Tear Film Break-up Time Scores Research Articles

A COMPARATIVE STUDY TO EVALUATE THE EFFICACY OF CARBOXYMETHYLCELLULOSE AND POLYETHYLENE GLYCOL ARTIFICIAL TEARS ON SUBJECTIVE AND OBJECTIVE PARAMETERS OF DRY EYE DISEASE

Purpose: To compare the changes in Ocular Surface Disease Index (OSDI) and Tear Film Break up Time (TBUT) with carboxymethylcellulose and polyethylene glycol containing articial tears in patients of dry eye disease (DED). Methods: This prospective randomized study consisted of patients above 18 years of age diagnosed as a case of dry eye disease. The patients were equally divided into two groups; Group A & Group B. Participants in Group A were prescribed carboxymethylcellulose (0.5%) containing articial tears while participants in Group B were prescribed polyethylene glycol (0.4%) containing articial tears. OSDI and TBUT scores were recorded at baseline, at 1 week and then at 6 weeks. Results: OSDI and TBUT scores were comparable at baseline in both the groups. Group B had signicantly improved OSDI and TBUT scores compared to Group A after 1 week and also after 6 weeks. Conclusion: Polyethylene glycol (0.4%) articial tears are superior to Carboxymethylcellulose (0.5%) articial tears in improving OSDI as well as TBUT scores in DED patients

Autologous platelet-rich plasma eye drop versus artificial tear eye drop for symptomatic dry eye disease: A prospective comparative interventional study.

Purpose:To evaluate and compare the efficacy of autologous platelet-rich plasma (aPRP) eye drop and artificial tear (AT) eye drop in moderate to severe symptomatic dry eye disease (DED).Methods:This prospective interventional study included 121 eyes of 61 patients of moderate to severe DED. Patients were divided into aPRP (31 patients) and AT (30 patients) group. Ocular Surface Disease Index (OSDI) score, tear film breakup time (TBUT) (s), corneal fluorescein staining (CFS) score, and Schirmer test score (mm) of both the groups were evaluated and compared pre-treatment and post-treatment at the end of 3 months.Results:The mean age of the aPRP group and AT group was 52.8 ± 12.8 years and 55.5 ± 13.4 years, respectively. At the end of 3 months, OSDI score reduced more in the aPRP group as compared to AT group, and the mean difference (−22.7) was statistically significant (P < 0.001). There was no significant difference in post-treatment Schirmer test score between the two groups (P = 0.44). Post-treatment improvement in TBUT and CFS score in the aPRP group was significantly higher in the aPRP group as compared to that in the AT group (P < 0.05). Bruising at the site of blood withdrawal was noted in two patients in the aPRP group.Conclusion:aPRP is safe and more effective than AT in treating patients with moderate to severe symptomatic DED.

Analysis of the Association between Galectin-3 Concentration in Tears and the Severity of Dry Eye Disease: A Case-Control Study.

This study aimed to investigate the relationship between the severity of dry eye disease (DED) and galectin-3 concentration (gal-3) and its cleavage (gal-3C) in tear fluid. Twenty-eight DED patients and 14 controls were recruited at Keio University Hospital. The lissamine green conjunctival staining (LG) score, fluorescein corneal staining (FL) score, tear film break-up time (TBUT), Schirmer’s test, and ocular symptoms questionnaire score (dry eye questionnaire score, DEQS) were evaluated. Furthermore, the correlation between these parameters and the concentrations of gal-3 in tears (ng/µg) and the detection rate of gal-3C (%) were analyzed. Gal-3 concentration in tears was positively correlated with the LG score (R = 0.60, p < 0.01), FL score (R = 0.49, p < 0.01), and DEQS (R = 0.45, p < 0.01), and negatively correlated with the TBUT score (R = −0.40, p < 0.01) and Schirmer’s I value (R = −0.36, p < 0.01). The detection rate of gal-3C in tears was significantly associated with the severity of DED, especially with the LG (p < 0.01) and FL (p < 0.01) scores. Therefore, the concentration of gal-3 and the detection rate of gal-3C in tears had a significant relationship with the severity of ocular surface barrier disruption.

Chambered warm moist air eyelid warming devices - a review.

Eyelid warming is an important treatment for meibomian gland dysfunction (MGD). Specialized chambered devices, using warm moist air have been developed. To critically evaluate the literature on the safety and efficacy of chambered warm moist air devices in MGD treatment and pinpoint areas of future research. PubMed and Embase were searched on 06 June 2021. The search term was '(warm OR heat OR steam OR goggle OR spectacle OR moist air) AND (meibomian OR MGD OR blepharitis OR eyelid OR dry eye OR DED)'. All relevant articles with available English full text were included. Eighteen articles assessing the application of chambered warm moist air eyelid warming devices were identified. In single-application studies, steam-based eyelid warming increased the eyelid temperature and improved symptoms, lipid layer thickness, and tear film breakup time (TBUT). In treatment studies, the steam-based devices improved TBUT and symptom scores. However, in the only randomized controlled trial (RCT) comparing chambered steam-based heat to hot towel treatment, there was no difference between groups for the primary outcome measure; the proportion of subjects noting symptom improvement after 4 weeks. Currently available chambered warm moist air eyelid warming devices are safe and effective at raising eyelid temperature to therapeutic levels and improving signs and symptoms of dry eye. However, it is not clear if they provide a greater benefit than other eyelid warming therapies. Further well-conducted RCTs comparing moist and dry heat devices should be conducted on patients across the range of DED severities and subtype spectrum.

Efficacy of Switching from Cyclosporine A 0.05% Anionic Emulsion to Cyclosporine A 0.1% Cationic Emulsion in Patients with Dry Eye Associated with Sjögren's Syndrome.

Purpose: To evaluate the clinical efficacy of switching from cyclosporine A (CsA) 0.05% anionic emulsion (CsA AE) to CsA 0.1% cationic emulsion (CsA CE) in patients with dry eye (DE) associated with Sjögren's syndrome (SS). Methods: Forty patients with SS-associated DE who were unresponsive to CsA AE for 6 months were enrolled. After baseline measurements, the CsA AE was switched to CsA CE. The ocular surface disease index (OSDI), Sjögren's International Collaborative Clinical Alliance (SICCA), and Schirmer's test scores and tear film breakup time (TBUT) were evaluated at baseline and 1 and 3 months after switching. Results: Two patients dropped out, and 38 were analyzed. OSDI and SICCA ocular staining scores were significantly reduced at 1 and 3 months after switching, compared with the baseline scores (all P < 0.01). Although no significant changes were noted in the corneal staining scores (CSSs), patients with higher baseline CSS (≥4) showed an improvement in the scores at 1 month (P = 0.03) and 3 months (P = 0.01) after switching. There were no significant changes in TBUT and Schirmer's test scores during the follow-up periods. Conclusions: In patients with SS-associated DE, switching from CsA AE to CsA CE was effective in improving ocular symptoms and conjunctival staining. In addition, corneal staining was decreased in patients with severe keratitis.

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

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

Evaluation of Corneal Epithelial Thickness and Dry Eye Disease Tests in Thalassemic Adolescents.

PurposeTo assess dry eye disease (DED) in thalassemic adolescents by evaluating corneal epithelial thickness (CET) and various dry eye clinical tests and correlate them to tissue iron overload.MethodsThe study included 120 Beta-thalassemia patients (11 to 18 years) and 120 matched controls. CET maps were captured using anterior segment optical coherence tomography. OSDI questionnaire was completed. Dry eye tests included Schirmer test, tear film breakup time ‎‎ (TBUT), and ocular surface staining (OSS) with fluorescein and lissamine green. We recorded serum ferritin ‎level, and liver iron concentration (LIC) measured by magnetic resonance imaging.ResultsSuperior and inferior CET was thinner, while map standard deviation (MSD) was higher in thalassemics compared to controls (all P‎<0.001‎). Thalassemic group also showed higher OSDI scores‎ (P‎<0.001), shorter TBUT ‎‎(P‎<0.001‎), and higher OSS grades (P‎<0.001‎). Both superior and inferior CET was correlated positively with TBUT, and negatively with OSS (all P < 0.001). Serum ferritin and LIC showed negative correlations with CET (superior and inferior, both P< 0.001), positive correlations with MSD, P< 0.001, as well as with TBUT (P< 0.001), OSS ‎(P< 0.001), and OSDI scores (P< 0.001).ConclusionThalassemic adolescents had thinner CET with higher thickness’ variability, shorter TBUT and more marked OSS‎ than controls. Correlation of higher serum ferritin and hepatic iron overload with irregular epithelial thinning and more affected dry eye tests results supports our hypothesis that high tissue iron levels could play a pivotal role in DED pathogenesis in thalassemic patients.

Comparing the efficacy of 2% topical rebamipide and 0.1% topical sodium hyaluronate with or without 0.05% topical cyclosporine in patients with dry eye disease

Background: Dry Eye Disease (DED) is a multifactorial and complex disease of the ocular surface, with a high prevalence in adults. Aims and Objectives: To compare the efficacy of 2% topical Rebamipide and 0.1% topical Sodium hyaluronate with or without 0.05% topical cyclosporine in patients with dry eye disease (DED). Materials and Methods: This prospective, randomised, comparative, interventional study was conducted at a tertiary level academic centre on 240 eyes of 120 patients having DED, with Schirmer's test (without anesthesia) value less than or equal to 10mm and tear film breakup time (TBUT) less than or equal to 10 secs. After detailed ophthalmic examination, patients were randomly allocated in 4 different groups (A B C D). Group A were given 2% topical Rebamipide, group B received 2% topical Rebamipide with 0.05% topical Cyclosporine, group C were started on 0.1% topical Sodium Hyaluronate and group D were given 0.1% topical Sodium Hyaluronate with 0.05% cyclosporine. Each of these drops was given for 4 times a day for a period of 12 weeks. All patients were followed up after 2 weeks, 4 weeks and 12 weeks. Results: Out of 120 patients, 79 (65.83%) were female and 41 (34.16%) were male. The change in the mean schirmer's score and mean TBUT score was statistically significant in all four groups from baseline to 12 weeks (p<0.05). On comparing with each other, no significance difference was noted in any group. Conclusion: According to our study, 3 months of treatment with either 2% topical Rebamipide or 0.1% sodium hyaluronate is equally effective for DED and addition of 0.05% cyclosporine have no adjunctive role.

Clinical Dry Eye and Meibomian Gland Features Among Dry Eye Patients in Rural and Urban Ghana.

AimTo compare differences in clinical dry eye features and meibomian gland health status between dry eye patients from rural and urban populations in Ghana.MethodsWe examined 211 (rural=109, urban=102) participants with subjective dry eye symptoms. Tear film break -up time (TBUT), Schirmer’s test and ocular surface staining (OSS) were assessed. Symptoms were evaluated using the SPEED II questionnaire. Meibomian glands (MG) in the right eye upper (UL) and lower lids (LL) were imaged using a custom meibographer. MG area was determined by intensity threshold segmentation using Image J software. MG loss (MGL) was also graded based on Pult’s grading scheme. Mann–Whitney, Spearman correlation, chi-square and odds analyses were performed; p<0.05 was considered significant.ResultsRural participants showed greater SPEED scores, reduced TBUT, and lower Schirmer scores, p <0.05. The proportion of rural participants with MGL were significantly more (82.3%) than urban participants (63.3%), p <0.05. They also showed greater MGL than urban participants, p <0.05. Chi-square test revealed significantly different meiboscale distributions (UL: χ2=13.58, LL: χ2=15.29) between the groups, p <0.05. Overall significant relationships were observed between MGL and age [rs= 0.61], OSS [rs= 0.35], TBUT [rs= −0.52], and Schirmer scores [rs= −0.40], p <0.05.ConclusionThe data suggest that the participants from the rural population have worse dry eye and meibomian gland health status than those from the urban population. The significant relationships between the various clinical variables suggest important links between MGD and DED. Subtle differences in the everyday working and living environment could likely account for the differences in the severity of DED and MGD between the two groups. And considering the increased pattern of urbanization, industrialization and modernization and the related environmental effects in Africa, future longitudinal studies on specific environmental risk factors or mediators of DED and MGD are necessary to ascertain the MGD and DED situation in Ghana and Africa at large.

Evaluation of Dry Eye Disease in Geriatric and Pre-Geriatric Middle-Aged Subjects Attending a Tertiary Care Hospital in Puducherry

Purpose:&nbsp; To determine the prevalence and risk factors of dry eye disease in Geriatric (&gt;65 years) and Pre-geriatric (40-65 years) populations and to compare the same between both the groups.&nbsp; Setting:&nbsp; Indira Gandhi Government General Hospital and Post graduate Institute, Puducherry, India Design: Prospective, cross-sectional, clinical study Methods:&nbsp; All patients above 40 years attending the out-patient departments were given the Mc Monnie and Ho screening questionnaire for dry eye symptoms and risk factors. Those with a score of &gt; 14.5 were further evaluated using Ocular Surface Disease Index (OSDI) severity subjective questionnaire, and objective clinical tests inclusive of Schirmer’s test, Meibomian Gland Dysfunction (MGD) assessment, Tear Film Break Up Time (TBUT), Fluorescein staining and Impression cytology. The prevalence, risk factors, clinical signs and symptom-sign correlation were determined and compared between the two groups.&nbsp; Results:&nbsp; Among the 1029 patients screened, the prevalence of dry eye was 9.9%, being significantly higher among the geriatric (15.4%) versus pre-geriatric group (7.7%), p&lt;0.000, among women (12%) versus men (6.6%), p&lt;0.000, among arthritic (22.8%) versus non-arthritic (9.6%), p=0.005, and among diabetic (30.4%) versus non-diabetic patients (3.4%), p&lt;0.000. Geriatric patients had a greater prevalence of Grade 4 MGD (66%) versus pre- geriatric group (26.9%), p&lt;0.000. TBUT scores were low (&lt;10 seconds) in both groups and co-related with OSDI symptom severity scores (r=1).&nbsp; Conclusions:&nbsp; Aging, female gender, arthritis and diabetes were found to be significant risk factors. The Mc-Monnie and Ho questionnaire is a valid screening tool only for evaporative dry eye and is complemented by OSDI for screening in a hospital based setting. &nbsp; &nbsp;

Expression of Nod-like Receptors and Clinical Correlations in Patients With Dry Eye Disease

To investigate the expression pattern of nucleotide-binding oligomerization domain (Nod)-like receptors that detects "danger" intracellular signaling and its correlation with clinical dry eye (DE) markers. Cross-sectional study. A total of 50 participants with 50 eyes were included: 23 eyes with Sjögren syndrome (SS)-DE, 14 eyes with non-SS-DE, and 13 healthy controls with non-DE. Ocular Surface Disease Index (OSDI) was self-answered and clinical tests including the tear film breakup time (TBUT), Schirmer test, and corneal fluorescein staining (CFS) were performed. Specimens for expression pattern analysis were obtained by conjunctival impression cytology and biopsy. Nod-1, inhibitor kappa B kinase-alpha (IκKα), and nuclear factor kappa B (NF-κB) expression was determined by reverse transcription quantitative real-time polymerase chain reaction and Western blot. Correlations between Nod-1 and ocular surface parameters were determined. Patients with SS-DE had significantly higher OSDI and CFS scores and lower TBUT and Schirmer test scores than those with non-SS-DE patients (all P < .05). Compared with the control group, both the SS-DE and non-SS-DE groups showed significant upregulation in mRNA expression levels of Nod-1 (relative 3.48-fold and 1.72-fold upregulation, respectively, P < .01), IκKα (relative 1.83-fold and 1.24-fold upregulation, respectively, P < .01), and NF-κB (relative 1.84-fold and 1.32-fold upregulation, respectively, P < .01). Western blot analysis showed that Nod-1 protein expression increased in both the SS-DE and non-SS-DE groups (relative 2.71-fold and 1.64-fold upregulation, respectively, P < .05) compared with that in the control group. Similar findings were observed for IκKα and NF-κB. In DE participants, the expression of Nod-1 significantly correlated with the OSDI (R2= 0.61, r= 0.78, P<.01), Schirmer test score (R2= 0.44, r= -0.66, P < .01), and CFS (R2= 0.46, r= 0.68, P < .01) but did not significantly correlate with TBUT (R2 <0.01, r= 0.08, P= .66). Nod-1 expression was increased in the conjunctiva of DE, especially SS-DE, and was associated with disease severity. Expression of Nod-like receptors might play an important role in initiating the inflammatory response in DE.

The effect of individual biological rhythms on dry eye

This study aims to assess whether an individual’s chronotype (i.e. morningness versus eveningness) has an impact on tear film. Eighty-six dry eye patients not having any underlying systemic or metabolic diseases and either a morning or evening chronotype were included in the study. Tear film break-up time (BUT) and Schirmer tests are common objective tests that are used to diagnose the eye dryness. Using multivariate analysis of covariance (MANCOVA), we investigated the interaction effect of chronotype x sex on insomnia, Schirmer (mm) and BUT (sec) measurements after adjusting for age. We found that the participants who were more prone to evening chronotype characteristics reported to have more severe dry eye signs which monitor with the aid of the Schirmer and tear film break-up time test. In addition, those with higher scores in insomnia severity index had lower Schirmer test and tear film break-up time scores. These findings suggest that chronobiological factors may play a crucial role in the dry eye symptom severity.

Intense Pulsed Light Applied Directly on Eyelids Combined with Meibomian Gland Expression to Treat Meibomian Gland Dysfunction.

To determine the efficacy and safety of intense pulsed light (IPL) applied directly on the eyelids and meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD). IPL application on the periocular skin effectively improves meibomian gland secretion and tear film break-up time (TBUT) in patients with MGD/dry eye. This prospective, randomized, double-masked, controlled study involved 44 patients. One eye was randomly selected for IPL treatment; the other served as a control. Study eyes received three IPL treatments at 4-week intervals; IPL was applied directly on the eyelids, and the eye was protected with a Jaeger lid plate. Control eyes received sham IPL treatments. Both eyes received MGX and artificial tears. Meibomian gland yielding secretion score (MGYSS), TBUT, Standard Patient Evaluation of Eye Dryness (SPEED), cornea fluorescein staining (CFS), meibography, best corrected visual acuity (BCVA), intraocular pressure (IOP), and fundus examination were performed. Compared to the baseline, MGYSS, TBUT, and SPEED and CFS scores improved in the study eyes, while only SPEED and CFS scores improved in the control eyes (p < 0.001 for all). Changes in MGYSS and TBUT were higher in the study eyes than in the control eyes (p < 0.05), but changes in SPEED and CFS scores were similar (p > 0.05). BCVA and IOP improved in both the study and control eyes (p < 0.05). Five patients experienced mild pain and burning during IPL treatment. One patient suffered partial eyelash loss. IPL combined with MGX safely and effectively treated MGD.

A randomized, double-blind, placebo-controlled study of oral antioxidant supplement therapy in patients with dry eye syndrome.

PurposeTo evaluate the efficacy of oral antioxidant supplementation in the treatment of patients with dry eye syndrome (DES).MethodsA prospective, randomized, double-blinded study compared the effects of an antioxidant supplement (containing anthocyanosides, astaxanthin, vitamins A, C, and E, and several herbal extracts, including Cassiae semen and Ophiopogonis japonicus) with placebo on patients with DES. We assessed dry eye symptoms, visual acuity, Schirmer’s test, tear film breakup time, cornea and conjunctiva fluorescein staining, serum anti-SSA/anti-SSB antibodies, and the level of reactive oxygen species (ROS) in tears. The supplementation period was 8 weeks and patients were followed up every 4 weeks for 16 weeks. A linear mixed model was used to compare the groups, while within-group differences were tested by repeated-measures analysis of variance.ResultsForty-three patients, 20 and 23 in treatment and placebo groups, respectively, completed the study. Liver and renal functions were normal. Diastolic blood pressure decreased in the treatment group. There were no significant differences in systolic blood pressure, dry eye symptoms, serum anti-SSA and anti-SSB, visual acuity, intraocular pressure, or fluorescein corneal staining between the groups. Tear film breakup time scores and Schirmer’s test without topical anesthesia significantly improved in the treatment group. Tear ROS level differed between the groups and decreased after treatment. Overall subjective impression revealed a significant improvement with treatment compared with placebo.ConclusionOral antioxidant supplementations may increase tear production and improve tear film stability by reducing tear ROS. The vegetable-based antioxidant supplement used in this study is safe and can be utilized as an adjuvant therapy to conventional artificial tear therapy for patients with DES.

A Randomized Controlled Trial of Omega 3 Fatty Acids in Rosacea Patients with Dry Eye Symptoms

ABSTRACTObjective or purpose: To evaluate the efficacy of dietary omega-3 fatty acids (O3FAs) in rosacea patients having dry eye symptoms.Methods: A prospective, interventional, randomized, double-masked, placebo-controlled, multi-centric study was done. Symptomatic patients with rosacea were recruited based on their response to (Dry Eye Scoring System, DESS©); a score of 0–3 was assigned to dry eye-related symptoms like ocular fatigue, blurring of vision, itching or burning, sandy or gritty sensation, and redness, respectively (DESS©). Subjects were (n = 130) were randomized to receive either O3FAs (n = 65) or placebo (n = 65) capsules (olive oil) twice daily for 6 months. Patients were evaluated at baseline, 1, 3, and 6 months. Change in subjective dry eye symptoms was the primary outcome measure. Change in meibomian gland score (MGS), Schirmer score, and tear film breakup time (TBUT) were the secondary outcome measures.Results: Repeated-measures ANOVA revealed that there was a significant (p < 0.001) change in symptoms (F(1.506, 88.825 = 315.193), MGS (F(1.336, 78.796 = 84.438), Schirmer score (F(1.322, 78.022 = 86.559), and TBUT (F(1.354, 79.898 = 179.020.559) in O3FA group as compared to placebo group. Post-hoc test revealed that there was a significant change in dry eye symptoms at all points of time; there was a significant change in MGS, Schirmer score, and TBUT also, but only after 3 months of intervention. Linear regression established that symptom severity could significantly predict MGS, Schirmer score, and TBUT. There was a significant change in the slope (intercept) of the regression plots in O3FA group as compared to the placebo group.Conclusion: Rosacea patients with dry eye symptoms have significant improvement in symptoms, MGS, TBUT, and Schirmer score, following dietary intervention with O3FAs for 6 months.

Effect of Systemic Infliximab Therapy in Patients with Sjögren’s Syndrome

Objectives:To investigate the effect of systemic infliximab therapy on tear function tests and the ocular surface in patients with Sjögren’s syndrome secondary to various autoimmune diseases.Ma­te­ri­als and Met­hods:This prospective study included 22 eyes of 22 patients with Sjögren’s syndrome who began treatment with systemic infliximab. Tear film break-up time (TBUT), anesthetized Schirmer’s 1 test, fluorescein staining test, and Ocular Surface Disease Index (OSDI) scores were recorded before treatment and in the 3rd and 6th months of treatment.Re­sults:In the 3rd month of infliximab therapy, no significant changes were observed in Schirmer’s values, TBUT, fluorescein staining, or OSDI scores (p=0.260, p=0.357, p=0.190 and p=0.07, respectively). In the 6th month of infliximab therapy, no significant changes were observed in TBUT, fluorescein staining, Schirmer’s value or OSDI scores (p=0.510, p=0.320, p=0.220 and p=0.344, respectively).Conclusion:Infliximab therapy, which is commonly used in systemic autoimmune diseases such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis, and ankylosing spondylitis, did not show a positive effect on ocular surface and tear function tests.

Oral omega-3 fatty acids treatment in computer vision syndrome related dry eye.

To assess the efficacy of dietary consumption of omega-3 fatty acids (O3FAs) on dry eye symptoms, Schirmer test, tear film break up time (TBUT) and conjunctival impression cytology (CIC) in patients with computer vision syndrome. Interventional, randomized, double blind, multi-centric study. Four hundred and seventy eight symptomatic patients using computers for more than 3h per day for minimum 1 year were randomized into two groups: 220 patients received two capsules of omega-3 fatty acids each containing 180mg eicosapentaenoic acid (EPA) and 120mg docosahexaenoic acid (DHA) daily (O3FA group) and 236 patients received two capsules of a placebo containing olive oil daily for 3 months (placebo group). The primary outcome measure was improvement in dry eye symptoms and secondary outcome measures were improvement in Nelson grade and an increase in Schirmer and TBUT scores at 3 months. In the placebo group, before dietary intervention, the mean symptom score, Schirmer, TBUT and CIC scores were 7.5±2, 19.9±4.7mm, 11.5±2s and 1±0.9 respectively, and 3 months later were 6.8±2.2, 20.5±4.7mm, 12±2.2s and 0.9±0.9 respectively. In the O3FA group, these values were 8.0±2.6, 20.1±4.2mm, 11.7±1.6s and 1.2±0.8 before dietary intervention and 3.9±2.2, 21.4±4mm, 15±1.7s, 0.5±0.6 after 3 months of intervention, respectively. This study demonstrates the beneficial effect of orally administered O3FAs in alleviating dry eye symptoms, decreasing tear evaporation rate and improving Nelson grade in patients suffering from computer vision syndrome related dry eye.

The diagnostic value and accuracy of conjunctival impression cytology, dry eye symptomatology, and routine tear function tests in computer users.

Aims and Objectives:To compare the diagnostic value and accuracy of dry eye scoring system (DESS), conjunctival impression cytology (CIC), tear film breakup time (TBUT), and Schirmer's test in computer users.Methods:A case–control study was done at two referral eye centers. Eyes of 344 computer users were compared to 371 eyes of age and sex matched controls. Dry eye questionnaire (DESS) was administered to both groups and they further underwent measurement of TBUT, Schirmer's, and CIC. Correlation analysis was performed between DESS, CIC, TBUT, and Schirmer's test scores. A Pearson's coefficient of the linear expression (R2) of 0.5 or more was statistically significant.Results:The mean age in cases (26.05 ± 4.06 years) was comparable to controls (25.67 ± 3.65 years) (P = 0.465). The mean symptom score in computer users was significantly higher as compared to controls (P < 0.001). Mean TBUT, Schirmer's test values, and goblet cell density were significantly reduced in computer users (P < 0.001). TBUT, Schirmer's, and CIC were abnormal in 48.5%, 29.1%, and 38.4% symptomatic computer users respectively as compared to 8%, 6.7%, and 7.3% symptomatic controls respectively. On correlation analysis, there was a significant (inverse) association of dry eye symptoms (DESS) with TBUT and CIC scores (R2 > 0.5), in contrast to Schirmer's scores (R2 < 0.5). Duration of computer usage had a significant effect on dry eye symptoms severity, TBUT, and CIC scores as compared to Schirmer's test.Conclusion:DESS should be used in combination with TBUT and CIC for dry eye evaluation in computer users.

A randomized controlled trial of omega-3 fatty acids in dry eye syndrome.

To evaluate the role of dietary supplementation of omega-3 fatty acids in dry eye syndrome. A prospective, interventional, placebo controlled, double blind randomized trial was done at two referral eye centers. Two hundred and sixty-four eyes of patients with dry eye were randomized to receive one capsule (500mg) two times a day containing 325mg EPA and 175mg DHA for 3 months (omega-3 group). The omega-3 group was compared to a group of patients (n=254) who received a placebo (placebo group). There were 4 patient visits (at baseline, 1 month, 2 months and 3 months). On each visit, recording of corrected distance visual acuity (CDVA), slit lamp examination and questionnaire based symptom evaluation and scoring was done. A symptomatic score of 0-6 was mild, 6.1-12 moderate and 12.1-18 severe dry eye. Response to intervention was monitored by routine tear function tests like Schirmer I test, tear film break-up time (TBUT), Rose Bengal staining and most notably, conjunctival impression cytology. Sixty-five percent of patients in the omega-3 group and 33% of patients in placebo group had significant improvement in symptoms at 3 months (P=0.005). There was a significant change in both Schirmer's test value and TBUT values in the omega-3 group (P<0.001), both comparisons. However, there was a larger drift in TBUT values in omega-3 than the placebo group, in comparison to Schirmer's test values. The mean TBUT score was 2.54±2.34 in the omega-3 group and 0.13±0.16 in placebo group, respectively. The mean reduction in symptom score in omega-3 group was 2.02±0.96 as compared to 0.48±0.22 in placebo group (P<0.001). Despite a slight increase mean score, the Schirmer scores did not correlate well with symptomatic improvement. Omega-3 fatty acids have a definite role for dry eye syndrome. The benefit seems to be more marked in conditions such as blepharitis and meibomian gland disease. The role of omega fatty acids in tear production and secretion needs further evaluation.

Rebamipide (OPC-12759) in the Treatment of Dry Eye: A Randomized, Double-Masked, Multicenter, Placebo-Controlled Phase II Study

To investigate the dose response for efficacy of 1% and 2% rebamipide ophthalmic suspension compared with placebo in patients with dry eye. A randomized, double-masked, multicenter, placebo-controlled, parallel-group, dose-response phase II study. A total of 308 patients with dry eye. After a 2-week screening period, patients were randomized to receive placebo or 1% rebamipide or 2% rebamipide administered as 1 drop in each eye 4 times daily for 4 weeks. The primary objective end point was change in fluorescein corneal staining (FCS) score from baseline to last observation carried forward (LOCF). Secondary objective end points were lissamine green conjunctival staining (LGCS) score, tear film break-up time (TBUT), and the Schirmer's test. Secondary subjective end points included dry eye-related ocular symptoms (foreign body sensation, dryness, photophobia, eye pain, and blurred vision) score and patients' overall treatment impression score. Rebamipide dose response was observed in FCS, LGCS, and TBUT scores. Both 1% and 2% rebamipide were significantly more effective than the placebo in terms of the change from baseline to LOCF for FCS, LGCS, and TBUT scores. There was no significant difference between the rebamipide and placebo groups from baseline to LOCF in Schirmer's test values, and dose response was not observed. In the predefined dry eye subpopulation with a baseline FCS score of 10 to 15, the mean change from baseline in the 2% rebamipide group was larger than that in the 1% rebamipide group. Change from baseline to LOCF for all 5 dry eye-related ocular symptom scores and patients' overall treatment impression showed significant improvements in the 1% and 2% rebamipide groups compared with the placebo group, except for photophobia in the 1% rebamipide group. No deaths or drug-related serious adverse events occurred in any treatment group. The incidence of ocular abnormalities was similar across the rebamipide and placebo groups. Rebamipide was effective in treating both objective signs and subjective symptoms of dry eye and were well tolerated in this 4-week study. Although 1% and 2% rebamipide were both efficacious, 2% rebamipide may be more effective than 1% rebamipide in some measures. Proprietary or commercial disclosure may be found after the references.