OSDI Score Research Articles

Tear Film Immunological Profile in Patients with Ocular Graft versus Host Disease

ABSTRACT Purpose To analyze and compare the tear immunological profile in ocular GVHD (oGVHD) patients with that in non-oGVHD patients and to correlate them with ocular surface parameters based on the International Chronic Ocular GVHD Consensus Group (ICCGVHD) diagnostic criteria. Methods Tear samples from 20 individuals who underwent allo-hematopoietic stem cell transplantation and were grouped according the presence or absence of oGVHD were analyzed using Bio-Plex assay. Results IL-8 and MIP-1α levels were significantly higher in tears from oGVHD patients compared with those in tears from non-oGVHD patients (p<0.001 and p=0.001, respectively). Tear IL-8 levels correlated significantly with OSDI criteria (ρ=0.5159, p=0.001), ocular hyperemia (ρ=0.469, p=0.002), and corneal staining (ρ=0.339, p=0.032), whereas tear Mip-1α levels correlated with OSDI score (ρ=0.358, p=0.023). Conclusion We demonstrated higher tear levels of IL-8 and MIP-1α in oGVHD patients and significant correlations between theses cytokines and ocular surface parameters based on the ICCGVHDCG criteria.

Prevalence and risk factors associated with dry eye disease among adults in a population-based setting in South-West Nigeria.

Dry eye disease (DED) occurs as a result of an abnormality in tear production, tear consistency, and tear evaporation. The aim of this study is to determine the prevalence and risk factors associated with dry eye disease in a population-based setting in Southwest Nigeria. A cross-sectional study was conducted at a medical outreach at Iperu Remo in Nigeria. A systematic random sampling technique was used to select 415 participants. Symptoms of dry eye were evaluated using the Ocular Surface Disease Index questionnaire. Tear film break-up time (TBUT), fluorescein staining, Schirmer test with anesthesia, and meibomian gland were evaluated. The diagnosis of DED was confirmed when the OSDI score is ≥13 and TBUT is less than 10 seconds. Data were analyzed using descriptive statistics, Chi-square, and logistic regression analyses at a 0.05 level of significance. The overall prevalence of DED was 28.2%. Adults aged between 31 and 40 years were 23 times more likely to be diagnosed with dry eyes (aOR = 23.13; 95% CI: 1.32 - 405.99; P = 0.032) compared to those between 16 and 20 years. Female adults were about four times more likely to be diagnosed with dry eyes (aOR = 3.59; 95% CI: 1.44 - 8.94; P = 0.006). The use of drugs was also significantly associated with dry eyes. This study shows a fairly high prevalence of DED among adults in a semi-urban area in Southwest Nigeria. Ophthalmologists and other eye care workers need to be cautious about the DED and offer appropriate treatment options to patients.

MGD Treatment using Intense Pulsed Light and Low Level Light Therapy

Purpose. Primary objective of this study was the assessment of dry eye related subjective and objective findings of MGD patients prior and after IPL and LLLT treatment. Material and Methods. 38 subjects with diagnosed MGD were enrolled in a prospective single center study in an optometric practice based in Wil (Switzerland). All subjects underwent IPL/LLLT treatments every 14 days from baseline until four treatments were conducted. OSDI, BCVA, IOP, NIKBUT, osmolarity, lower lid margin appearance and meibography data were captured at baseline before the first IPL/LLLT treatment and 14 days after the last treatment. Pre and post OSDI score, NIKBUT and osmolarity of the right was statistically analyzed using Wilcoxon rang sum test for matched pairs. Results. OSDI score decreased significantly from 32 to 14 (p = &lt;0.001). NIKBUT values did not increased significant- ly from 11.4 ± 12.4 s to 11.7 ± 5.9 (p = 0.498). Osmolarity in- creased significantly from 322.2 ± 12.6 mOsm/L to 327.9 ± 9.6 (p = 0.006). 26 of 38 subjects (68.4 %) were satisfied or very satisfied by this new form of therapy whereas 12 subjects (31.6 %) did not report a subjective change. Conclusion. The combined IPL/LLLT therapy is a promising therapy form usable in optometric and ophthalmological practices. The majority of the subjects reported subjective improvements, which were not confirmed by objective find- ings. Due to the high reduction of sicca symptoms and the high degree of satisfaction with the IPL/LLLT treatment, it can be stated, that an IPL/LLLT application is effective in MGD patients. Keywords Meibomian glands, Meibomian gland dysfunction, Intense Pulsed Light (IPL), Low Level Light Therapy (LLLT)

EvoTears – LipoNit: Vergleich zweier lipidhaltiger Präparate

Purpose. Rewetting solutions and eye sprays are getting more popular recently and are available in many different compositions. They promise to help against symptoms of dry eyes. This study tries to determine if the eye drops EvoTears, which contains lipids, helps better against symptoms of dry eyes as the liposomal eye spray LipoNit. Material and Methods. Both preparations were tested on a total of 23 subjects (11 female, 12 male, age 33 years ± 13.8 years, 23 – 60 years). In a single-blinded, balanced, rand- omized and prospective cross- over study, according to the ethical principles of the Declaration of Helsinki, the subjective sensation as well as objective findings of dry eye were de- termined and evaluated in each case before dispensing and after a one-week application of the respective preparation. For the subjective determination the OSDI questionnaire was used. Objectively, lipid layer thickness was determined and evaluated using Polaris device (BON), as well as tear meniscus height and noninvasive tear film break-up using Oculus Keratograph. After one week of application of the respective preparations, the subjective and objective findings before and after application were compared. Furthermore, in an additional questionnaire, each subject was able to assign points for the simplicity of application as well as points for the subjective improvement of dry eyes of both preparations. Results. The difference of the findings in both products in between the week of usage were 0 in all four findings (OSDI, NIKBUT, meniscus height, lipid layer thickness). This means that both of the investigated Liquids have more or less the same impact on dry eyes. Further, this study statistically proves that EvoTears significantly reduces the OSDI Score after using (p-value 0,0403). There is a tendency that Evo- Tears also improves the thickness of the lipid layer, although it is almost statistically significant (p-value 0,0708). All the other findings were statistically not significant. Most of the participants felt the handling of LipoNit much easier com- pared to EvoTears. However, EvoTears had a slightly bigger impact on subjective feeling. Conclusion. In this study, EvoTears and LipoNit were found to have similar effects on dry eye. A statistically significant difference existed only in the OSDI questionnaire (decrease OSDI score) in combination with EvoTears. In principle, the results obtained could be attributed to the short applica- tion period of one week, the small number of subjects or a non-compliance. In addition, only participants with moderate dry eyes were examined. Despite all this, the subjective dry eye symptoms decreased with both agents. Keywords Rewetting solution, ophthalmic sprays, dry eyes, EvoTears, LipoNit, OSDI questionnaire

Inter-Eye Comparison of the Ocular Surface of Glaucoma Patients Receiving Surgical and Medical Treatments.

Background: Ocular surface frequently affects glaucoma patients. In this paper we aimed at evaluating the impact of glaucoma surgery on the ocular surface of patients who received unilateral trabeculectomy. Methods: 26 consecutive patients successfully treated with trabeculectomy on one eye (Trab Eye) and under control with topical treatments on the fellow eye (Med Eye) were included in this observational study. They received IDEEL and OSDI questionnaires, Tear Film Osmolarity (TFO), grading of conjunctival hyperemia, fluorescein tear break-up time (tBUT), grading of corneal staining and Schirmer test. Results: IDEEL and OSDI scores were 48 ± 38 and 11 ± 12, respectively, with moderate correlation (r = 0.50, p = 0.03). Compared with Med eyes, Trab Eyes had higher tBUT (6.5 ± 3.5 vs. 5.1 ± 2.7 s, p = 0.004), lower conjunctival hyperemia (0.8 ± 0.9 and 1.7 ± 1.1 respectively, p < 0.001) and lower corneal staining (0.3 ± 0.5 and 0.6 ± 0.5, respectively, p = 0.03). Correlation between corneal staining and conjunctival hyperemia was 0.55 in Trab Eyes (p = 0.01) and 0.44 in Med Eyes (p > 0.05). Patients with bilateral corneal staining had had threefold worse questionnaire scores (p < 0.05). The duration of treatment and the daily exposure to preservatives did not directly affect OS parameters in this cohort of patients. Conclusions: Patients receiving successful trabeculectomy showed better OS homeostasis (higher TBUT, lower grading of conjunctival hyperemia and corneal staining) than fellow medically treated eyes. Presence of corneal epithelial damage in both eyes is the factor more consistently affecting questionnaire scores.

A study to assess the efficacy of topical cyclosporine A 0.05% in the management of dry eye with meibomiam gland dysfunction

: Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. Meibomian Gland Dysfunction (MGD) is an abnormality of the meibomian gland that blocks the secretion of lipids. Without sufficient lipid production, tears evaporate quickly causing Dry Eye.MGD is associated with multiple pathological mechanisms including inflammation, microbial factors and lipid deficiencies. Topical Cyclosporine A (CsA) 0.05% is a calcineurin inhibitor that reduces inflammation by specifically inhibiting T‑cell activity, which reduces ocular surface inflammation and improves tear film dynamics. This was a prospective observational study done on 100 patients at the Department of Ophthalmology Basaveshwar teaching and general hospital, on patients of dry eyes due to meibomian gland dysfunction. Patients who were diagnosed with dry eyes due to meibomian gland dysfunction were invited to take part in the study. Patients were divided randomly into two groups of 50 patients each. This study, was explained in detail to them. An informed consent was obtained. Patients fulfilling the inclusion criteria were listed.All OSDI scores (symptom intensity, frequency and aggravation) revealed decreasing patterns throughout the observation period in both the groups. In single analysis, the cyclosporine A 0.05% group showed a significant improvement for each score at 3 months (p &amp;#60; 0.01, p = 0.01, p = 0.02, respectively). The mean TBUT after treatment in the group A (cyclosporine A group) increased to 12.36± 3.58(p&amp;#60;0.001) seconds, and in the group B (Control group) the TBUT score increased to 11.01±3.06 seconds. After 3 Months, there was statistically significant improvement in the mean Schirmer’s scores in both the treatment groups, however improvement was significantly greater in Cyclosporine A group. Prior to the treatment in group A (Cyclosporine A) mean Lissamine staining score was 2.73±0.15 and post treatment it reduced to 1.32±0.15 which was statistically significant (P&amp;#60;0.001). In group B (Control group) score before treatment was 2.46±0.15 and after treatment it reduced to 2.39±0.27 (p=0.11), not much difference was seen. : Findings from our study showed that there were significant improvements in the dry eye conditions due to defect in meibomian gland by treatment of topical Cyclosporine A 0.05% and sodium hyaluronate 0.1%.

MiR-204-containing exosomes ameliorate GVHD-associated dry eye disease.

Graft-versus-host disease (GVHD)–associated dry eye disease is characterized by extensive inflammatory destruction in the ocular surface and causes unbearable pain and visual impairment. Current treatments provide limited benefits. Here, we report that exosomes from mesenchymal stromal cells (MSC-exo) administered as eye drops notably alleviate GVHD-associated dry eye disease by suppressing inflammation and improving epithelial recovery in mice and humans. In a prospective clinical trial, 28 eyes with refractory GVHD–dry eye disease exhibited substantial relief after MSC-exo treatment, showing reduced fluorescein scores, longer tear-film breakup time, increased tear secretion, and lower OSDI scores. Mechanistically, MSC-exo reprogramed proinflammatory M1 macrophages toward the immunosuppressive M2 via miR-204–mediated targeting of the IL-6/IL-6R/Stat3 pathway. Blockade of miR-204 abolished the effects of MSC-exo, while overloading L929-exo with miR-204 markedly attenuated dry eye. Thus, this study suggests that MSC-exo are efficacious in treating GVHD-associated dry eye disease and highlights miR-204 as a potential therapeutic agent.

Evaluation of ocular surface disease symptoms and patient satisfaction in dry eye disease after 84 days of treatment with preservative‐free eye drops containing sodium hyaluronate and trehalose

AbstractPurposeDry eye disease (DED) has a multifactorial etiology, including insufficient tear production and/or excessive tear evaporation linked to multiple conditions. A preservative‐free eye drop formulation containing sodium hyaluronate and trehalose (SH‐THL, Thealoz® Duo) capitalizes on the bioprotectant properties of trehalose. This study evaluated the improvement of ocular surface disease (OSD), dry eye signs and symptoms, treatment satisfaction in patients with DED receiving SH‐THL.MethodsMulti‐center, international, non‐interventional prospective survey lasting 84 days with up to 2 post‐baseline visits in up to 310 adult subjects with clinically confirmed DED requiring artificial tears. Clinical signs with Schirmer Test, tear Break Up Time, hyperemia, dry eye symptoms with OSDI® scale and the five‐item dry eye questionnaire (DEQ‐5) as well as patient satisfaction were assessed at baseline, visit 1 (28 days) and 2 (84 days). SH‐THL was to be instilled when needed. The number of eye drops instilled per day was determined using the Kali Care Drop Meter (n=42).ResultsData from 238 patients were analyzed. 83.2% were women, the mean age was 57.9 ± 15.1 years. At baseline, the overall OSDI was 42.2 ± 19.9 and 61.3% of patients had severe OSDI. The DEQ‐5 score was 12.4±4.1 and the patient treatment satisfaction score was 6.4 ± 2.1. The OSDI significantly improved (p &lt; 0.001) after 84 days. The DEQ‐5 score significantly improved at visit 1, persisting until visit 2 (both p &lt; 0.001) with a statistically significant (p = 0.002) difference between visit 1 and 2. Patient satisfaction with treatment significantly improved (p &lt; 0.001) at visit 1 and 2 compared to baseline. All clinical signs significantly improved after 84 days of SH‐THL.ConclusionsResults confirm that continued use of eye drops containing SH‐THL reduced DED signs and symptoms, OSDI scores, and result in a very high patient satisfaction.

Комплексная терапия синдрома «сухого глаза» на фоне хронического периферического увеита

Aim: to study clinical presentations of dry eye disease (DED) in intermediate uveitis (pars planitis) and develop a complex treatment algorithm including tear substitutes, reparative, and anti-inflammatory therapies combined with laser photocoagulation. Patients and Methods: the study enrolled 98 patients divided into the study group (n=78) and the comparison group (n=20). Study group patients received complex treatment, including tear substitutes, anti-inflammatory therapies, and laser photocoagulation. Comparison group patients received topical medications only. All patients underwent a complex examination including the OSDI questionnaire, visual acuity, IOP measurements, slit lamp examination, binocular dilated fundus examination with scleral indentation, and Schirmer’s test 1 at baseline, after baseline three and six months. Treatment efficacy was assessed based on the severity of intermediate uveitis presentations. Results: intermediate uveitis exacerbates DED. The more active chorioretinal inflammation near the ora serrata is, the more severe clinical, functional changes of the ocular surface are. Complex treatment significantly improved typical DED complaints by the OSDI score (by 34.8%), ocular surface by slit-lamp examination (lower occurrence of conjunctival fold overhang, by 51.8%), mild eyelid and conjunctival hyperemia, and conjunctival discharge. Six months after treatment, a 2-fold (vs. baseline) increase in total tear secretion and resorption of vitreous exudates and retinal edema were reported in the study group. Changes in all parameters in the study group were more significant than in the comparison group. Conclusion: complex treatment algorithm (tear substitutes, reparative, and anti-inflammatory therapies combined with laser photocoagulation) provides a more rapid and stable reduction in chorioretinal inflammation near the ora serrata. It significantly improves subjective and objective DED signs compared to conventional pharmacotherapy. Keywords: dry eye disease, intermediate uveitis, laser photocoagulation, ora serrata. For citation: Tatarnikova E.B., Krivosheina O.I. Complex treatment for dry eye disease in intermediate uveitis. Russian Journal of Clinical Ophthalmology. 2022;22(1):30–35 (in Russ.). DOI: 10.32364/2311-7729-2022-22-1-30-35.

Dry Eye Symptoms and Signs in US Veterans With Gulf War Illness

To examine dry eye (DE) symptoms and signs in individuals with vs without Gulf War illness (GWI). Prospective cross-sectional study. We performed a prospective, cross-sectional study of South Florida veterans who were active duty during the Gulf War era (GWE; 1990-1991) and seen at an eye clinic between October 1, 2020, and March 13, 2021. Veterans were split into 2 groups: those who met Kansas criteria for GWI (cases, n=30) and those who did not (controls, n=41). DE symptoms were assessed via standardized questionnaires whereas DE signs were assessed using a series of ocular surface parameters. Differences between groups were assessed via Mann-Whitney U test. Linear regression analyses were used to examine which GWI symptoms most closely aligned with DE symptoms. Veterans with GWI had higher DE symptoms scores compared to controls (Ocular Surface Disease Index [OSDI] scores: mean 41.20±22.92 vs 27.99±24.03, P=.01). In addition, veterans with GWI had higher eye pain scores compared with controls (average eye pain over past week: 2.63±2.72 vs 1.22±1.50, P=.03), including on neuropathic ocular pain questionnaires (Neuropathic Pain Symptom Inventory modified for the Eye [NPSI-E]: 17.33±17.20 vs 9.63±12.64, P=.03). DE signs were mostly similar between the groups. GWI symptoms "nausea or upset stomach" (β=14.58, SE=3.02, P < .001) and "headache" (β=7.90, SE=2.91, P=.011) correlated with higher OSDI scores. Individuals with GWI have more severe DE symptoms and ocular pain scores but similar tear and ocular surface parameters compared to controls without GWI. This finding suggests that mechanisms beyond tear dysfunction drive eye symptoms in GWI.

The Effects of Smartphone, Tablet and Computer Overuse on Children’s Eyes During the COVID-19 Pandemic

Aim: Due to restrictions during the Coronavirus disease-2019 (COVID-19) pandemic, smartphone, tablet and computer (STC) overuse might occur. There were some concerns that light sources which emit blue light might affect anterior and posterior segment structures. We investigated the effects of STC overuse on children's eyes during the pandemic. Materials and Methods: Sixty-four children's findings at baseline (the early period of the pandemic) (group 1) were compared with those after 1 year (group 2). Correlations between daily STC use time (DSTCUT) and the ocular parameters in group 2 were evaluated. Results: Compared to group 1, group 2 had longer DSTCUT (1.49 +/- 0.33 vs 5.62 +/- 0.57 hours, p 0.05). In group 2 as DSTCUT increased, TBUT (r=-0.368, p=0.034) decreased, OSDI score (r=0.384, p=0.028) increased and more myopic SER (r=0.340, p=0.045) occurred. Conclusion: To our knowledge, this is the first study in children to comprehensively investigate the effects of STC overuse during a pandemic on ocular surface, anterior and posterior segment structures together. We found that STC overuse during the pandemic might increase the tendency to dry-eye and myopia, and might cause axial elongation. We also determined that at 1-year follow-up, STC overuse had no effect on CCT, keratometry, ACD, LT, and posterior segment parameters.

Clinical improvement of ocular surface parameters in dry eye patients following treatment with urea/crosslinked-hyaluronate eyedrops correlates with the secretion of MUC-4

ABSTRACT Objectives to assess the ocular surface status and patient’s satisfaction before and after treatment with urea/crosslinked hyaluronate (U-HACL) tear substitute in dry eye (DE) patients. Methods 17 DE patients were included in the study. They instilled U-HACL drops 3 times/day for two months. Symptoms (by OSDI questionnaire and VAS), osmolarity, tear film (through Schirmer test and tear film break-up time), corneal and conjunctival damage (with NEI and van Bijsterveld scores), impression cytology (number of PAS positive cells and MUC-4 immunostaining) and tear sampling were analyzed pre- and post-treatment. Results After the treatment, there was a significant improvement of VAS (7.16±2.59 vs. 3.94±2.23), OSDI (56.96±25.97 vs. 29.94±20.15), Schirmer (8.22±6.86 vs. 10.66±6.92), TFBUT (3.16±2.28 vs. 5.55±2.47), NEI (7.16±2.50 vs. 2.88±2.80) and van Bijsterveld (10.27±4.25 vs. 6.5±3.79) score, p<0.01. No significant changes in osmolarity were found. There was a significant increase of PAS positive cells and in the expression levels of MUC-4 (respectively, 44.21 ± 14.8 vs. 67.0 ± 10.1 and 49.79 ± 20.0 vs. 75.9 ± 20.7), p<0.01. Conclusion Patients showed significant clinical improvement following the administration of U-HACL eye drops. In particular, the rise of MUC-4 expression probably contributed to the increase in ocular wettability and amelioration of clinical parameters.

Lingnan fire needling combined with 0.1% sodium hyaluronate eye drops in the treatment of xerophthalmia: a randomized controlled trial

To observe the effect of Lingnan fire needling combined with artificial tears in the treatment of xerophthalmia. A total of 86 xerophthalmia patients were equally and randomly divided into treatment group and control group. The patients of both groups were received treatment with 0.1% sodium hyaluronate eye drops in their eyes 3 times a day, one drop in each eye. In addition, the patients of treatment group also treated by Lingnan fire needling on bilateral Shaoze (SI1), Neichengqi and beside lacrimal puncta once a week. The treatment was conducted for 4 consecutive weeks. Before and after 4 weeks of treatment, the clinical efficacy, visual acuity, intraocular pressure, ocular symptom score, OSDI score, fluorescence staining （FL） score, schemer I, tear menisci height, tear film break-up time (BUT) and eye redness index were recorded and evaluated. After the treatment, self-comparison showed that the symptom score, OSDI score, FL score and eye redness index were significantly decreased (P<0.05), and BUT was notably increased in both groups (P<0.05) in comparison with their own pre-treatment. The tear menisci height in the treatment group was higher than that before the treatment (P<0.05). Comparison between the two groups showed that the symptom score, OSDI score and eye redness index were obviously lower in the treatment group than in the control group (P<0.05), whereas the BUT and tear menisci height were evidently higher (P<0.05). The total effective rate of the treatment group was 84.88% (73/86), better than 76.74% (66/86) of the control group (P<0.05). Lingnan fire needling combined with 0.1% sodium hyaluronate eye drops is more effective than simple sodium hyaluronate eye drops for xerophthalmia patients, with significant curative effect and no adverse reactions.

Comparing SPEED and OSDI Questionnaires in a Non-Clinical Sample.

PurposeTo compare the performance of OSDI and SPEED questionnaires in a non-clinical sample in Pakistan.MethodsSPEED and OSDI questionnaires were simultaneously administered to a sample of 600 participants in Pakistan with an average age of 31.0 ± 10.1 years.ResultsMean SPEED scores were calculated according to the OSDI categories and were found to be 3.33 ± 3.44, 5.45 ± 3.77, 7.86 ± 4.33, and 9.39 ± 4.56 for the normal, mild, moderate, and severe groups, respectively. Using Cronbach’s alpha, the total OSDI and SPEED scores were calculated to be 0.924 and 0.879, respectively. A receiver operating curve was plotted, and the area under the curve (AUC) was estimated to be 0.791. Using this curve, the cutoff score for the SPEED questionnaire was found to be 4.00 (P < 0.001).ConclusionThe SPEED questionnaire can be used as an effective alternative to the OSDI.

Evaluation of the Ocular Surface, Conjunctival Impression Cytology and Meibomian Gland Dropout in Patients with Familial Mediterranean Fever

Familial Mediterranean fever (FMF) is an idiopathic disease with chronic inflammation. We aimed to determine the changes caused by the chronic inflammatory nature of FMF on the ocular surface, meibomian glands (MG), and conjunctiva via conjunctival impression cytology (CIC). Forty-two FMF patients with a mean age of 11.93±3.92 years and 36 control patients with a mean age of 11.83±3.38 years were included in the study. Ocular surface anomalies of the patients were evaluated using Schirmer II, TBUT and OSDI. MG function (meibum quality), morphology (meiboography), and CIC were evaluated. Although there was a significant difference between the groups in terms of Schirmer II and TBUT, OSDI scores did not significantly differ (P=0.022, 0.010, and 0.099 respectively), and no significant dry eye sign was observed in either group. There was significant difference between the groups in terms of the percent area of MG dropout, MG density, meiboscore (P=0.020, 0.023, and 0.031 respectively), but no significant difference was observed in relation to MG quality (P=0.650). Although conjunctival impression cytology was of a higher grade in the patients with FMF according to Nelson's classification, no significant difference was observed between the groups (P=0.109). Although there was a decrease in the number of MGs in FMF patients, no significant deterioration was observed in conjunctival cytology. In these patients, tear film stability may deteriorate in particular. Clinicians should be aware of the possibility of ocular surface disease secondary to MG dropout in patients with FMF.

Effectiveness of eye-light therapy in improving dry eye symptoms

: We aimed to examine the effectiveness of eye-light therapy in improving the dry eye symptoms.: The retrospective case series where patients who underwent eye-light therapy between March 2019 to May 2020 were analyzed. Twenty patients aged ≥18 years with dry eyes were included. Patients with ocular infections, complications, contact lens users and missing data were excluded. OSDI scores and tear parameters such as noninvasive break up time (NIBUT), lipid layer thickness (LLT), tear meniscus height, meibography of upper and lower lid were evaluated pre and post one month Eye-Light therapy.: Twenty patients with mean±SD age of 43.55±20.53 years and mean spherical equivalent refractive error of 0.69±1.79 diopters were analyzed. OSDI was significantly associated with NBUT (r=-0.50, P = 0.02), lipid layer thickness (r=-0.45, P=0.047) and tear height (r =-0.45, P=0.046). OSDI was positively associated with upper lid meibography (r=0.74, P=&amp;#60;0.001) and lower lid meibography (r=0.45, P=0.045). Post-therapy, reduction in OSDI score post-therapy was present, NBUT was similar, lipid layer thickness and tear height were increased, meibography of upper lid was reduced, and meibography of lower lid did not alter much. Eye-light therapy is effective in reducing dry eye related symptoms with minimal immediate effect on tear film parameters post therapy. Eye-light therapy acts as an adjunct to ameliorate MGD. MGD being a chronic disease requires sustained therapy with environmental changes. Long term evaluation is required to assess the tear film changes and the pattern of efficacy of light therapy.

TO EVALUATE THE EFFECT OF TOPICAL 2% REBAMIPIDE OPHTHALMIC SUSPENSION IN PATIENTS WITH DRY EYE DISEASE.

Background: Dry eye is an important public health problem causing ocular discomfort, fatigue and visual disturbance that may interfere with daily activities&#x0D; Methods: It is a prospective, randomized, analytical hospital based study. Minimum Sample size of 80 patients which is randomly allocated in the study (cases) and control group. In the study group topical 2% rebapimide ophthalmic suspension and in control group 0.5% caboxymethyl cellulose ophthalmic solution were given after comprehensive ophthalmic evaluation.&#x0D; Results: In mild OSDI score chi square test showed p value as 0.07 which was statistically not significant. In moderate OSDI score chi square test showed p value as 0.07 which was statistically not significant. In severe OSDI score chi square test showed p value as 0.04 which was statistically significant.&#x0D; Conclusion: Rebamipide 2% ophthalmic suspension is an effective treatment in dry eye disease due to mucin deficiency. There was significant improvement in signs and symptoms of dry eye&#x0D; Keywords: OSDI, Dry eye, Rebamipide 2% ophthalmic suspension

Relationship between OSDI score and biomicroscopic ocular surface damages in glaucomatous patients treated with preserved antiglaucomatous eye drops

Our goal was to identify factors that may influence the OSDI score, in particular, ocular surface damage in patients on preserved glaucoma eye drops. This was a cross-sectional study of 155 glaucoma patients treated with preserved glaucoma eye drops. They all completed the "Ocular Surface Disease Index" (OSDI) questionnaire and underwent complete ophthalmological examination with precise evaluation of the status of the ocular surface. The assessment included Shirmer I testing, tear break up time (TBUT), eyelid, conjunctival and corneal examination with fluorescein and lissamine green staining. We analyzed factors that may influence the OSDI score and its relationship with the biomicroscopic signs. Benzalkonium chloride (BAK) was used in 80% of cases. The OSDI score was≥13 in 61.3% of cases and classified as severe in 22.6% of cases. The biomicroscopic signs of ocular surface disease were at least minimal in 87.1% of cases. The severity of the OSDI score was statistically associated with patient age (P<0.001), treatment duration (P<0.001), multiple medications (P=0.011), and use of BAK (P=0.004). Blepharitis (P=0.013), Meibomian gland dysfunction (P=0.039), corneal neovascularization (P=0.025) and superficial punctate keratitis (SPK) (P=0.044) were retained as predictors of a pathological OSDI score. A disparity between the severity of symptoms and biomicroscopic signs was noted. Symptoms and clinical signs are complementary for assessment of the various aspects of ocular surface disease. OSDI score is correlated with ethnicity, glaucoma treatment duration, number of medications, BAK use and clinical ocular surface changes, especially SPK.

Alteration of corneal biomechanical properties in patients with dry eye disease.

PurposeTo evaluate the association between symptoms and signs of dry eye diseases (DED) with corneal biomechanical parameters.MethodsThis cross-sectional study enrolled 81 participants without history of ocular hypertension, glaucoma, keratoconus, corneal edema, contact lens use, diabetes, and ocular surgery. All participants were evaluated for symptoms and signs of DED using OSDI questionnaire, tear film break-up time (TBUT), conjunctival and corneal staining (NEI grading) and Schirmer test. Corneal biomechanical parameters were obtained using Corvis ST. Mixed-effects linear regression analysis was used to determine the association between symptoms and signs of DED with corneal biomechanical parameters. Difference in corneal biomechanical parameter between participants with low (Schirmer value ≤10 mm; LT group) and normal (Schirmer value >10mm; NT group) tear production was analyzed using ANCOVA test.ResultsThe median OSDI scores, TBUT, conjunctival and corneal staining scores as well as Schirmer test were 13±16.5 (range; 0–77), 5.3±4.2 seconds (range; 1.3–11), 0±1 (range; 0–4), 0±2 (ranges; 0–9) and 16±14 mm (range; 0–45) respectively. Regression analysis adjusted with participants’ refraction, intraocular pressure, and central corneal thickness showed that OSDI had a negative association with highest concavity radius (P = 0.02). The association between DED signs and corneal biomechanical parameters were found between conjunctival staining scores with second applanation velocity (A2V, P = 0.04), corneal staining scores with second applanation length (A2L, P = 0.01), Schirmer test with first applanation time (A1T, P = 0.04) and first applanation velocity (P = 0.01). In subgroup analysis, there was no difference in corneal biomechanical parameters between participants with low and normal tear production (P>0.05). The associations were found between OSDI with time to highest concavity (P<0.01) and highest displacement of corneal apex (HC-DA, P = 0.04), conjunctival staining scores with A2L (P = 0.01) and A2V (P<0.01) in LT group, and Schirmer test with A1T (P = 0.02) and HC-DA (P = 0.03), corneal staining scores with A2L (P<0.01) in NT group.ConclusionsAccording to in vivo observation with Corvis ST, patients with DED showed more compliant corneas. The increase in dry eye severity was associated with the worsening of corneal biomechanics in both patients with low and normal tear production.

Prevalence of dry disease in patients of type 2 diabetes mellitus: A cross-sectional study

Background and Aim: Dry eye disease has a significant impact including physical, social, psychological, negatively affecting daily activities and workplace productivity. This study is conducted to find the prevalence of dry disease in patients of type 2 diabetes mellitus and to find the correlation between glycemic control and prevalence of dry eye. Material and Methods: A total of 130 patients fulfilled the criteria and total 200 eyes are included in the study. Type II diabetic patients diagnosed by the American Diabetes Associations criteria. The duration of diabetes, fasting and post-prandial blood sugar and Hb1Ac values were recorded. A complete ocular examination of the lid margins, conjunctiva, cornea and tear film was done. Examination of fundus was done to access the grade of diabetic retinopathy in the patients. Relevant examination of other important ocular structures was done. Following this, tests to diagnose dry eye were performed. These are tear break up time (TBUT), ocular surface staining by Rose Bengal and fluorescein staining, Schirmer’s tests and conjunctival impression cytology. Diagnosis of dry eye was made if OSDI Score was more than 12 with one of the positive specific tests for dry eye. Results: Prevalence of dry eye in diabetes in males and females were comparable to each other that are 44.99% and 54.01%. A statistically significant co-relation was found on comparing between Schirmer score of that eye and HbA1c level of that individual. All the patient with severe NPDR and PDR had Schirmer score of below 5 mm. Our study found that with increased duration of diabetes, the chance of developing dry eye increases, and poor glycemic control increases the severity of dry eye. The severity of diabetes has a positive correlation with goblet cell loss and morphological changes in conjunctival impression cytology. Conclusion: Significant correlation between the prevalence of dry eye in the diabetic patient which shows poor glycemic control is directly related to dry eye. This study reveals that attention should also be paid on dry eye, particularly among patients suffering from DM when they are concerned about diabetic retinopathy.