Pool Of Tears Research Articles

Higher Order Aberrations in Patients with Unilateral Nasolacrimal Duct Obstruction.

To compare corneal higher order aberrations (HOAs) in patients with epiphora caused by unilateral primary acquired nasolacrimal duct obstruction (PANDO) and their fellow eyes. A total of 122 eyes of 61 patients with unilateral PANDO were included. Affected eyes were named as group 1 and contralateral eyes as group 2. The Munk score and fluorescein dye disappearance test (FDDT) were assessed. Corneal topographic and HOAs measurements were taken by Sirius topography. There were 47 female and 14 male patients. The mean keratometry was 43.84 ± 1.4 in group 1 and 43.96 ± 1.4 in group 2 (p = 0.73). The mean corneal topographic astigmatism was 0.81 ± 0.7 in group 1 and 0.78 ± 0.5 in group 2 (p = 0.57). The mean coma-like aberration was 0.19 ± 0.2 in group 1 and 0.10 ± 0.1 in group 2 (p = 0.03). The mean spherical-like aberration was 0.16 ± 0.1 in group 1 and 0.11 ± 0.1 in group 2 (p = 0.04). The mean total corneal HOA was 0.30 ± 0.5 in group 1 and 0.23 ± 0.2 in group 2 (p = 0.04). The mean Munk score was 3.47 ± 1.0 in group 1. There was a positive correlation between the Munk score and both coma-like aberration (r = 0.53, p = 0.003) and total corneal HOAs (r = 0.44, p = 0.010). The mean FDDT grade was 2.60 ± 0.1 in group 1. A positive correlation was observed between the FDDT grade and both coma-like aberration (r = 0.48, p = 0.001) and total corneal HOAs (r = 0.33, p = 0.001). Epiphora in patients with PANDO can affect corneal HOAs. As patients' symptoms and tear pooling were increased as corneal HOA levels increased.

Tear secretion is preserved while the area of meibomian glands is reduced in patients with prosthetic eyes, contributing to the symptoms of dry eye

Background/aimsIt is unclear whether a reduction in tear secretion contributes to the discomfort experienced by those with prosthetic eyes. Tear secretion has hitherto only been measured with the Schirmer test...

Pool of Tears

Pool of Tears

Alice in Wonderland by Unsuk Chin (review)

Unsuk Chin. Alice in Wonderland. DVD (Blu-ray). Kent Nagano / Bayerisches Staatsorchester und Chor. Directed and designed by Achim Freyer. With Sally Matthews, Piia Komsi/Julia Rempe, Dietrich Henschel, Andrew Watts, Guy de Mey, Gwyneth Jones. [Berlin]: EuroArts, 2008. 2072414. $39.99. Since the publication of the original novel of Lewis Carroll in 1865, the fairy tale of Alice's Adventures in Wonderland has been adapted into books, operas, ballets, movies, TV plays, etc. This operatic version, Alice in Wonderland, opens up a new perspective for audiences. The opera is the result of East-West cooperation with Korean composer Unsuk Chin, Chinese American playwright David Henry Hwang, Japanese American conductor Kent Nagano, German stage director Achim Freyer, and costume designer Nina Weitzner. The opera has a total of ten parts. As an introduction to the opera, Scene I displays a fairytale setting of illusively wonderful but inconceivable circumstance. Alice, a young girl acted by British soprano Sally Matthews, appears in an exaggerated mask in a dream world. While reading a book in the library she is thrown into a treasure chamber with several locked doors. Alice meets three strange figures all wearing masks: a boy carrying a mummified cat followed by two men identical to each other. Since all of them are wearing masks, apart from operatic singing, animated actions become crucial for the audience to interpret their thoughts and their feelings. Apart from pantomime-like body movements, the vocal part of the opera is also anti-traditional in scale and mode, although classical singing remains central to the opera. The operatic music, using colorful orchestration, dramatizes the character's presence frequently but not always. Also, the opera attaches great importance to con temporary audio-visual effects. This is expressed in singing, orchestral accompaniment, each character's costumes, and the staging, all of which transport the audience into an almost surrealistic wonderland. Scene I, meant to impress the audience with all of the musical and custom-and-mask descriptions, seems full of suggestions, meaning that these performing elements set the tone for what the entire opera looks like. The opera follows a Western opera pattern but is also a modern performance that combines both concepts. Scenes II and III form the initial phase of Alice's experience in the wonderland. Besides Alice, the White Rabbit (Scene II) and the swimming mouse encountered by Alice become central figures. Here, a subject through performance is to show imaginary changes of Alice's size and to dramatize a pool of tears shed mythically by sad Alice. The constant changes in Alice's size point to Alice's ongoing identity crises, an aspect worth pondering. Just as Alice repeatedly wonders: Who in the world am I? me who I am! Tell Tell me! these unanswered questions are dramatized further in Interlude I. Throughout Interlude I, Alice's body action and a huge blue Caterpillar depicted by the music lead to a vivid pantomime. The Caterpillar is acted by a group of four performers, including a noticeable instrumentalist playing bass clarinet. The Caterpillar sits on a large mushroom, and his masked head is copied from Alice's image rather than Caterpillar's own. An un certainty is created by this dramatic design. On the one hand, the Caterpillar is like an adviser from whom Alice hears words of wisdom about the advantages of changing her sizes. On the other hand, he is also a phantom of Alice appearing with her illusory image, which seems to mirror the real Alice in front of him. In this scene, the two characters neither sing nor recite lines. Instead, the bass clarinet plays a solo piece when Caterpillar and Alice are on the stage. When the Caterpillar is motionless, the music that the Caterpillar enacts fills the stage to represent his advice. In contrast, Alice uses body language to converse with Caterpillar. …

Quantitative analysis of proteins in the tear fluid of patients with diabetic retinopathy

Diabetic retinopathy is the leading cause of new cases of legal blindness among adults in the developed countries. Approximately 40% of all people with diabetes have diabetic retinopathy and 5% of these have sight-threatening form. As the advanced stage, where there is a high risk for vision loss, can develop without any serious symptoms, sometimes it is hard to detect it. A non invasive method to detect biomarkers characteristic for diabetic retinopathy from the tear fluid was developed. Tear samples from diabetic patients with no retinopathy, non proliferative and proliferative stages of diabetic retinopathy were analyzed and the protein content of each sample was compared to the protein content of tear pool from healthy volunteers. The samples were labeled with iTRAQ fourplex labels and were analyzed with nanoHPLC coupled ESI-MS/MS mass spectrometry. The lipocalin 1, lactotransferrin, lacritin, lysozyme C, lipophilin A and immunoglobulin lambda chain were identified as possible biomarker candidates with significantly higher relative levels in the tear of patients with diabetic retinopathy.

Personal Accounts: Tall Paul

Personal Accounts: Tall Paul

Phosphate and electrolyte content of topical steroid drops and potential clinical implications

The ocular surface is constantly bathed by tears, which provide nutrition and protection to the ocular surface epithelium. The milieu of the ocular surface, including the fluids and electrolytes are...

The Looking Glass Wars (review)

Reviewed by: The Looking Glass Wars Karen Coats Beddor, Frank The Looking Glass Wars. Dial, 2006358p ISBN 0-8037-3153-1$17.99 M Gr. 7-10 Trading on the public imagination that has embraced the "real" stories behind beloved childhood fantasies such as Peter Pan and The Wizard of Oz, Beddor undertakes to reinvent Wonderland. Seven-year-old Alyss Heart witnesses the death of her mother in a blood-soaked coup by her aunt Redd and plunges into the Pool of Tears with her faithful bodyguard, Hatter Madigan. Separated from Madigan en route, Alyss ends up in Victorian England, where she eventually finds herself in the improbable position of adopted daughter of the Liddells and fiancé to Prince Leopold, while Madigan travels the globe for thirteen years in search of her whereabouts. When he does find her, they return to Wonderland to lead the loyal resistance in overthrowing the vicious Redd. If this story were even the least bit self-conscious, it might achieve the level of mediocre camp, but Beddor manages to strip the Wonderland of anything like self-reflexive wit, opting instead for an attempted pathos that utterly misses its mark. Readers are supposed to feel sorry, for instance, for the dead playing-card soldiers, remembering that they were "beings who laughed, cried, or rejoiced, or had loved ones waiting for them at home." Writing is slow and talky yet the characters and scenes have videogame sensibilities: the Cheshire cat is transformed into a hypermuscular, nine-lived assassin, Redd's playing-card soldiers have a metal carcass that renders them nearly invincible (their transformation is illustrated, just to add to the pain), and Hatter Madigan is morbidly efficient with his cadre of ninja-like weaponry concealed in his hat and cuffs. Meanwhile, Alyss and her Wonderland sweetheart, Dodge, are as dully two-dimensional as Carroll's characters are wittily so. As a result, Beddor misses his audience entirely: Alice fans will be awash in misery and betrayal, fantasy fans won't find characters to care about, and gamers likely won't make the nearly 400-page commitment to noninteractive slow-paced thrills. Copyright © 2006 The Board of Trustees of the University of Illinois

Effects of fibrovascular traction and pooling of tears on corneal topographic changes induced by pterygium.

To investigate the effects of fibrovascular traction and the pooling of tears at the pterygium apex on the corneal topographic changes induced by pterygium. A total of 16 eyes of 14 cases with primary pterygium were included in the study. A computerized corneal topography system was used for corneal topography examinations. Baseline keratographs were taken two times at straight gaze. A repeat corneoscope photograph was immediately obtained in temporal gaze. Then the tears at the pterygium apex were dried with a cellulose sponge, and a new corneoscope photograph was immediately obtained without allowing one to blink. Corneal topographic maps (numeric maps) were divided into 301 fields in 24 meridians. One colour was allocated to each field, representing its mean refractive power for all groups. In all eyes, keratometric astigmatism at the 3 mm central cornea and total mean corneal refractive power were found. Data were compared using paired-samples two-tailed t-tests. Keratometric astigmatism at the 3 mm central cornea was significantly reduced at the temporal gaze (3.10+/-2.34 D, t=3.40, P=0.027) and dried eyes (2.12+/-1.01 D, t=4.74, P=0.001) according to the first baseline measurement (4.31+/-1.91 D) of the total mean corneal refractive power was found to be 43.45+/-1.28 D (39.29-45.87) at the first baseline measurement. There was no change at the temporal gaze (43.54+/-1.06 D, P>0.05). However, the total corneal refractive power was significantly higher in dried eyes (44.26+/-0.93 D, t=34.92, P<0.001). The steepest region of corneal topography was a superior quadrant, and the flattest area was a nasal quadrant at the baseline. At the temporal gaze, the cornea was significantly flatter in the superior and inferior sides of the pterygium meridian. After dried pooling of tears, topographic abnormalities returned, and the cornea became more uniform and symmetric. We conclude that the pooling of tears at the pterygium apex plays an important role, but fibrovascular traction has no effect on the corneal topographical changes induced by pterygium.

Corneal iron ring associated with orthokeratology

Two teenaged girls had orthokeratology to correct myopia. The postoperative development of corneal iron rings in both eyes was disclosed by a biomicroscopic examination at 3 months in 1 patient and 5 months in the other. The location of the corneal iron rings coincided with the fitting curve of the reverse-geometry rigid contact lens, suggesting that the rings might have developed from tear pooling.

Contact lens fitting after photorefractive keratectomy: a comparison of two groups of patients

SummaryFrom a research programme comparing two photorefractive keratectomy (PRK) methods, Group S using Summit ExciMed UV 200, and Group V using the VisX 20:20 excimer laser system, 10 patients from each group were recruited. They were referred 6–12 months post‐PRK for lens fitting to correct resultant ametropia or irregular astigmatism. Ablation zone diameters were: Group S, 4.5 mm; Group V, 4–6 mm. For Group S, best fit rigid gas permeable (RGP) lenses generally had a back optic zone radius (BOZR) 0.10 mm steeper than the mean keratometry reading (K) and overall diameter of 9.20–10.0 mm. For Group V best fit RGP lenses generally had a BOZR of 0.20 mm steeper than the mean K. The lenses often required large diameters to improve lens centration and extra negative power to compensate for the positive power of the central tear pool. Several patients required soft lens fitting to improve comfort and some finally opted for repeat PRK.

Contact lens fitting after photorefractive keratectomy: a comparison of two groups of patients

From a research programme comparing two photorefractive keratectomy (PRK) methods, Grouo S using Summit ExciMed UV 200, and Group V using the VisX 20:20 excimer laser system, 10 patients from each group were recruited. They were referred 6–12 months post-PRK for lens fitting to correct resultant ametropia or irregular astigmatism. Ablation zone diameters were: Group S, 4.5 mm; Group V, 4–6 mm. For Group S, best fit rigid gas permsable (RGP) lenses generally had a back optic zone radius (BOZR) 0.10 mm steeper than the mean keratometry reading (K) and overall diameter of 9.20–10.0 mm. For Group V best fit RGP lenses generally had a BOZR of 0.20 mm steeper than the mean K. The lenses often required large diameters to improve lens centration and extra negative power to compensate for the positive power of the central tear pool. Several patients required soft lens fitting to improve comfort and some finally opted for repeat PRK.

Mechanism of Corneal Topographic Changes

Pterygia induce irregular corneal astigmatism that sometimes necessitates surgical removal before the lesion has advanced close to the visual axis. This astigmatism may occur either due to traction generated by the pterygium mechanically pulling on and distorting the cornea, or by the pooling of tears in advance of the pterygium, or both. To evaluate the effect of localized tear pooling on pterygium-induced astigmatism, corneoscope photographs were obtained before and after absorbing excess tears at the pterygium-corneal interface with a cellulose sponge. Pterygia from these patients were then excised and examined with transmission electron microscopy for the presence of myofibroblasts. The absence of myofibroblasts in these lesions as well as the alterations in corneoscopy induced by localized removal of tears at the advancing edge of the pterygia suggest that corneal distortion in the presence of pterygia is caused in part by local changes in the tear film.

Ocular disposition of inulin from single & multiple doses of positively charged multilamellar liposomes: evidence for alterations in tear dynamics and ocular surface characteristics.

The effect of entrapment of inulin, a model medium molecular weight compound, in positively charged, multilamellar liposomes on ocular inulin absorption following instillation of single and multiple doses to the albino rabbit eye was studied. In spite of their affinity for the ocular surfaces, these liposomes provided 5 and 100 times lower ocular concentrations of inulin at 30 minutes post-dosing than aqueous solutions and neutral liposomes, respectively, and failed to sustain inulin concentrations in any anterior segment tissues over 120 min. This negative effect of positive liposomes on the ocular bioavailability of inulin can partly be attributed to a 2-fold faster disappearance rate from the tear pool, which more than offset their intrinsic ability to increase corneal drug permeability. For unknown reasons, multiple doses of these liposomes resulted in further reduction in ocular inulin absorption when compared with single doses.

Corneal iron lines after refractive keratoplasty.

Twenty-three of 55 patients who underwent refractive keratoplasty for the correction of aphakia were found to have a pigmented corneal epithelial line similar to the Fleischer ring. In 21 of 23 cases, the pigmented ring was adjacent to the superficial keratectomy scar that resulted from the keratorefractive operation. In two cases, the pigmented line was located central to the lamellar keratectomy scar. Histopathologic study demonstrated that the line was due to iron in the form of ferritin particles deposited within basal corneal epithelial cells. We believe that the steep anterior corneal curvature (average, 51.45 diopters) and changes in corneal topography at or central to the margin of the lamellar keratoplasty may lead to malapposition of the eyelid to the cornea and cause disturbances in the precorneal tear film. Iron from the tears may then be deposited in the corneal epithelium in areas of tear pooling.

Vehicle influence on ocular disposition of sodium cromoglycate in the albino rabbit

The influence of vehicle composition on the ocular disposition of sodium cromoglycate, a drug used for the prophylaxis of vernal keratoconjunctivitis, has been studied. The vehicles investigated consisted of a water-soluble base (15% polyvinyl alcohol, PVA, in water); an absorption base (10% acetylated lanolin in a paraffin base); and an oleaginous base (a polyethylene/mineral oil blend). The albino rabbit was chosen as the animal model. The disposition of sodium cromoglycate in tears, conjunctiva, cornea, iris-ciliary body and aqueous humor of the rabbit was monitored at 30, 60 and 240 min post-instillation using radiotracer techniques. At the early time periods, all 3 bases were judged to perform adequately in that they provided approximately the same sodium cromoglycate concentrations in the tear pool, conjunctiva and cornea as the aqueous vehicle. However, after 240 min, the oleaginous polyethylene/mineral oil formulation provided the highest concentrations of drug in the conjunctiva, the target tissue. The water-soluble PVA formulation gave significantly lower levels in the tears, the conjunctiva and the cornea. At this same point, the absorption base containing acetylated lanolin produced the highest drug concentration in the tear pool. Collectively, these data suggest that of the 3 bases studied, the oleaginous base and the absorption base show most promise as vehicles to extend the residence time of sodium cromoglycate in the eye. Obviously, the final choice of vehicle will also be influenced by factors such as the physical and chemical stability of the drug in the formulation chosen and patient acceptance.

Corneal Epithelial Iron Deposition

Different patterns of iron deposition in the epithelium in 96 of 120 corneal buttons that had superficial irregularities of different causes, as examined after staining grossly with Prussian blue by Gomori's method were detected. These observations were confirmed by light microscopy in 86 cases. The deposition was either diffuse or it formed a linear pattern within the epithelium adjacent to elevated areas of corneal scarring. The authors believe that the tear film is the source of iron in these cases, and that relative pooling of tears on an irregular surface is the mechanism by which iron lines are formed.

Ocular distribution of liposome-encapsulated epinephrine and inulin in the albino rabbit.

A methodology has been developed to evaluate the disposition of liposome-encapsulated epinephrine and inulin in the conjunctival sac and selected ocular tissues. Relative to inulin, epinephrine effluxed much more rapidly from liposomes and disappeared more rapidly from the tear pool. As a result, liposomes were found to exert opposite effects on the ocular uptake of epinephrine and inulin. Over a period of 45 minutes, the concentration of epinephrine in the eye was 1.5 - 3 times lower when presented in liposomes than in aqueous solutions. This contrasted with the 3 to 15 fold increase in inulin concentration in the eye from liposomal preparations of the compound. Specifically, much of the increase in inulin concentration in the cornea can be attributed to an increase seen in the epithelium. Despite elevated inulin concentrations in the ocular tissues it bathes, the aqueous humor was devoid of inulin unless the corneal epithelium was physically removed prior to topical dosing. Collectively, these findings suggest that both the manner in which an entrapped compound interacts with the constituents of liposomes and the manner in which liposomes interact with the absorptive surfaces of the eye can significantly influence its pharmacokinetics in the eye.

Tarsal Strip Procedure for Correction of Eyelid Laxity and Canthal Malposition in the Anophthalmic Socket

Surgically anophthalmic sockets commonly have laxity of the lower eyelid, inferior displacement of the lower eyelid and lateral canthus, shallowing of the inferior fornix, and a deep superior sulcus. These deformities result in difficulty in prosthesis retention, pooling of tears and mucus, epiphora and lower eyelid irritation, and poor cosmesis with an appearance of facial asymmetry. The causes of these problems are numerous, but the main anatomic deformity is a marked laxity and elongation of the lateral canthal tendon. The tarsal strip procedure is ideal for correcting or improving these deformities simultaneously with one simple procedure. We are very pleased with our results in 26 patients with surgically anophthalmic sockets in which this procedure was utilized. We highly recommend the tarsal strip procedure not only to correct these conditions in anophthalmic sockets but in almost any condition where laxity of the eyelids or canthal malposition requires surgical correction.

Tear calcium levels and contact lens wear.

Hydrophilic contact lens spoliation can be associated with the deposition of calcium salts. The relationship between the concentration of calcium in tear fluid and contact lens use has been studied in healthy volunteers and in patients using various forms of hard and soft contact lenses, tear samples being collected with Schirmer strips and with lenses in situ. Methods are suggested for correcting data on calcium per strip to concentration when this cannot be directly determined. Further data were obtained by direct extraction of freshly removed soft contact lenses. The collected results indicate some variation in tear calcium concentrations, but values are unrelated to use of contact lens and type of lens fitted, and to the rates of tear flow with our procedures for collection. Local calcium concentrations are unlikely therefore to be a significant primary factor in soft contact lens spoliation, but the enlargement of the tear pool associated with the use of a soft contact lens does greatly increase the amount of calcium present, and this may be a factor in secondary deposition.