Schirmer Test Results Research Articles

Is hydroxychloroquine effective in treating primary Sjogren\u2019s syndrome: a systematic review and meta-analysis

BackgroundTo systematically review and assess the efficacy and safety of hydroxychloroquine (HCQ) for treating primary Sjogren’s syndrome (pSS).MethodsFive electronic databases (Pubmed, EMBASE, Web of science, Ovid, Cochrane Library) were searched for randomized controlled trials and retrospective or prospective studies published in English that reported the effect of HCQ on pSS. The subjective symptoms (sicca symptoms, fatigue and pain) and the objective indexes (erythrocyte sedimentation rate and Schirmer test) were assessed as main outcome measures. A meta-analysis and descriptive study on the efficacy and safety of HCQ were conducted. The estimate of the effect of HCQ treatment was expressed as a proportion together with 95% confidence interval, and plotted on a forest plot.ResultsFour trials with totals of 215 SS patients, including two randomized controlled trials, one double blind crossover trial and one retrospective open-label study, were analyzed in this review. For dry mouth and dry eyes, the effectiveness of HCQ treatment was essentially the same as placebo treatment. For fatigue, the effectiveness of HCQ was lower than placebo. The efficacy of HCQ in treating pain associated with pSS was superior to that of the placebo. There was no significant difference between HCQ-treated groups and controls in terms of Schirmer test results, but HCQ could reduce the erythrocyte sedimentation rate compare with placebo. A descriptive safety assessment showed that gastrointestinal adverse effects were the most common adverse effects associated with HCQ.ConclusionsThis systematic review showed that there is no significant difference between HCQ and placebo in the treatment of dry mouth and dry eye in pSS. Well-designed, randomized, controlled trials are needed to provide higher-quality evidence to confirm our findings, and future studies should focus on some other index or extraglandular measures, such as cutaneous manifestations, to further explore the therapeutic effect of HCQ in pSS.

Effects of Topical Timolol and Latanoprost by Tear Film Evaluation and Impression Cytology

Aim or Purpose: The primary objective of this study is to describe the effects of application of topical timolol or latanoprost on the conjunctiva with the use of tear break-up test, Schirmer test and impression cytology; the secondary objective of this study is to evaluate the impact of dry eye symptoms on the quality of life among glaucoma patients. Design: Prospective case series study. Methods: All patients were asked to answer the ocular surface disease index (OSDI) questionnaire. Dry eye work-up consisted of tear break-up test, staining tests with fluorescein and Lissamine green, Schirmer test with anesthesia, and conjunctival impression cytology. Conjunctival samples were then examined, evaluated and their changes documented by a single ocular pathologist. Results: A total of eighteen participants, including twenty eight eyes, fifteen in the timolol group and thirteen in the latanoprost group, were included in this study. Baseline characteristics were comparable between the two groups. There is a trend of decrease in tear break-up time with increasing duration of use of medication in the subgroup analysis for both the timolol and latanoprost groups. The latanoprost group showed a significant decrease in the Schirmer test but the timolol group did not. The conjunctival changes scores for the latanoprost group showed a significant increase with increasing duration of use of medication but the timolol group did not. Conclusion: Increased duration of use of latanoprost showed significant goblet cell loss, as indicated by increased conjunctival changes score, and also a decreased Schirmer test result. Prolonged use of latanoprost showed significant increase in dry eye symptoms and severity as indicated by increased OSDI score. Long-term use of timolol showed no significant changes in OSDI score, TBUT score, Schirmer test result and conjunctival changes score.

Conjunctival Cytological Alterations in Ocular Behçet Disease.

To evaluate the ocular surface alterations and tear film functions in patients with ocular Behçet disease (BD). This study included 48 eyes of 48 patients with inactive BD and a control group of 33 age- and sex-matched subjects. Schirmer I and tear break-up time (TBUT) tests were used to evaluate the tear film of the subjects. Impression cytology was used to evaluate morphological changes of the conjunctival surface epithelial cells. The mean Schirmer I test result was 11.6 ± 5.9 mm/5 minutes and 16.1 ± 4.6 mm/5 minutes in the Behçet and control groups, respectively. The mean TBUT test result was 9.8 ± 5.6 seconds and 13.2 ± 5.7 seconds in the study and control groups, respectively. The Schirmer and TBUT test results were significantly lower in the study group than in the controls (P = 0.001 and P = 0.011, respectively). The mean impression cytology score was 1.3 ± 0.9 in the study group and significantly higher than the control group value of 0.4 ± 0.6 (P = 0.001). Tear film functions and conjunctival surface epithelial morphology were significantly altered in patients with ocular BD.

Reversibility of Gland Dropout and Significance of Eyelid Hygiene Treatment in Meibomian Gland Dysfunction

To observe reversibility of meibomian gland (MG) dropout and analyze correlated factors and to compare the treatment efficiency with and without eyelid hygiene in patients with meibomian gland dysfunction (MGD). Consecutive 78 eyes of 78 MGD (stage 2-3) patients who finished follow-up examination after 1-month of treatment were recruited in this retrospective study. All patients were treated with artificial lubricant and eyelid hygiene. Related ocular surface evaluation and meibomian gland assessment were examined. There were 26 (33%) patients (included in group 1) who ignored doctors' order for eyelid hygiene, and 52 (67%) patients (included in group 2) were compliant. There was no statistical difference between group 1 (age, 44.4 ± 12.2) and group 2 (age, 38.9 ± 16.6) in characteristics and pretreatment clinical indexes. However, after 1-month of treatment, only the ocular surface disease index of group 1 improved (P = 0.048), whereas all clinical indexes of group 2, except the Schirmer test result, improved (including expressibility, all P < 0.05). A 5% decrease in MG dropout of both upper (5.4%) and lower (4.6%) eyelids in group 2 was observed. Improvement in upper-eyelid dropout and expressibility were the predictors of lower-eyelid dropout improvement. The reversibility had no correlation with age, sex, pretreatment MGD stage, disease duration, and use of topical antiinflammation medication. With expressibility-improving treatment, MG dropout was reversible to some extent. Eyelid hygiene is an efficient treatment of MGD; however, there is a need for ophthalmologists to instruct patients on conduct and supervise patients' compliance.

Matrix Metalloproteinase 9 Testing in Dry Eye Disease Using a Commercially Available Point-of-Care Immunoassay

To measure matrix metalloproteinase 9 (MMP-9) in the tear film of patients with dry eye disease (DED) compared with controls and to correlate clinical findings. In a prospective study, 101 patients and controls underwent MMP-9 testing of the tear film. Thereafter, they were evaluated for symptoms and signs of DED. Included patients were those who showed 3 of the following 4 dry eye criteria: ocular surface disease index (OSDI) score of more than 12, tear film break-up time (TBUT) of 10 seconds or less, Schirmer test results without anesthesia of less than 10 mm/5 minutes, and corneal staining results of 1 or more. Fifty-four healthy eyes and 47 eyes fulfilling diagnostic criteria for DED of various levels of severity were included in this study. The tear film was analyzed for MMP-9 by a commercially available test (InflammaDry; Rapid Pathogen Screening, Inc, Sarasota, FL) detecting MMP-9 levels of more than 40 ng/ml. Symptoms and signs of DED were evaluated using the OSDI questionnaire, TBUT, conjunctival and corneal staining, Schirmer test results without anesthesia, and meibomian gland examination. These findings were correlated to results of the MMP-9 test in tears. Positive MMP-9 results in tears. In 19 of 47 patients confirmed with dry eye (40.4%) and in 3 of 54 controls (5.6%), the MMP-9 results were positive. This difference was statistically significant (P < 0.001). Thus, the MMP-9 results indicated a clinically significant inflammation in 40% of dry eye patients. Positive results correlated well with subjective symptoms of DED evaluated by OSDI (P= 0.001), TBUT of less than 5 seconds (P < 0.013), Schirmer test results (P < 0.001), conjunctival staining (P < 0.001), and corneal staining (P= 0.007). Moreover, MMP-9 results correlated with the number of obstructed meibomian ducts (P= 0.005) and a pathologic meibomian gland secretion (P= 0.001). The MMP-9 results were increased significantly in women (P < 0.001) and in patients with autoimmune disease (P= 0.005), especially Sjögren's syndrome (P= 0.001) and thyroid disease (P= 0.012). Matrix metalloproteinase 9 testing in DED is a valuable new diagnostic tool. It correlated well with other dry eye tests and identified the presence of ocular surface inflammation in 40% of confirmed dry eyepatients. It may be especially helpful to identify patients with ocular surface inflammation and autoimmune disease and may facilitate the decision to institute anti-inflammatory treatment in these patients.

Role of artificial tears in reducing the recurrence of pterygium after surgery: a prospective randomized controlled trial.

To determine whether artificial tears can reduce recurrence of pterygium after surgery. A total of 128 primary pterygium cases after excision were randomized into two groups according to postoperative drugs: 64 cases received topical dexamethasone (control group), and 64 cases received topical dexamethasone and hydroxypropyl methylcellulose (treatment group). The pterygium was removed with amniotic membrane graft technique in all cases. Recurrence was observed within 6months after surgery, and survival analysis was used to evaluate the difference between groups. There were no significant differences in age and gender of patients, size of pterygium, Schirmer's test results and tear breakup time between both groups (p>0.05). Recurrence rate in the treatment group (16%) was significantly less than the control group (33%), p=0.018 (log-rank test). Using artificial tears as an adjunctive drug could lower pterygium recurrence after excision.

Ocular findings in coal miners diagnosed with pneumoconiosis

Objective: Our study aimed at evaluating ocular findings and structural changes in coal mine workers who were chronically exposed to coal mine dust and diagnosed with pneumoconiosis.Methods: Ocular findings of 161 eyes of 81 patients diagnosed with pneumoconiosis who had previously worked or are currently working in coal mines were analyzed. Forty-six coal mine workers and sex matched healthy people (n = 20) participated in the study. Workers who had early changes of pneumoconiosis were included in Group 1 (n = 17), workers diagnosed with pneumoconiosis were included in Group 2 (n = 29), and healthy subjects were included in Group 3 (n = 20). Outcome measures were the difference in peripapillary retinal nerve fiber layer (RNFL) thickness, choroidal thickness (CT), central macular thickness (CMT) and tear function tests between the groups.Results: RNFL thickness values in Group 1 and 2 were lower than in Group 3, the control group, in all quadrants except the temporal quadrant. However, there was no statistically significant difference in peripapillary RNFL thickness values in any quadrants among the three groups (p > 0.05). Central subfoveal choroidal thickness and CMT measurements were thinner in Group 1 and 2 than in the control group. However, this difference among groups was not statistically significant (p > 0.05). Mean schirmer's test result was 8.8 ± 1.6 mm in group 1, 7.1 ± 1.8 mm in Group 2 and 11.5 ± 3.6 mm in the control group. Mean tear break up time (BUT) test result was 7.1 ± 1.3 seconds (sec) in Group 1, 6.5 ± 1.8 sec in Group 2 and 10.4 ± 2.9 s in the control group. The Schirmer's test and BUT test results were both statistically significantly lower in coal mine workers (Group 1 and 2) compared to the control group. Group 1 and Group 2 did not show statistically significant difference in terms of Schirmer's test and BUT test results.Discussion: The association between pneumoconiosis and coal mine dust contiguity is thought to be due to the effect of coal dust by producing chronic inflammation. In addition, there are several trace elements in coal dust which are toxic to vital tissues. In this study, ocular findings suggest that systemic levels of trace elements and chronic inflammation may not reach to a level that influences ocular structures. Nonetheless, tear functions seem to be affected in coal mine workers.Conclusion: This study suggests that the systemic effect of coal mine dust in ocular structures is not evident. However, direct contact with coal mine and fume leads to a decrease in tear function tests.

Effects of Humidity on Tests of Tear Production.

To determine if the Schirmer test is affected by environmental humidity, to quantify any effects, and to consider the ways in which this may affect the diagnosis of dry eye disease. All experiments took place within a controlled environment chamber at a range of 5% to 95% relative humidity (RH). In vitro testing immersed Schirmer strips at 5 mm depth in water for 5 minutes. In vivo tests were conducted using the standard clinical method. All experiments were conducted using both standard Schirmer strips and Schirmer strips sheathed in a plastic film in order to reduce the possible effects of evaporation. In vitro results showed a clear decrease in Schirmer wetting length as RH was reduced. Schirmer test strips that were encased within a plastic sheathing were less affected by changing RH. As well as wetting length, the rate of wetting of Schirmer strips was also affected by changes in RH. In vivo data showed that Schirmer results in participants with severe dry eye disease were less affected by changes in RH than "normal" participants. Patients with severe dry eye disease produce Schirmer test results which are unaffected by environmental humidity. However, patients with moderate Schirmer wetting lengths may be falsely diagnosed as having dry eye disease if their test is undertaken in a low-humidity environment. This phenomenon may be overcome with the use of plastic sheathing. Previous studies investigating the effects of environmental conditions on the tear film may have been affected by this phenomenon.

A Clinical Trial Comparing the Safety and Efficacy of Topical Tacrolimus versus Methylprednisolone in Ocular Graft-versus-Host Disease

To evaluate the safety and efficacy of topical tacrolimus 0.05% versus topical methylprednisolone 0.5% in patients with ocular graft-versus-host disease (GVHD). Phase 1/2 prospective, randomized, double-masked clinical trial. Eighty eyes of 40 patients diagnosed with chronic ocular GVHD were enrolled. Forty patients with ocular GVHD were randomized; 24 patients were treated with topical tacrolimus 0.05% and 16 patients were treated with topical methylprednisolone 0.5% twice daily for 10 weeks, in addition to continuing their baseline treatment regimen. Safety was evaluated based on occurrence of adverse events. Tolerability was assessed based on subject reports of discomfort after drop instillation. Intraocular pressure (IOP) was monitored. The main efficacy end points were corneal fluorescein staining (CFS), tear film break-up time (TBUT), Schirmer test results, and expression of the ocular surface inflammatory markers human leukocyte antigen-DR (HLA-DR) and intercellular adhesion molecule-1 (ICAM-1). Symptoms were evaluated using the Ocular Surface Disease Index (OSDI). After 10 weeks of treatment, no major adverse events occurred in either treatment group, and there was no significant difference in the composite tolerability scores between the 2 groups (P= 0.06). However, burning sensation was more pronounced with tacrolimus (P= 0.002). Topical tacrolimus was more effective than methylprednisolone in reducing the CFS score at week 10 (55% vs. 23% reduction, respectively; P= 0.01) and achieved significant improvement in TBUT when compared with baseline (P < 0.001). Reduction in OSDI score achieved statistical significance with tacrolimus (27% reduction; P= 0.02), but was marginal with methylprednisolone (32% reduction; P= 0.06). Expression of ICAM-1 by ocular surface epithelium decreased significantly in both groups (tacrolimus, P= 0.003; methylprednisolone, P= 0.008), whereas HLA-DR expression decreased significantly only in the tacrolimus group (P= 0.03). Schirmer test scores did not change significantly in either group during the study; IOP increased significantly with methylprednisolone at week 10 (P= 0.04). Topical tacrolimus 0.05% is safe, generally well tolerated, and effective for the treatment of ocular GVHD without the hypertensive effects of topical corticosteroids.

The effects of smoking on dry eye parameters in healthy women

Aim: To investigate the effects of chronic smoking on dry eye parameters.Methods: Ocular surface disease index (OSDI) and tear function tests such as Schirmer’s test, tear break-up-time (TBUT) test and impression cytology of 63 female chronic smokers and 40 age-matched female non-smokers were analyzed statistically.Results: The mean OSDI scores, Schirmer test results and TBUT levels were 35.85 ± 24.01 point, 14.25 ± 5.94 mm and 5.17 ± 2.85 s in chronic smokers and 15.20 ± 12.93 point, 15.48 ± 7.01 mm and 10.03 ± 3.44 s in non-smokers, respectively. Differences in OSDI scores, TBUT levels and impression cytology grades among the chronic smokers and non-smokers were statistically significant.Conclusion: Smoking behavior seems to affect the dry eye parameters negatively.

Is optical coherence tomography an effective device for evaluation of tear film meniscus in patients with acne rosacea?

To investigate the tear meniscus using Fourier-domain optical coherence tomography (FD-OCT) in patients with acne rosacea and to determine the relationship between tear film break-up tests (TBUT), Schirmer test and FD-OCT values and to compare them with that of healthy controls. One hundred and four patients with acne rosacea and 104 body mass index age-sex-matched healthy subjects were enrolled in this prospective case-control study. Tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus cross-sectional area (TMA) were measured using FD-OCT (RTVue-100); TBUT, Schirmer test and dry eye questionnaire (OSDI) were evaluated. Correlation was assessed using Spearman's correlation coefficient. Mean TMH, TMD, TMA, TBUT, and Schirmer test values of acne rosacea patients were significantly lower than and OSDI score significantly higher than those of controls. Tear mensicus values were significantly correlated with OSDI scores, TBUT, and Schirmer test results. The intraobserver intraclass correlation coefficient (ICC) for tear parameters ranged from 0.90 to 0.96 and interobserver ICC ranged from 0.92 to 0.94, which revealed high reproducibility for all measurements parameters both acne rosacea and control subjects. Accuracy of dry eye diagnosis by FD-OCT was 60.4% for TMH, 58.7% for TMD, and 64.8% for TMA. Tear meniscus measurement with FD-OCT could provide acceptable specificity and sensitivity in diagnosis of dry eye in acne rosacea patients.

Clinical Findings, Follow-up and Treatment Results in Patients with Ocular Rosacea

Objectives:To report the clinical features, treatment options and complications in patients with ocular rosacea.Materials and Methods:The records of 48 eyes of 24 patients with ocular rosacea were retrospectively reviewed. Patients’ ocular signs and symptoms were scored between 1 and 4 points according to disease severity; tear film break-up time (BUT) and Schirmer’s test results were recorded before and after the treatment. Preservative-free artificial tears, topical antibiotic eye drops/ointments, short-term topical corticosteroids, topical 0.05% cyclosporine and oral doxycycline treatment were applied as a standard therapy to all patients. Additional treatments were given as needed. Complications were recorded.Results:Twenty-four patients with a mean age of 48.5±35.4 (32-54) years were followed for a mean 15±9.4 (8-36) months. Ocular findings included meibomitis in 100% of cases, anterior blepharitis in 83% (40 eyes), punctate keratopathy in 67% (32 eyes), chalazia in 50% (24 eyes), corneal neovascularization in 50% (24 eyes) and subepithelial infiltrates in 16.6% (8 eyes). Significant improvement of symptoms and clinical findings were achieved in all patients with treatment. The increases in Schirmer’s test and BUT were 3.3±1.5 and 4.5±2.8, respectively (p<0.05). Descemetocele and small corneal perforation occurred in 2 eyes; re-epithelialization was achieved in both eyes with tissue adhesive application (1 eye) and additional amniotic membrane transplantation (1 eye). Four eyes of three patients showed significant regression of corneal neovascularization with topical bevacizumab therapy.Conclusion:Ocular rosacea may present with a variety of ophthalmic signs. It is possible to control the ophthalmic disease with appropriate therapeutic modalities including topical corticosteroids, topical cyclosporine and systemic doxycycline.

The Importance of Minor Salivary Gland Biopsy in Sjögren Syndrome Diagnosis and the Clinicopathological Correlation.

Minor salivary gland biopsy is one of the objective tests used in the diagnosis of Sjögren syndrome. The aim of our study was to compare the clinical and laboratory data of primary and secondary Sjögren syndrome cases with a lymphocyte score 3 and 4 in the minor salivary gland biopsy. Data from a total of 2346 consecutive minor salivary gland biopsies were retrospectively evaluated in this study. Clinical and autoantibody characteristics of 367 cases with lymphocyte score 3 or 4 and diagnosed with primary or secondary Sjögren syndrome were compared. There was no difference between lymphocyte score 3 and 4 primary Sjögren syndrome patients in terms of dry mouth, dry eye symptoms and Schirmer test results but Anti-Ro and Antinuclear Antibody positivity was statistically significantly higher in cases with lymphocyte score 4 (p= 0.025, p= 0.001). Anti-Ro test results were also found to be statistically significantly higher in secondary Sjögren syndrome patients with lymphocyte score 4 (p= 0.048). In this study, the high proportion of cases with negative autoantibody but positive lymphocyte score is significant in terms of showing the contribution of minor salivary gland biopsy to Sjögren syndrome diagnosis. Lymphocyte score 3 and 4 cases were found to have similar clinical findings but a difference regarding antibody positivity in primary Sjögren syndrome. We believe that cases with lymphocyte score 4 may be Sjögren syndrome cases whose clinical manifestations are relatively established and higher autoantibody levels are therefore found.

The effects of hormone replacement therapy on dry eye syndromes evaluated by Schirmer test depend on patient age.

This study was performed to explore the effects of hormone replacement therapy (HRT) on aqueous tear production and tear quality in dry eye syndrome (DES) patients of different ages. Eighty-eight women with DES at least one year after spontaneous menopause were randomly divided into the HRT group that were treated with orally estrogen and medroxyprogesterone acetate or a control group that did not receive any treatment. The aqueous tear production and tear quality were measured by Schirmer test and tear film break up time (TBUT) before and after one month of treatment. The subjects were subdivided according to age; the HRT group was divided into groups A (age range: 44-49 years) and B (age range: 50-57 years), and the controls were divided into groups C (age range: 46-49 years) and D (age range: 50-55 years). The changes in results of Schirmer test and TBUT before and after treatment were compared within each group and were correlated with the age of the participants. After one-month follow-up, HRT use improved the Schirmer test but the effect was significant only for participants less than 50 years old. The improvement in Schirmer test result was negatively correlated with the age of the participants. The TBUT did not change significantly within each group after HRT use. HRT use may improve aqueous tear production but not the quality of tears in DES, and the effect on tear production is dependent on age.

Dry Eye Related to Commonly Used New Antidepressants.

Antidepressants may have an impact on the course of eye dryness. The aim of this study was to investigate the effects of commonly used new antidepressants on eye wetting. Fifty-four patients using new antidepressants and 57 controls were recruited. The Beck Depression Scale and Beck Anxiety Scale questionnaires were completed by the patients, and drug use time and dosages were recorded. The Schirmer test was performed without prior instillation of topical anesthesia to the ocular surface, and the wetting result was recorded for each eye. Escitalopram, duloxetine, and venlafaxine were used by 27, 13, and 14 patients, respectively. The Schirmer test results in the patients were significantly lower than in the controls (P < 0.001). The patients using selective serotonin reuptake inhibitors (SSRIs) displayed lower wetting measurements (≤5 mm) compared with those using serotonin-norepinephrine reuptake inhibitors, which was independent of the duration of antidepressant usage (P < 0.05). Although SSRIs do not have anticholinergic adverse effects except paroxetine, we found that both SSRIs and serotonin-norepinephrine reuptake inhibitors increased the risk for eye dryness. The lower Schirmer test results of the SSRIs may be associated with a mechanism other than the anticholinergic system. An awareness of the drugs that contribute to dry eye will allow ophthalmologists, optometrists, and other physicians to better manage patients who have this problem.

Evaluation of ocular findings in patients with vitiligo.

In this study, we aimed to investigate ocular manifestations in patients with vitiligo. Sixty-one patients with vitiligo were included in the study. From the patients who referred for examination to the dermatology and ophthalmology clinic, 57 patients without any systemic disease were taken as the control group. In both groups, otorefractometry, keratometry, visual acuity test, intraocular pressure measurement, anterior segment, and fundus examinations of the eye with slit lamp, Schirmer test, and perimetry were carried out. The mean age was 24.54±11.90years and 23.03±8.72years in the patients and control group, respectively. The mean Schirmer test results were as follows: 16.74±9.11mm and 17.64±9.41mm for the right and left eyes of the patients, and 21.96±12.51mm and 23.42±12.51mm for the right and left eyes of controls, respectively. Of the patients, 36 eyes showed lenticular findings. However, only 12 eyes of the controls have some lenticular findings. Twenty-nine eyes in the vitiligo group and four in the controls showed some fundus findings. When the two groups were compared with each other, there was a statistically significant difference between them in terms of Schirmer test results, lens, and fundus findings (P<0.05 for all). However, there was no significant difference in terms of age, gender, visual acuity, refraction, keratometry, intraocular pressure, perimetry, and corneal findings (P>0.05 for all). Patients with vitiligo may have more lenticular and retinal findings than normal. They can be more prone to dry eye syndrome as well.

The Effect of Pseudoexfoliation and Pseudoexfoliation Induced Dry Eye on Central Corneal Thickness

ABSTRACTPurpose/aim of the study: The aim of this study is to investigate the effect of pseudoexfoliation (PEX) and PEX-induced dry eye on central corneal thickness (CCT).Materials and methods: This cross-sectional study consists of total 270 eyes of 135 patients (67 females, 68 males) in total. After excluding the PEX (−) 32 eyes with PEX in the other eye, totally 130 eyes in PEX (−) group and 108 eyes in the PEX (+) group were included in the study. The PEX (+) group was regrouped as PEX syndrome (80 eyes of 50 patients) and PEX glaucoma (28 eyes of 20 patients).Results: In the PEX (−) group, the mean Schirmer test result was 12 ± 4 mm (4–25 mm), in the PEX syndrome group 10 ± 4 mm (4–22 mm), in the PEX glaucoma group 9 ± 3 mm (4–15 mm). The difference among the PEX (−) group, the PEX syndrome and the PEX glaucoma groups was statistically significant (p < 0.001, p < 0.001, respectively). In the PEX (−) group, the mean tear break up time test result was 11 ± 2 s (5–16 s), in the PEX syndrome group 8 ± 3 (3–16 s), in the PEX glaucoma group 8 ± 3 s (5–15 s). Mean CCT result was 544 µm in the PEX (−), 521 µm in the PEX syndrome group and 533 µm in the PEX glaucoma group. The difference among the PEX (−) group, the PEX syndrome and the PEX glaucoma groups was significant (p < 0.001, p = 0.030, respectively). There was a significant (+) correlation between intraocular pressure and CCT in the eyes with PEX (r = 0.307, p = 0.001). However, there was no statistically significant correlation between CCT, Schirmer and tear break up time tests in the eyes with PEX.Conclusions: PEX material can cause decrease in tear film secretion and disturb tear film stability. There is no effect of PEX-induced dry eye on CCT. Lower CCT values in the eyes with PEX material may be a result of decrease in corneal stromal cell density. Moreover, higher CCT values may be because of decreased endothelial cells in PEX glaucoma patients.

Serologic profile and clinical markers of Sjögren syndrome in patients with rheumatoid arthritis

The aim of this study was to evaluate the clinical relevance of rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (anti-CCP) in patients with Sjögren syndrome (SS) secondary to rheumatoid arthritis (RA). The study included 118 individuals, and the subjects were divided into three groups: rheumatoid arthritis (RA; n = 46), RA with secondary Sjögren syndrome (RA/SS; n = 20) and healthy controls (C; n = 52). Clinical and laboratory characteristics, including ocular, oral, and serum markers, anti-CCP, and rheumatoid factor (RF), were compared in addition to biopsy of labial minor salivary glands. The RA group exhibited unstimulated salivary flow rate, and Schirmer test results were similar to those for C and higher than those for RA/SS (P < .05). Furthermore, the frequency of xerophthalmia and xerostomia was similar among the RA and C groups, and much higher in the RA/SS group (P < .05). Anti-CCP positivity and serum levels were similar in both RA groups, irrespective of SS diagnosis (RA × RA/SS; P > .05). RF presented a similar frequency and serum level between the RA and RA/SS groups (P > .05). Secondary SS seems to be a cluster of oral and ocular symptoms among patients with RA. Anti-CCP and RF are not relevant to evaluate the presence of SS among these patients.

Long-Term Outcome of Treatment with Topical Corticosteroids for Severe Dry Eye Associated with Sjögren's Syndrome.

This retrospective study was performed to analyze the long-term outcome of topical corticosteroid treatment for severe dry eye associated with Sjögren's syndrome (SS). Patients who had severe dry eye associated with SS were topically treated with loteprednol etabonate 0.5% (group A, n=66) or fluorometholone 0.1% (group B, n=67) twice daily and were followed up for 2 years. Visual acuity (VA), intraocular pressure (IOP), Schirmer test, tear film breakup time (BUT), keratoepitheliopathy, and symptom scores were measured at baseline and 6, 12, 18, and 24 months after treatment. VA and IOP were not changed significantly during follow-up in either group. Schirmer test results, keratoepitheliopathy, and symptom scores at 6, 12, 18, and 24 months (p<0.05) and tear film BUT at 12, 18, and 24 months (p<0.05) significantly improved after treatment compared with baseline in both groups. No significant differences between the groups were found in any parameter during follow-up. At 24 months, the number of patients with IOP elevation of more than 2 mmHg compared with baseline was 4 in group A (6.1%) and 9 in group B (13.4%). The mean IOP in these patients was lower in group A than in group B (15.00±0.82 mmHg versus 16.50±1.12 mmHg; p=0.04). Long-term application of low-dose topical corticosteroids is effective for controlling signs and symptoms of chronic, severe dry eye associated with SS. Loteprednol etabonate 0.5% may have a lower risk for IOP elevation than fluorometholone 0.1%.

Preservative-free betaxolol for POAG patients: evaluation of hypotensive effect and ocular surface safety

To evaluate ocular surface changes in patients with primary open-angle glaucoma (POAG) as well as the hypotensive effect of preservative-free betaxolol eye drops. A total of 22 patients (42 eyes) aged 55-83 with POAG stage I-II were examined. All of them were switched from betaxolol b.i.d. to its preservative-free analogue (Xonef BK). The baseline examination included visual acuity measurement, Morisky-Green test (questionnaire), Norn test, Schirmer's test, lissamine green staining, and ocular tonometry. The latter was repeated 2 and 4 weeks after the drug had been switched, while the whole complex--2 months after the beginning of the study. The total tear production in POAG patients under betaxolol therapy was 19.1 ± 10.6 mm. After the 2 months of preservative-free betaxolol use there were no statistically significant changes in Schirmer's test results (p = 0.248). Tear film break-up time (Norn test) improved from 7.8 ± 0.5 secto 9.8 ± 0.8 sec (p = 0.067) as well as the results of lissamine green staining (W = 90.0, p < 0.022). In the Morisky-Green Test betaxolol patients scored only 2.6 ± 0.05 points on average, thus showing non-compliance. After the 2 months of preservative-free betaxolol instillations the scores increased up to 3.1 ± 0.07 (p = 0.04). According to Dunnett's test, used for multiple comparisons, intraocular pressure did not change significantly in either of the study periods (baseline and follow-up measurements at weeks 2, 4, and 8 were taken into account). The study proves Xonef BK safe, effective, and appropriate in all types of glaucoma.