Preservative-free Artificial Tears Research Articles

Clinical Characteristics and Treatment of Ophthalmic Sequelae of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis at a Tertiary Eyecare Centre in Hungary.

This study analysed the causative factors and clinical characteristics of acute and chronic ocular sequelae of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) treated at a large third-referral centre in a developed country (Hungary) over a 15-year period. This was a retrospective review of patients with acute and/or chronic SJS/TEN who were managed between 2006 and 2020 at the Department of Ophthalmology of Semmelweis University in Budapest, Hungary. For each subject, clinical data, including patient demographics, clinical history, causative agents of SJS/TEN, and conservative and surgical treatment details, were reviewed. Ninety-six eyes of 48 patients were included (28 female; 58.3%); the age at disease onset was 32.1 ± 22.4years. The most common causative factors were medicines (n = 36; 75.0%). Among these drugs, 29.2% were nonsteroidal anti-inflammatory drugs (NSAIDs) (n = 14), 20.8% were antibiotics (n = 10) and 14.6% were antiepileptic drugs (n = 7). In patients with chronic SJS/TEN, the most commonly found ocular sequelae were conjunctival hyperaemia in 45 (56.3%) eyes, symblepharon in 38 (47.5%) eyes, trichiasis/distichiasis in 37 (46.3%) eyes, corneal neovascularization in 31 (38.8%) eyes and corneal scarring in 29 (36.3%) eyes. In patients with chronic SJS/TEN, the most frequently used topical conservative treatment included antibiotics in 53 (66.3%) eyes, preservative-free artificial tears in 50 (62.5%) eyes and topical corticosteroids in 42 (52.5%) eyes of 40 patients. The most frequently performed ocular surgeries for managing chronic ocular sequelae in patients with SJS/TEN were epilation for trichiasis (n = 27; 33.8%), cataract surgery (n = 14; 17.5%), entropion surgery (n = 12; 15.0%), penetrating keratoplasty (PK) (n = 11; 13.8%) and amniotic membrane transplantation (n = 4; 5.0%). Our results suggest that NSAIDs, antibiotics and antiepileptic drugs are the most common causative factors for SJS/TEN in Hungary. Like in other countries, in Hungary, the ocular management of patients with acute and chronic SJS/TEN is heterogeneous, and most cases do not follow modern therapeutic guidelines.

Ocular Surface Analysis of Dry Eye Disease After Cataract Surgery

Purpose: We aimed to compare the efficacy and safety of 0.3% hydroxypropyl methylcellulose/dextran (HPMC/Dextran) and 0.3% sodium hyaluronate (SH) in the treatment of dry eye disease (DED) in postcataract surgery patients by analyzing the presurgery and postsurgery ocular surface. Methods: This double-blinded, randomized, parallel-group study enrolled 96 patients with ocular surface dysfunction, specifically DED, after phacoemulsification. Patients were randomized to receive either HPMC/Dextran (n = 56) or 0.3% SH (n = 40). All patients received 1 drop per eye, 4 times per day. Data from OCULUS Keratograph 5M and Schirmer I tests without anesthesia were collected at baseline and 1 week, 1 month, and 3 months postoperatively. Results: Three months postsurgery, the ocular surface, Schirmer I test, tear meniscus height (TMH), noninvasive tear film break-up time (NITBUT), meibography, redness, and Ocular Surface Disease Index were significantly improved. The Schirmer I test, TMH, and NITBUT improved significantly (P = 0.07, 0.17, and 0.43, respectively; analysis of variance, P < 0.05) in the SH group compared with the HPMC/Dextran group. In a subgroup analysis of patients with severe dry eye, Schirmer I test ≤ 5 mm/5 minutes and NITBUT < 5 significantly improved (P = 0.00 and 0.001, respectively) at 3 months in the SH group compared with the HPMC/Dextran group. Thus, 0.3% SH gave significantly superior tear secretion and tear film instability outcomes. Conclusions: Both types of preservative-free artificial tears are effective in treating postsurgery DED. Compared with HPMC/Dextran, 0.3% SH artificial tears showed more improvements in Schirmer I test and NITBUT postsurgery.

Conjunctival and nasal microflora in patients on topical cyclosporine for dry eye.

Introduction: Dry eye is a common ocular condition causing discomfort and visual disturbances. Anti-inflammatory agents like Cyclosporine A (CsA) are often used in its treatment. However, the impact of CsA on ocular flora remains understudied. This research aimed to evaluate changes in conjunctival and nasal microflora in patients receiving topical cyclosporine for dry eye. Methods: In this cross-sectional study, conjunctival and nasal samples were collected from two groups of dry eye patients. Group 1 consisted of 38 patients using CsA eye drops, while Group 2 included 34 patients using preservative-free artificial tear drops. Bacterial cultures were grown from the samples, and the identified organisms underwent antibiotic susceptibility testing. Additionally, alpha diversity metrics were employed to assess the diversity of bacterial species in the samples. Results: Bacterial growth was observed in 75% of conjunctival samples and 97.22% of nasal samples. Staphylococcus epidermidis was the predominant organism in both groups. Alpha diversity analysis showed no significant differences in Shannon diversity and OTU richness between the groups for most bacterial species. Antibiotic susceptibility tests revealed no substantial variations in resistance patterns between the groups. Conclusion: This study provides valuable insights into the impact of CsA eye drops on conjunctival and nasal flora in dry eye patients. The findings suggest that CsA does not significantly influence the composition, diversity, or antibiotic resistance patterns of ocular flora. Long-term topical cyclosporine treatment for dry eye does not significantly impact conjunctival microflora or lead to antibiotic resistance. These results have important implications for the safe use of CsA in patients undergoing ocular treatments, particularly those at risk of intraocular infections.

Quantitative Ocular Surface Changes in Patients Undergoing Immune Checkpoint Inhibitor Therapy

ABSTRACT Purpose To describe the clinical course and evaluate treatment of ocular surface changes in patients receiving immune checkpoint inhibitor (ICI) therapy. Methods Multiple markers of ocular surface dryness were evaluated in 16 patients on ICI therapy. The Wilcoxon rank-sum test was used to determine the significant change in the initial and final ocular surface indices. Results Fifty percent of the eyes demonstrated worsening Schirmer I scores; 29% showed an increase in lissamine green staining. During follow-up, 43% of patients experienced a decline in OSDI scores. Treatments included preservative-free artificial tears (88%), cyclosporine (25%), topical corticosteroids (31%), warm compresses (25%); punctal plugs (13%). Median follow-up time was 3.4 months (range:0–79 ); median ICI treatment duration was 7 months (range:1–40). Four patients died during the observation period. Conclusion A significant proportion of patients experience changes in ocular surface markers while treated with ICIs. Medical intervention can lead to stabilization of ocular surface disease.

Artificial tears: Promising treatment or silent threat to public health?

Dry Eye Disease (DED) is a multifactorial chronic inflammatory condition of the corneal surface, attributed to insufficient or low-quality production of tears, accounting for 5-50% of the cases globally. Artificial tears are the first line of treatment as they reduce ocular surface tension, and improve film stability and optical quality. EzriCare Artificial Tears are preservative-free, multi-dose, readily accessible eye drops containing carboxymethylcellulose sodium solution (10 mg in 1 ml) aiming for relief against DED. This article discusses the public health challenges faced by the use of EzriCare Artificial Tears and emphasizes the need for alternative therapies for the effective management of DED. We searched for articles documenting the incidence of the current multi-drug resistant P. aeruginosa strain outbreak caused by the use of preservative-free artificial tears and the challenges faced through the use of artificial tears on PubMed, and Google Scholar. EzriCare and other preservative-free artificial tears have been reported to pose a serious public health risk as they have been found to be the commonly used product among the people infected with the current multi-state outbreak of the multi-drug resistant P. aeruginosa strain. The current multi-state outbreak of the multi-drug resistant P. aeruginosa strain has raised concerns about the safe use of other artificial products. It is high time that further trials should be conducted on other alternative strategies and evaluate the safety and efficacy of nanotechnology in the treatment of dry eye disease.

Improving Visual Comfort during Computer Gaming with Preservative-Free Hyaluronic Acid Artificial Tears Added to Ergophthalmological Measures.

Digital asthenopia (DA) or Computer Vision Syndrome can occur after prolonged use of digital devices and is usually managed with ergophthalmological measures and the use of artificial tears. This prospective, controlled study evaluated the use of hyaluronic acid artificial tears on the signs and symptoms of DA in participants of a videogame convention. Subjects (n = 56) were randomized into a control group (CG, n = 26), which followed ergophthalmological measures, and a study group (SG, n = 30), which followed ergophthalmological measures and instilled 1 drop of artificial tears with hyaluronic acid 0.15% four times a day. Subjects were evaluated before and after playing for three consecutive days for eye dryness (SPEED questionnaire), conjunctival hyperemia, corneal fluorescein staining, conjunctival lissamine green staining, tear breakup time, Schirmer I test, near convergence and accommodation, and using questionnaires for DA symptoms. After 3 days of intense videogaming, the SPEED score of CG increased significantly (p = 0.0320), while for the SG it was unchanged. Similarly, the CG presented significant increases in ocular fatigue (p = 0.0173) and dryness (p = 0.0463), while these parameters decreased significantly in the SG (p = 0.0149 and p = 0.00427, respectively). This study confirms the protective effect of hyaluronic acid artificial tears against DA symptoms associated with prolonged visual display terminal use.

Effect of Topical Anesthesia on Reducing Pain Associated with Mydriatic Eye Drops during Retinopathy of Prematurity Screening

Introduction: The study aimed to investigate the effectiveness of topical anesthetic drops in reducing the pain associated with mydriatic eye drops prior to the retinopathy of prematurity (ROP) examination. Methods: Premature infants who underwent first-time ROP examinations in an outpatient setting were included in this randomized controlled trial. The study group included the infants who were administered topical anesthesia prior to the first mydriatic drops, and the control group included the infants who were given preservative-free artificial tear drops. Pain assessment was performed using the premature infant pain profile (PIPP). Results: A total of 66 infants, 35 in the control group and 31 in the study group, were included in the study. The PIPP scores of the infants during the first, second, and third mydriatic drops were 5.3 ± 2.0; 4.9 ± 1.7; and 4.0 ± 1.8, respectively, in the study group and 5.3 ± 1.7; 5.6 ± 1.8; and 4.6 ± 1.8, respectively, in the control group. No significant difference was found in the scores between the two groups. The PIPP score after the third drop was significantly lower than that after the second drop in the control group, and the PIPP score after the third drop was significantly lower than that obtained after the first and second drops in the study group. Discussion/Conclusion: This study showed no significant benefit of the topical anesthetic drop in the prevention of pain associated with mydriatic eye drops. The decrease in the pain response observed in repeated administrations is a novel finding.

Microbial Contamination of Preservative-Free Artificial Tears Based on Instillation Techniques.

Preservative-free artificial tears eliminate the side effects of preservatives but are prone to microbial contamination. This study evaluates the incidence of microbial contaminations in single-use vials of preservative-free 0.1% hyaluronate artificial tears. Based on what touched the vial tip during its first use, 60 unit-dose vials (0.5 mL) were divided into groups A (no touch, n = 20), B (fingertip, n = 20), and C (lid margin, n = 20). The vials were recapped after the first use, and the residual solution was cultured 24 h later. The solution from 20 aseptically opened and unused vials was also cultured (group D). Microbial contamination rates were compared between the groups using the Fisher’s exact test. Groups B and C contained 45% (9/20) and 10% (2/20) contaminations while groups A and D contained undetected microbial growth. The culture positivity rates were significantly different between groups A and B (p = 0.001) and groups B and C (p = 0.013) but not between groups A and C (p = 0.487). We demonstrate a significantly higher risk of contamination when fingertips touch the vial mouth. Therefore, users should avoid the vial tip touching the fingers or eyelid during instillation to prevent contamination of the eye drops.

Analysis of Globular Cells in Corneal Nerve Vortex.

PurposeLess was known about globular cells which were a type of dendritic cells (DCs) in cornea. We aimed to investigate the morphological and distribution characteristics of globular cells in corneal vortex and their clinical correlations with ocular surface.MethodsCase records of patients who underwent in vivo confocal microscopy (IVCM) were evaluated retrospectively. The morphology and distribution features of globular cells in cornea nerve vortex and their co-existence status with Langerhans cells (LCs) were analyzed. Data of ocular surface symptoms and signs were collected and their correlations with globular cells distribution patterns and dendritic forms were performed. Dry eye patients without LCs were treated with preservative-free artificial tears, while patients with LCs were treated with artificial tears and fluoromethalone until the activated LCs disappeared.ResultsA total of 836 eyes from 451 individuals were included. Three distribution patterns of globular cells in vortex were investigated, type 1 scattered globular cells (57.66%), type 2 large amounts of globular cells (≥50 cells) gathering in vortex and along some fixed vortex direction horizontally (13.52%) and type 3 no globular cells (28.83%). Their location and cell count altered slightly in the follow-ups but would not disappear. LCs could co-exist with globular cells and could fade after treatment. The type 2 distribution pattern was associated with older age (p = 0.000) and higher upper eyelid Meiboscore (p = 0.006). Dendritic globular cells had higher Meiboscore than Non-dendritic forms.ConclusionsGlobular cells had characteristic distribution patterns and biological features different from LCs. They were associated with long-term irritation of the meibomian gland dysfunction.

Dramatic Improvement of Severe Cicatricial Ectropion after Discontinuing Long-Term Erlotinib Therapy in a Patient with Lung Cancer

There is no consensus on the choice of systemic and ophthalmic treatment for patients who develop ocular toxicity with erlotinib in the few cases reported previously. Various ocular complications related to erlotinib have been reported, with one of the most serious being corneal perforation. Our patient was at risk of potential corneal perforation because of severe cicatricial ectropion and diffuse punctate corneal epitheliopathy. Therefore, erlotinib treatment was temporarily discontinued with the approval of the oncology department and the patient was closely followed. She was prescribed steroid eye ointment, single-use preservative-free artificial tears, and eye lubricant gel to protect the ocular surface. On day 4 of treatment, the patient’s findings were significantly improved. After 1 week, the cicatricial ectropion had dramatically improved and the patient’s complaints were completely resolved. To our knowledge, there is no case report of a patient with both ocular toxicity after long-term use that shows dramatic improvement with drug cessation, and severe cicatricial ectropion affecting the entire lower eyelid. Here, we described a patient who used erlotinib for 3 years due to non-small cell lung cancer and developed severe cicatricial ectropion which improved dramatically within one week of temporarily discontinuing erlotinib and discussed the possible reasons. Although ocular complications with erlotinib are usually encountered early in treatment, it should be kept in mind that erlotinib-related ocular complications may also arise with long-term use.

Changes of Lacrimal Puncta by Anterior Segment Optical Coherence Tomography after Topical Combined Antibiotic and Steroid Treatment in Cases of Inflammatory Punctual Stenosis.

Purpose To evaluate the role of medical treatment and assessing its effect on resolving epiphora and improving punctum size by high resolution AS-OCT imaging comparing punctal parameters in patients before and after treatment with topical combined antibiotic and steroid treatment in cases of inflammatory punctual stenosis. Patients and Methods. Double-blinded controlled randomized study which was conducted on two groups of patients who had acquired punctal stenosis and epiphora presented to Ophthalmology Clinics of Sohag University Hospitals in the period between Jan 2021 and April 2021. The study included 44 eyes of 50 subjects complaining of epiphora. They were divided into two groups, the epiphora group one (EG1) received eye drops containing combination of antibiotics and steroids (orchadexoline eye drops, each ml contains 5 mg chloramphenicol, 1 mg dexamethasone sodium phosphate, 0.25 mg tetryzoline hydrochloride, 2 mg hydroxypropyl methyl cellulose, 10 mg α-tocopherol acetate (vitamin E), and 8 mg macrogol 400), 5 times daily for the first week, three times daily for the next two weeks, and one time daily for another one week. The second epiphora group (EG2) received preservative-free artificial tears (sodium hyaluronate-, polyethylene-, and propylene glycol-based), three times daily for four weeks. The patients were examined before treatment, one week, one month, and one and half months later. Results Both groups were comparable regarding mean age (49 ± 13 vs 53 ± 11 years, P value = 0.2) and sex (males were 38.6% vs 31.8%, female were 61.4% vs 68.2%, P value = 0.6), respectively, with no statistically significant difference between both groups. Both groups were comparable regarding outer punctual diameter and length between the puncti before treatment. Outer punctal diameters were (EG1 228 ± 113 um, EG2 241 ± 115 um, P value = 0.5). Length between the puncti were (EG1 129 ± 73 um, EG2 137 ± 72 um, P value = 0.6). There was marked improvement of the outer punctual diameter (EG1 373 um ± 92 um, EG2 240 ± 109 um, (P value < 0.0001) and length between the puncti (EG1 217 ± 109 um, 136 ± 71 um (P value < 0.0002)) during the follow-up period. EG1 showed more improvement than EG2 when compared during the follow-up period. Conclusions Topical combined antibiotic and steroid treatment was an effective method in treating cases of inflammatory punctual stenosis as found by monitoring of punctal parameter changes by AS-OCT. AS-OCT was found to be a useful method for evaluation of the lacrimal punctal parameters especially with different treatment modalities in epiphora cases.

Impact of Diquafosol Ophthalmic Solution on Tear Film and Dry Eye Symptom in Type 2 Diabetic Dry Eye: A Pilot Study

Purpose: Diquafosol ophthalmic solution (DQS) stimulates P2Y2 receptors on the ocular surface, which enhances mucin secretion from goblet cells. Therefore, tear film stability and hydration of the ocular surface can be achieved independent from lacrimal gland function. Methods: This prospective, open-label pilot study included 60 eyes of 30 diabetic patients diagnosed with dry eye disease (DED) and were randomly assigned to either DQS (n = 30 eyes) or hyaluronate (HA) group (n = 30 eyes). Participants in the DQS group received 3% diquafosol ophthalmic solution, whereas HA group received 0.1% sodium HA preservative-free artificial tears. The dosage for both drugs was 1 drop, 6 times per day for 4 weeks. Tear film lipid layer (TFLL), noninvasive breakup time (NITBUT), corneoconjunctival staining (CS) score, meibomian gland (MG), conjunctival hyperemia [redness score (RS)], ocular surface disease index (OSDI) was assessed and compared at baseline, day 14, and day 28. Results: Comparing baseline and day 28 measurements revealed that both groups found significant improvements in NITBUT, CS, MG quality, MG expressibility, and OSDI scores significantly (P < 0.05), in addition TFLL improvements were only found in the DQS group. At day 28, the magnitude of change in mean NITBUT was 1.74 (DQS) versus 0.31 (HA), 1.16 (DQS) versus 0.37 (HA) point grade reduction in corneoconjunctival staining score and 9.80 (DQS) versus 4.80 (HA) point grade in mean OSDI score. Conclusion: Three percent diquafosol ophthalmic solution treatment demonstrated the ability to improve the tear film dry eye parameters and clinically reduced sign and symptoms of DED in diabetic dry eye patients. Clinical Trials.gov ID: NCT04980144.

20% Autologous serum vs. 0.05% cyclosporine and preservative-free artificial tears in the treatment of Sjögren related dry eye.

To compare the 3-month results of treatment with 20% autologous serum or combination treatment with preservative-free artificial tears and 0.05% cyclosporine in patients with dry eye disease due to primary Sjögren's syndrome. A total of 130 eyes of 65 patients with newly diagnosed dry eye disease due to primary Sjögren's syndrome were included in the study. The patients were divided into two treatment groups: 66 eyes of 33 patients were assigned to the autologous serum treatment group, and 64 eyes of 32 patients were assigned to the combination treatment group. Schirmer test, tear break-up time and Ocular Surface Disease Index (OSDI) scores were recorded at pretreatment and at 3 months of treatment. At 3 months of treatment, the mean Schirmer value and the mean tear break-up time were significantly higher in the combination treatment group (p<0.0001 and p=0.034, respectively). The OSDI score at 3 months was significantly lower in the autologous serum Group (p=0.004). When the two groups were evaluated separately, the improvements in Schirmer, tear break-up time test, and OSDI scores from before to after treatment were statistically significant: p<0.0001, p<0.001, and p<0.0001, respectively, for the authologus serum Group, and p<0.0001, p<0.001, and p<0.0001, respectively, for the combination treatment group. In short-term treatment of dry eye disease due to primary Sjögren's syndrome, treatment with autologous serum was significantly superior to -combination treatment with preservative-free artificial tears and 0.05% cyclosporine in terms of improvement in OSDI scores. Improvements in Schirmer test and tear break-up time scores were significantly superior in the group treated with preservative-free artificial tears and 0.05% cyclosporine.

Ocular biodistribution of once‐daily bilastine eye drops reveals highest levels in conjunctiva up to 24 hours post‐administration

AbstractPurposeA novel effective, safe and well tolerated topical formulation of bilastine, a second‐generation H1‐antihistamine, has been developed for allergic conjunctivitis treatment. This in vivo biodistribution study aimed to determine the exposure to topical bilastine of different ocular tissues and verify if the evolution of conjunctival levels over time supports the intended once daily posology.MethodsTwenty‐four Dutch‐Belted rabbits received 30 µl/eye of 6 mg/ml bilastine formulation (a preservative free artificial tear containing sodium hyaluronate). Blood samples were obtained through the ear artery. Three animals were sacrificed per time point, and aqueous and vitreous humor, cornea, conjunctiva, iris/ciliary body, crystalline lens and retina/choroid samples were collected from both eyes. Bilastine concentrations in matrices were determined by validated LC‐MS/MS methods and pharmacokinetic parameters were determined usin a non‐compartmental analysis.ResultsBilastine Cmax was achieved from 30 min to 6 h after drug administration. Bilastine exposure was highest in conjunctiva (Cmax: 2545.04 ng/g, at 6 h post‐administration; AUCt: 11382.40 ng·h/g) and cornea (Cmax: 609.11 ng/g, at 1 h post‐administration; AUCt: 1993.88 ng·h/g), followed by the iris/ciliary body, retina/choroid, aqueous humor, plasma, vitreous humor, and crystalline lens. Quantifiable bilastine concentrations were observed up to 24 h post‐instillation in conjunctiva (388.45 ng/g), cornea (28.68 ng/g), iris/ciliary body (12.42 ng/g), retina/choroid (1.91 ng/g) and crystalline lens (0.12 ng/g). In plasma, aqueous and vitreous humor, bilastine was detected up to 12 h post‐administration.ConclusionsThe results show the preferential distribution of bilastine eye drops in the conjunctiva, the intended target tissue, while absorption is limited and potential for systemic side effects low. Significant levels of bilastine found in conjunctiva up to 24 h post‐dose support the once daily posology.

Оптические аберрации глаза при кератоконусе

The review presents the basic concepts of the wavefront, ocular aberrations and their changes in keratoconus (KC) — the most common form of primary ectatic corneal disorder. It also considers the issues of the posterior corneal surface impact on the indicators of general astigmatism and the wavefront. The authors note that a possible reason for the increase in the aberration level in KC are concomitant signs of dry eye syndrome (DYS). Adding that, the review also discusses methods for correcting aberrations in KC. To date, contact lens vision correction with rigid gas permeable lenses remains the most effective method of visual rehabilitation. The prescription with a combination of artificial tears and reparative medicine allows to almost completely neutralize the phenomena of keratomalacia (conjunctival xerosis). If a patient with KC has initial signs of DYS, it is advisable to use preservative-free low-viscosity artificial tears based on hyaluronic acid of various concentrations. If the patient uses contact lens vision correction to prevent hypoxia complications, it is justified to prescribe the antioxidant agent, methylethylpiridinol, which has an antiaggregational and antihypoxic effect. Keywords: keratoconus, ocular aberrations, posterior corneal surface, wavefront, Zernike polynomials, dry eye syndrome, antioxidant. For citation: Averich V.V., Egorova G.B. Ocular aberrations in keratoconus. Russian Journal of Clinical Ophthalmology. 2022;22(3):168– 174 (in Russ.). DOI: 10.32364/2311-7729-2022-22-3-168-174.

Topical Cyclosporine-A for Management of Epiphora in Eyes with Acquired Punctal Stenosis

Background: Cyclosporine A (CsA) is an inhibitor of calcineurin that prevents T-cell production of inflammatory cytokines and disrupts the immune-mediated inflammatory response that plays a crucial mechanism in punctal stenosis. Purpose: To evaluate the clinical outcomes and tolerances of CsA in treating epiphora in eyes with punctal stenosis. Study Design: Prospective study. Methods: The study included patients who presented with symptomatic epiphora associated with lower punctal stenosis during the period between July 2019 and December 2020. Patients were treated with topical 0.05% CsA on twice daily dose with topical preservative-free artificial tears Q.I. D. Patients were followed up monthly for at least 3 months by Munk epiphora grading, Fluorescein dye disappearance test (FDT) and evaluation of the patient satisfaction. Results: A total of 26 patients with 47 eyes were included in the study with a mean age of 55.1 ± 10.24 years. All the eyes had grade 0 lower punctal stenosis with grade 4 on Munk grading and grade 3 in FDT. There was a statistically significant difference in the Munk grading and FDT along the follow-up period compared to the baseline values (p rd month. None of the patients encountered any complications during treatment. Conclusion: CsA can control the inflammation of the conjunctival sac and restore the integrity of the ocular surface with subsequent symptomatic relief of the epiphora in eyes with punctal stenosis.

Effect of eyelid-warming device on meibomian gland dysfunction

Background Meibomian gland dysfunction (MGD) has a significant effect on patients’ quality of life. Despite the numerous treatment options, it is still difficult to obtain complete relief of signs and symptoms. Blephasteam is an eyelid-warming device that is easy to use and standardized for treatment of MGD. Objective This study aimed to evaluate of the effect of Blephasteam on MGD compared with the traditional warm compresses. Patients and methods This is a prospective comparative interventional study that included 40 eyes of 20 patients with MGD. Patients were subdivided into two groups: in group I, warm compresses were applied to the eyelids twice daily for 20–30 min for 2 weeks, whereas in group II, the patients used the Blephasteam device three sessions per week for 2 weeks. Both groups received treatment by systemic tetracycline, topical antibiotic and steroid, and preservative-free artificial tears eye drops for 2 weeks. The patients were assessed before treatment and after 2 weeks, 1 month, and 3 months using the Standard Patient Evaluation of dry Eye Disease questionnaire for dry eye, breakup time test (invasive and noninvasive; IBUT and NIBUT), and the shape of the lipid layer of the tear film by a tearscope. Results Both groups showed statistically significant improvement regarding the dry eye symptoms, IBUT and NIBUT, and the lipid layer interferometry. However, the follow-up visits showed statistically significant better results in group II than in group I for the Standard Patient Evaluation of dry Eye Disease questionnaire (P=0.044, 0.001, and 0.001, respectively). In addition, the IBUT was statistically significantly better in group II than in group I during the follow-up (P=0.014, 0.007, and 0.002, respectively) as well as the NIBUT (P=0.043, P<0.001, and P<0.001, respectively). There was no statistically significant difference in interferometry between the two groups during the follow-up. Conclusions Both traditional warm compress and Blephasteam were effective in MGD treatment, but Blephasteam was more effective.

Effect of Autologous Serum Eye Drops on Corneal Haze after Corneal Cross-linking.

Corneal haze remains a frequent post-operative finding in patients undergoing corneal cross-linking. It has been shown that autologous serum tears promote epithelial healing and reduce post-operative pain; however, the role in the prevention of corneal haze has not been reported. This study aimed to compare the effect of autologous serum tears versus preservative-free artificial tears on the prevention and resolution of post-cross-linking corneal haze. A retrospective cohort study was conducted in a sample population from one surgeon at a tertiary eye center from 2016 to 2019. Seventy-six eyes of consecutive patients who underwent cross-linking were included. Records were reviewed for corneal Scheimpflug densitometry values and maximum keratometry, epithelial healing time, and the use of either autologous serum tears or preservative-free artificial tears. Corneal densitometry values, expressed in standardized grayscale units (GSU), were recorded for the anterior 150-μm corneal stroma and in the 0.0 to 2.0 mm and 2.0 to 6.0 mm zones. Forty-four eyes received autologous serum tears, whereas 32 eyes received preservative-free artificial tears. The baseline GSU of the anterior stromal 0 to 2 mm annulus and the 2 to 6 mm annulus did not significantly differ between groups (P = .50 and P = .40, respectively). There was a statistically significant increase in mean GSU for both anterior 0 to 2 mm and 2 to 6 mm zones between baseline and 1 month (P < .001) and 3 months (P < .001). When comparing the two groups, no statistically significant difference was found post-operatively between the mean GSU at 1 month for the anterior 0 to 2 mm (P = .38) nor the 2 to 6 mm zone (P = .12), or for the third month (P = .60 and P = .44, respectively). Using Scheimpflug densitometry, we did not find a significant difference in the post-cross-linking corneal haze at 1 and 3 post-operative months between patients who use autologous serum tears and those who use preservative-free artificial tears.

Treatment of persistent epithelial defects with single-dose autologous serum eye drops.

We aimed to investigate the efficacy and safety of single-dose autologous serum eye drops (ASEDs) for treatment of persistent corneal epithelial defects (PEDs). About 34 eyes of 26 patients treated from March 2016 to May 2020 with a single dose of ASEDs for PEDs that did not respond to conventional treatment were retrospectively evaluated. Patient demographics, predisposing factors, size, and duration of the PED, duration of treatment, and dosage of ASEDs, PED healing time, success rate of the ASED treatment, and follow-up time after the onset of ASED treatment were recorded. Autologous serum eye drops (20%) were prepared by diluting the serum with preservative-free artificial tears in single-dose vials. Vials were stored at -20°C and used daily after dissolving. The mean patient age was 47.0 ± 18.5 years, and 13 (50%) of the patients were male. The most common indication for ASEDs was PED after keratoplasty. The mean duration of ASED treatment was 8.5 ± 6.3 months, and mean follow-up time was 22.8 ± 12.2 months. Autologous serum eye drop treatment was effective in 25 (73.5%) eyes and partially effective in 5 (14.7%) eyes. None of the eyes displayed complications related to the treatment. In patients with PED for whom conservative treatment is insufficient, ASEDs prepared by dilution with preservative-free artificial tears in single-dose vials and administered based on the daily use principle appear to be effective and safe.

Role of artificial tears with and without hyaluronic acid in controlling ocular discomfort following PRK: a randomized clinical trial

To compare outcomes of applying preservative free artificial tears (PFAT) with and without hyaluronic acid (HA) in early postoperative course following photorefractive keratectomy (PRK). In this triple-blinded randomized clinical trial, PRK procedure was performed on both eyes of 230 patients. Following PRK, patients were divided into three groups: the HA+ group, 44 patients PFAT containing HA; the HA- group, 71 patients PFAT without HA were administered 5 times per day (every 4h); the third group, 115 patients received no PFAT before lens removal. On the 1st and 4th postoperative day, Visual Analogue Score (VAS) was utilized to evaluate patient's level of pain. Participants were asked to complete a questionnaire about the severity of eye discomfort ranked from 0 to 10 (0=no complaint; 10=most severe complaint experienced). In eyes receiving PFAT with or without HA (Drop group), mean scores for epiphora, foreign body sensation, and blurred vision on the 1st postoperative day were statistically lower (P<0.05). Filamentous keratitis (FK) was detected in 11 (4.7%) eyes, and recurrent corneal erosion (RCE) was observed in 5 (2.1%) eyes. In the control group, FK was noted in 16 (6.9%) eyes while 13 (5.6%) eyes had RCE and 5 (2.1%) eyes had corneal haze. The rate of complications was statistically lower in Drop group (P=0.009). However, the aforementioned scores were not statically different between HA+ and HA- group one and two (P=0.29). Following PRK, applying PFAT with and without HA yields faster visual recovery, decreases postoperative ocular discomfort and haze formation; however there is no additive effect for HA.