Ocular Surface Staining Score Research Articles

Reproducibility of Ocular Surface Staining in the Assessment of Sjögren Syndrome-Related Keratoconjunctivitis Sicca: Implications on Disease Classification.

ObjectiveThe objective of this study was to assess the performance and reproducibility of the two currently used ocular surface staining scores in the assessment of keratoconjunctivitis sicca in Sjögren syndrome (SS) research classification.MethodsIn a multidisciplinary clinic for the evaluation of sicca, we performed all tests for the American European Consensus Group (AECG) and the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, including the van Bijsterveld score (vBS) and the Ocular Staining Score (OSS), in 994 participants with SS or with non‐SS sicca. We analyzed the concordance between the scores, the diagnostic accuracy and correlation with clinical variables, and interrater and intrasubject reproducibility.ResultsA total of 308 (31.1%) participants had a discordant vBS and OSS that was due to extra corneal staining points in the OSS. The presence of one or more of the additional points was highly predictive of SS classification (odds ratio = 3.66; P = 1.65 × 10e‐20) and was associated with abnormal results of all measures of autoimmunity and glandular dysfunction. Receiver operating characteristic curves showed optimal cutoff values of four for the vBS (sensitivity = 0.62; specificity = 0.71; Youden's J = 0.33) and five for the OSS (sensitivity = 0.56; specificity = 0.75; Youden's J = 0.31). Notably, there was very poor consistency in interobserver mean scores and distributions (P < 0.0001) and in intrasubject scores after a median of 5.5 years (35% changed status of the ocular criterion).ConclusionOcular surface staining scores are useful for SS research classification; however, they are subject to significant interrater and intrasubject variability, which could result in changes in classification in 5%‐10% of all subjects. These results highlight the need for objective and reproducible markers of disease that have thus far remained elusive for SS.

Efficacy of azithromycin 1.5% eyedrops vs oral doxycycline in meibomian gland dysfunction: a randomized trial

To determine the efficacy of azithromycin 1.5% eyedrops compared with oral doxycycline in patients with moderate to severe meibomian gland dysfunction (MGD). This prospective randomized trial included 169 participants with newly diagnosed moderate to severe MGD. Participants were randomly assigned to treatment with azithromycin 1.5% eyedrops (n = 85) twice daily for 2days then once daily until 4weeks or oral doxycycline (n = 84) 100mg twice daily for 4weeks. Signs and symptoms of MGD were evaluated at baseline and 4weeks later. The percentages of participants with improvement in meibum quality were assessed as a primary outcome. Secondary outcomes were MGD-related symptoms, meibum expressibility, Oxford ocular surface staining score, tear film break up time (TBUT), and drug side effects. Although there were significant improvements in all outcomes in both groups, there was no between-group differences in the percentages of participants with improved meibum quality (P = 0.80), MGD-related symptoms (P > 0.05), meibum expressibility (P = 0.92), Oxford ocular surface staining score (P = 0.59), and TBUT (P = 0.99). Five (5.88%) participants in azithromycin group and four (4.76%) participants in doxycycline group discontinued medications due to drug side effects (P = 0.75). Both azithromycin 1.5% eyedrops and oral doxycycline significantly improved signs and symptoms in patients with moderate to severe MGD. Both azithromycin 1.5% eyedrops and oral doxycycline showed no difference in term of improved signs and symptoms of MGD as well as drug side effects that lead to discontinuation of medication.

Evaluation of the Efficacy and Safety of A Novel 0.05% Cyclosporin A Topical Nanoemulsion in Primary Sjögren’s Syndrome Dry Eye

ABSTRACTPurpose: To evaluate the efficacy and safety of a novel topical cyclosporin A 0.05% nanoemulsion in comparison with a conventional emulsion in primary Sjögren’s syndrome dry eyes.Methods: Prospective, randomized, double-blinded study was conducted.Results: Corneal and conjunctival staining score was improved in both groups, with a faster change noted in the nanoemulsion group at 12 weeks (p < 0.05). Tear film break-up time was significantly improved in the nanoemulsion group at 12 weeks (p < 0.05), while ocular surface disease index score was improved in both groups without a difference at 12 weeks. Schirmer I value and goblet cell grade did not change in both groups. IL-6 and MMP-9 were significantly decreased in both groups at 12 weeks.Conclusions: Both nanoemulsion and conventional cyclosporin A improved ocular signs, symptoms, and conjunctival inflammation. However, the novel cyclosporin A nanoemulsion showed faster improvement of ocular surface staining scores than the conventional emulsion.

Efficacy and safety of dual-polymer hydroxypropyl guar- and hyaluronic acid-containing lubricant eyedrops for the management of dry-eye disease: a randomized double-masked clinical study.

BackgroundAn artificial-tear formulation containing the dual polymers hydroxypropyl guar (HPG) and hyaluronic acid (HA) is approved for the treatment of dry-eye disease (DED). The present study compared the efficacy and safety of the HPG-HA dual-polymer formulation vs a sodium hyaluronate (SH)-containing artificial-tear formulation in patients with DED.MethodsIn a prospective, 6-week, multicenter, double-masked, parallel-group study, patients with DED aged ≥18 years and total ocular surface staining (TOSS) score ≥4 and ≤9 were randomized (1:1) to receive either HPG-HA or SH four times a day for 42 days. Changes from baseline in TOSS (primary end point), impact of dry eye on everyday life (IDEEL) treatment-satisfaction scores (effectiveness and inconvenience), and tear-film breakup time (TFBUT) at day 42 were assessed using a fixed-sequence testing strategy. Noninferiority was assessed on the primary end point based on the upper limit of two-sided 95% CIs for mean treatment difference (HPG-HA or SH) <2 units.ResultsIn total, 99 patients were randomized (HPG-HA, n= 50; SH, n= 49). At day 42, the least square (LS) mean ± SE change from baseline in TOSS was −1.16±0.24 and −0.92±0.23 in the HPG-HA and SH groups, respectively, and the treatment difference was −0.24±0.33 (95% CI −0.90 to 0.42). Noninfe-riority was demonstrated as the upper limit of the 95% CI was <2 units. LS mean change from baseline at day 42 for HPG-HA vs SH was −3.18 (P=0.4817) in IDEEL treatment-effectiveness scores, −12.56 (P=0.0001) in treatment-inconvenience scores, and 0.30 seconds (P=0.5789) in TFBUT.ConclusionThe HPG-HA dual-polymer formulation was noninferior to the SH lubricant eye-drops for improvement in ocular surface staining in DED. HPG-HA did not show improvement over SH in IDEEL treatment-satisfaction scores. No new safety findings were reported.

Lipid layer thickness and tear meniscus height measurements for the differential diagnosis of evaporative dry eye subtypes.

To explore a new diagnostic index for differentiating the evaporative dry eye (EDE) subtypes by analysis of their respective clinical characteristics. A cross-sectional study of 139 patients (139 eyes) with EDE who were enrolled and classified as obstructive meibomian gland dysfunction (MGD) (n=81) and non-obstructive MGD (n=58) EDE. All patients completed a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and were evaluated for average lipid layer thickness (LLT), tear meniscus height measurements (TMH), tear break-up time (TBUT), ocular surface staining score, Schirmer I test (SIT), lid margin abnormalities, and meibomian gland function and morphology. Age, average LLT, TMH, scores of lid margin abnormalities, meibum quality, meibomian gland loss (MGL) (all P≤0.001), and TBUT (P=0.03) were all significantly different between obstructive MGD EDE patients and non-obstructive MGD EDE patients. Average LLT in obstructive MGD EDE was correlated with meibomian expressibility (r=-0.541, P≤0.001), lid margin abnormalities were marginally not significant (r=0.197, P=0.077), and TMH was correlated with MGL (total MGL: r=0.552, P≤0.001; upper MGL: r=0.438, P≤0.001; lower MGL: r=0.407, P≤0.001). Average LLT in non-obstructive MGD EDE, was correlated with meibomian expressibility and Oxford staining (r=-0.396, P=0.002; r=-0.461, P≤0.001). The efficiency of combining average LLT and TMH was optimal, with a sensitivity of 80.2% and a specificity of 74.1%. Obstructive MGD EDE patients had an average LLT≥69 nm and TMH≥0.25 mm, while non-obstructive MGD EDE patients had an average LLT<69 nm and TMH<0.25 mm. Obstructive MGD EDE and non-obstructive MGD EDE have significantly different clinical characteristics. Combining average LLT and TMH measurements enhanced their reliability for differentiating these two subtypes and provided guidance for offering more precise treatments for EDE subtypes.

Labial Salivary Gland Transplantation for Severe Dry Eye in a Rhesus Monkey Model.

To evaluate the effectiveness of autologous labial salivary gland with labial mucous membrane graft in a rhesus monkey model with severe dry eye. Eight eyes of eight rhesus monkeys with severe dry eye were included. Four eyes underwent autologous labial salivary gland and mucous membrane graft (group 1) and four eyes served as controls (group 2). The ocular surface was evaluated before and after transplantation surgery (at 1, 4, 8, 12, and 24 weeks). Conjunctival impression cytology was performed before and 24 weeks after transplantation. Finally, a histological analysis of the cornea, conjunctiva, and transplanted grafts was performed. At inclusion (n = 8) the mean Schirmer test was 1.31 ± 0.53 mm, the mean fluorescein score was 4.7 ± 1.65, and the mean lissamine green staining was 4.38 ± 0.48. After transplantation, a significant increase in tear secretion was observed with the mean Schirmer test results in group 2 significantly higher than those observed for group 1 at all time points (P < 0.05). Similarly, fluorescein and lissamine green scores were significantly lower in group 2 than in group 1 at all time points after transplantation (P < 0.05). Impression cytology specimens showed severe conjunctival squamous metaplasia without goblet cells in both groups. Under light microscopy, no significant difference was observed between the cornea and the conjunctiva of the two groups. Labial salivary gland transplantation provided a basal secretion of tears and improved ocular surface staining scores during the first 3 months in a severe rhesus monkey model of dry eye. However, this was not accompanied by major improvement of ocular surface tissues.

Efficacy of rebamipide 2% ophthalmic solution in the treatment of dry eyes.

AIM:The aim of this study is to evaluate the efficacy of 2% rebamipide ophthalmic solution on the tear functions and ocular surface status in patients with dry eyes.MATERIALS AND METHODS:A prospective study was carried out on forty eyes of patients having signs and symptoms of dry eye. Two percent rebamipide ophthalmic solution was applied four times a day for a period of 4 weeks. Patients were evaluated on the basis of dry eye-related symptom score, tear film break-up time (TFBUT), tear meniscus height, fluorescein ocular surface staining score (FOSS), and the Schirmer's test at the end of 2, 4, 6, and 12 weeks and their values were compared with the baseline.RESULTS:Significant improvement was noted in the mean dry eye-related symptom score, TBUT, and the FOSS values from the baseline at the end of 2, 4, 8, and 12 weeks. The values of tear meniscus height and Schirmer's test were improved at the end of 8 weeks but were not statistically significant.CONCLUSION:Nearly 2% rebamipide ophthalmic solution provided relief in the symptoms of patients having dry eyes. It also prevented further ocular surface damage and aided in stabilizing the tear film.

Assessment of meibomian glands and tear film in post‐refractive surgery patients

Corneal refractive surgery may impact meibomian gland and tear film in post-refractive surgery patients. To compare ocular surface parameters between post-refractive surgery patients and normal controls. Cross-sectional single centre study. A total of 120 eyes of 120 subjects were divided into three groups: (i) 60 controls and 60 patients underwent corneal refractive surgery at least 12 months ago; (ii) 30 post-laser in-situ keratomileusis (LASIK) patients and (iii) 30 post-laser epithelial keratomileusis (LASEK)/photo-refractive keratectomy (PRK) patients. Tear meniscus height, non-invasive keratographic tear film break-up time and meibography were measured using the Keratograph® 5M. Fluorescein break-up time, ocular surface staining, examination of lid margins and meibomian glands, Schirmer's test and Ocular Surface Disease Index questionnaire were performed. Ordinary logistic regression was performed to evaluate the impact of clinical variables including refractive surgery on the meiboscores. In post-LASIK patients, ocular surface parameters including Ocular Surface Disease Index scores, fluorescein break-up time and staining scores, except Schirmer's scores, were significantly worse than those in controls (P < 0.050). Ocular surface staining scores in post-LASEK/PRK patients was higher than that in the controls (P = 0.001). In post-refractive surgery patients, grade of meibomian gland parameters and meiboscores were worse than those of controls (all P < 0.050). Histories of refractive surgery were associated with high meiboscore (β = 1.100, P = 0.043 for LASIK and β = 1.039, P = 0.042 for LASEK/PRK). Corneal refractive surgery may adversely affect the ocular surface, and a reduction of functional meibomian glands can contribute to chronic tear film dysfunction after corneal refractive surgery.

Comparison of 0.2% and 0.18% hyaluronate eye drops in patients with moderate to severe dry eye with keratitis or keratoconjunctivitis.

PurposeComparison of efficacy and safety of 0.2% and 0.18% hyaluronic acid (HA) eye drops three times a day (tid) in patients with moderate to severe dry eye disease, related to keratitis or keratoconjunctivitis.Patients and methodsProspective, multicenter, randomized, single-masked, phase IIIb, noninferiority study (0.2% HA vs 0.18% HA) in two parallel groups over a period of 84 days. N=70 patients were evaluated. Primary efficacy outcome was ocular surface (OS) staining change on day 35 (D35), compared to baseline. Fluorescein and lissamine green were used for staining of cornea and conjunctiva. Secondary efficacy outcome included tear film breakup time, OS staining score on day 84 (D84), ocular comfort index, as well as patients’ and doctors’ evaluation.ResultsCompared to day 0 (D0), 0.2% HA achieved a 47.7% reduction in staining score (−3.00±2.81 [standard deviation] points, n=38 patients) at D35; 0.18% HA showed a 41.2% reduction (−2.59±2.20 [standard deviation] points, n=32 patients). Statistical analysis showed noninferiority in efficacy of 0.2% HA compared to 0.18% HA on D35. At D84, the reduction in staining score had further increased to 64.5% for 0.2% HA and to 56.4% for 0.18% HA. Both eye drops improved tear film breakup time and ocular comfort index values. Investigators and patients assessed both treatments with 5 of 7 points (Likert Scale, medians). The rate of adverse events (AE) was 2.3% for 0.2% HA and 7.1% for 0.18% HA with no serious AE.Conclusion0.2% and 0.18% HA eye drops significantly improved signs and symptoms of dry eye disease and were well tolerated with few AEs. Noninferiority of 0.2% HA compared to 0.18% HA was demonstrated for reduction of OS lesions. In some parameters, there was a nonsignificant trend in favor of 0.2% HA concentration.

Sjogren's Syndrome with Polyserositis, Gastrointestinal Findings and Ascending Aortic Aneurysm

SjA¶gren’s syndrome (SS) is an autoimmune disease with glandular and extraglandular manifestations. Pleural and pericardial effusions in association with SS are rare. Similarly, ascites is rare and it can occur in SS when combined with primary biliary cirrhosis (PBC). Inflammatory Abdominal Aortic Aneurysm together with SS has been described only in one case. We report herein the case of a 70-year-old man with SS presenting with polyserositis (pleural and pericardial effusion and ascites) and gastrointestinal manifestations (atrophic gastritis and candida esophagitis) and ascending aorta aneurysm. SS was diagnosed based on xerophthalmia, xerostomia, extraglandular manifestations, positive results for the Schirmer test, ocular surface staining score, histopathologic examination of labial buccal mucosa revealing focal lymphocytic sialadenitis and unstimulated salivary flow rate. The only positive autoantibody was against smooth muscle cells (ASMA). We thought that pleural, pericardial effusions, ascites, gastrointestinal findings and ascending aortic aneurysm may be related with autoimmunological inflammation of SS. To evaluate the extent of aortic vasculitis, we performed a whole body 18-Fluorodeoxyglucosepositron emission tomography (FDG-PET) and showed increased uptake of FDG in aneurysmal section of the ascending aorta. Treatment with high dose corticosteroid was proved to be successful in both clinically and laboratory.

Effects of Pigment Location in Tinted Contact Lenses on the Ocular Surface.

To evaluate the effects of the location of pigments in decorative tinted soft contact lenses on the ocular surface. Thirty test subjects were enrolled in this study. All subjects wore the following types of contact lenses, classified according to the location of the pigment layer, in one eye in three different testing sessions: conventional clear lenses, tinted lenses with a pigment layer embedded in the lens matrix, and tinted lenses with an exposed pigment layer on the surface. Tear samples were collected, the ocular surface status was evaluated, and subjective symptoms were surveyed after lens wear for 8 hours. The tinted lenses with surface pigments resulted in a greater increase in epidermal growth factor and interleukin-8 levels compared with the clear lenses and tinted lenses with embedded pigments (p < 0.050). Ocular surface parameters and subjective symptom scores were significantly different among three lens types (p < 0.050), with the clear lenses showing superior results compared with the two tinted lenses (p < 0.050). The tinted lenses with exposed pigments resulted in a greater degree of conjunctival redness and ocular surface staining and poorer symptom scores compared with the tinted lens with embedded pigments (p < 0.050). Our results suggest that the presence of surface pigments in tinted contact lenses increases ocular inflammation and results in a poorer ocular surface status and greater discomfort compared with clear lenses and tinted lenses with an embedded pigment layer.

Safety and efficacy of a hydroxypropyl guar/polyethylene glycol/propylene glycol-based lubricant eye-drop in patients with dry eye

AimsTo demonstrate non-inferiority of a hydroxypropyl guar/polyethylene glycol/propylene glycol lubricating eye-drop (HPG/PEG/PG) compared with an osmoprotective carboxymethylcellulose/glycerine eye-drop (O/CMC) for ocular surface staining.MethodsThis was a multicentre, randomised, observer-masked, parallel-group study....

Efficacy and safety of a cationic emulsion in the treatment of moderate to severe dry eye disease: a randomized controlled study.

To evaluate the efficacy and safety of a preservative-free cationic emulsion (CE) with a 0.18% hyaluronate sodium (HS) solution in patients with moderate to severe dry eye disease (DED) with keratitis or keratoconjunctivitis. Eighty-five patients were randomized (1:1) in this multicenter, prospective, reference-controlled, parallel-group, investigator-masked study to receive CE (n = 44) or HS (n = 41). Clinical signs and symptoms were assessed over 3 months. The primary efficacy endpoint was noninferiority of CE to HS in change from baseline of ocular surface staining (OSS) score at 1 month. In the per protocol (PP) set and full analysis set (FAS), CE showed a similar and noninferior (p&lt;0.0001) improvement in OSS scores compared with HS at 1 month (PP: -2.5 ± 1.3 vs -1.9 ± 1.6; FAS: -2.2 ± 1.5 vs -2.0 ± 1.8 for CE vs HS). Other clinical signs of DED similarly improved in both groups. In the FAS, global symptoms score of ocular discomfort was significantly better with CE compared with HS at 1 month (-14.8 ± 17.3 vs -7.6 ± 14.2; p = 0.0469), including greater alleviation of itching (-14.8 ± 21.2 vs -1.7 ± 19.7; p = 0.0100) and eye dryness (-21.9 ± 28.3 vs -8.4 ± 21.4; p = 0.0016). Similar trends were observed at 3 months for itching and eye dryness. Investigator global efficacy assessment and quality of life scores for eye pain and driving favored CE at 3 months. Incidence of adverse events was low in both treatment groups. CE was similar to HS with regards to safety and efficacy for objective signs but was superior to HS in improving DED symptoms in patients with moderate to severe DED.

Brief Report: Patients With Primary Sjögren's Syndrome Who Are Positive for Autoantibodies to Tripartite Motif-Containing Protein 38 Show Greater Disease Severity.

Autoantibodies reactive with Ro52 (tripartite motif-containing protein 21 [TRIM21]) are detected in 70% of patients with primary Sjögren's syndrome (SS). TRIM21 belongs to a 34-member C-IV family of TRIM proteins. Although autoantibodies against other TRIM proteins within the C-IV family have been detected in the sera of patients with primary SS, their clinical relevance remains unclear. This study was undertaken to investigate the frequency of anti-TRIM38 in patients with primary SS and evaluate its association with various clinical measures of the disease. Serum samples from patients with primary SS (n = 235) and controls (n = 50) were analyzed for reactivity with in vitro-transcribed and -translated (35) S-methionine-labeled TRIM38 protein. The associations of anti-TRIM38 with various laboratory and clinical measures of primary SS were evaluated. Reactivity of anti-TRIM38 with different structural domains of TRIM38 was analyzed. Affinity-purified anti-TRIM38 antibodies were used to immunoprecipitate TRIM21. TRIM38-reactive autoantibodies were detected in the sera of 24 of the 235 patients with primary SS and 2 of the 50 controls. Anti-TRIM38 positivity was significantly associated with the presence of anti-Ro60, anti-Ro52, anti-La, rheumatoid factor, and hypergammaglobulinemia. Clinically, anti-TRIM38 was associated with significantly higher ocular surface staining scores, lower Schirmer's test scores, and minor labial salivary gland biopsy focus scores of ≥3.0. Anti-TRIM38 antibodies mainly recognized the cortactin-binding protein 2 (CortBP-2; amino acids 128-238) and the B30.2/SPRY (amino acids 268-465) domains on TRIM38. Affinity-purified antibodies to TRIM38-CortBP-2 and TRIM38-B30.2/SPRY domains reacted with TRIM21. Our data demonstrate that anti-TRIM38 specificity arising in a subset of patients with primary SS is associated with increased severity of the disease.

Effect of the osmolarity change in multipurpose solutions induced by an improper contact lens case cleaning procedure.

To determine whether variations in multipurpose disinfecting solution (MPDS) storage osmolarity from inappropriate contact lens (CL) case cleaning affect ocular surface integrity and wearer comfort. There were twenty contact lens cases (study CLCs) in the study group. Ten were filled with ReNu Multiplus(®) and 10 with SoloCare Aqua™ (MPDS-1 and -2, respectively) and kept closed for 8h; the cases were then emptied and kept open for air-drying for 16h. This procedure was carried out every day for two months. Storage solution osmolarity was measured on days 0, 15, 30, 45 and 60. Ten subjects were then fitted with both month-old lenses stored in the study CLCs and with new lenses stored in new cases with fresh solution for 24h (control CLCs). Symptoms, tear osmolarity and percentage of subjects whose conjunctival hyperaemia and ocular surface staining scores changed were determined after 1h of wear. Study CLC osmolarity increased in both solutions after two months (p<0.05). For MPDS-1 there were differences in stinging between study CLCs and control CLCs after 10min of CL wear (p=0.04), and in comfort after 10 (p=0.035) and 60min wear (p=0.042). Significant (p<0.05) differences between study CLC and control CLC groups were also found for MPDS-2 in limbal hyperaemia (study: 50% change; control: 0% change) and bulbar and corneal staining (study: 80% change; control: 20% change). The stored-MPDS osmolarity increase caused by air-drying the CLCs could affect the ocular surface. This increase might reduce lens wear comfort.

Comparison of Changes in Ocular Surface Status after Wearing Orthokeratologic and Rigid Gas Permeable Lens

Purpose: To evaluate the differences in dry eye and meibomian gland dysfunction (MGD) by comparing ocular surface status before and after wearing an orthokeratologic (OK) lens and rigid gas permeable (RGP) lens made of the same material. Methods: The ocular surface and meibomian gland statuses of 12 eyes of 12 OK lens wearers (OK lens group) and 16 eyes of 16 RGP wearers (RGP lens group) were evaluated before and 1 and 3 months after lens wearing. Ocular surface disease index (OSDI), tear film break-up time (TBUT), Schirmer’s test I, and ocular surface staining score were evaluated for ocular surface parameters. Meibomian gland function was evaluated by assessing lid margin abnormality, meibomian gland expressibility, and meibum quality. Results: TBUT and ocular surface staining score after 1 and 3 months of wearing an OK lens were significantly aggravated (p = 0.004, p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an OK lens (p < 0.001, p < 0.001, p < 0.001, p = 0.002). After 1 and 3 months of wearing an RGP lens, OSDI, TBUT, and ocular surface staining score were aggravated (all p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an RGP lens (all p < 0.001). MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were significantly more aggravated in the RGP lens group than in the OK lens group after 3 months (p < 0.001, p < 0.001, p = 0.001, p < 0.001). Conclusions: Use of OK and RGP lenses affects ocular surface status. Especially, meibomian gland parameters and OSDI showed greater changes in RGP lens wearers than OK lens wearers. J Korean Ophthalmol Soc 2016;57(4):546-554

Effectiveness and Optical Quality of Topical 3.0% Diquafosol versus 0.05% Cyclosporine A in Dry Eye Patients following Cataract Surgery.

Purpose. To evaluate the effectiveness and optical quality of 3.0% topical diquafosol versus 0.05% cyclosporine A in dry eye patients following cataract surgery. Methods. In total, 40 eyes of 40 patients newly diagnosed with dry eye syndrome 1 week after cataract surgery were randomized to receive either 3.0% diquafosol ophthalmic solution six times daily or 0.05% cyclosporine A twice daily for 3 months. Outcome measures were tear film break-up time (TBUT), results on Schirmer 1 test, ocular surface staining score, the ocular surface disease index (OSDI) score, and higher-order aberrations (HOAs). Measurements were taken at baseline and at 1, 2, and 3 months. Results. In the diquafosol group, TBUT showed higher outcomes than the cyclosporine A group at 1 and 3 months. Both groups showed increased scores on Schirmer 1 test. The ocular surface staining score decreased in all periods in both groups. Vertical coma and total HOAs decreased more in the cyclosporine A group than in the diquafosol group at 3 months. Conclusion. Both 3.0% diquafosol and 0.05% cyclosporine A were effective in treating dry eye after cataract surgery. Diquafosol was more effective in increasing the tear secretion, but cyclosporine A was more effective in improving optical aberrations.

Chronic dry eye in photorefractive keratectomy and laser in situ keratomileusis: Manifestations, incidence, and predictive factors

To evaluate dry-eye manifestations after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) and determine the incidence and predictive factors of chronic dry eye using a set of dry-eye criteria. Walter Reed Army Medical Center, Washington, DC, USA. Prospective, non-randomized clinical study. Dry-eye evaluation was performed before and after surgery. Main outcome measures included dry-eye manifestations, incidence, and predictive factors of chronic dry eye. This study comprised 143 active-duty U.S. Army personnel, ages 29.9 ± 5.2 years, with myopia or myopic astigmatism (manifest spherical equivalent -3.83 ± 1.96 diopters) having PRK or LASIK. Schirmer scores, corneal sensitivity, ocular surface staining, surface regularity index, and responses to dry-eye questionnaire significantly changed over time after PRK. After LASIK, significant changes were observed in tear breakup time, corneal sensitivity, ocular surface staining, and responses to questionnaire. Twelve months postoperatively, 5.0% of PRK and 0.8% of LASIK participants developed chronic dry eye. Regression analysis showed that pre-operatively lower Schirmer score will significantly influence development of chronic dry eye after PRK, whereas preoperatively, lower Schirmer score or higher ocular surface staining score will significantly influence the occurrence of chronic dry eye after LASIK. Chronic dry eye was uncommon after PRK and LASIK. Ocular surface and tear-film characteristics during pre-operative examination might help to predict chronic dry-eye development in PRK and LASIK. The authors have no financial interest in any product, drug, instrument, or equipment discussed in this manuscript.

Influence of Eyelid Pressure on Fluorescein Staining of Ocular Surface in Dry Eyes

To determine the relationship between eyelid pressure during blinking and the fluorescein staining of the cornea and conjunctiva in dry eye patients. Cross-sectional prospective study. The pressure of the upper and lower eyelids was measured with a specially designed blepahro-tensiometer in 130 eyes of 65 dry eye patients (D group) and in 58 eyes of 31 normal controls (N group). The correlations between the location and degree of ocular surface staining scores and the eyelid pressure were calculated for the D group. The pressures of the upper and lower eyelids were significantly higher in the D group than in the N group (upper P < .0001, lower P = .0040). The lower eyelid pressure was significantly correlated with the ocular surface staining scores for the inferior cornea (r = 0.19, P = .0307) and conjunctiva (r = 0.19, P = .0252). The significant correlation between the eyelid pressure and the ocular surface staining suggests that mechanical friction on the ocular surface by the eyelids may be one of the factors that affects the fluorescein staining of the inferior ocular surface.

Effectiveness and relevant factors of 2% rebamipide ophthalmic suspension treatment in dry eye.

BackgroundRebamipide with mucin secretagogue activity was recently approved for the treatment of dry eye. The efficacy and safety in the treatment of rebamipide were shown in two pivotal clinical trials. It was the aim of this study to evaluate the effect of 2 % rebamipide ophthalmic suspension in patients with dry eye and analyze relevant factors for favorable effects of rebamipide in clinical practice.MethodsThis was a retrospective cohort study of 48 eyes from 24 patients with dry eye treated with 2 % rebamipide ophthalmic suspension. Dry eye-related symptom score, tear film break-up time (TBUT), fluorescein ocular surface staining score (FOS) and the Schirmer test were used to collect the data from patients at baseline, and at 2, 4, 8, and 12 week visits. To determine the relevant factors, multiple regression analyses were then performed.ResultsMean dry eye-related symptom score showed a significant improvement from the baseline (14.5 points) at 2, 4, 8 and 12 weeks (9.80, 7.04, 7.04 and 7.83 points, corrected P value <0.001, respectively). Median FOS showed a significant improvement from the baseline (3.0 points) at 2, 4, 8 and 12 weeks (2.0, 2.0, 1.0 and 1.0 points, corrected P value <0.001, respectively). TBUT and Schirmer test values were not significantly improved after the treatment. For ocular symptoms, three parameters (foreign body sensation, dry eye sensation and ocular discomfort) showed significant improvements at all visits. The multiple regression analyses showed that the fluorescein conjunctiva staining score was significantly correlated with the changes of dry eye-related symptom score at 12 weeks (P value = 0.017) and dry eye-related symptom score was significantly correlated with independent variables for the changes of FOS at 12 weeks (P value = 0.0097).ConclusionsTwo percent rebamipide ophthalmic suspension was an effective therapy for dry eye patients. Moreover the fluorescein conjunctiva staining score and dry eye-related symptom score might be good relevant factors for favorable effects of rebamipide.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-015-0040-0) contains supplementary material, which is available to authorized users.