Schirmer Scores Research Articles

Corneal fluorescein staining and ocular symptoms but not Schirmer test are useful as indicators of response to treatment in chronic ocular GVHD

PurposeTo evaluate long-term ocular surface clinical signs and symptoms response to therapy in patients with chronic ocular GVHD. MethodsRetrospective review and data modeling. We reviewed the records of post-bone marrow transplantation patients who were newly diagnosed with ocular GVHD and initiated therapy, and analyzed changes in symptoms (Ocular Surface Disease Index [OSDI]; Symptom Assessment in Dry Eye [SANDE]) and signs (corneal fluorescein staining [CFS]; Schirmer test). We used a LOESS technique to fit a model in function of data variations and obtain a predictive value of the scores progression over time. ResultsThe records of 123 patients who were followed-up for over 2 years (up to 62 months) were reviewed. The median baseline scores recorded were: OSDI 52 units, SANDE 62.2 units, CFS 2.0 Oxford units, and Schirmer 4 mm. After six months of follow up, scores improved for OSDI (−18.6 units, p = 0.007), SANDE (23.7 units, p = 0.01), and CFS (−0.7 Oxford units, p < 0.001). Data analysis showed that after a 2-year follow up the three parameters continued to improve: OSDI -13.67 units (27% reduction), SANDE -17.55 units (28%), CFS -1.1 units (54%), but Schirmer test scores progressively worsened −1.2 mm (22%). ConclusionIn patients with ocular GVHD symptoms and corneal fluorescein staining improved after initiation of treatment, meanwhile Schirmer scores declined progressively. This indicates that appropriate treatment in chronic ocular GVHD can lead to mid- and long-term improvements in symptoms and corneal epitheliopathy; however, sustained reduction in Schirmer test scores suggests chronic tear production impairment.

Collyres de sérum autologue : traitement à long-terme dans le syndrome sec oculaire

Dry eye disease is a multifactorial pathology of the ocular surface. The high incidence of this pathology, as well as its significant impact on quality of life and vision and its financial cost, makes it a real public health problem. While the treatment of mild cases is generally simple and effective, treatment of severe forms is often disappointing. The use of autologous serum tears (AST) represents a therapeutic alternative for the most severe cases. The purpose of our study is to evaluate the efficacy of long-term AST treatment in patients with severe dry eye disease refractory to conventional treatment or secondary to systemic diseases such as Sjögren's syndrome or Graft versus Host disease (GVH), or ocular pathologies such as neurotrophic keratitis, chemical burns and ocular cicatricial pemphigoid. This is a monocentric retrospective observational study conducted on 47patients, with 83eyes treated with autologous serum eye drops for isolated or secondary dry eye disease at the Marseille Public Hospitals between April 2014and April 2017. The patients' subjective symptoms (ocular surface disease index [OSDI] score), their degree of satisfaction and the side effects were collected using questionnaires. Tear Break Up Time (BUT) and Schirmer scores were noted. A clinical evaluation based on fluorescein staining (Oxford score) was carried out prior to treatment with AST at P0followed by 5periods: P1 (between 1and 3months), P2 (3to 9months), P3 (9to 15months), P4 (15months to 24months), and P5 (>24months). Out of the 83eyes treated, the mean age was 54.39±21.56. There were 20males (42.55%) and 27females (57.44%); treatment indications consisted mainly of 25.53% GVH, 21.27% severe dry eye disease and 19.14% Sjögren syndrome. The mean duration of follow-up was 9.82months±15.50. The OSDI score decreased by 19.32points±29.37 (P<0.05) between P0and P1and by 23.06points±18.41 (P<0.05) between P0and P4. The Oxford clinical score showed a significant decrease by the third month of treatment, between P0and P2, by 1.32points±1.76 (P<0.05). The Schirmer test and the BUT also showed an improvement in dry eye symptoms over time with AST, significantly at P1 (P<0.05). Complementary biological analyzes on the composition of AST are under way in order to identify predictive factors of effectiveness; patients not responding to AST treatment might respond to allogeneic serum from healthy donor cord blood. On this first series of 83eyes treated with ASD, clinical efficacy was noted in most of the patients. No infectious complications were reported, and the satisfaction rate was very high.

The Effect of Low-Dose Aspirin on Dry Eye Parameters and Ocular Surface Disease Index Questionnaire.

To evaluate the effects of acetylsalicylic acid (aspirin) on tear film parameters and dry eye disease. Fifty-seven patients using low-dose aspirin regularly for antiaggregant purposes as well as 49 controls, who required antiaggregant treatment but who had not yet started, were included in the study. Tear osmolarity, tear break-up time (TBUT), Schirmer and Oxford grading of ocular surface staining were performed on all patients and dry eye symptomatology was assessed using the ocular surface disease index questionnaire (OSDI). The mean osmolarity was 302.11 ± 16.22 mOsm/L in the aspirin group and 313.88 ± 19.57 mOsm/L in the control group (P < 0.01). The mean Schirmer's score was 24.16 ± 10.52 mm and 21.94 ± 10.11 mm (P = 0.232), TBUT was 13.61 ± 3.31 s and 10.39 ± 4.46 s (P < 0.01), OSDI score was 5.15 ± 5.98 and 16.94 ± 14.17 (P < 0.01), and Oxford score was 0.12 ± 0.33 and 0.12 ± 0.44 in aspirin and control groups, respectively (P = 0.99). Dry eye diagnosis was lower in the aspirin group, but statistical significance was present only in TBUT and osmolarity-based dry eye diagnosis (P ≤ 0.01). In terms of symptom-based dry eye diagnosis with the threshold of OSDI ≥23, none of the aspirin group had dry eye diagnosis, whereas 32.6% of the control group had the diagnosis (P < 0.01). The use of low-dose aspirin might be great option for treatment of ocular surface inflammatory disease through increasing TBUT and decreasing tear osmolarity with a resultant symptomatic satisfaction.

Assessment of efficacy of topical azithromycin 1.5 per cent ophthalmic solution for the treatment of meibomian gland dysfunction

BackgroundThe aim was to evaluate the clinical efficacy of topical azithromycin 1.5 per cent ophthalmic solution in treatment of the clinical signs and symptoms associated with meibomian gland dysfunction (MGD).MethodsIn this retrospective study, 35 patients with MGD were treated with topical azithromycin 1.5 per cent ophthalmic solution for 30 days. Topical azithromycin 1.5 per cent ophthalmic solution was prescribed twice daily for two days and then once daily for a total of 30 days. Daily lid hygiene with dilute baby shampoo was instructed for all patients. Patient total symptom score, meibomian gland grading score, Schirmer score with anaesthetic, tear film break‐up time (TFBUT) and corneal fluorescein staining score were evaluated at baseline and after one and three months.ResultsPatient total symptom score, meibomian gland grading score, Schirmer score with anaesthetic, TFBUT and corneal staining score reduced significantly from the baseline to the first month (p < 0.05, for each); however, at the third month, there was no significant difference from baseline in the meibomian gland grading score, Schirmer score with anaesthetic, TFBUT and corneal fluorescein staining score (p > 0.05, for each).ConclusionThese results demonstrate that topical azithromycin 1.5 per cent ophthalmic solution appears effective in the short‐term treatment of the clinical signs and symptoms associated with MGD.

Relation of accommodative microfluctuation with dry eye symptoms in short tear break-up time dry eye.

PurposeTo investigate accommodative microfluctuations (AMFs) and visual function in short tear break-up time (BUT)-type dry eye (DE) and non-DE subjects.MethodsThis prospective comparative study included 48 volunteers with DE symptoms (mean age 34.8 ± 5.5 years, age range 25–42 years) and 73 without DE symptoms (mean age 30.6 ± 4.7 years, age range 25–42 years). The eyes were divided into two groups: (1) DE group with DE symptoms and BUT ≤ 5 s and (2) non-DE group without DE symptoms and BUT > 5 s. We excluded eyes with Schirmer score ≤ 5 mm and positive keratoconjunctival epithelial damage. Tear evaluation, AMF, and functional visual acuity (VA) examinations were performed. AMF parameters included total high-frequency component (HFC), HFC with low accommodation for the task of staring into the distance (HFC1), and HFC with high accommodation for deskwork (HFC2). Functional VA parameters included starting VA, functional VA, visual maintenance ratio, and blink frequency.ResultsA total of 33 and 34 eyes were categorized in the DE and non-DE groups, respectively. Mean blink frequency and HFC1 values were significantly higher in the DE group than they were in the non-DE group.ConclusionsDEs with symptoms showed abnormal AMF and visual function, which may be associated with DE symptoms.

Effectiveness of Combined Tear Film Therapy in Patients with Evaporative Dry Eye with Short Tear Film Breakup Time

The aim of this study was to evaluate the effectiveness of combined tear film therapy targeted to aqueous, mucin, and lipid layers in patients with refractory evaporative dry eye (EDE) with short tear film breakup time (TBUT). The patients who had EDE with short TBUT and severe symptoms refractory to artificial tears were treated with hyaluronic acid (HA) 0.15% and diquafosol tetrasodium (DQS) 3% (Group 1), HA and carbomer-based lipid-containing eyedrops (Liposic EDO Gel, LPO) (Group 2), or HA, DQS, and LPO (Group 3). Ocular Surface Disease Index (OSDI) score, visual analog scale (VAS) symptom score, TBUT, Schirmer score, and corneal and conjunctival staining scores were evaluated, and noninvasive tear film breakup time (NIBUT) and tear meniscus height were measured using Keratograph® 5 M before and 1 and 3 months after treatment. OSDI scores, VAS scores, TBUT, and NIBUT were improved at 1 and 3 months after treatment in all groups (all P < 0.05). At each follow-up visit, the total OSDI, OSDI symptom, and all VAS scores were significantly lower in group 3 compared with groups 1 and 2 (all P < 0.05). In addition, TBUT and NIBUT were significantly higher in group 3 compared with groups 1 and 2 (all P < 0.05). No significant adverse effects were noted in the groups during treatment. Mucin or lipid-targeting agents combined with aqueous supplements in patients with refractory EDE with short TBUT might improve subjective symptoms and TBUT. Of this, targeting whole tear film layers was most effective in improving ocular symptoms and tear film quality.

The Prospective Health Assessment of Cataract Patients' Ocular Surface (PHACO) study: the effect of dry eye.

PurposeTo determine the incidence and severity of dry eye as determined by the International Task Force (ITF) scale in patients being screened for cataract surgery.Patients and methodsThis was a prospective, multi-center, observational study of 136 patients, at least 55 years of age, who were scheduled to undergo cataract surgery. The primary outcome measure was the incidence of dry eye as evaluated by grade on the ITF scale and secondary outcome measures include tear break-up time (TBUT), ocular surface disease index score, corneal staining with fluorescein, conjunctival staining with lissamine green, and a patient questionnaire to evaluate symptoms of dry eye.ResultsMean patient age was 70.7 years. A total of 73.5% of patients were Caucasian and 50% were female. Almost 60% had never complained of a foreign body sensation; only 13% complained of a foreign body sensation half or most of the time. The majority of patients (62.9%) had a TBUT ≤5 seconds, 77% of eyes had positive corneal staining and 50% of the eyes had positive central corneal staining. Eighteen percent had Schirmer’s score with anesthesia ≤5 mm.ConclusionThe incidence of dry eye in patients scheduled to undergo cataract surgery in a real-world setting is higher than anticipated.

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

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

Clinical utility of cyclosporine (CsA) ophthalmic emulsion 0.05% for symptomatic relief in people with chronic dry eye: a review of the literature.

To review the literature on the efficacy of cyclosporine (CsA) ophthalmic emulsion 0.05% on symptomatic relief in chronic dry eye disease. There is consistent evidence of objective improvements in chronic dry eye disease (Schirmer score, corneal and interpalpebral dye staining, and tear breakup time) with CsA, but variable results with symptomatic improvement, possibly due to patient tolerance of CsA, similar comforting effect with artificial tears and CsA vehicle, and the inherent subjective nature of symptom monitoring and analysis. This review explores the literature on CsA with special attention to symptomatic relief.

Severe symptoms of short tear break-up time dry eye are associated with accommodative microfluctuations.

AimValidating the hypothesis that accommodative microfluctuations (AMFs) may be associated with severe symptoms in short tear break-up time (BUT) dry eye (DE).MethodsThis study included 12 subjects with short BUT DE (age: 49.6±18.3 years). Diagnoses were performed based on the presence of DE symptoms, BUT ≤5 s, Schirmer score >5 mm, and negative keratoconjunctival epithelial damage. Tear evaluation, AMF, and functional visual acuity (VA) examinations were conducted before and after DE treatment. The AMF parameters evaluated were: total high-frequency component (HFC), HFC with low accommodation for the task of staring into the distance (HFC1), HFC with high accommodation for deskwork (HFC2). A subjective questionnaire of DE symptoms was also performed.ResultsMean BUT increased from 1.9±2.0 to 6.4±2.5 s after treatment (P<0.05). The mean logarithm of the minimum angle of resolution functional VA significantly improved (from 0.19±0.19 to 0.12±0.17; P<0.05). Mean power spectrum values for total HFC and HFC1 decreased (from 61.3±5.7 to 53.8±6.6 dB and from 62.9±10.5 to 52.4±6.2 dB, respectively; P<0.05), while the mean HFC2 power spectrum values did not differ before and after treatment (P>0.05). Subjective DE symptoms were reduced in nine patients.ConclusionAlong with the improvement of BUT after treatment, DE symptoms diminished and HFC1 and functional VA improved, suggesting that tear film instability is associated with deterioration of functional VA, AMF, and DE symptoms.

Osmoprotectants, carboxymethylcellulose and hyaluronic acid multi-ingredient eye drop: a randomised controlled trial in moderate to severe dry eye

PurposeTo assess the safety and efficacy of an eye drop combining osmoprotectants, carboxymethylcellulose and hyaluronic acid (O/CMC/HA) in reducing symptomatic, moderate to severe dry eye, compared with HA.MethodsIn this investigator-masked, randomised study, patients instilled 1–2 drops/eye of O/CMC/HA or HA (2–6 times/day) for 3 months. Primary endpoint: mean change in Global Ocular Staining Score (GOSS) from baseline at day 35. Noninferiority of O/CMC/HA was tested in the per-protocol population; if achieved, superiority was tested in the intent-to-treat population. Secondary efficacy endpoints: mean change from baseline in GOSS, Ocular Surface Disease Index (OSDI), Schirmer score, tear break-up time (TBUT), corneal/conjunctival staining, conjunctival hyperaemia, symptoms, and patient/investigator assessments.ResultsBaseline characteristics were comparable between groups (n=40 each). O/CMC/HA was noninferior (and not superior) to HA based on similar GOSS reductions from baseline at day 35 and month 3 in both groups (P=0.778, day 35, per-protocol population). Overall, O/CMC/HA and HA provided similar reductions in OSDI, Schirmer score, TBUT, corneal staining and hyperaemia from baseline at 35 days (P≥0.155). More patients reported less severe stinging/burning, sandiness/grittiness, and painful/sore eyes at month 3 with O/CMC/HA (P≤0.039), and more rated the dropper bottle easy to use (87.5%), compared with HA (46.2%; P=0.002). Other patient and investigator assessments were similar between groups. O/CMC/HA and HA were well tolerated.ConclusionsO/CMC/HA is noninferior to HA in improving objective signs of dry eye, with potential advantages for subjective symptoms and patient acceptance.

Effects of punctal occlusion on global tear proteins in patients with dry eye

PurposeTo investigate effects of punctal occlusion on global tear protein levels in patients with dry eye. MethodsIn this prospective, longitudinal, single-center study, nonabsorbable punctal plugs were inserted bilaterally into the lower punctum of 30 patients with moderate dry eye. Dry eye symptoms, fluorescein corneal staining, Schirmer I test, tear film break-up time, and safety were assessed in the more severely affected eye. Tear proteins at weeks 1 and 3 were quantified by iTRAQ relative to baseline preocclusion levels. ResultsOf 29 patients who completed the study, 23 (mean age 49.8 years) had sufficient tear samples for analysis. After 3 weeks, punctal occlusion significantly upregulated tear proteins, including glutathione synthase (mean of 1.6-fold, P = 0.01) and interleukin-1 receptor antagonist (1.7-fold, P = 0.032) and downregulated cholinergic receptor (neuronal) alpha-7 (0.79-fold, P = 0.039) and lymphocyte cytosolic protein-1 (0.66-fold, P = 0.012). Clustering analysis of global tear proteins revealed two clear profile changes; the first group of patients (cluster 1, n = 10) had a reduction in the inflammatory proteins (e.g., S100A8) and rise in lacrimal proteins supporting the ocular surface (e.g., lysozyme), whereas the second group (cluster 2, n = 13) had an increase in inflammatory proteins and a decrease in lacrimal proteins. Logistic regression analysis revealed that cluster 1 patients had significantly (P = 0.006) lower Schirmer scores at baseline (mean [standard deviation]: 4.3 [4.3] mm) than cluster 2 (6.8 [2.6] mm). ConclusionsPunctal plugs produced a beneficial pattern of tear protein change in patients with relatively low Schirmer scores within 3 weeks of punctal occlusion.

Automated Measurement of Tear Film Dynamics and Lipid Layer Thickness for Assessment of Non-Sjögren Dry Eye Syndrome With Meibomian Gland Dysfunction.

To investigate automated values from an advanced corneal topographer with a built-in real keratometer, color camera, and ocular surface interferometer for the evaluation of non-Sjögren dry eye syndrome (NSDES) with meibomian gland dysfunction (MGD). Sixty-four patients (64 eyes) diagnosed with NSDES with MGD were enrolled. All eyes were evaluated using the Ocular Surface Disease Index (OSDI), fluorescence staining score, tear film breakup time (TBUT), Schirmer test, and MGD grade. Noninvasive Keratograph average tear film breakup time (NIKBUTav), tear meniscus height (TMHk), meibomian gland (MG) dropout grade, and lipid layer thickness (LLT) using interferometry were measured. Among automated indexes, NIKBUTav (mean 7.68 ± 4.07 s) and the MG dropout grade (mean 1.0 ± 0.5) significantly correlated with the OSDI (mean 40.6 ± 22.9) (r = -0.337, P = 0.006; and r = 0.201, P = 0.023, respectively), as did all conventional indicators, except the Schirmer score (mean 9.1 ± 5.9 mm). TMHk (mean 0.21 ± 0.18 mm) had significant correlation with the Schirmer score, the staining score (mean 1.2 ± 0.7), TBUT (mean 3.8 ± 1.8 s), and NIKBUTav (r = 0.298, P = 0.007; r = -0.268, P = 0.016; r = 0.459, P < 0.001; and r = 0.439, P < 0.001, respectively), but not any MGD indicator, even the MG dropout grade. NIKBUTav showed significant correlations with all clinical parameters and other automated values, except the Schirmer score and LLT (mean 83.94 ± 20.82 nm) (all (Equation is included in full-text article.)≥ 0.25 and P < 0.01). The MG dropout grade highly correlated with all indexes except TMHk (all (Equation is included in full-text article.)≥ 0.25 and P < 0.05). LLT was significantly associated with TBUT, MGD grade (mean 2.0 ± 0.7), and MG dropout grade (r = 0.219, P = 0.047; r = -0.221, P = 0.039; and r = 0.433, P < 0.001, respectively), although it was not related to patient symptoms. Automated noninvasive measurements using an advanced corneal topographer and LLT measured with an ocular surface interferometer can be alternatives to conventional methods to evaluate tear conditions on the ocular surface; the former device can provide information about conformational MG changes in NSDES with MGD.

Oral Omega-3 Fatty Acid Supplementation for Laser In Situ Keratomileusis-Associated Dry Eye.

To determine the effect of oral omega-3 fatty acid (ω3FA) supplementation in laser in situ keratomileusis (LASIK)-associated dry eye. In this prospective, open-label study, patients undergoing LASIK were randomized to receive either 1.2 g/d of a triglyceride formulation of oral ω3FA (treatment group) or 400 mg/d vitamin E (control group) for 1 week before and continued for 12 weeks after surgery. Ocular surface disease index, tear breakup time, ocular surface staining, and Schirmer scores were evaluated and compared preoperatively and at 3 months after LASIK. The study included 30 patients in each group. All parameters were comparable at baseline. Ocular surface disease index scores increased comparably in both groups (1.9 ± 0.6 increase in the treatment group; 2.8 ± 0.5 in the control group) (P = 0.267). Compared with baseline levels, tear breakup time decreased significantly (P < 0.01) but comparably in both treatment (-2.3 ± 0.4 seconds decrease) and control (-3.5 ± 0.7 seconds decrease) groups (P = 0.105). More eyes in the control group (43.4%) had conjunctival staining with Lissamine green at 3 months compared with the treatment group (14%) (P = 0.009). The Schirmer score at 3 months was higher (P = 0.003) in the treatment group (30.5 ± 0.90 mm) than in the control group (25.7 ± 1.3 mm) with a increase of 5.9 ± 1.3 mm from baseline in the treatment group and a decrease of 1.5 ± 1.2 mm in the control group. Supplementation with ω3FA in patients undergoing LASIK had a positive influence on tear secretion, whereas tear film stability remained unaffected when compared with the control group.

Correlation of ocular manifestations with the duration and activity of disease in patients with rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis which can affect extra-articular tissues including eyes. Objective: This study was aimed to evaluate the ocular manifestations, their correlation with the duration and activity of disease in patients with RA. Materials and Methods: Patients diagnosed with RA of disease onset age >20 years, irrespective of sex were selected for the study. The eye manifestations were done clinically and also with the help of slit lamp, ophthalmoscope and Schirmer’s test. The findings were statistically analysed. Result: One hundred cases of RA were selected (mean age 52.54 years). Keratoconjunctivitis sicca was the commonest finding (40%) along with few cases of keratitis (3%), scleritis (1%) and episcleritis (1%). A statistically significant negative correlation was found between the duration of disease and the Schirmer score (r=-0.785; p=0.001). Further, no statistically significant correlation between ocular manifestation and the disease severity were found. Higher ophthalmic involvement was found in seropositive patients. Conclusion: The commonest ocular manifestation found was keratoconjunctivitis sicca. The frequency and severity of involvement of eyes were found to be significantly associated with the duration of the disease. This emphasizes the need for the routine ophthalmic evaluation of RA patients on a periodic basis for the early detection as well as the prevention of ophthalmic complications and thereby modifying treatment.

Bulbar conjunctival microvascular responses in dry eye

PurposeConjunctival microvascular responses may be a surrogate metric of efferent neural pathway function innervating the ocular surface as changes in blood flow occur within seconds after a stimulus. As somatosensory dysfunction may partially underlie dry eye (DE), in this study we evaluate whether bulbar conjunctival microvascular alterations correlate with various aspects of DE. MethodsFifty-six DE patients were prospectively recruited from a Veterans Affairs ophthalmology clinic over an 11-month period. DE symptoms and ocular pain were assessed along with DE signs. A novel functional slit lamp biomicroscope (FSLB) was used to image the temporal bulbar conjunctiva from the right eye before and after central corneal stimulation with an air puff. Blood flow velocities were measured and noninvasive microvascular perfusion maps (nMPMs) were created. ResultsThe bulbar blood flow velocity was 0.50 ± 0.15 mm/s at baseline and increased to 0.55 ± 0.17 mm/s after stimulation (P < 0.001); the average change in velocity was 0.05 ± 0.09. nMPMs values and venule diameter, on the other hand, did not significantly increase after stimulation (1.64 ± 0.004 at baseline, 1.65 ± 0.04 after stimulation, P = 0.22 and 22.13 ± 1.84 μm at baseline, 22.21 ± 2.04 μm after stimulation, P = 0.73, respectively). Baseline blood flow velocity positively associated with Schirmer scores (r = 0.40, P = 0.002). Those with higher self-rated wind hyperalgesia demonstrated less change in blood flow velocity (r = −0.268, P = 0.046) after air stimulation on the central cornea. ConclusionConjunctival blood flow velocity, but not vessel diameter or complexity, increases after wind stimuli. Baseline flow positively correlated with Schirmer scores while change in flow negatively correlated with self-reported wind hyperalgesia.

Tear Film and Ocular Surface Evaluation in Gestational Diabetes Mellitus

ABSTRACTBackground: Dry eye syndrome is one of the complaints of diabetic patients. The aim of the present study was to evaluate the tear functions in pregnant women with gestational diabetes mellitus (GDM) using tests: Schirmer, tear break-up time (TBUT), and tear film osmolarity (TFO) tests and the Ocular Surface Disease Index score (OSDI). Methods: Pregnant women with GDM (Group 1, n=46) and healthy pregnant women (Group 2, n=36) were enrolled. Initially, all participants were asked to answer the OSDI and then they underwent a detailed ophthalmic examination including Schirmer, TBUT, and TFO tests. The individuals with ocular or systemic disorders that might affect the tear function tests and who were using topical medications were excluded. Results: The results of Schirmer, TBUT, TFO tests and OSDI scores were 11.20±4.93 mm, 5.59±2.16 sec, 309.65±14.80 mOsm/L, and 9.59 ± 9.69 in Group 1, respectively, and 12.33±5.33 mm, 5.67±2.68 sec, 308.36±16.00 mOsm/L, and 10.62±8.66 in Group 2, respectively. There was no significant difference in any of the tear function tests and OSDI scores between the study groups (p>0.05). Conclusion: GDM seems to have no negative effects on tear function tests. This may be due to a lack of duration of hyperglycemia long enough to affect the tear function tests of pregnant women.

Comparison of the clinical efficacy of preserved and preservative-free hydroxypropyl methylcellulose-dextran-containing eyedrops

PurposeThis study aimed to compare the efficacy of two sustained-release formulation of artificial tear drops. Patients and methodsThis is a randomized patient-masked clinical trial, a total 88 patients into two group A (n=41; with single dose of artificial tear, containing dextran 70, 1mg/ml and hypromellose, 3mg/ml hydroxypropyl methylcellulose (HPMC) and group B (n=47; with multidose of artificial tear, containing 0.3g HPMC and 0.1g of dextran 70, with 0.01% benzalkonium chloride (BAK) as preservative) were completed the study. The ocular surface disease index (OSDI) questionnaire, tear break up time (TBUT), corneal and conjunctival staining and Schirmer test, were performed. Repeated measures ANOVA was used to assess the differences among the two products. A p-value less than 0.05 was considered significant. ResultsThe mean of age of the participants in the Group A and B was 44.08±6.29 (range, 33–58 years) years and 45.83±8.42 (31–60 years), respectively. In comparing two groups before the intervention, the OSDI scores, the TBUT scores, the conjunctival and corneal staining scores and the Schirmer scores did not show statistically significant differences (p=0.339, p=0.640, p=0.334, p=0.807 and p=0.676, respectively). After 4 weeks, the OSDI scores, conjunctival and corneal staining scores showed improvement in compare to those before the intervention (p<0.001). But, the differences for the Schirmer test score and TBUT score was not significant (p=0.115, p=0.013, respectively). ConclusionOur outcomes indicated that improvement occurred with use of both products but there was no statistically significant difference between them.

Dry Eye Disease in Patients with Newly Diagnosed Depressive Disorder

ABSTRACTPurpose: Psychiatric conditions and not just the treatments themselves might be involved in the pathophysiology of dry eye disease (DED). The aim of our study was to evaluate the association between depression and DED using objective and subjective tests in patients with newly diagnosed depressive disorder who were not using any medication which may help us to determine the sole effect of depression on dry eye.Methods: Thirty-six patients from the psychiatry clinic with a new diagnosis of depressive disorder and 32 controls were included in the study. All met the Diagnostic and Statistical Manual IV criteria for depression. Beck Depression Inventory (BDI) was used to measure depression severity and the State-Trait Anxiety Inventory (Stai1, Stai2) for concomitant anxiety symptoms. The Ocular Surface Disease Index (OSDI) and Visual Functioning Questionnaires (VFQ25) were completed and used to confirm diagnosis of DED in conjunction with the tear break up time (TBUT), ocular surface vital dye staining, and Schirmer’s test.Results: The comparison of depressive and control groups revealed significantly lower Schirmer (20.3 ± 9.9 vs. 25.7 ± 9.3 mm) and TBUT (7.8 ± 5.7 vs. 12.5 ± 7.8 s) scores with a consistently higher Oxford score (1.8 ± 3.2 vs. 0.2 ± 0.4) in the depressive group. Although the parameters were affected in the depressive group, this did not influence OSDI (86.1 ± 13.6 vs. 86.6 ± 13.3) and VFQ25 (30.8 ± 21.6 vs. 38.5 ± 29.1) scores. In both groups, the three psychological test scores (Stai1–2 and BDI) were correlated to each other but none of these tests were correlated to OSDI, VRQL, Schirmer, TBUT, and Oxford staining scores.Conclusion: Our study shows a definite association between depression and DED. We feel that it is important that psychiatrists take this into account especially while prescribing antidepressants which may aggravate dry eye signs.

In Vivo Confocal Microscopy in Dry Eye Disease Associated With Chronic Graft-Versus-Host Disease.

To compare densities of corneal epithelial dendritic cells (DCs), corneal subbasal nerves, and conjunctival epithelial immune cells (EICs) between patients with dry eye disease (DED) with and without graft-versus-host disease (GVHD) using in vivo confocal microscopy (IVCM). This study included 54 patients who had moderate to severe DED either associated with (n = 33) or without (n = 21) chronic GVHD. In addition to evaluating clinical parameters of DED, images obtained by laser-scanning IVCM of the central cornea and superior tarsal conjunctiva were analyzed to measure densities of corneal epithelial DCs, corneal subbasal nerves, and conjunctival EICs. Although there were no significant differences between GVHD and non-GVHD groups in symptom scores, the GVHD group had significantly worse corneal fluorescein staining, tear break-up time, and Schirmer's scores than the non-GVHD group. Corneal epithelial DC density, corneal subbasal nerve density, and conjunctival EIC density were 148 ± 135 cells/mm2, 16.3 ± 6.1 mm/mm2, and 670 ± 267 cells/mm2, respectively, in the GVHD group; and 122 ± 99 cells/mm2, 18.3 ± 5.1 mm/mm2, and 572 ± 271 cells/mm2, respectively, in the non-GVHD group. After adjusting for clinical parameters, including the DED severity, none of the IVCM parameters was significantly different between the GVHD versus non-GVHD groups (P = 0.82, P = 0.21, and P = 0.60, respectively). In GVHD-associated DED, cellular changes in the cornea and conjunctiva observed by IVCM were similar to those seen in patients who have non-GVHD dry eye with the same level of disease severity. Therefore, corneal and conjunctival IVCM findings in GVHD-associated DED are possibly reflective of the local disease (DED) severity rather than the underlying systemic disease process.