-mucose deficiency (35 %) in S-ABC patients; OSC were represented by lipid-aqua-deficiency (48 %) and lipid-aqua-mucose-deficiency (52 %) in C-ABC patients. In our opinion, the diagnostics of these clinical variants of OSP diagnosis, opens up opportunities for differentiated tear replacement therapy. MGD was diagnosed in one half of S-ABC patients and in all C-ABC patients, which we believe determines another possible therapy direction — eyelid therapeutic hygiene aimed at MGD relieving and lipid deficiency compensation.

Ocular surface changes during COVID-19 pandemic among university faculty members with dry eye disease in northern India: A longitudinal study

ObjectiveThe pandemic has brought a paradigm shift in pedagogical modalities throughout the world, with a resultant increase in screen time and ultra-violet light exposure among both students and teachers. The current study was conducted to analyze ocular surface changes in university faculty members with dry eye disease (DED) during the second wave of COVID-19 pandemic in India. MethodsA cross-sectional study was conducted among university faculty members of a medical university in India. An online questionnaire was sent via social media from December 2020 to January 2021, which consisted of questions on demographic details, DED symptoms and use of visual display terminals. All those participants who had DED based on Ocular Surface Disease Index (OSDI) score were followed-up after one month when the pandemic had subsided. ResultsOut of the 150 faculty members in the university, 130 completed the survey (response rate 86.7%). The number of participants with symptomatic DED based on OSDI score was 111 (85.3%). All these participants showed a statistically significant change in subjective measurement of DED symptoms after one month, using OSDI questionnaire. ConclusionDED symptoms increased during the pandemic and there was a statistically significant change in the OSDI scores suggestive of ocular surface damage and a positive relationship with increased digital screen time. The finding has implications as targeted interventions need to be undertaken to mitigate the effects of increased screentime, especially among populations with more duration of near work using digital screens.

The influence of some general diseases for changes on the ocular surface after trabeculectomy

BACKGROUND: By now, possible effects of diabetes mellitus and arterial hypertension on the ocular surface changes after trabeculectomy have not been evaluated. AIM: Analysis of the effects of arterial hypertension therapy and diabetes mellitus on the ocular surface changes after trabeculectomy. MATERIALS AND METHODS: The study group consisted of 443 patients, including those with arterial hypertension (179 patients), non insulin dependent compensated type 2 diabetes mellitus (25 patients) and their combination (53 persons), operated in 2016–2020 in the City Multifield Hospital No. 2, Saint-Petersburg, for primary open-angle noncompensated glaucoma and then observed for 6 to 24 months. The dynamics of ocular surface disease index (OSDI), tear film break-up time (TBUT), and amount of total tear production has been studied. RESULTS: The probability of the trabeculectomy success did not depend on the concomitant comorbidity. In contrast to intraocular pressure, the criteria for subjective and objective assessment of the ocular surface state were not subject to such obvious changes. In diabetic patients, the studied criteria have not changed compared to the baseline. CONCLUSIONS: The mentioned systemic diseases do not influence the state of the ocular surface in patients with glaucoma, and are not an independent risk factor for the failure of the IOP-lowering surgical procedure. The presence of diabetes mellitus prevents the accompanying a successful trabeculectomy regression of symptoms and clinical and functional signs of dry eye disease.

Ocular surface and meibomian gland evaluation in euthyroid Graves’ ophthalmopathy

PurposeEuthyroid Graves’ ophthalmology (EGO) refers to the subgroup of thyroid eye disease patients with distinct clinical presentations. This study evaluated the ocular surface and meibomian gland changes in EGO patients.MethodsA cross-sectional study was conducted at The Chinese University of Hong Kong including 34 EGO patients and 34 age-and sex- matched healthy controls. Outcome measures include anterior segment examination, keratographic and meibographic imaging.ResultsBetween 34 EGO patients and 34 age and sex-matched healthy controls, EGO was associated with a higher ocular surface disease index (P < 0.01), higher severity of meibomian gland dropout (upper: P < 0.001, lower: P < 0.00001) and higher percentage of partial blinking (P = 0.0036). The worse affected eyes of the EGO patients were associated with corneal staining (P = 0.0019), eyelid telangiectasia (P = 0.0009), eyelid thickening (P = 0.0013), eyelid irregularity (P = 0.0054), meibomian gland plugging (P < 0.00001), expressibility (P < 0.00001), and meibum quality (P < 0.00001). When the two eyes of the same EGO patient were compared, the degree of meibomian gland dropout was higher among the worse affected eyes (upper: P < 0.00001, and lower: P < 0.00001). Tear meniscus height, lipid layer thickness, and noninvasive break-up time were comparable between the two eyes of EGO patients and also between EGO patients and healthy controls. TMH was positively correlated with the degree of exophthalmos (r = 0.383, P < 0.05).ConclusionEGO patients have more ocular surface complications and meibomian gland dropouts than healthy controls. Almost 60% of them had dry eye symptoms, but aqueous deficiency was not apparent. Further studies are warranted to clarify the mechanism of dry eye in EGO.(249 words).

Effects of dietary imbalances of micro- and macronutrients on the ocular microbiome and its implications in dry eye disease

Dry eye disease (DED) is a complex and multifactorial ocular surface disease affecting a large proportion of the population. There is emerging evidence of the impact of the microbiomes of the ocular surface and gut on the symptoms of DED, with many parallels being drawn to inflammatory diseases of other organ systems. A key factor involved in the promotion of healthy microbiomes, and which has been associated with ocular surface disease, is micro- and macronutrient deficiency. A comprehensive review of how these deficiencies can contribute to DED is absent from the literature. This review reports the composition of healthy ocular and gut microbiomes, and how nutrient deficiencies may impact these floral populations, with linkage to the subsequent impact on ocular health. The review highlights that vitamin B1 and iron are linked to reduced levels of butyrate, a fatty acid implicated in inflammatory conditions such as ulcerative colitis which itself is a condition known to be associated with ocular surface diseases. Vitamin B12 has been shown to have a role in maintaining gut microbial eubiosis and has been linked to the severity of dry eye symptoms. Similar beneficial effects of gut microbial eubiosis were noted with vitamin A and omega-3 polyunsaturated fatty acids. Selenium and calcium have complex interactions with the gut microbiome and have both been implicated in the development of thyroid orbitopathy. Further, diabetes mellitus is associated with ocular surface diseases and changes in the ocular microbiome. A better understanding of how changes in both the gut and eye microbiome impact DED could allow for an improved understanding of DED pathophysiology and the development of new, effective treatment strategies.

Ocular surface changes in patients who have undergone head and neck radiation therapy.

Dry eye syndrome (DES) is a familiar sequelae of radiation therapy (RT) for head and neck cancers (HNC). Ocular surface changes such as DES occur due to injury to the conjunctival epithelium, goblet cells, corneal surface, lacrimal glands, and meibomian glands. This study aimed at the evaluation and early detection of changes in ocular surface parameters in patients receiving RT for extraocular HNC. Forty-two eyes of 21 patients undergoing HNC RT were evaluated. Radiation technique and dose of radiation to the lens and eye were recorded. Subjects were evaluated for meibomian gland changes by meiboscore grading, ocular surface disease index (OSDI) questionnaire, Schirmer's test, tear film break-up time (TBUT), and slit-lamp examination before RT, immediately post RT, and 6 weeks post RT. A comparison of the ipsilateral eye on the irradiated side to the contralateral eye was done. A significant reduction in TBUT was seen immediately post RT and 6 weeks post RT ( P < 0.001 and 0.008, respectively), with an increase in meiboscore at both visits ( P < 0.001). An OSDI score of >13 was seen in 23.80% of patients post RT, with a significant difference from baseline ( P < 0.001). On comparing ipsilateral and contralateral eye groups, a significant difference from baseline was seen in TBUT ( P < 0.001 and 0.033, respectively) and meiboscore ( P < 0.001 for both eyes). A significant change of >1 second in TBUT and >1.7 in meiboscore was seen with a mean dose of around 8 Gy to the lens. All patients undergoing HNC RT should be followed up for ocular surface and meibomian gland changes. The contralateral eye should also be evaluated. Patients receiving lower doses to the ocular structures should also be kept under follow-up.

Ocular surface changes following computer use in post-LASIK patients.

To assess the impact of computer use on the ocular surface of individuals after laser insitu keratomileusis (LASIK). The dry eye symptoms and ocular surface of 18 post-LASIK young individuals and 18 controls were evaluated before and after performing a 30-min task on a computer without (Visit 1) and with (Visit 2) initial instillation of artificial tears. Symptoms were assessed using the Ocular Surface Disease Index (OSDI), Symptom Assessment in Dry Eye questionnaire version two (SANDE II) and Computer Vision Syndrome Questionnaire (CVS-Q). The ocular surface was assessed by measuring corneal higher order aberrations, tear meniscus height (TMH), conjunctival redness, blink rate and incomplete blinking, lipid layer thickness (LLT) and non-invasive keratograph break-up time (NIKBUT). SANDE II scores were >0 after the computer task in both groups (p ≤ 0.01). SANDE II and CVS-Q scores did not differ between LASIK and controls (p ≥ 0.43). Greater bulbar-temporal conjunctival redness, TMH and LLT and shorter NIKBUT were found after computer use in the LASIK group (p ≤ 0.04), whereas no changes were observed in the controls (p ≥ 0.20). Lower SANDE II and CVS-Q scores were reported at Visit 2 compared with Visit 1 in both groups (p ≤ 0.01). Likewise, no worsening of dry eye signs was observed at Visit 2 (p ≥ 0.11). Ocular symptoms reported during computer use were comparable between the groups. However, a worsening of dry eye signs was mostly observed in post-LASIK individuals. The instillation of artificial tears was effective in preventing the effects of computer use on the ocular surface in post-LASIK patients.

Enquête de qualité de vie auprès de 3738 patients traités par injections intravitréennes pour leur dégénérescence maculaire liée à l’âge

To evaluate the peri- and post-intravitreal injection (IVI) symptoms reported by patients who have been repeatedly injected for age-related macular degeneration (AMD) and to analyze these according to the protocols of the injector. Multi-center, cross-sectional, consecutive, analytical survey. The IVI protocols of 106 injectors differed in terms of the number of instillations of povidone-iodine, its contact time, and rinsing of the ocular surface post-injection. In total, 3,738 patients responded to the survey, 60.1% of whom were women; 36.4% had received more than 20 IVIs; 50.7% of patients reported irritation upon application of povidone-iodine. Post-IVI, depending on the symptom in question, between 44.8% and 57.4% of patients reported symptoms of ocular surface change. The number of instillations of povidone-iodine, its contact time with the ocular surface, and abundant rinsing post-IVI increased the immediate symptoms. Patients who received more IVIs were more prone to experiencing gritty eyes, and the incidence of acute pain increased in patients who had previously received over 20 IVIs. Women and patients previously treated for dry eye or glaucoma were at greater risk of worse symptoms. Comparing injecting centers' practices with patients' self-assessments showed an aggravation of symptoms of ocular surface changes related to povidone-iodine. This survey contributes to providing data for the implementation of a protocol to improve the quality of life of patients injected repeatedly for AMD.

Evaluation of Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum.

To assess Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum and correlate with ocular surface changes. This cross-sectional study evaluated patients with xeroderma pigmentosum. All patients underwent a comprehensive and standardized interview. The best-corrected visual acuity of each eye was determined. Detailed ophthalmic examination was conducted, including biomicroscopy examination of the ocular surface, Schirmer test type I, and meibography, and fundus examination was also performed when possible. Meibomian gland dysfunction was assessed by non-contact meibography using Oculus Keratograph® 5M (OCULUS Inc., Arlington, WA, USA). Saliva samples were collected using the Oragene DNA Self-collection kit (DNA Genotek Inc., Ottawa, Canada), and DNA was extracted as recommended by the manufacturer. Factors associated with abnormal meiboscores were assessed using generalized estimating equation models. A total of 42 participants were enrolled, and 27 patients underwent meibography. The meiboscore was abnormal in the upper eyelid in 8 (29.6%) patients and in the lower eyelid in 17 (62.9%). The likelihood of having abnormal meiboscores in the lower eyelid was 16.3 times greater than that in the upper eyelid. In the final multivariate model, age (p=0.001), mutation profile (p=0.006), and presence of ocular surface malignant tumor (OSMT) (p=0.014) remained significant for abnormal meiboscores. For a 1-year increase in age, the likelihood of abnormal meiboscores increased by 12%. Eyes with OSMT were 58.8 times more likely to have abnormal meiboscores than eyes without ocular surface malignant tumor. In the final model, age, xeroderma pigmentosum profile, previous cancer, and clinical alterations on the eyelid correlated with a meiboscore of ≥2. Meibomian gland dysfunction was common in patients with xeroderma pigmentosum, mainly in the lower eyelid. The severity of Meibomian gland dysfunction increases with age and is associated with severe eyelid changes.

Swept-source optical coherence tomography in ocular surface diseases: anterior segment analysis repeatability and its limits.

This study aims to evaluate the repeatability of anterior segment optical coherence tomography (AS-OCT) in diverse ocular surface disorder (OSD) cohorts, exploring various anterior segment parameters and their accuracy in different disease groups. A total of 239 participants across six distinct OSD groups and healthy controls underwent nonmydriatic AS-OCT imaging using the Tomey CASIA 2 device. Anterior segment parameters including anterior chamber depth, width, angle metrics, corneal thickness, keratometry, lens vault, and others were meticulously assessed. Statistical analyses determined repeatability limits and coefficients of variation for each parameter within the different OSD cohorts. Repeatability for anterior chamber and corneal parameters remained consistent across all OSD groups, indicating minimal impact of ocular surface disease on accuracy. The coefficient of variation (CoV) for the trabecular iris-space area was about 20% for all cohorts. Ocular surface inflammation emerged as a key factor in dry eye, affecting immune-mediated and non-immune conditions alongside age-related ocular surface changes. While anterior chamber depth measurements showed variations, particularly in immune (CoV = 2.5%) and non-immune (CoV = 3.8%) OSD groups, parameters like anterior chamber width and angle to angle showed similar values among the cohorts. Keratometry measures remained stable despite OSD (CoV lower than 1%). The Tomey CASIA 2 demonstrated reliable repeatability for measuring anterior segment parameters in diverse OSD cohorts. Despite challenges posed by dry eye conditions, this technology holds promise in assessing OSD, suggesting potential clinical protocols similar to those in healthy controls.

Corneal complications of ocular GvHD

Corneal fluorescein staining is one of the tests recommended to diagnose and grade ocular graft versus host disease (GvHD) according to the International Chronic Ocular GvHD Consensus Group. Despite superficial punctate keratopathy is the most common corneal manifestation, patients with more severe stages may develop corneal neovascularization, sterile corneal ulceration and even perforation. Previous in vivo confocal microscopy (IVCM) studies reported significant microstructural changes in the cornea of patients with ocular GvHD, including a higher density of dendritic cells and globular immune cells, a network of hyper‐reflective activated keratocytes, and a lower density and higher tortuosity of sub‐basal corneal nerves. Dendritic cells act as antigen‐presenting cells, and play a key role in ocular surface immune homeostasis. Thus, their increased density may be indicative of immune activation and inflammation of the ocular surface in patients with ocular GvHD. Interestingly, Kheirkhah et al. reported higher dendritic cell density in patients with DED owing to systemic immune disease (i.e., Sjögren syndrome and ocular GvHD) compared to patients with DED of other origins. Recently, our group employed a fully automated IVCM analysis system to compare corneal sub‐basal nerve plexus in patients with DED owing to both ocular GvHD and Sjögren syndrome and in healthy control subjects. Although overall patients with DED showed lower density of nerve fibres and branches, shorter nerve fibres and higher fibre width compared to healthy controls, no significant difference was observed between patients with ocular GvHD and Sjögren syndrome for all IVCM metrics. In agreement with this observation, other studies reported no significant difference of IVCM parameters in DED patients with and without ocular GvHD after adjusting for clinical severity of dry eye. This suggests that the ocular surface changes observed by IVCM in ocular GvHD may be possibly reflective of the local disease severity rather than the underlying systemic process.

Keratoconus: Ocular surface considerations, from bench to bedside

Aims/Purpose: This comprehensive systematic narrative study is aimed to describe the close interactions between the ocular surface and keratoconus with its vast spectrum of diagnostic and treatment techniques, both basic and clinical.Methods: This investigation searched PubMed, Scopus, Cochrane, Embase, and Web of Science for relevant papers published up to January 2023. The systematic review used MeSH and non‐MeSH terms. Unrestricted language and publishing schedule. After a comprehensive search, all of the search results were imported into Endnote software after a thorough search. Duplicate and less relevant citations have been eliminated in Endnote. In addition to the databases indicated, we searched Google Scholar for “Ocular surface” AND ((keratoconus) OR (“pellucid marginal degeneration”) OR (“corneal ectasia”) OR (“iatrogenic ectasia”)).Results: Treating dry eye, MGD, and blepharitis may slow KC progression and relieve symptoms. Eye rubbing and mechanical injury could spread bacteria to the eyelids, causing blepharitis. Tarsorrhaphy is the most powerful manoeuvre to help heal epithelial defects, especially in moderate and severe forms of DED. Use high‐quality eyedrops, especially preservative‐free ones, to increase tissue viscosity on the ocular surface and protect tear film to reduce epithelium injury before and after surgery. Finally, Vitamins, minerals, metal ions, and antioxidants may prevent dry eye and KC. In addition, improper air quality, wind, pollution, low humidity, watching TV, reading, and surgical procedures can cause dry eye illness, increase MMP‐9 and IL‐6 and decrease EGF during exacerbation.Conclusions: This is the first systematic narrative review to explore the mutual interaction between the ocular surface and KC and the wide spectrum of diagnostic and therapeutic options. Dry eye and tear film instability have been documented as a non‐ectatic differential diagnosis for KC and ectatic disorders. Nonetheless, KC and DED are both common topics. Future research should look into the effect of pre‐treating ocular surface health on postoperative outcome and the efficacy of the therapeutic strategy in reversing KC ocular surface changes.

Ocular surface changes in mice with streptozotocin-induced diabetes and diabetic polyneuropathy

PurposeDiabetes mellitus (DM) is a leading risk factor for corneal neuropathy and dry eye disease (DED). Another common consequence of DM is diabetic peripheral polyneuropathy (DPN). Both complications affect around 50 % of the DM patients but the relationship between DM, DED and DPN remains unclear. MethodsIn this study, we examined mice with early onset of DM and PN after streptozotocin (STZ)-induced diabetes (DPN). We compared the early morphological changes of the sciatic nerve, dorsal root and trigeminal ganglia with the changes in the ocular surface, including tear proteomic and we also investigated respective changes in the gene expressions and morphological alterations in the eye tissues involved in tear production. ResultsThe lacrimal gland, conjunctival goblet cells and cornea showed morphological changes along with alterations in tear proteins without any obvious signs of ocular surface inflammation. The gene expression for respectively altered tear proteins i.e., of Clusterin in cornea, Car6, Adh3a1, and Eef1a1 in eyelids, and Pigr in the lacrimal gland also showed significant changes compared to control mice. In the trigeminal ganglia like in the dorsal root ganglia neuronal cells showed swollen mitochondria and, in the latter, there was a significant increase of NADPH oxidases and MMP9 suggestive of oxidative and neuronal stress. In the dorsal root ganglia and the sciatic nerve, there was an upregulation of a number of pro-inflammatory cytokines and pain-mediating chemokines. ConclusionThe early ocular changes in DM Mice only affect the lacrimal gland. Which, is reflected in the tear film composition of DPN mice. Due to the high protein concentration in tear fluid in humans, proteomic analysis in addition to noninvasive investigation of goblet cells and cornea can serve as a tools for the early diagnosis of DPN, DED in clinical practice. Early treatment could delay or even prevent the ocular complications of DM such as DED and PN.