Tear Film Break-up Time Test Research Articles

Increased Tear Fluid Production as a Compensatory Response to Meibomian Gland Loss: A Multicenter Cross-sectional Study

To compare tear film parameters as well as meibomian gland morphologic features and function among patients with meibomian gland dysfunction (MGD), those with non-Sjögren syndrome aqueous-deficient dry eye (non-SS ADDE), those with non-SS ADDE and MGD, and normal subjects. Multicenter, cross-sectional, observational case series. Forty-one eyes of 41 patients (all women; mean age ± standard deviation, 62.1±9.9 years) with non-SS ADDE, 70 eyes of 70 patients (all women; 66.0±8.7 years) with MGD, 17 eyes of 17 patients (all women; 72.4±7.8 years) with non-SS ADDE and MGD, and 70 eyes of 70 normal control subjects (all women; 65.0±7.1 years). Ocular symptoms were scored from 0 to 14 and lid margin abnormalities from 0 to 4 according to their respective number. Meibomian gland changes were scored from 0 to 6 (meiboscore) on the basis of noncontact meibography findings, and meibum was graded from 0 to 3 depending on its volume and quality. Conjunctival and corneal epithelial damage were scored from 0 to 9 (fluorescein score). Tear film break-up time (TBUT) was measured as an index of tear film stability, and tear fluid production was evaluated with Schirmer's test. Ocular symptom score, lid margin abnormality score, meiboscore, meibum grade, fluorescein score, TBUT, and Schirmer's test value. The ocular symptom score did not differ significantly between the MGD and non-SS ADDE groups (P = 0.762). The lid margin abnormality score, meiboscore, and meibum grade were significantly higher in the MGD group than in the non-SS ADDE group (P = 0.0012, P < 0.0001, and P < 0.0001, respectively). The fluorescein score, TBUT, and Schirmer's test value were significantly worse in the non-SS ADDE group than in the MGD group (P < 0.0001, P = 0.0061, and P < 0.0001, respectively). The meiboscore correlated significantly with Schirmer's test value only in the MGD group (ρ = 0.508, P = 8.3×10(-6)). An increase in tear fluid production likely compensates for loss of meibomian glands in individuals with MGD.

Effect of Oral Lactoferrin on Cataract Surgery Induced Dry Eye: A Randomised Controlled Trial

Cataract surgery is one of the most frequently performed intra-ocular surgeries, of these manual Small Incision Cataract Surgery (SICS) is a time tested technique of cataract removal. Any corneal incisional surgery, including cataract surgery, can induce dry eye postoperatively. Various factors have been implicated, of which oneis the inflammation induced by the surgery. Lactoferrin, a glycoprotein present in tears is said to have anti-inflammatory effects, and promotes cell growth. It has been used orally in patients of immune mediated dry eye to alleviate symptoms. This study was aimed to evaluate the dry eyes induced by manual Small Incision Cataract Surgery, and the effect if any, of oral lactoferrin on the dry eyes. A single centre, prospective randomised controlled trial with a concurrent parallel design. The study was carried out on patients presenting in the OPD of Rohilkhand Medical College hospital for cataract surgery. Sixty four patients of cataract surgery were included in the study. Patients with pre-existing dry eyes, ocular disease or systemic disease predisposing to dry eyes were excluded from the study. The selected patients were assigned into two groups by simple randomisation-Control Group A-32 patients that did not receive oral lactoferrin postoperatively. Group B-32 patients that received oral lactoferrin 350 gm postoperatively from day 1 after SICS. All patients were operated for cataract and their pre and postoperative (on days 7, 14, 30 and 60) dry eye status was assessed using the mean tear film break-up time (tBUT) and Schirmer test 1 (ST 1) as the evaluating parameters. Subjective evaluation of dry eye was done using Ocular Surface Disease Index (OSDI) scoring. Data was analysed for 58 patients, as 6 did not complete the follow up. Unpaired t-test was used to calculate the p-values. There was a statistically significant difference between the tBUT values of the Control and Lactoferrin group from day 14 onwards. The tBUT of control group on day 60 was 7.86 (±0.86) seconds as compared to 13.9(± 0.99) seconds in the lactoferrin group. The Schirmer test 1 values also showed a statistically significant difference between the two groups- 15.86 (± 5.83) seconds in the control group versus 30.9 (±1.66) in the lactoferrin group on day 60. OSDI score showed 42.8% patients complaining of at least mild dry eye symptoms in the control group, as compared to 26.6% patients in the lactoferrin group on day 60. Small Incision Cataract Surgery induces dry eye postoperatively. Oral lactoferrin given postoperatively improves tear film status and dry eye after cataract surgery.

Ocular Surface Findings in Chronic Renal Failure

The purpose of this study was to describe the ocular surface findings in chronic renal failure (CRF). Sixty eyes of 30 patients with CRF group and 70 eyes of 35 healthy subjects were evaluated. Schirmer-I, tear film break-up time tests and conjunctival impression cytology were performed in addition to complete ophthalmologic examination. The presence of dry eye symptoms and conjunctival calcification were noted. The groups were age and gender matched. The mean break-up time was 10.3±3.1 in group-1 and 11.2±1.7 seconds in the group-2 (p=0.03). The mean Schirmer score was 11.2±2.8 mm and 12.0±1.7 mm in the CRF and control group (p=0.095), respectively. In CRF group, conjunctival impression cytology was revealed as grade-0 findings in 16 eyes, grade 1 findings in 41 eyes and grade 2 findings in 3 eyes, in control group, it was revealed grade-0 findings in 48 eyes, grade 1 findings in 22 eyes and showed no changed in grade 2 (p<0.001). In CRF group, conjunctival calcification was regarded as grade 0 findings in 18 eyes, grade 1 findings in 34 eyes and grade 2 findings in 8 eyes. Grade 0 changes were seen in all subjects in group 2 (p<0.001). Itching (45%), redness (95%) and foreign body sensation (83%) were observed more frequently in the CRF group and also in all eyes with conjunctival calcification in both groups (p<0.001). Chronic renal failure patients suffer more than normal subjects from ocular surface complaints because of conjunctival calcifications and tear film instability although they have the same tear production with their contemporaries.

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.

Botulinum Toxin Type A Injection for Lateral Canthal Rhytids

Botulinum toxin injection for lateral canthal rhytids has been reported to result in dry eye, but its effect on tear film stability and tear production has not been studied thoroughly. To investigate the effect of botulinum toxin type A on tear film stability and tear production after treatment of lateral canthal rhytids. We performed a clinical intervention study at a regional hospital in Taiwan of 58 women 30 to 60 years of age with lateral canthal rhytids from January 1 through December 31, 2011. Botulinum toxin type A at 2 different preparations and doses (dose A: 3 injections of 2 U in 0.05 mL of normal saline per injection; dose B: 3 injections of 4 U in 0.05 mL of normal saline per injection) was injected at the lateral canthal areas. One eye of each study participant was randomly chosen for dose A, and the other eye received dose B. Baseline tear film break-up time (TBUT) and Schirmer tests without and with anesthesia were measured before and at 1 week, 1 month, 3 months, and 6 months after botulinum toxin injection. The TBUT and Schirmer test results were compared between different periods and doses. The TBUT decreased significantly at 1 week after botulinum toxin type A injection (P = .003), and the effect persisted at 1 month and 3 months after treatment (P = .01 and .02, respectively). In younger participants, the TBUT recovered faster than in older patients. The results of the Schirmer tests without and with anesthesia decreased gradually, with significant reduction at 1 month after treatment (P = .05 and .02, respectively) and then recovered gradually. Both the TBUT and Schirmer test results decreased more in eyes that received dose B than in those that received dose A; however, none of the differences were statistically significant. Tear film stability decreased as early as 1 week after botulinum toxin type A treatment for lateral canthal rhytids, and the effect persisted for more than 3 months. Tear production decreased to the trough at 1 month after treatment and then recovered gradually.

Sjögren's syndrome: An underdiagnosed condition in mixed connective tissue disease

OBJECTIVE:To determine the prevalence of sicca symptoms, dry eye, and secondary Sjögren's syndrome and to evaluate the severity of dry eye in patients with mixed connective tissue disease.METHODS:In total, 44 consecutive patients with mixed connective tissue disease (Kasukawa's criteria) and 41 healthy controls underwent Schirmer's test, a tear film breakup time test, and ocular surface staining to investigate dry eye. In addition, the dry eye severity was graded. Ocular and oral symptoms were assessed using a structured questionnaire. Salivary gland scintigraphy was performed in all patients. Classification of secondary Sjögren's syndrome was assessed according to the American-European Consensus Group criteria.RESULTS:The patients and controls had comparable ages (44.7±12.4 vs. 47.2±12.2 years) and frequencies of female gender (93 vs. 95%) and Caucasian ethnicity (71.4 vs. 85%). Ocular symptoms (47.7 vs. 24.4%) and oral symptoms (52.3 vs. 9.7%) were significantly more frequent in patients than in controls. Fourteen (31.8%) patients fulfilled Sjögren's syndrome criteria, seven of whom (50%) did not have this diagnosis prior to study inclusion. A further comparison of patients with mixed connective tissue disease with or without Sjögren's syndrome revealed that the former presented significantly lower frequencies of polyarthritis and cutaneous involvement than did the patients without Sjögren's syndrome. Moderate to severe dry eye was found in 13 of 14 patients with mixed connective tissue disease and Sjögren's syndrome (92.8%).CONCLUSIONS:Sjögren's syndrome, particularly with moderate to severe dry eye, is frequent in patients with mixed connective tissue disease. These findings alert the physician regarding the importance of the appropriate diagnosis of this syndrome in such patients.

The effects of topical antiglaucoma drugs as monotherapy on the ocular surface: a prospective study.

Purpose. The aim was to compare the effects of antiglaucoma eye drops on the tear functions and ocular surface. Method. Eighty-five eyes of 43 patients with glaucoma were included into this randomized prospective study. Timolol without preservative (1), timolol with benzododecinium bromide (2), latanoprost (3), bimatoprost (4), travoprost with benzalkonium chloride (5), and brimonidine with purite (6) were given to 6 groups. Schirmer I, tear film breakup time (TBUT), staining scores, and impression cytology samples were evaluated before and during 12-month-follow-up period. Results. At the end of 12 months, there was no detected change in Schirmer I and TBUT tests indicating dry eye. Corneal staining scores were higher in groups 1 and 2, while conjunctival staining scores were higher in group 6. Goblet cell count decreased in groups 1 and 5 in superior and inferior, group 2 in superior, and groups 3 and 6 in inferior conjunctiva. Squamous metaplasia grades showed a significant increase in groups 1 and 2 at 3rd, 6th, and 12th month controls (P < 0.05). Conclusion. We observed nonserious impact on tear functions and ocular surface with antiglaucoma monotherapy. Beta blockers induced more damage on the ocular surface suggesting the role of the dosing and active substances beside preservatives.

Effect of Long Term Glycemic Control on Precorneal Tear Film in Diabetic Patients

Purpose of the study was to find out the relation between HbA1c which is an useful indicator of long term glycemic control and the qualitative and quantitive activity of precorneal tear film with the help of Tear Film Break up Time(TBUT) and Schirmer's test respectively.40 type 2 diabetic patients and 20 age and sex matched healthy controls undergone HbA1c level, TBUT estimation and Schirmer's test after proper consent and explanation. Statistically significant (p value <0.05) decrease in TBUT and Schirmer's test values were observed in diabetic patients when compared to control group which further deteriorates with increase in HbA1c level. Our finding lead us to conclude that long term glycemic control can modify the qualitative and quantitative properties of tearfilm thus HbA1c level can be considered as one of the important predictor of dry eye syndrome among the diabetic patients.

Dry eye syndrome: A rising occupational hazard in tropical countries

<b>Aim</b> : The aim of this study was to find out the prevalence of dry eye and evaluate personal and environmental risk factors attributable to dry eye in a hospital-based population. <b>Materials and Methods</b> : In this cross-sectional study, 1890 patients above 15 years of age were screened randomly for dry eye. McMonnies Dry Eye Questionnaire, Schirmer's test, tear film breakup time (TBUT), presence of conjunctival injection, punctate epithelial erosions (PEE), and meibomian gland dysfunction (MGD) were used to diagnose dry eye. Patient demographics including age, sex, smoking, and occupation and working environment were also recorded. Correlation of dry eye signs with symptoms and TFBUT and Schirmer's tests was also assessed. <b>Results</b> : The prevalence of dry eye was 10.58%. The prevalence was higher in outdoor workers (17.77%). The male: female ratio was 2.33:1. The number of males was highest in the 56-60 (13%) and 60-65 (14%) years age groups while that of females was highest in the 46-50 (16.67%) years age group. A total of 10% of the patients were smokers, while 8% were tobacco chewers. A 2.15-fold increase was found in the odds for dry eye in those exposed to excessive wind, 1.91-fold to sunlight exposure, and 2.04 for air pollution. Abnormally low TBUT and Schirmer's tests were significantly associated with dry eye signs (<i>P</i>=0.009 and 0.014, respectively). <b>Conclusion</b> : Dry eye is a leading cause of ocular discomfort in OPD patients. Excessive exposure to wind, sunlight, high temperature, and air pollution was significantly related to dry eyes. There was a significant correlation between patient's history, symptoms, dry eye signs and objective tests for tear film. The rural people and those with outdoor occupation are more exposed to extraneous influences of environmental factors in tropical climate. These factors affect the tear film and ocular surface causing the dry eye syndrome.

P2Y2 receptor agonists for the treatment of dry eye disease: a review

Recent advances in the understanding of dry eye disease (DED) have revealed previously unexplored targets for drug therapy. One of these drugs is diquafosol, a uridine nucleotide analog that is an agonist of the P2Y2 receptor. Several randomized controlled trials have demonstrated that the application of topical diquafosol significantly improves objective markers of DED such as corneal and conjunctival fluorescein staining and, in some studies, tear film break-up time and Schirmer test scores. However, this has been accompanied by only partial improvement in patient symptoms. Although evidence from the literature is still relatively limited, early studies have suggested that diquafosol has a role in the management of DED. Additional studies would be helpful to delineate how different subgroups of DED respond to diquafosol. The therapeutic combination of diquafosol with other topical agents also warrants further investigation.

Analysis of parameters for the automatic computation of the tear film break-up time test based on CCLRU standards

Dry eye syndrome is affecting a remarkable percentage of population. The prevalence is 10–15% of normal population, and 18–30% of contact lenses users. The break-up time (BUT) is a clinical test used for the diagnosis of this disease. In this work, we perform an analysis of parameters for a global and a local automatic computation of the BUT measure, based on criteria of specificity and sensitivity. We have tested our methodology on a dataset composed of 18 videos annotated by 4 different experts. The local analysis preserves the results of the global approach providing useful additional information about the break-up tear zone.

Tear Meniscus Evaluation by Anterior Segment Swept-Source Optical Coherence Tomography

To investigate the repeatability of tear meniscus measurements using anterior segment swept-source optical coherence tomography (OCT) and the relationship of tear meniscus measurements with tear film breakup time and Schirmer test results. Prospective, observational, cross-sectional study. We enrolled 26 healthy subjects (26 eyes; 20 men and 6 women; mean age, 36.5 ± 6.8 years) at the University of Tokyo School of Medicine, Tokyo, Japan, in this study. Examinations were conducted in the following sequence: anterior segment vertical raster scans by swept-source OCT, tear film breakup time, and Schirmer test. Each subject underwent OCT measurements twice by the same grader, and the central upper and lower tear menisci height and area and the lower tear meniscus volume were examined. Each OCT image was evaluated by 2 masked graders using the software calipers. The average upper and lower tear meniscus heights were 231 ± 78μm and 256 ± 57μm, respectively, and the average upper and lower tear meniscus areas were 18 829 ± 7823μm(2) and 21 903 ± 8173μm(2), respectively. The average tear meniscus volume was 0.1327 ± 0.051mm(3). The intergrader intraclass correlations for all the parameters were more than 95%. The OCT tear meniscus measurements and the Schirmer test scores were correlated significantly (P < .05, Spearman nonparametric correlation analysis). However, tear film breakup time was not correlated significantly with any of the parameters of tear menisci (P > .05). Anterior segment swept-source OCT is a noninvasive and practical method that can be used for quantitative evaluation of tear fluid.

Ocular Findings in Patients with Autoimmune Liver Disease

Purpose: This is a collaborative study from the ophthalmology and gastroenterology departments of a tertiary care hospital, designed to investigate the ocular features in patients with autoimmune liver disease (ALD).Methods: Seventy-two eyes of 36 patients with ALD, and 40 eyes of 20 controls with normal ocular findings were evaluated. Schirmer test, tear film break-up time, pachymetry, macular thickness with optic coherence tomography, and optic nerve head analysis with the HRT III were performed in addition to complete ophthalmologic examination.Results: Of the 36 patients, 31 were female (86.1%) and 5 were male (13.9%). The average age of patients was 47.7 ± 13.3 years (21–76 years). Autoimmune hepatitis in 22 patients (61.1%), primary biliary cirrhosis in 10 patients (27.8%), and primary sclerosing cholangitis in 4 patients (11.1%) were detected as etiologic causes. Cataract was seen more often in the study group. Tear film break-up time and Schirmer test results were significantly lower in the study group than in the controls. Other parameters were not different from control group.Conclusions: ALD showed a marked preponderance of females, with sex ratios of 6 females per male supportive to literature. The basal tear secretion and tear film stability are lower, and the dry eye symptoms are more common among the cases with ALD.

Children with dry eye type conditions may report less severe symptoms than adult patients

To compare the symptom scores of children with those of adults with the same degree of mild ocular surface signs. This study included patients with at least one ocular surface symptom and sign. Data obtained from 45 subjects aged 8.79 ± 2.95 yr (Mean ± SD) (pediatric group) and 45 adults aged 52.87 ± 10.87 yr (adult group) who were matched to each pediatric patient based on ocular surface signs were analyzed. Demographic data including age and sex; parameters of ocular surface signs including fluorescein staining score, tear film breakup time and Schirmer test score; symptom scores including ocular surface disease index (OSDI) and visual analog scale (VAS) were assessed and compared between the two groups. Significant differences emerged in sex ratio as well as in age between the two groups (P < 0.001, for both). Regarding ocular surface signs and tear film tests, the study revealed no significant differences in fluorescein staining score (1.44 ± 1.95 vs. 1.40 ± 1.68 P = 0.913), tear film break up time (4.96 ± 1.94 vs. 3.82 ± 1.85 s, P = 0.612) and Schirmer score (12.79 ± 9.05 vs. 10.11 ± 8.45 mm / 5 min, P = 0.370). Regarding dry eye symptoms, both OSDI and VAS were significantly lower in the pediatric group (P = 0.001 and < 0.001, respectively) than in the adult group. Pediatric patients with mild ocular surface damage may report fewer dry eye symptoms compared to adult patients with similar stages of ocular surface damage.

Comparison of ocular-surface disease index questionnaire, tearfilm break-up time, and Schirmer tests for the evaluation of the tearfilm in computer users with and without dry-eye symptomatology

ObjectiveTo compare the diagnostic values of the Schirmer’s and tearfilm breakup time (TBUT) tests and the Ocular Surface Disease Index (OSDI) in dry-eye syndrome.Subjects and methodsThirty-five employees of Ümraniye Training and Research Hospital who used computers in their daily work participated in this prospective study. All participants completed the OSDI. Following routine ophthalmologic examination, the TBUT and Schirmer’s test were undertaken and outcomes were compared.ResultsThe mean age was 29.09 ± 6.73 (range 20–46) years. Mean OSDI questionnaire, TBUT, and Schirmer’s test scores were detected as 37.12 ± 19.05 (range 4–75), 11.37 ± 3.69 seconds (range 4–18 seconds), and 25.80 ± 8.43 mm (range 6–35 mm), respectively. There was a significant inverse correlation between the OSDI and TBUT scores (r = −0.385, P = 0.022). No significant correlation existed between the OSDI and Schirmer’s test scores.ConclusionDry eye is a common problem among computer users. The OSDI questionnaire, used together with the TBUT, is easily performed and may be of benefit in supporting the diagnosis of dry-eye syndrome.

Association between Depression and Dry Eye Disease in an Elderly Population

A population-based cross-sectional study to investigate the association between depression and dry eye disease (DED) in a community-dwelling elderly population. The subjects were 657 Korean elders ≥ 65 years of age randomly selected from an official household registration database in Yongin, Korea. DED symptoms were assessed using the six-item Dry Eye Questionnaire. DED signs were evaluated using the Schirmer test, fluorescein stain score, tear film break-up time (BUT). Depression was assessed using the Korean version of the Short Geriatric Depression Scale (SGDS-K). The association between DED and depression was evaluated using logistic linear analyses. The SGDS-K score correlated with the number of positive responses in the Dry Eye Questionnaire (r = 0.229, P < 0.001), but not with tear film break-up time (r = 0.041, P = 0.139) or Schirmer test score (r = 0.048, P = 0.642). In the binary logistic regression model, female sex (P = 0.014), residence in urban areas (P < 0.001), depression (P < 0.001), and Schirmer score of ≤ 5 mm (P = 0.035) were associated with the risk of DED. Depression was associated with the risk of DED (P < 0.001) in the patients with Schirmer score > 5 mm but not in those with Schirmer score ≤ 5 mm (P = 0.290). Depression was associated with DED symptoms in subjects with normal or mildly reduced tear production.

Sicca complex among Egyptian patients with chronic hepatitis C virus infection

The objective of this study was to assess the prevalence of sicca complex (SC) in patients with chronic hepatitis C virus (HCV) infection and its association with clinical and laboratory features of liver disease. Subjective and objective criteria of xerophthalmia and xerostomia were investigated in 120 HCV Egyptian patients. The lacrimal gland function was assessed by: tear film break-up time and lid parallel conjunctival folds test (LIPCOF), dacroscintigraphy (DSG) for lacrimal drainage and that of salivary glands by sialoscintigraphy. Sixty six of 120 patients (55%) had SC; all (100%) were proved to have xerostomia by sialoscintigraphy and xerophthalmia detected by ophthalmologic tests. Using dacroscintigraphy all SC patients (100%) were positive for lacrimal drainage abnormalities. Only 10.1% were symptomatic for SC. None of our patients had anti-Ro or anti-La antibodies. The presence of SC was associated with older age (r = 0.28, p = 0.00), female gender (p = 0.001), cirrhosis (r = 0.34, p = 0.00), thrombocytopenia (r = -0.72, p = 0.00), and rheumatologic manifestation (p = 0.000), but not with viral load (r = 0.19, p = 0.06). DSG showed significant statistical correlation with ophthalmologic tests (r = 0.87, p = 0.00). High prevalence of SC in HCV Egyptian patients was detected. LIPCOF and DSG are objective and noninvasive methods for early diagnosis of xerophthalmia and assessment of the nasolacrimal drainage, respectively. Hindrance of lacrimal drainage proved by DSG was frequently encountered in HCV patients with SC (100%) and strongly correlated with xerophthalmia.

Estudio de la función lagrimal y la superficie conjuntival en pacientes diabéticos

Objectives This study was performed to investigate whether different grades of diabetic retinopathy correlate with tear and ocular surface function in diabetic patients without subjective symptoms of dry eye. Methods A total of 129 eyes of 72 patients without dry eye, assessed using McMonnies questionnaire were recruited to the study. The tear film and ocular surface were evaluated using the Schirmer test, tear film break-up time (BUT), fluorescein and lissamine green staining test, and conjunctival impression cytology. The results were analysed. Results A normal Schirmer test and BUT was obtained in 51 and 67% of the eyes of diabetics patients, respectively. Fluorescein and lissamine green staining were negative in 81 and 95% of the eyes. The area and density of goblet cells was 580.46 ± 370 μm 2 and 235.58 ± 109.03 goblets cell/mm 2, respectively. Conclusions Diabetic retinopathy patients without subjective symptoms of dry eye and normal Schirmer and BUT test showed pathological grades of squamous metaplasia.

Effects of estradiol–drospirenone on ocular and nasal functions in postmenopausal women

Background Hormones may have an impact on the incidence and course of dry-eye syndrome, and also nasal obstruction, especially in postmenopausal women. The aim of this study was to investigate the effects of drospirenone 2 mg + estradiol 1 mg (Angeliq®, Bayer AG, Berlin, Germany) on ocular functions and nasal airflow in postmenopausal women.Methods Thirty-four postmenopausal women were recruited for the study. A questionnaire on ocular surface disease index (OSDI) was administered; after routine ophthalmologic examination, tear film break-up time (TBUT) and Schirmer tests were performed. Intraocular pressure was measured with a Goldmann applanation tonometer. Nasal airflow resistance values were measured using rhinomanometry. Participants were submitted to oral daily treatment with drospirenone 2 mg + estradiol 1 mg. The duration of the study was 6 months and the participants were studied in the basal condition and after 6 months of therapy.Results The OSDI score and intraocular pressure were significantly higher before treatment than after treatment (p < 0.001); however, the results of the TBUT and Schimer test were significantly lower (p < 0.05). Rhinomanometric values were better during drospirenone 2 mg + estradiol 1 mg therapy than those observed at baseline (p < 0.001).Conclusions Oral daily treatment with drospirenone 2 mg + estradiol 1 mg reduces the risks for ocular diseases and nasal obstruction in postmenopausal women.

Study of tear function and the conjunctival surface in diabetic patients

ObjectivesThis study was performed to investigate whether different grades of diabetic retinopathy correlate with tear and ocular surface function in diabetic patients without subjective symptoms of dry eye. MethodsA total of 129 eyes of 72 patients without dry eye, assessed using McMonnies questionnaire were recruited to the study. The tear film and ocular surface were evaluated using the Schirmer test, tear film break-up time (BUT), fluorescein and lissamine green staining test, and conjunctival impression cytology. The results were analysed. ResultsA normal Schirmer test and BUT was obtained in 51 and 67% of the eyes of diabetics patients, respectively. Fluorescein and lissamine green staining were negative in 81 and 95% of the eyes. The area and density of goblet cells was 580.46±370μm2 and 235.58±109.03 goblets cell/mm2, respectively. ConclusionsDiabetic retinopathy patients without subjective symptoms of dry eye and normal Schirmer and BUT test showed pathological grades of squamous metaplasia.