Tear Film Break-up Time Test Research Articles

A COMPARATIVE STUDY OF PRE-CORNEAL TEAR FILM BETWEEN DIABETICS AND NON-DIABETICSUSING OCULAR SURFACE DISEASE INDEX

Purpose: To determine distinctive characteristics of pre-corneal tear film in eyes of diabetics and compare them with non-diabetics. Design: Hospitalbasedobservationalcross-sectional study. Methods: The study was done in thedepartmentofophthalmology from July2022-December2023. Patients presenting to outpatient department of ophthalmology who were of age>45 years, have a history of diabetes for more than three years and those without diabetes as control groups were chosen.300patients weretaken forthestudyand dividedinto two groups(150 diabetics and 150 non-diabetics). Sample size was decided based on a convenient sampling method.Ocular surface disease index(OSDI) questionnaire was used to assess symptoms and signs.Corneal sensitivity test, Tear film breakup time(TBUT) and Schirmer tests were done. The corneal and conjunctival stains were used. Chi-square test was used to examine outcomes. Other tests were applied accordingly. Results: Diabetic patients had poorer OSDI scores compared to Non-diabetic patients(p 0.001*). Patients with diabetes had reduced corneal sensitivity(p<0.05*). Schirmer II and TBUT values were significantly prolonged in Diabetics compared to Non-diabetcs(p<0.05*). Duration of diabetes significantly increased the severity of dry eye. Dry eye was more prevalent in diabetic retinopathy patients(p=0.02*). Strong association was found between HbA1C and severity of diabetic retinopathy with P<0.05*. Conclusion:The duration of diabetes and stage of retinopathy are closely linked to the occurrence and severity of tear film dysfunction. Early detection and treatment are vital for preventing dry eye syndrome and its potential progression to vision-threatening complications, through simple non-invasive methods.

Gender-Related Differences in Dry Eye Symptoms Following Involutional Ectropion and Entropion Surgery.

This prospective case-control study investigated gender-related differences in dry eye symptoms following surgery for involutional ectropion and entropion. A total of 109 patients, aged between 65 and 89, were categorized by eyelid condition and gender. Postoperative assessments included the Tear Film Break-Up Time (TBUT) test, Schirmer I test results, corneal and conjunctival staining, eyelid margin characteristics, and scores from the Ocular Surface Disease Index (OSDI) questionnaire. The analysis revealed notable gender-related differences in dry eye manifestations. Initially, men exhibited lower TBUT scores but higher Schirmer test readings compared to women; however, these disparities diminished over time. No significant gender differences were detected in corneal and conjunctival staining, indicating similar levels of ocular surface damage across genders. Males showed significantly higher values in several eyelid margin characteristics (LMI, LMT) at various postoperative time points. According to the OSDI questionnaire, women experienced more severe symptoms of dry eye both pre- and post-operatively, suggesting a greater subjective symptom burden. When comparing surgical outcomes for ectropion and entropion, both conditions showed improvement in eyelid positioning and dry eye symptoms post-surgery. Despite these improvements, women with either condition reported more severe dry eye symptoms compared to men throughout the postoperative period. This study highlights the gender-specific variations in dry eye symptoms following eyelid malformation surgery and emphasizes the importance of adopting gender-sensitive approaches in postoperative care to improve outcomes and ocular health.

Association of digital device usage and dry eye disease in school children.

To investigate the influence of digital device use (computers, laptops, tablets, smartphones) on dry eye disease (DED) in a pediatric population. This was a cross-sectional study. School children studying in grades 5-9 at two private schools in the city of Ahmedabad, the capital city of Gujarat, India were invited to participate in the study. In this study, 462 children underwent ocular examination including tear film breakup time (TBUT) and Schirmer's test. Questionnaires were administered for collecting information on the type and duration of digital device usage separately for academic and leisure activities and the Ocular Surface Disease Index (OSDI) score. The mean age of participants was 11.2 + 1.4 years, and 63% were boys. The mean OSDI score was 37.2 + 11.8, and 90.5% had symptoms of DED. Children with moderate to severe DED (n = 88, 19%) had longer daily duration of device use and lower Schirmer's test and TBUT values compared to children with mild DED (P = 0.001). A cumulative exposure time of more than 3-3.5 h per day had a significantly increased risk of DED. Multivariable logistic regression analysis showed that increment in computer usage (odds ratio [OR] 1.94 for every half an hour increase, 95% confidence interval [CI] = 1.2-3.1) and children studying in higher grades (OR 1.30, 95% CI = 1.1-1.6) had a higher risk of moderate to severe dry eye. Cumulative device exposure time of more than 3-3.5 h per day had a significantly increased risk of pediatric DED. Children with an increment in computer usage by half an hour per day had a higher chance of experiencing moderate to severe dry eye. Policymakers should aim to restrict the screen time below 3 h on a daily basis.

Comparison of Effects of Preserved and Preservative Free Anti-Glaucoma Drugs in Causing Dry Eyes

Objective: The aim of this study was to assess the potential impact of antiglaucoma medication preservatives on ocular surface health and the subsequent development of dry eye symptoms. Methods: A non-randomized controlled trial study was conducted from March 2023 to June 2023.The study enrolled 32 patients, with 16 participants in each group. Patients meeting the inclusion criteria, including confirmed diagnosis of glaucoma and stable ocular health, were allocated to Group A(preserved medication) or Group B(preservative-free medication).Tear Film Break-Up Time(TBUT) and Schirmer's test were employed as objective indicators of tear film stability and tear production respectively. Measurements were recorded at baseline and after a 3-month duration of medication use. Results: At 1st visit, mean TBUT was 10.87 sec and mean Schirmer's test was 13.75 mm in group A while in group B it was 11.25 sec and 14.56 mm respectively. After 3 months of medication use, mean TBUT and mean Schirmer’s was 9.62 sec and 11.81 mm respectively in group A while in group B it was 10.18 sec and 13.18 mm respectively. The results showed that initial ocular status was similar in both groups however the decrease in values showed ocular surface deterioration. Notably group A demonstrated a more substantial decline in tear production compared to group B. Conclusion: This study underscores the importance of both preserved and preservative-free anti-glaucoma medications. Although both may potentially exacerbate dry eye symptoms to a greater extent, preservative-free anti-glaucoma may offer benefits in maintaining ocular surface health with long-term use.

Prevalence and Risk Factors of Dry Eye Disease in the South of Palestine.

The prevalence of dry eye disease (DED) is rising globally and needs to be urgently addressed by medical professionals because it lowers patients' quality of life. There are as yet no available data in the literature about the prevalence of and risk factors for DED in the Gaza Strip, a gap that the present study seeks to address. A cross-sectional study was carried out between March and August 2022 in Gaza governorates using a proportional stratified sampling technique. Only Gazan individuals ≥ 18 years old and able to follow the instructions were included. The Ocular Surface Disease Index (OSDI) questionnaire, which has previously been translated into Arabic and validated, was applied to evaluate DED symptoms. Subjective clinical tests for DED conducted were tear meniscus height (TMH), meibomian gland dysfunctions (MGDs), Marx line (ML), conjunctival Lissamine green staining (LGS), tear film break-up time test (TBUT), corneal fluorescein staining (CFS) and Schirmer II tear test (STT). DED was defined based on an Arab-OSDI score ≥ 13 and at least one positive clinical sign. A total of 426 participants were assessed from four areas (North Gaza Strip, 82; Gaza City, 147; Mid-Zone Gaza Strip, 62; South Gaza Strip, 135). The prevalence of DED in the present study was 31.5% (95% CI: 27.1, 36.1). Age > 50 years old (odds ratio [OR] = 10.45; 95% CI: 2.95, 37.05; P < 0.001), female gender (OR = 3.24; 95% CI: 1.40, 7.52, P = 0.006), menopause or pregnancy (OR = 2.59; 95% CI: 1.25, 5.35; P = 0.03) and pharmacotherapy (artificial tears; OR = 9.91; 95% CI: 2.77, 35.46; P < 0.001) were each associated with DED symptoms. South Gaza Strip (OR = 0.04; 95% CI: 0.01, 0.12; P < 0.001), unemployed (OR = 11.67; 95% CI: 1.43, 95.44; P = 0.02), non-consumption of caffeine (OR = 0.40; 95% CI: 0.19, 0.88; P = 0.02) and TMH < 0.2 (OR = 1.80; 95% CI: 1.02, 3.19; P = 0.04) were associated with TBUT < 5 s. LGS was associated with those > 50 years old (OR = 2.70; 95% CI: 1.38, 5.28; P = 0.004), previous refractive or ocular surface surgeries (OR = 2.97; 95% CI: 1.34, 6.59; P = 0.008) and CFS ≥ 1 (OR = 1.91; 95% CI: 1.07, 3.44; P = 0.03). Various aspects of DED were linked with different risk factors, suggesting that DED subtypes have different underlying pathophysiologies.

Subjective Dry Eye Symptoms and Objective Ocular Surface Signs in a Civil Air Crew Population: A Cross-Sectional Study.

Background Aviation professionals are often exposed to conditions such as low cabin air pressure, reduced humidity, and prolonged artificial lighting, which may predispose them to dry eye disease (DED). We therefore designed a cross-sectional study with three primary objectives.Our first aim was to determine the prevalence of subjective dry eye symptoms among civilflight personnel. To achieve this, we administered theStandard Patient Evaluation ofEyeDryness (SPEED) questionnaire.Second, we performed ocular examinations to assess objective DED indicators, such as the Schirmer's-1 (SCH-1) test and tear film break-up time (TBUT). We then correlated the results of these objective tests with the subjective symptoms reported by the participants.Last, we aimed to identify the independent risk factors for positive SCH-1 and TBUT results among aircrew personnel who did not report subjective dry eye symptoms. Methods The study sample consisted of 189 aircrew personnel (94 men and 95 women; mean age: 35.8 ± 10.4 years). They completed the SPEED questionnaire, a tool for assessing ocular surface symptoms. Participants' symptoms were classified as normal (SPEED scores 0-6), moderate (SPEED scores 7-15), or severe (SPEED scores 16-28). The objective assessment included the SCH-1 test for tear production and the TBUT test for tear film quality. Results A significant majority of participants (n = 165; 87.3%)did not report any subjective symptoms of DED. However, 12.2% (n = 23) and 0.5% (n = 1) of the study subjects experienced moderate and severe symptoms, respectively. The SCH-1 test and TBUT test were positive in 25.4% (n = 48) and 24.9% (n = 47) of the participants, respectively. Interestingly, among the aircrew personnel who did not report any subjective dry eye symptoms (SPEED scores 0-6), 18.8% (n = 31) and 17.6% (n = 29) showed abnormal results on the SCH-1 test and TBUT, respectively. Age was identified as the only independent predictor of a positive TBUT (odds ratio = 1.05, 95% confidence interval (CI) = 1.01-1.08, p = 0.01), with a borderline significant association with a positive SCH-1 test (odds ratio = 1.03, 95% CI = 0.99-1.07, p = 0.06). Conclusions The disparity between subjective symptoms and objective tests emphasizes the significance of incorporating objective measures for screening and diagnosing DED in civil flight personnel. If independently confirmed by future research, our findings could potentially lead to the routine implementation of surveillance protocols that incorporate objective DED indicators. Moreover, as age emerged as an independent predictor of positive results on objective tests, it is crucial to consider age-specific screening strategies.

The Effect of Autografts from the Inferior and Superior Bulbar Conjunctiva on the Ocular Surface in Primary Pterygium Surgery: A Cytology Study.

This study aimed to evaluate the effect of using an inferior or superior conjunctival autograft in primary pterygium surgery on the postoperative ocular surface. Forty eyes of 40 patients who underwent pterygium surgery with autograft were included in the study. Cytological cell counts were performed on samples taken from the bulbar conjunctiva by impression cytology before and 1 year after the operation. Schirmer 1 test score, lissamine green conjunctival staining score, tear film break-up time (TBUT), and fluorescein corneal staining scores were evaluated. The pain levels of the patients were evaluated with visual analog scale at postoperative 1 day and 1 week. Corneal and conjunctival staining, TBUT, and Schirmer test results demonstrated significant improvement in all patient groups after surgery, but there was no difference between groups (p>0.05). In both preoperative and postoperative impression cytology, the number of goblet cells in the inferior bulbar conjunctiva was higher than in the superior bulbar conjunctiva (p<0.001), while there was no such difference in epithelial cell or mucin staining. There were no significant cytological changes postoperatively in either group (p>0.05). Pterygium surgery with autografting improved tear function tests regardless of graft location. Goblet cell count was higher in the inferior bulbar conjunctiva than in the superior bulbar conjunctiva in both postoperative and preoperative impression cytology. However, there was no significant difference in postoperative epithelial and goblet cell counts or mucin staining between the groups before and after surgery. We think that using the inferior bulbar conjunctiva is an appropriate choice in cases where the superior conjunctiva cannot be used as a graft or when future glaucoma surgery is possible.

Tear and Saliva Metabolomics in Evaporative Dry Eye Disease in Females.

Accurate diagnosis of dry eye disease (DED) is challenging, and even today there is no gold standard biomarker of DED. Hypothesis-free global metabolomic studies of tears from DED patients have great potential to discover metabolites and pathways affected in the pathophysiology of DED, and to identify possible future biomarkers. These metabolites and biomarkers could be important for diagnosing and monitoring disease as well as for new therapeutic targets and strategies. As DED is associated with dry mouth, this study aimed to perform metabolomic analyses of tears and saliva from patients with decreased tear film break-up time but normal Schirmer test, and age-matched controls with both tear production and stability within physiological range. We applied strict inclusion criteria to reduce sampling bias in the metabolomic analyses and selected only age-matched females with Schirmer test values between 10-15 mm/5 min. The tear film analysis arm included 19 patients (with tear film break-up time 0-5 s) and 12 controls (with tear film break-up time 10-30 s), while the salivary analysis arm consisted of a subset which included 18 patients and six controls. Metabolomic analyses were performed using liquid chromatography and high-resolution mass spectrometry. Analyses using a global database search detected a total of 56 metabolites in tear samples that were significantly different between the groups. Of these, several have known associations with DED. These metabolites are present in meibum and have anti-oxidative characteristics or associations with the ocular microbiome, and altered concentrations suggest that they may play a significant role in DED associated with decreased tear film stability. In saliva, hypotaurine levels were lower among patients with tear film instability. In this pilot study, we found different levels of several metabolites in patients with decreased tear film break-up time that may have associations with DED. Future studies are required to replicate our findings and clarify the exact roles of these metabolites.

CORRELATION OF DRY EYES WITH ON-SCREEN TIME AMONG MEDICAL STUDENTS

Objective: An increased global dependence on digital screen use has resulted in a tremendous increase in screen-related ocular complaints such as dryness, ocular strain, burning sensation, grittiness, and transient blurring. This study aims to focus on the correlation between the duration of screen exposure and dry eyes among young medical students with the help of the combination of a questionnaire based on subjective symptoms of dry eyes and screen time and further tests to confirm dry eyes in those having symptoms. Numerous mechanisms have been mentioned in screen-associated evaporative dry eyes, including reduced blink rate, hazardous effects of blue light emitted from digital screens, and inflammatory changes. Methods: A cross-sectional study was conducted among 253 medical students at MIMS, Uttar Pradesh, from January 2021 to December 2022. Upon obtaining informed consent, all participants were given Schirmer 1 and tear film breakup time (TBUT) test. Patients with Schirmer 1 and TBUT reading &lt;10 mm were identified as dry-eye patients. After that, a pre-designed questionnaire was applied to all dry-eye participants that asked about different symptoms of dry eyes and screen time and the correlation between subjective symptoms of dry eyes, dry-eye tests, and screen time was evaluated. Results: About 20.8% of medical students had dry eyes, and those who used their phones for 2–5 h had statistically higher rates of the condition. The length of breaks was also found to be strongly correlated with dry eye. Conclusion: Prolonged duration of digital screen exposure in any form (laptop and mobile phones, etc.) is directly related to the risk of dry-eye disease in the long term. Majority of the students (75%) were willing to reduce their screen time as a preventive measure toward dry eye.

Association Between Screen Time and Tear Film Stability

Tear film is a layer that nourishes, lubricates and protects the anterior surface of eye. The usage of electronic gadgets can affect the tear film stability causing ocular dryness. Recently, due to the increased frequency of online educational and leisure activities, there has been reported increase in the prevalence of dry eye among users of electronic gadgets. Objective: To evaluate association between screen time and stability of tear film. Methods: A descriptive cross-sectional study was conducted from January to august 2021 at The University of Lahore. 120 participants aged above 18 years were recruited using nonprobability sampling technique. After taking consent from the participant’s questionnaire was completed, followed by slit lamp examination for evaluation tear film breakup time (TBUT). Results: 120 healthy people of either gender who were at least 18 years old participated in this study, selected through random sampling, informed consent was acquired from all participants. The TBUT test was performed on all subjects, 74 had severe dry eyes, 21 had moderate dry eyes, and just 24 had normal eyes. Each subject's screen time was tracked after the subjects were divided into four groups. The Chi square was used to assess the relationship between screen time and tear film break up time. Results had a p value less than 0.01 and were statistically significant. Conclusions: This study concluded that as the screen time increases it effects the stability of tear film.

Ocular Surface Disease in Patients With Atopic Dermatitis Treated With Dupilumab: A Prospective Case-Control Study.

The aim of this study was to evaluate the variation of dry eye disease (DED) prevalence in patients with atopic dermatitis (AD) treated with dupilumab. This prospective case-control study included consecutive patients with moderate-to-severe AD scheduled for dupilumab between May and December 2021 and healthy subjects. DED prevalence, the Ocular Surface Disease Index, tear film breakup time test, osmolarity, Oxford staining score, and Schirmer test results were collected at baseline, 1 month, and 6 months after dupilumab therapy. The Eczema Area and Severity Index was assessed at baseline. Ocular side effects and discontinuation of dupilumab were also recorded. Seventy-two eyes from 36 patients with AD treated with dupilumab and 36 healthy controls were included. Prevalence of DED increased from 16.7% at baseline to 33.3% at 6 months in the dupilumab group ( P = 0.001), whereas it remained unchanged in the control group ( P = 0.110). At 6 months, the Ocular Surface Disease Index and Oxford score increased (from 8.5 ± 9.8 to 11.0 ± 13.0, P = 0.068, and from 0.1 ± 0.5 to 0.3 ± 0.6, P = 0.050, respectively), the tear film breakup time test and Schirmer test results decreased (from 7.8 ± 2.6 s to 7.1 ± 2.7 s, P < 0.001, and from 15.4 ± 9.6 mm to 13.2 ± 7.9 mm, P = 0.036, respectively) in the dupilumab group, whereas they remained stable in the control group ( P > 0.05). Osmolarity was unchanged (dupilumab P = 0.987 and controls P = 0.073). At 6 months after dupilumab therapy, 42% of patients had conjunctivitis, 36% blepharitis, and 2.8% keratitis. No severe side effects were reported, and none of the patients discontinued dupilumab. No association between Eczema Area and Severity Index and DED prevalence was shown. DED prevalence increased in patients with AD treated with dupilumab at 6 months. However, no severe ocular side effects were found and no patient discontinued therapy.

Optimal acupuncture protocol improving symptoms of typical dry eye syndrome: meta-analysis and systematic review

Previous meta-analyses have shown a superiority of acupuncture over artificial tear for treating typical dry eye syndrome (DES). However, given that the acupuncture protocols were quite diverse in the randomized controlled trials (RCTs) included in the meta-analyses, it is necessary to establish the acupuncture guidelines. Thus, the optimal acupuncture protocol involved in improvements of tear-film breakup time (BUT) or Schirmer tear test (STT) was examined by meta-analyses for RCTs in patients with typical DES. Eight databases until Jun 2018 were searched for 21 RCTs (n = 1542 eyes) comparing effectiveness of acupuncture versus artificial tear control. Indirect comparison of Bucher analysis was used to find specific acupoints (SAPs) improving BUT or STT by comparing the outcomes between subgroups of the RCTs including and excluding certain SAPs. Meta-analysis was examined for the outcomes in subgroups of the RCTs based on the number of SAPs, and network meta-analysis was for multiple pairwise comparisons across the protocols using the SAPs to yield relative effects. The Bucher analyses identified nine SAPs with positive effects on BUT or STT, and the positive relations of two SAPs involved in improvements of both BUT and STT suggested potential combinations of three (‘KI3–LI4–SP6’ or ‘KI3–GB14–ST2’) or four SAPs (‘KI3–BL1–EX-HN7–SP6’). Subgroup meta-analyses showed the SAP-depending improvements of BUT or STT in the subgroups including more than three SAPs, compared with the artificial tear control. Meta-regression and network meta-analyses revealed significant correlations between the number of SAPs and the improvements of BUT and STT, and demonstrated that acupuncture using four SAPs for 21–30 days, particularly at two–three times per week, can be optimal for improving the symptoms of typical DES. These results provide useful information for guiding acupuncture in clinical trials for DES.

The Effect of Oral Isotretinoin Therapy on Meibomian Gland Characteristics in Patients with Acne Vulgaris.

The aim of the study was to determine the effect of oral isotretinoin therapy on the functional and morphological condition of the anterior segment of the eye, with particular emphasis on the meibomian glands. Twenty-four patients (48 eyes) with a diagnosis of acne vulgaris were involved in the survey. All patients underwent a thorough ophthalmological examination at three time points: before therapy, 3months after the start of therapy, and 1month after the completion of isotretinoin therapy. The physical examination included the following elements: blink rate, analysis of the lid margin abnormality score (LAS), tear film break-up time (TFBUT) and Schirmer's test, meibomian gland loss (MGL), and the evaluation of the meibum quality score (MQS) and meibum expressibility score (MES). Additionally, the total score of an ocular surface disease index (OSDI) questionnaire was analysed. In comparison with pretreatment values, significant increases in OSDI during and after the treatment (p = 0.003 and p = 0.004, respectively) were observed. Substantial deterioration during the treatment was observed for MGL (p < 0.0001), MQS (p < 0.001) and LAS (p < 0.0001), while an improvement in those parameters after isotretinoin cessation was observed (p = 0.006, p = 0.02 and p = 0.0003, respectively). The frequency of using artificial eye drops was positively associated with MGL during (Spearman's rank correlation coefficient (Rs) = + 0.31; p = 0.03) and after the cessation of the therapy (Rs = + 0.28; p = 0.04). Meibomian gland atrophy correlated significantly with MQS during (Rs = + 0.29; p = 0.04) and after treatment (Rs = + 0.38; p = 0.008). The decrease in TFBUT values correlated with increased LAS (Rs = -0.31; p = 0.03) during the course of isotretinoin usage. We found no changes in Schirmer's test or blink rates. Isotretinoin therapy leads to increased ocular complaints related to lipid tear film component dysfunction. This is due to reversible changes in meibomian gland morphology and function observed during drug usage.

Is a Dry Eye Disorder in Firefighters an Occupational Disease?

To examine firefighters (FFs) exposed to high levels of fire smoke and, as a result, to uncover risk factors for dry eye disorder (DED) compared to age-and gender-matched healthy individuals. In this cross-sectional study, 51 FFs from the Afyonkarahisar Municipality Fire Department were chosen at random (group 1). A control group (group 2) included 51 age- and gender-matched healthy individuals. The Ocular Surface Disease Index (OSDI) questionnaire was administered after all participants were thoroughly explained the study's objectives and procedures. Then, using a portable hand biomicroscope, an ocular exam was performed on-site. DED was defined as a non-anesthetic Schirmer test result of <10 mm and/or a tear film break-up time (TBUT) of <5 seconds. Groups 1 and 2 had mean ages of 44.82±7.29 and 44.73±7.41 years, respectively (p=0.946). The median work duration in group 1 was 14 years (min-max: 1-27 years). TBUT test revealed a significantly increased DED prevalence in group 1 than group 2 (p=0.046). Despite the non-significant difference (p=0.276), Schirmer test revealed that group 1 had a higher DED prevalence than group 2. The OSDI score revealed that group 1 had more mild, moderate, and severe DED than group 2 (p=0.359). Longer work duration was associated with a higher DED prevalence (p=0.179). Given the high prevalence of fire smoke-induced DED in FFs, preventive measures such as regular ocular exams, encouraging personal protective equipment usage, and health education programs can assist in avoiding complications and reducing the burden of ocular diseases.

A comparative study to evaluate the effect of various postoperative treatment protocols on dry eye and patient satisfaction after phacoemulsification.

Foreign body sensation and irritation are common after cataract surgery, as is the exacerbation of dry eye disease if present. This study compared postoperative dry eye treatments and patient satisfaction. Age-related cataract patients undergoing phacoemulsification were recruited and were divided randomly into 4 postoperative treatment groups: Group A: Antibiotic + Steroids; Group B: Antibiotic + Steroids + Mydriatic; Group C: Antibiotic + Steroids + Mydriatic + Non-steroidal Ant-inflammatory drugs (NSAIDs); Group D: Antibiotic + Steroids + Mydriatic + NSAID + Tear substitute. Patients were assessed at 1, 3, and 5 weeks post-operatively for uncorrected distance and near vision, best corrected visual acuity (BCVA) for distance and near, Schirmer's-1 test, and Tear Film Break-Up Time test. At each visit, patients were assessed for dry eye-related subjective parameters using Ocular Surface Disease Index questionnaire. Study participants numbered 163. (87 male and 76 female patients). No statistically significant difference was present in visual acuity for near and distance. The mean values of Schirmer's test and TFBUT were better in group D patients at each postoperative visit, with significant differences noted in comparison with other groups. The patient response to pain and dry eye symptoms was superior in groups C and D, with group D producing the best results. Compared to group A, patients in groups C and D were more satisfied with their vision and surgery. The addition of tear substitutes to steroids and NSAIDs has been associated with decreased dry eye-related symptoms and a better subjective feeling of vision, although no significant difference was noted in vision measured objectively.

A simple technique of meibography for morphological and functional evaluation of meibomian glands in dry eye conditions.

Dry eye disease (DED) is because of a decrease in the tear film's volume or a change in the composition of tears. Evaporative dry eye is the most common type, which is due to meibomian gland dysfunction (MGD). In this study, the morphology of meibomian glands was evaluated in all kinds of dry eyes to look for any loss of meibomian glands, assess the function of remaining glands, and investigate the relationship between anatomy, function, and severity of DED. A total of 300 patients were included in the study, with 150 eyes in the study group and 150 in the control group. Meibomian gland morphology was assessed by examining the tarsal plate after everting the eyelids. Tear film function was evaluated using tear film break-up time (TBUT) and Schirmer's test (SCH I and II). Meibomian gland morphology was examined with a slit-lamp under magnification, a transilluminator using a small light emitting diode (LED) bulb, and non-contact meibography using an auto refracto-keratometer (ARK). Females had a higher prevalence of dry eyes in our study. In all, 103 eyes (68.6%) in the study group had evaporative dry eye, making it the most prevalent type. Among the 150 controls, 104 controls with 69.3% had no dry eye symptoms, and in those with symptoms, the evaporative type was the most common, with a 28% prevalence. TBUT should be performed in all patients with detectable MG abnormality. Meibography has high specificity and sensitivity to diagnose MGD and in turn dry eyes and should be considered a routine screening modality.

Evaluation of the ocular surface in asymptomatic glaucoma patients on topical medications and following trabeculectomy - A cross-sectional study.

This present prospective, cross-sectional study aims to comprehensively evaluate the ocular surface in asymptomatic patients with diffuse blebs after trabeculectomy versus chronic anti-glaucoma medication use and compare it with the age-matched normal population. Objective clinical evaluation was done by tear film break-up time (TBUT) and Schirmer's test (ST) in the three groups-trabeculectomy >6 months with a diffuse bleb (Wurzburg bleb classification score ≧10), chronic anti-glaucoma medication (AGM >6 months) group, and normal population. In all groups, tear film osmolarity was checked with the TearLab® device (TearLab Corp., CA, USA), and subjective evaluation was performed by administering Ocular Surface Disease Index (OSDI) questionnaire. Patients already on chronic lubricants or any other drug for the treatment of dry eyes (viz. steroids, cyclosporin) or having symptoms suggestive of an abnormal ocular surface, who had undergone refractive or intraocular surgery, and contact lens users were excluded. In total, 104 subjects/eyes were recruited over 6 weeks. Thirty-six eyes recruited in the trab group were compared with 33 eyes studied in the AGM group, and both these groups were compared to 35 normal eyes. When compared to normals, TBUT and ST were significantly lower (P = 0.003 and 0.014) and osmolarity and OSDI were statistically significantly higher (P = 0.007 and 0.003) in the AGM group, whereas only TBUT was statistically significantly different (P = 0.009) when the trab group was compared to normals. Also, when the trab group was compared to the AGM group, ST was found to be higher (P = 0.003) and osmolarity was lower (P = 0.034). To conclude, ocular surface is affected even in asymptomatic patients on AGM but near normalcy is possible following trabeculectomy when blebs are diffuse.

Assessment of Tear Meniscus Dimensions Using Anterior Segment Optical Coherence Tomography in Vitamin D Deficiency in a Pediatric Population.

To investigate of the effect of vitamin D (Vit-D) deficiency on the tear film in children and compare it with that of healthy subjects. This prospective and cross-sectional study comprised 75 eyes of children who had Vit-D deficiency (Group 1) and 85 eyes of age- and gender-matched healthy children (Group 2). The tear-film break-up time (TF-BUT) and Schirmer test values, as well as the Ocular Surface Disease Index (OSDI) scores, were recorded for the participants in all groups. Measurement of the tear meniscus area (TMA) and tear meniscus height (TMH) was performed 2 times in the same day via the use of anterior segment-optical coherence tomography (AS-OCT). The mean age of the participants in Group 1 was 12.42 ± 3.40 years, while in Group 2, it was 12.59 ± 2.32 years (p = 0.758). Group 1 comprised 43 females and 32 males, while Group 2 comprised 44 females and 41 males (p = 0.250). The mean TMH, TMA, and Schirmer test values were found to be significantly lower in children with Vit-D deficiency (Group 1) than in healthy children (Group 2), with p < 0.05 for all the values. It was concluded that there was no significant difference in the values for the mean TF-BUT and OSDI scores (p = 0.029 and p = 0.596, respectively). The children with Vit-D deficiency exhibited lower TMH, TMA, and Schirmer test values. The alterations that were observed in these parameters were more prominent in the participants who had lower Vit-D levels.

Clinico-cytological analysis of conjunctiva and ocular surface symptoms of patients on topical anti-glaucoma medications attending Lagos University Teaching Hospital, Lagos, Nigeria: A case-control study.

The long-term use of topical anti-glaucoma medications is often associated with ocular surface toxicity that can affect the patient's drug compliance and quality of life. This study assessed the effect of these medications, using cytological changes of the conjunctiva and ocular surface symptoms. This was a clinic-based, case-control study that was conducted at the Lagos University Teaching Hospital that compared glaucoma patients on topical medications with age-sex-matched controls. The controls were non-glaucoma patients, who were not on any topical ocular medications at least 6 months prior to the study. The Ocular Surface Disease Index (OSDI) questionnaire was used to assess ocular surface symptoms. Schirmer's I test, tear film break-up time (TBUT) test and corneal fluorescein staining of the ocular surface were used for ocular surface disease (OSD) assessment and conjunctival impression cytology (CIC) for histological assessment and grading. Six hundred and ninety-six eyes of 348 respondents, 174 cases and 174 controls, were assessed for OSD. The mean ages of the case and control groups were 56.3 ± 12.9 years and 55.5 ± 13.2 years, respectively, with no statistical difference (P = 0.589). All ocular parameters assessed were significantly abnormal in the case group compared to the control group. The use of topical anti-glaucoma medications was significantly associated with abnormal TBUT (P < 0.001), Schirmer's test (P < 0.001), ocular surface staining (P < 0.001), CIC (P < 0.001) and OSDI scores (P = 0.001). A significant association was seen between abnormal TBUT and the number of medications (P = 0.044, odds ratio [OR] =0.79, 95% confidence interval [CI]: 0.44-1.14), between abnormal ocular surface staining and duration of anti-glaucoma medications usage (P = 0.0104, OR = 1.2, 95% CI: 1.04-1.43) and between abnormal CIC and the duration of anti-glaucoma medications (P = 0.0007, OR = 0.7, 95% CI: 0.59-0.86). The study demonstrates that prolonged use of topical anti-glaucoma medications may be associated with damage to the ocular surface structures.

Topographic tear film trend and new parameters for non-invasive break up time test.

To evaluate the quantitative and qualitative results of the noninvasive tear film break-up time (NI-BUT) test and investigate the predictive ability of the new NI-BUT parameter in discriminating between normal Ocular Surface Disease Index (OSDI; scores ≤12) and abnormal OSDI (scores ≥13). A total of 341 eyes of 341 volunteers who applied for routine eye outpatient control were included in the prospective study. All participants' noninvasive first tear film break-up time (NIF-BUT), noninvasive average tear film break-up time (NIAvg-BUT) and average value of the first three break-up time (A3F-BUT) were analyzed. A3F-BUT, the new NI-BUT parameter, is calculated by adding the NIF-BUT value to the 2nd break-up time value that has a difference of at most 1 second from the NIF-BUT value and to the 3rd break-up time and then dividing the respective sum by 3. Receiver operating characteristic (ROC) curve and forward logistic regression analyses were performed to determine the parameter that had the best predictive ability between the OSDI groups. The NI-BUT values of 255 eyes of 255 volunteers included in the study were analyzed statistically. The mean NIF-BUT, NIAvg-BUT, and A3F-BUT values were calculated as 5.3±3.0, 8±3.1, and 5.8±3.0 seconds, respectively. All three parameters were found to be significantly lower in the abnormal OSDI group (P=0.014, 0.034, and 0.011, respectively). The area under the curve (AUC) of the A3F-BUT to predict abnormal OSDI was AUC=0.625 (0.529-0.720), P=0.011 and NIF-BUT was AUC=0.599 (0.502-0.696), P=0.043. The A3F-BUT parameter and NIF-BUT parameters were found to be significantly efficient in discriminating abnormal OSDI. The new parameter for the NI-BUT test has more predictive ability in the discrimination of OSDI groups.