Ocular Surface Staining Research Articles

Corneal sensitivity and ocular surface health in patients undergoing femtosecond LASIK retreatment for residual refraction.

To assess corneal sensitivity and the ocular surface in patients undergoing primary femtosecond laser in situ keratomileusis (FS-LASIK) and those undergoing FS-LASIK retreatment under the same flap due to residual refractive error. Ekol Eye Hospital, Izmir, Turkey. Prospective case series. 19 patients with previous FS-LASIK who had myopic and astigmatic refractive error were included in the study group, and 19 age-matched and sex-matched patients undergoing FS-LASIK for the first time as the control group. Corneal sensitivity, Schirmer test, tear film break-up time (TBUT), Oxford grading scheme for ocular surface staining, and Ocular Surface Disease Index (OSDI) were measured preoperatively and at postoperative 1 week and 1, 3, and 6 months. The mean refractive correction in the study and control groups, respectively, was 2.18 ± 0.78 diopters (D) (range: 1.00 to 3.50) and 2.76 ± 1.20 D (range: 1.00 to 4.50; P = .07). Corneal esthesiometry results in the study and control groups, respectively, were 6.10 ± 12.55 vs 9.90 ± 11.50 mm at 1 week ( P = .001), 41.95 ± 6.98 vs 45.09 ± 5.88 mm at 1 month ( P = .004), 56.09 ± 3.37 vs 56.19 ± 2.52 mm at 3 months ( P = .8), and 58.60 ± 2.01 vs 58.80 ± 1.39 mm at 6 months ( P = .5). Significant difference between the 2 groups in Schirmer test score that disappeared at postoperative 3 months and in TBUT and ocular surface staining that disappeared at 6 months, whereas the statistically significant difference in OSDI score persisted at 6 months ( P = .03) was detected. Corneal surface sensitivity and ocular surface health are more impaired in patients undergoing FS-LASIK retreatment due to residual refractive error.

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

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

The efficacy of a netilmicin/dexamethasone gel combination in the treatment of posterior blepharitis in moderate-severe dry eye patients.

To evaluate the safety and efficacy of netilmicin/dexamethasone combination in the treatment of meibomian gland dysfunction (MGD)-associated posterior blepharitis. In this prospective and controlled study were enrolled 40 patients with MGD and symptoms of dry eye disease. Two groups were established: 20 patients (group 1) received netilmicin 3 mg/ml and dexamethasone 1 mg/ml eye gel, whereas in group 2 (20 patients) received vehicle for 15 days. Patients were evaluated at baseline, 15 and 45 days, including SANDE and VARS questionnaire, non-invasive tear film breakup time (NIBUT), tear meniscus height (TMH), ocular redness and meibography score. Moreover, fluorescein tear-film breakup time (TBUT), fluorescein ocular surface staining, lid margin evaluation including hyperemia, edema and meibum expressibility and quality examinations were carried out. Furthermore, intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were considered as safety parameters. In group 1, at 15 and 45 days there were statistically significant changes in VARS and SANDE score (p < 0.0001) as well as lid margin parameters, TBUT and fluorescein ocular surface staining (p < 0.0001). Comparing the two groups, a significant improvement of SANDE score was observed at 15 days in group 1 as well as lid margin parameters, TBUT and fluorescein ocular surface staining at 15 and 45 days (all p < 0.0001). Netilmicin/dexamethasone combination is effective and safe to treat MGD-associated posterior blepharitis improving both symptoms and ocular surface signs.

Association between the use of prostaglandin analogues and ocular surface disease: a systematic review.

Patients with glaucoma often experience chronic ocular surface diseases, potentially underestimated in frequency and severity. To provide updated estimates of ocular surface diseases linked to prostaglandin analogue antiglaucoma eye medication, a systematic review was conducted. Twenty-seven publications were selected from databases like PubMed, Scopus, and Web of Science, following a search strategy targeting glaucoma and prostaglandins while excluding certain medications '(Glaucoma AND prostaglandins OR 'prostaglandin analogues')('eye drops' OR 'artificial tears' OR 'ocular surface' OR 'dry eye' OR 'dry eye syndrome' OR 'ocular surface disease' OR 'tear film') NOT ('beta blockers' OR 'alpha adrenergic agonists' OR 'carbonic anhydrase inhibitors' OR 'rho-quinase')'. The review revealed a correlation between prostaglandin analogue use and ocular surface damage, assessing parameters such as tear break-up time, Schirmer test value, ocular surface staining, hyperaemia score, and meibomian gland characteristics. Some studies explored switching patients to alternative glaucoma medications, noting varied effects on ocular surface parameters. Comparisons suggested better tolerance and outcomes with preservative-free options over prostaglandins. Additionally, the impact of treatment duration and diquafosol on ocular health, including meibomian gland loss, was examined across different formulations. Although a link between prostaglandin analogues (with or without preservatives) and ocular surface damage was established, inconsistencies in methodologies and assessment across studies were noted. This comprehensive review, spanning a decade of glaucoma research, underscores the need for re-evaluation of treatment strategies in ophthalmology. It stresses the significance of informed decision-making for enhanced glaucoma care, taking into account the observed effects of various medications on eye health.

Efficacy of Topical Cyclosporine Combined with Punctal Plugs in Treating Dry Eye Disease and Inflammation

Purpose To evaluate the effect of punctal plugs combined with cyclosporine eye drops on dry eye disease (DED) and ocular surface inflammation. Methods In a clinical trial, 73 patients were randomly allocated into three groups: punctal plug group, combination therapy group, and cyclosporine group. At the baseline and four weeks after treatment, the Schirmer I test score, fluorescein tear film break-up time (FBUT), ocular surface staining score and dry eye symptoms were assessed. Tear samples were collected to detect the level of inflammatory factors (interleukins, matrix metalloproteinase 9 (MMP-9) and tumor necrosis factor alpha (TNF-α)). In an animal experiment, a New Zealand rabbit dry eye model was induced. The rabbits were randomly divided into control group, punctal plug group, and combination therapy group (n = 6). Conjunctival goblet cell density, protein level of MMP-9 in conjunctiva and mRNA levels of inflammatory factors in conjunctiva and cornea were measured before and after treatment. Results In combination therapy group of the clinical trial, the following results were observed: significant improvement in Schirmer I test scores and FBUT compared to the cyclosporine group and punctal plug group, respectively; a decrease in the tear levels of IL-6, IL-1, and MMP-9 compared to the punctal plug group; and a decrease in the tear levels of IL-1α, IL-6, and IL-17 compared to the baseline (all p < 0.05). In the animal experiment, rabbits in combination therapy group had a higher goblet cell density (p < 0.01) and lower mRNA levels of IL-16 (p < 0.05), IL-17 (p < 0.05), and MMP-9 (p < 0.01) in conjunctiva and that of MMP-9 (p < 0.01) in cornea compared to punctal plug group. Conclusion Cyclosporine eye drops combined with degradable punctal plugs is a more optimized clinical treatment strategy for DED compared with degradable punctal plugs or cyclosporine eye drops alone, considering the influence of comprehensive clinical efficacy and ocular surface inflammation.

Efficacy of 100% autologous platelet-rich plasma and 100% autologous serum in dry eye disease: a randomised controlled trial

ObjectiveThe 0bjective is to compare treatment effects between undiluted autologous platelet-rich plasma (APRP) and autologous serum (AS) in patients with moderate-to-severe dry eye disease (DED).Methods and analysisA single-centre, randomised, double-masked,...

Response predictors of a topical corticosteroid-based regimen for dry eyes: A real-life study.

To examine the effectiveness and identify clinical response predictors of a short corticosteroid-based regimen consisting of topical preservative-free 0.1% dexamethasone (Monopex®, Théa Laboratories) in conjunction with artificial tears (AT) for dry eyes in a real-life clinical setting. Patients were recruited from the Norwegian Dry Eye Clinic and were allowed to use ATs of their own choice in addition to the prescribed 14-day topical dexamethasone course. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ-5), Schirmer test (ST), fluorescein tear film break-up time (FBUT), ocular surface staining (OSS), meibum expressibility (ME), meibum quality (MQ), number of expressible meibomian glands among the central eight glands in the lower lids (NMG) and intraocular pressure (IOP) were measured at baseline and at 1-month follow-up. The average values of clinical parameters from both eyes were used for analyses. A paired t-test and a significance value of p < 0.05 were used for statistical analyses. Associations between sex, age, baseline values and the changes after the intervention (Δ) were explored using linear regression. A total of 167 patients (124 women, mean age 54 years ±17 (standard deviation)) were included. One month after initiation of intervention, OSDI and DEQ5 scores improved from 39.5 ± 22.1 to 31.4 ± 21.3 (p < 0.001) and from 12.6 ± 4.2 to 11.0 ± 4.6 (p < 0.001), respectively. OSS improved from 2.2 ± 1.4 to 1.8 ± 1.5 (p < 0.001), NMG increased from 4.8 ± 2.2 to 5.1 ± 2.2 (p < 0.05), while IOP decreased from 12.9 ± 3.3 to 12.4 ± 3.5 mmHg (p < 0.05). Significant associations were found between the change in symptoms and objective measures of DED (ΔOSDI, ΔDEQ5, ΔOSS, ΔFBUT, ΔNMG, ΔMQ) and their respective baseline values (OSDI, DEQ5, OSS, FBUT, NMG, MQ). The remaining tests did not show statistically significant changes. Improvement in dry eye symptoms and signs were observed following a short course of topical, preservative-free 0.1% dexamethasone treatment in combination with AT. Individuals exhibiting more pronounced symptoms and signs witnessed the most profound improvements with the treatment regimen, suggesting that poor baseline parameters may serve as response predictors of the treatment regimen. While the real-life data presented herein are valuable, the conclusions are limited by the inherent biases of a non-controlled study.

Is Orbital Lobe of the Lacrimal Gland Dispensable? Tear Volume, Ocular Surface, and MRI Volumetric Analysis.

To investigate the effects of lacrimal gland reduction surgeries on the tear volume and ocular surface. This is a cohort study of patients post 2 lacrimal gland reduction surgeries: partial orbital lobe dacryoadenectomy for refractory epiphora (4 patients, mean age: 31 ± 13.6 years, 3 males) and complete orbital lobe dacryoadenectomy for lacrimal gland pleomorphic adenoma (15 patients, mean age: 41 ± 12 years, 7 females). Changes in Schirmer I, ocular surface staining, symptomatology, and lacrimal gland volumetrics (MRI) were assessed before and after the surgical procedure. The median Schirmer value reduction following partial orbital lobe dacryoadenectomy was 5 mm at a mean follow-up of 18 ± 4.9 months. None of them developed dry eye disease or positive ocular staining. The gland volume was reduced by 45.9% to 53.5% in 3 patients and 13.3% in 1 patient. The epiphora improved moderately in 93% of patients. Of 15 patients with lacrimal gland pleomorphic adenoma excision, the median reduction in Schirmer I was 4 mm at a mean follow-up of 12.8 months. Partial or complete removal of the orbital lobe of the lacrimal gland does not induce dry eye disease in otherwise healthy individuals. However, gland volume does not recover following partial reduction, and it seems unlikely that the lacrimal gland regenerates following partial removal.

Efficacy of RCI001 as a Therapeutic Candidate in a Primary Sjögren Syndrome Mouse Model.

The aim of this study was to investigate the efficacy of RCI001 (RCI) in a mouse model of primary Sjögren syndrome. Eight 12-week-old NOD.B10-H2b mice were used in this study. All experimental animals were randomly divided into phosphate-buffered saline (PBS) and RCI groups in NOD.B10-H2b mice. The eyes of mice were topically treated with PBS or RCI twice a day for a week. Ocular surface staining (OSS) and tear secretion were compared between before and after treatment. The transcript levels of inflammatory cytokines and nicotinamide adenine dinucleotide phosphate oxidase (NOX) in the conjunctiva and cornea (CC) and lacrimal gland were assayed. In addition, immunofluorescence staining of the conjunctiva was assessed. The RCI group showed significant clinical improvement in OSS and tear secretion after 1 week of treatment compared with the baseline (both P < 0.001) and showed better improvement in OSS and tear secretion than the PBS group after 1 week of treatment (both P < 0.05). The levels of IL-1β and IL-17 in CC and IL-6 in the lacrimal gland were also significantly reduced in the RCI group compared with the PBS group (each P < 0.05). Transcript levels of NOX2 and NOX4 were also significantly reduced in CC of the RCI group compared with those of the PBS group (P < 0.05). The RCI group also resulted in lower conjunctival expression of oxidative stress markers (4-hydroxy-2-nonenal, hexanoyl-lysine, and NOX4) than the PBS group. Topical RCI001 demonstrated excellent therapeutic efficacy in a mouse model of primary Sjögren syndrome by inhibiting inflammation and oxidative stress.

Moderate-severe peripheral neuropathy in diabetes associated with an increased risk of dry eye disease.

This study establishes an increased risk of developing dry eye disease (DED) in patients with diabetic peripheral neuropathy using validated diagnostic criteria for both conditions. The disruption of ocular surface homeostasis has been associated with diabetes. However, it remains unclear if this association is independently influenced by peripheral neuropathy secondary to diabetes. This study aimed to investigate the clinical signs and symptoms of DED and their association with the severity of peripheral neuropathy in participants with type 2 diabetes. This prospective cross-sectional study recruited 63 participants with type 2 diabetes. All participants underwent a detailed assessment of DED using dry eye questionnaires (Ocular Surface Disease Index, Dry Eye Questionnaire-5), tear osmolarity, lipid layer thickness, noninvasive keratographic tear breakup time, phenol red thread test (PRT), and ocular surface staining. Corneal nerve morphology was imaged using corneal confocal microscopy. Based on the Total Neuropathy Scale, participants were stratified into no/mild (n = 48) and moderate/severe (n = 15) neuropathy groups. Dry eye disease was diagnosed in 31 participants (50%) of the total cohort, and the odds of developing DED in the moderate/severe neuropathy group were four times (95% confidence interval, 1.10 to 13.80; p=0.030) higher compared with the no/mild neuropathy group. The Dry Eye Questionnaire-5 scores were significantly higher (p=0.020), and PRT values (p=0.048) and corneal nerve fiber length (p<0.001) were significantly reduced in the moderate/severe neuropathy group compared with the no/mild neuropathy group. In regression analysis, neuropathy scores were independently associated with PRT measurements (β = -0.333, p=0.023) and nerve fiber length (β = -0.219, p=0.012) while adjusting for age, gender, hemoglobin A1c, and duration of diabetes. Type 2 diabetic patients with peripheral neuropathy have a risk of developing DED, which increases with the severity of neuropathy. The observation that worsening peripheral neuropathy is associated with reduced tear secretion suggests that it may contribute to aqueous insufficiency.

The Effect of Topical Rebamipide 2% in Managing Dry Eye Following Cataract Surgery

Purpose: To evaluate the potential advantages of using topical rebamipide 2% to manage dry eye following cataract surgery.Methods: Patients who underwent cataract surgery (phacoemulsification and intraocular lens insertion) were evaluated for dry eye 1 week postoperatively. Randomly selected patients were divided into the rebamipide group, who received 2% rebamipide eye drops, and the control group, who did not receive rebamipide. Various dry eye-related tests, including Schirmer’s test, the tear break-up time (TBUT), ocular surface staining, tear film osmolarity, tear lipid layer thickness, and the ocular surface disease index (OSDI) were performed in both groups 1 week, and 1 and 2 months postoperatively.Results: In the rebamipide group, we observed significant improvement in TBUT, the ocular surface staining score, and OSDI at 2 months postoperatively, as compared to 1 week (&lt;i&gt;p&lt;/i&gt; = 0.002, 0.014, and 0.013, respectively). Schirmer’s test, tear film osmolarity, and tear lipid layer thickness remained unchanged in the rebamipide group. Throughout the entire follow-up period, the rebamipide group had a significantly prolonged TBUT (1 month: &lt;i&gt;p&lt;/i&gt; = 0.007, 2 months: &lt;i&gt;p&lt;/i&gt; = 0.000), and lower ocular surface staining score (1 month: &lt;i&gt;p&lt;/i&gt; = 0.000, 2 months: &lt;i&gt;p&lt;/i&gt; = 0.000), as compared to the control.Conclusions: Following cataract surgery, the use of rebamipide eye drops produced improvements in TBUT, ocular surface staining scores, and OSDI. This suggests that rebamipide offers benefits in managing dry eye that can occur after cataract surgery.

The Effect of Face Mask Wear on the Ocular Surface and Contact Lens Microbiome.

As face mask wear can result in the redirection of nasal and oral exhalation toward the ocular region, this study investigated the impact of face mask wear on the conjunctiva, eyelid margin, and contact lens (CL) surface microbiome. In this prospective, cross-over study, experienced CL wearers (N=20) were randomized to wear a face mask for 6 hr/day (minimum) for a week or no mask for a week. The conjunctiva, eyelid, and CLs were then sampled. After a 1-week washout period, participants were crossed over into the alternate treatment for 1 week and sampling was repeated. Sampling was bilateral and randomly assigned to be processed for culturing or 16S ribosomal(r) RNA gene sequencing. Culturing showed no effect of mask wear on the average number of bacterial colonies isolated on the conjunctiva, eyelid, or CL, but there was increased isolation of Staphylococcus capitis on CL samples with mask wear (P=0.040). Culture-independent sequencing found differences in the taxonomic complexity and bacterial composition between the three sites (P<0.001), but there was no effect of bacterial diversity within and between sites. Mask wear did not impact dry eye or CL discomfort, but increased ocular surface staining was reported (P=0.035). Mask wear did not substantially alter the microbiome of the conjunctiva, eyelid margin, or CL surfaces in uncompromised healthy eyes.

Efficient capture of dry eye data from the real world: The Save Sight Dry Eye Registry

PurposeTo describe a web-based, high-quality data collection tool able to track the clinical data of patients with dry eye disease (DED) in routine clinical practice. DesignRetrospective analysis of core system web data from a prospectively designed, observational, routine clinical practice registry, the Save Sight Dry Eye Registry (SSDER). MethodsPatients with DED, from 11-Nov-2020 to 04-Mar-2024 were analysed. Ocular Surface Disease Index (OSDI) and Ocular Comfort Index (OCI) questionnaires collected patient-reported DED symptoms, and the Patient Health Questionnaire-4 (PHQ-4) screened for anxiety and depression. Outcome data include index visit demography, DED symptoms and signs. ResultsFifteen clinicians (ophthalmologists and optometrists) from nine practices across Australia, France, Germany, Nepal, Spain and the United Kingdom contributed data, comprising index visits of 958 eyes from 479 patients (mean±SD age 56±17 years; 78.7% female). Up to 89.9% of the patients had either evaporative or mixed DED based on clinician's judgement. Mean OSDI symptom score at index visit was 35.7 ± 19.4 (n = 366), and the mean sores for frequency and intensity of discomfort with the OCI was 31.9 ± 6.1 and 31.4 ± 6.8 (n = 202) respectively. Forty-one percent of patients had mild to severe symptoms of anxiety and depression. Median tear breakup time and tear meniscus height were 5 (IQR 2–8) seconds and 0.3 (IQR 0.2–0.4) mm, respectively. Ocular surface staining was graded as none (37.6%), minimal (31.7%), mild (19.8%), moderate (8.8%) and severe (2.1%). ConclusionThe SSDER facilitated the collection of data from patients with DED from real-world clinical practice. Presenting patients had moderate DED, which was mostly evaporative in nature. Symptoms of anxiety and depression were reported by more than one-third of the cohort.

The Mid-Term Effect of Preservative-Free Artificial Tears Containing Hyaluronic Acid on Dry Eye Incidence after Cataract Surgery: A Retrospective Cohort Study.

The aim of this study is to survey the effectiveness of preservative-free artificial tears containing hyaluronic acid (HA) on post-cataract surgery dry eye disease (DED) prevention. A retrospective cohort study was performed, and patients that received cataract surgeries were divided into either an HA group or non-HA group depending on the artificial tear they used. A total of 37 and 74 eyes were enrolled into the HA and non-HA groups, respectively, after the selection. The primary outcomes are postoperative superficial keratitis and multiple (>3) DED symptoms. The generalized linear model was utilized to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of primary outcomes between the two groups. There were 10 and 2 episodes of superficial keratitis in the non-HA group and HA group, respectively, and the HA group demonstrated a significantly lower incidence of superficial keratitis (p < 0.001). Moreover, 13 and 5 patients developed multiple DED symptoms in the non-HA and HA groups, and the HA group illustrated fewer multiple DED symptoms (p = 0.024). The lower preoperative tear break-up time (TBUT) was correlated with superficial keratitis in the HA group (p = 0.043), while old age, low preoperative TBUT and ocular surface staining were associated with superficial keratitis in the non-HA group (all p < 0.05). Lower preoperative TBUT was correlated with multiple DED symptoms in the HA group (p = 0.020), while female sex, low preoperative TBUT and any DED symptoms were associated with multiple DED symptoms in the non-HA group (all p < 0.05). In conclusion, the usage of preservative-free artificial tears containing HA is associated with lower postoperative DED events.

Effectiveness of an Acupuncture Steam-Warming Eye Mask on Dry Eye Disease in Visual Display Terminal Users: A Prospective Randomized Controlled Trial.

We aim to evaluate the effectiveness of an acupuncture steam-warming eye mask (ASEM) on dry eye disease (DED) in visual display terminal (VDT) users. This prospective randomized clinical trial included VDT users with DED-related features who were randomly assigned to the ASEM group (ASEM for 2 weeks, 20 participants) or the steam-warming eye mask (SEM) group (SEM for 2 weeks, 20 participants). The tear film break-up time (TBUT), Schirmer test, tear meniscus height, ocular surface staining scores, eyelid and meibomian gland exam, subjective symptoms, and quality of life (QoL) scores before and after treatment were collected. A generalized linear mixed model was applied to compare the improvement of symptoms and signs between the two groups. After the 2-week treatment, all the subjective symptoms and questionnaire scores in the ASEM group improved significantly (all p < 0.05), whereas the feelings of relaxation, comfortable, and refreshment did not change in the SEM group (both p > 0.05). The TBUT, tear meniscus height, and meibum quality in the lower eyelid were significantly better in the ASEM group than the SEM group (all p < 0.05), whereas no significant changes were observed in the Schirmer test and ocular surface staining scores. Compared with the SEM group, the ASEM group experienced a stronger feeling of refreshment (p = 0.013), lower sensation of ocular discharge (p = 0.031), higher TBUT (p = 0.045), better meibomian gland expressibility of both eyelids (both p < 0.05), and better meibum quality of both eyelids (both p < 0.05), even after adjustments for age and sex. In conclusion, comparing with SEM, ASEM can improve some subjective DED symptoms, tear film stability, and meibum status in VDT users.

Quality of Life and Symptomatology in Neuropathic Corneal Pain in Comparison With Dry Eye Syndrome.

To investigate and compare the quality of life (QoL) and symptomatology between neuropathic corneal pain (NCP) and dry eye disease (DED). We recruited 150 patients, comprising 50 patients with NCP and 100 patients with DED. Patients' symptoms and QoL were evaluated using the Ocular Pain Assessment Survey and Ocular Surface Disease Index questionnaires. Ocular surface assessments were also performed. Patients with NCP demonstrated significantly lower Oxford and National Eye Institute scores for ocular surface and corneal staining, respectively, and a better tear break-up time than patients with DED. However, patients with NCP reported significantly worse scores on most of the Ocular Pain Assessment Survey questions and significantly more severe overall pain (P = 0.019), maximal and average ocular pain and nonocular pain (all P < 0.05). The NCP group reported significantly worse QoL in all aspects of daily living (all P < 0.001). Patients with NCP spent more time thinking about their eye pain and reported significantly higher pain intensities than patients with DED when exposed to chemical and mechanical stimuli (all P ≤ 0.008). Burning sensation and photophobia were significantly more frequent in patients with NCP (P = 0.032 and P = 0.012, respectively). Similarly, the NCP group reported significantly worse total Ocular Surface Disease Index scores, significantly more frequent vision-related function impairment and painful or sore eyes than the DED group (P = 0.029, P = 0.031, and P = 0.014, respectively). Compared with DED, NCP is more debilitating, leading to more severe and frequent symptoms, and greater negative impact on all aspects of QoL.

Improvement in signs and symptoms of severe dry eye disease after dual therapy with high-potency steroids and 0.05% cyclosporine

Objective To evaluate the effectiveness and safety of combining 0.05% cyclosporine A (CsA) with high-potency steroids for treating severe dry eye disease (DED). Materials and methods This retrospective comparative case series included 93 patients treated with 0.05% CsA for severe DED. Among them, we included data from 54 eyes of 27 patients who received high-potency steroids in the study group and from 132 eyes of 66 patients who did not receive high-potency steroids in the control group. Data on demographic characteristics, comorbidities, medications and intraocular pressure (IOP) were recorded. The primary outcomes were changes in symptom and sign scores. The ocular surface disease index was used as the symptom score, whereas tear break-up time, Schirmer I test without anaesthesia, ocular surface staining scores and presence of meibomian gland dysfunction were considered as sign scores. Repeated one-way ANOVA and generalized linear mixed models were used to evaluate differences. Results In the control group, symptom scores decreased from 1 to 2 months and from 2 to 3 months after treatment (p = .002 and .049). In the high-potency steroid group, symptom scores improved during these intervals (p = .003 and .005). The sign score in the control group remained unchanged (all p > .05), while the high-potency steroid group exhibited progressive improvement in sign scores (all p < .05). The high-potency steroid group had more favourable symptom (p = .035) and sign (p < .001) scores than did the control group. However, multiple systemic diseases were associated with poor symptom (p = .025) and sign (p = .014) scores. The risks for glaucoma and cataract formation were similar between the two groups (all p > .05). Conclusions Dual therapy combining high-potency steroids and 0.05% CsA significantly improved the signs and symptoms of severe DED compared with 0.05% CsA monotherapy, without severe complications.

Discriminative performance of ocular surface staining and lid wiper epitheliopathy in dry eye disease: An investigator-masked, prospective registry-based, diagnostic accuracy study

PurposeTo evaluate the diagnostic performance of corneal and conjunctival staining, and lid wiper epitheliopathy (LWE) in detecting dry eye disease, as defined by the global consensus Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) criteria. MethodsA total of 2066 community residents (1285 females; mean ± SD age, 40 ± 19 years) were recruited in an investigator-masked, prospective registry-based, diagnostic accuracy study. Dry eye symptomology and ocular surface parameters were assessed in a single clinical session. The Sjögren's International Collaborative Clinical Alliance (SICCA) corneal and conjunctival staining scoring and Korb lid wiper epitheliopathy (LWE) grading were evaluated by an independent masked assessor. ResultsOverall, 807 (39 %) participants fulfilled the TFOS DEWS II criteria for dry eye disease, of which 178 (9 %) participants were classified as moderate-to-severe disease. The discriminative abilities of superior and inferior LWE (C-statistics, 0.724 and 0.712, respectively) were greater than corneal and conjunctival staining (C-statistics, 0.573 and 0.627, respectively). The Youden-optimal diagnostic cut-offs for the SICCA corneal and conjunctival staining scores were both ≥1, and the optimal thresholds for the Korb superior and inferior LWE grades were both ≥1. LWE was more commonly detected in both mild-to-moderate and moderate-to-severe dry eye disease, and demonstrated more consistent correlation with other ocular surface parameters across a broader range of disease severity. ConclusionsLWE demonstrates superior diagnostic performance relative to corneal and conjunctival staining. These findings would support the routine incorporation of LWE evaluation as part of the diagnostic workup of dry eye disease.

A randomized fellow-eye controlled trial study of 1% terpinen-4-ol vs 1% tea tree oil eyelid cleanser for the treatment of meibomian gland dysfunction

PurposeTo compare the pre- and post-treatment differences in non-invasive tear breakup time (NITBUT) between a 1 % terpinen-4-ol (T4O) and a 1 % tea tree oil (TTO) eyelid cleanser DesignA randomized controlled trial MethodThirty-three participants diagnosed with MGD were enrolled. All patients and the outcome evaluator were masked to the treatment allocation. One eye of each patient was randomly assigned to receive the T4O cleanser, while the fellow eye received the TTO cleanser. Baseline and eight week assessments included the collection of the ocular surface disease index (OSDI) questionnaire, NITBUT (in seconds), lipid layer thickness (in nanometers), ocular surface staining scores, and the presence of Demodex as cylindrical dandruff. The main outcome measurement was the pre- and post-treatment difference in NITBUT. Patient preference, safety, and tolerability were also assessed. ResultsThere was a statistically significant increase in NITBUT in the T4O group (n = 30; 2.27 ± 1.09; 95 % confidence interval [CI]: 0.12–4.42; p = 0.038), but not in the TTO group (n = 30; 0.04 ± 1.10; 95 % CI: -2.19–2.11; p = 0.972). Both groups showed significant improvement in post-treatment ocular surface staining scores. Fifteen subjects (50 %) preferred TTO due to less cooling sensation experienced during application, nine (30 %) preferred T4O, and six (20 %) had no preference. No major adverse events were observed. ConclusionEyelid cleaning with 1 % T4O in MGD for eight weeks was found to increase NITBUT with good tolerability, although it was less preferred compared to TTO.

Evaluation of Meibomian Gland Structure and Function in Patients with Vernal Keratoconjunctivitis Using Non Contact Meibography and Lipid Layer Interferometry

ABSTRACT Purpose This study evaluated the structural and functional impact of vernal keratoconjunctivitis (VKC) on meibomian glands (MGs) using a combination of noncontact meibography and lipid layer interferometry. Methods In this observational study 50 patients with moderate persistent or severe VKC and 50 age-matched controls underwent MG imaging and lipid layer thickness (LLT) measurements with Lipiview II. Image J software was used to assess MG loss (meibograde) in both lids. All patients underwent dry eye evaluation comprising tear break-up time (TBUT), ocular surface staining (OSS), Schirmer I scoring, and meiboscoring (expressibility and quality of meibum secreted). Results Meibograde, OSS score, and meiboscore was higher in cases (2.68 ± 0.96, 0.580 ± 1.07, and 0.56 ± 0.95 respectively) than controls (1.80 ± 0.67, 0.00 ± 0.00, 0.22 ± 0.47 respectively) (p < 0.001, 0.001, 0.025 respectively). LLT and TBUT was lower in cases (54.58 ± 9.43 nm and 4.92 ± 3.09 sec respectively) than controls (70.14 ± 22.50 nm and 12.02 ± 2.73 sec respectively) (both p’s = 0.001). Both groups had comparable Schirmer I scores. Conclusion Children with VKC have significant MG dropouts, deterioration in meibum quality and a thinner and less stable tear film. VKC patients are thus prone to a vicious cycle of inflammation attributable both to the allergic component and to deterioration in MG structure and function. Co-management of MG dysfunction warrants as much attention as the allergic component itself.