BackgroundHuman umbilical cord blood (HUCB) serum eye drops contain growth factors, neurotrophic agents, and antimicrobial compounds that may promote ocular surface healing and regeneration. Sjögren’s syndrome is a chronic autoimmune condition characterized by reduced tear production and ocular surface damage, often resulting in severe dry eye symptoms. Mustard gas chemical veterans also suffer from similar debilitating ocular complications due to chronic inflammation and meibomian gland dysfunction. While conventional treatments offer symptomatic relief, they lack essential components of natural tears.Materials and methodsThis pilot randomized controlled trial will evaluate the efficacy of HUCB eye drops in three patient groups: (A) Sjögren’s patients treated with HUCB drops, (B) Sjögren’s patients receiving conventional treatment, and (C) mustard gas veterans receiving conventional treatment in the right eye and HUCB drops in the left eye. Patients will be assessed using subjective and objective tools, including the Ocular Surface Disease Index (OSDI), visual acuity, tear film breakup time (TBUT), SM tube test, and fluorescein staining based on SICCA criteria. Group allocation will follow a blocked randomization sequence for groups A and B; group C will follow a within-subject paired-eye design. Follow-up will occur at 30 and 60 days.DiscussionThis study aims to assess the regenerative potential of HUCB serum in patients with autoimmune and chemically induced dry eye. Its results may support broader clinical use of HUCB drops in treating severe ocular surface disorders, including conditions like Stevens-Johnson syndrome and industrial chemical exposures.Trial registrationThis trial was registered at the Iranian Registry of Clinical Trials (Registration number: IRCT20230925059512N1, Registration date: 2024-08-11).

Acupuncture with micro-needle for dry eye disease: A study protocol for a randomized, sham-controlled, clinical trial.

Purpose: To compare the performance of two preservative-free artificial tears with sodium hyaluronate (SH) in patients with moderate-to-severe dry eye: a 0.24% SH eye drop with carbomer (CB) and triglycerides (TGs) as lipids (SH-CB-TG), and a comparator with 0.18% SH (C-SH). Methods: Relief of Eye Surface by Triple Action (RESTA), a multicenter, investigator-masked, noninferiority study (NCT03368404) assessed patients with moderate-to-severe dry eye (N = 79). Patients were randomized 1:1 to receive drops containing SH, CB, and medium-chain TGs [0.24% SH, 0.0625% CB, and 0.2% TGs; SH-CB-TG (Artelac® Complete); n = 45] versus an SH-only drop (0.18%; C-SH; n = 34) instilled 3-6 times daily for 90 days. The primary endpoint was change from baseline to Day 28 in total ocular surface fluorescein staining (OSFS) with noninferiority defined as a between-group 95% confidence interval (CI) upper bound <2 grades. Secondary endpoints included global OSFS at Day 90, individual OSFS component scores, dry eye symptoms, tear film break-up time, Schirmer's test, quality of life (QoL) measures, and instillation frequency. Results: At Day 28, mean OSFS score in the SH-CB-TG group decreased by 2.07 ± 1.67 versus 1.50 ± 1.64 for C-SH; the 95% CI upper limit was 0.13, confirming noninferiority. Dry eye signs, symptoms, and QoL measures improved continuously in both groups, with the SH-CB-TG group showing significantly improved QoL globally at Day 90 (P = 0.0306) and across several individual QoL parameters, plus an acceptable safety profile. Conclusions: Including medium-chain TGs in dry eye drops provides noninferior improvements of dry eye signs and symptoms versus viscosity agent-only drops and may enhance patient QoL.

ABSTRACT Purpose: To evaluate the association between strabismus and dry eye disease (DED), with a particular focus on the effect of alternation status on DED. Methods: Eighty eyes of 40 patients with constant strabismus were evaluated in this prospective, cross-sectional study. DED was evaluated using the Ocular Surface Disease Index (OSDI), Schirmer I test, noninvasive tear breakup time (NITBUT), tear film breakup time (TBUT). NITBUT values, including first breakup time (first NITBUT) and average breakup time (average NITBUT), were automatically calculated using a Scheimpflug corneal topography device. Results: The mean age was 16.9 ± 11.8 years, with an average deviation duration of 11.3 ± 11.4 years. Eighteen patients had good alternation, and 22 had poor alternation. Patients with poor alternation exhibited shorter first NITBUT and average NITBUT values in the deviating eyes compared to their sound eyes (p = .026 and p = .048, respectively). No significant correlations were found between DED findings and age, gender, deviation type or angle (all p > .05). However, OSDI scores correlated significantly with age (p < .001), duration of deviation (p < .001), and alternation status (p = .004). Additionally, the difference in first NITBUT values between the two eyes increased with a larger angle of distant deviation (p = .024) and worsening alternation status (p = .036). Conclusion: DED signs and symptoms may be more pronounced in the deviating eye of strabismus patients with poor alternation. Closer monitoring for DED in strabismus patients with poor alternation, especially in older individuals, may be advisable.

ABSTRACT Objective: To screen influencing factors of dry eye and evaluate a new diagnosis and treatment model combining tertiary hospitals with community health management. Methods: A total of 500 community residents from two Chinese hospitals between January – September, 2023 were included. Dry eye was diagnosed based on the presence of typical symptoms, an OSDI score > 13, a tear film break-up time (BUT) < 10 seconds, and/or a Schirmer I test (SIT) result < 10 mm/5 min, following the 2020 Chinese Dry Eye Expert Consensus. Diagnosed patients were randomized into a management group (community health management) and a control group (self-management). Both received standardized hospital treatment for six months. Disease cognition, symptom improvement, psychological state, eye comfort, satisfaction, and quality of life were compared. Results: Dry eye prevalence was 26.40% (132/500). Univariate analysis identified age, sex, drug use, connective tissue disease, laser corneal surgery, vitamin A deficiency, hepatitis C, mite infection, anxiety, depression, sleep disorder, and diabetes as influencing factors (p < 0.05). After six months, the management group showed better disease cognition, improved BUT and SIT, and lower OSDI scores than the control group (p < 0.05). SAS and SDS scores were lower, and VAS scores were reduced, while GQLI and management satisfaction were higher (p < 0.05). Conclusion: Factors such as drug use, laser surgery, vitamin A deficiency, hepatitis C, mite infection, and psychological and metabolic conditions influence dry eye. A combined hospital-community management model improves symptoms, psychological well-being, disease awareness, quality of life, and treatment satisfaction.

Investigating retention time and fluid dynamics of the vehicles in non-invasive topical ocular drug delivery systems.

In Vivo evaluation of autologous serum eye drops obtained via a closed-circuit collection device: Preliminary analysis of a Phase 2 pilot trial

Efficacy and safety of Syk/VEGFR-2 Dual-target Kinase Inhibitor (OT202) in Dry Eye: A Randomized, Vehicle-controlled, Phase 2 Trial.

ABSTRACT Clinical relevance Facial paralysis (FP) often leads to ocular surfacedisorders due to delayed or incomplete blinking. Background This study aimed to evaluate the ocular surface andmeibomian glands (MG) in patients with unilateral FP. Methods A total of 26 patients with unilateral FP were included.Invasive tear film break-up time (TF-BUT), ocular surface staining score,Schirmer II test, total eyelid score, and MG secretion score were assessed.Non-contact meibography was used to evaluate the percentage of MG loss area,meiboscore, and morphological features (thickening, thinning, tortuosity,fluffy areas, shortening, ghost areas) of the MGs. Results TF-BUT and Schirmer II test values were significantlylower in the FP group (p < 0.001 and p = 0.001, respectively). The Oxfordstaining score, MG expressibility score, and total eyelid score weresignificantly higher in the FP group (p < 0.001, p = 0.003, and p = 0.005,respectively). Meiboscore values were higher in both the upper and lowereyelids in the FP group compared to the control group, with a statisticallysignificant difference only in the lower eyelid (p = 0.270 for upper and p = 0.039 for lower). The presence of MG thickening wasremarkable in the FP group. The House-Brackmann grade was identified as theonly independent factor affecting both upper and lower eyelid meiboscores. Conclusion Facial paralysis impairs ocular surface parameters andincreases lid margin abnormalities. It is associated with higher meiboscoresand deterioration in meibomian gland morphology.

Background/Objective: Tear hyperosmolarity is the main triggering factor in the immunopathogenesis of dry eye disease (DED). Tear osmolarity is known as the relevant metric to evaluate DED severity; however, measuring tear osmolarity after slit lamp examination (SLE) is known as a contraindication due to variability. In this study, we investigated the effects of SLE and fluorescein staining (FS) on the variabilities of tear osmolarity. Methods: In this prospective observational study sixty-five patients were enrolled in the study, comprising 31 healthy controls and 34 DED patients. The tear osmolarity was measured in the right eye using the TearLab® system. The initial measurements were performed to establish baseline values before SLE, and additional measurements were performed after 20 s of SLE and followed by 20 s of SLE+FS. There were five-minute intervals between measurements. A correlation analysis was performed between OSDI score, tear film break-up time (TBUT), and tear osmolarity. A linear mixed-effects model was also applied to account for repeated measures and inter-subject variability. Results: The mean ages of the control and DED group were 31.3 ± 11.5 and 50.5 ± 15.5 years. Increased tear osmolarity was significantly associated with greater OSDI score and lower TBUT only in DED patients, but not in normal controls (OSDI:R = 0.378/p = 0.030, TBUT:R = -0.543/p = 0.011). The mean tear osmolarities in the normal controls were 298.3 ± 11.3, 299.1 ± 13.3, and 297.0 ± 12.6 mOsm/L at baseline (group 1), after SLE (group 2), and after SLE+FS (group 3), respectively, with no significant difference (p = 0.379). However, there was a significant difference in the tear osmolarities of the three groups in the DED patients (296.1 ± 11.5, 296.5 ± 11.0, and 291.2 ± 11.3 mOsm/L for groups 1-3, respectively/p < 0.001). The tear osmolarity of group 3 was significantly lower than those of groups 1 and 2 in the DED patients (p = 0.010/0.016). After FS, the mean tear osmolarity decreased by 4.9 ± 9.2 mOsm compared to the baseline in DED group. Conclusions: Tear osmolarity was only decreased in DED patients after SLE+FS, whereas it was unaffected in normal control subjects. Increased tear osmolarity in only DED patients correlated with increased symptom scores and decreased TBUT. These fluctuations in tear osmolarity reflect compromised tear film homeostasis in DED, highlighting the need to contextualize osmolarity data with clinical DED parameters.

To investigate the effect of coal industry-related airborne particulate matter (PM) on ocular surface tear film injury and inflammatory factor expression. Male Sprague-Dawley (SD) rats were randomly divided into the treatment group and the normal control group, with five rats in each group. A dust chamber was used to simulate the air contamination conditions associated with the coal industry. Tear secretion, tear-film breakup time (BUT), conjunctival congestion score, and relative expression levels of tear inflammatory factors, including interleukin (IL)-6, IL-17, and tumor necrosis factor (TNF)-α, were compared between the treatment group and the normal control group. After 4 weeks’ exposure, tear secretion (2.64 ± 0.57 mm vs 5.42 ± 0.28 mm), BUT (4.23 ± 0.47 s vs 6.15 ± 0.36 s), and conjunctival congestion score [2 (2, 3) vs 0 (0, 1)] were significantly different between the treatment group and the control group (all P < 0.05), and hematoxylin-eosin stain showed that the number of goblet cells decreased in the treatment group. In addition, the relative expression levels of IL-6, IL-17, and TNF-α in tears of the treatment group were significantly different from those of the normal control group (all P < 0.05). Coal industry-related airborne PM exposure can damage tear film function and increase relative expression levels of tear inflammatory factors in SD rats.

BACKGROUNDDry eye, also known as keratoconjunctival dryness, refers to a group of conditions that lead to eye discomfort and visual dysfunction. Being one of the most common complications of diabetes, it can lead to vision loss and, in severe cases, blindness in patients with diabetes.AIMTo investigate ocular dryness manifestations, assess corneal neuropathy, and identify associated influencing factors in patients with type 2 diabetes (T2D) complicated with comorbid dry eye syndrome (DES).METHODSData from 81 patients with T2D admitted to Xianyang First People’s Hospital between January 2022 and June 2023 (18 months) were retrospectively reviewed. Patients were divided into the DES and non-DES groups. Additionally, 50 individuals who concurrently underwent medical examinations served as the control group. Standardized assessments were conducted, including evaluations using the standard patient evaluation of eye dryness (SPEED) tool, noninvasive tear film breakup time (NIBUT) analysis, and Schirmer I test (SIt) determination of wetting length. Under a corneal confocal microscope, subbasal corneal neuropathy evaluations were conducted to determine the density, length, number, and tortuosity of the main nerves. Associations among SPEED scores, NIBUT, SIt results, and subbasal corneal neuropathy parameters in the DES group were examined. The DES and non-DES groups were further analyzed for differences in baseline characteristics, and potential risk factors for DES in patients with T2D were identified by multivariate logistic regression modeling.RESULTSThe T2D + DES group showed an increase in the SPEED score, along with a decrease in the NIBUT and SIt wetting length, compared with the non-DES and control groups (P < 0.05); however, no marked inter-group differences were noted for fluorescein staining test scores between T2D + DES group and DES group. Compared with the non-DES groups, the DES group exhibited reductions in density, length, and number of the main nerves, as well as an increase in nerve tortuosity (all P < 0.05), and all these changes were more pronounced in the non-DES group than in the DES group (all P < 0.05). In the DES group, the SPEED score demonstrated a significant negative correlation with nerve density and the length and number of the main nerves but a positive correlation with nerve tortuosity. Conversely, both the NIBUT and SIt wetting length showed a positive association with the density and number of the main nerves; however, the SIt wetting length demonstrated an inverse correlation with nerve tortuosity. Multivariate modeling identified several independent risk factors for DES in T2D, such as age, diabetes duration, lacrimal gland dysfunction, and insufficient insulin secretion, as well as fasting blood glucose and glycated hemoglobin.CONCLUSIONPatients with T2D are more susceptible to DES. The T2D + DES group exhibited significant reductions in the density, length, and count, along with increased tortuosity, of the main nerve. These corneal nerve changes are also intimately linked to the severity of DES.

To investigate regional changes in tear film quality associated with orthokeratology (Ortho-K) lens wear using high-resolution spatial mapping and to evaluate the potential of artificial intelligence (AI) models in anticipating these changes. This study analysed tear film quality in 92 Ortho-K wearers divided into three groups based on lens wear duration (10-29 days, 30-90 days, and ≥91 days). Placido-based topographer measurement was used to generate regional tear film maps before and after treatment. A custom MATLAB pipeline enabled regional comparisons and statistical mapping. A feedforward neural network was trained to forecast local tear film quality using spatial data. Single-value global mean metrics showed minimal changes in tear film quality across groups. However, regional mean mapping revealed significant mid-peripheral and peripheral deterioration over time, particularly in nasal and temporal corneal zones. These changes were often overlooked by global averaging and remained invisible through tear film breakup time (TBUT) measurements. The AI model predicted spatial tear quality with high accuracy (R ≥ 0.9 in testing), capturing nuanced regional variations. The regional analysis uncovers subtle, clinically relevant tear film disruptions caused by Ortho-K lens wear, particularly in peripheral areas. These insights challenge the adequacy of traditional single-value global mean assessments. The AI model demonstrates the potential for non-invasive, predictive evaluation of tear stability, supporting more personalised and effective Ortho-K care.

Relevance. Modern methods of corneal keratotopography and tomography play a key role in the diagnosis, monitoring, and surgical treatment planning of keratoconus (KC). However, the accuracy of measurements in KC may be affected by instability of the precorneal tear film (PTF) induced by dry eye syndrome (DES). Purpose: to evaluate the clinical significance of PTF changes in KC on the interpretation of corneal tomographic data and to develop an optimized diagnostic protocol for minimizing their impact. Patients and methods. The study included 115 patients (230 eyes) with bilateral non-operated KC. A comprehensive assessment of PTF status was performed (biomicroscopy of the anterior segment using vital dyes, tear film break-up time — Norn’s test, total and basal tear secretion — Schirmer’s and Jones’ tests), followed by Scheimpflug tomography (evaluating key topographic indices, kerato- and pachymetry, as well as elevation, asphericity, and wavefront aberrations) before and after instillation of sodium hyaluronate-based artificial tears. Results. The results revealed significant PTF instability in KC patients, manifested by reduced tear film break-up time and high corneal staining intensity. After temporary PTF stabilization with artificial tears, a significant decrease was observed in anterior corneal surface indices (ISV, IVA, KI, CKI, IS, IHD), keratometry values (K1, K2, Kmean, Kmax), and aberrations (RMS total, LOA, HOA). Strong correlations were found between PTF status and topographic parameters: positive with staining (r = 0.621–0.787) and negative with tear film break-up time (r = –0.334 to -0.787). Conclusion. PTF impairment in KC significantly distorts tomography results, potentially leading to misdiagnosis of disease progression. Instillation of artificial tears prior to examination improves measurement accuracy by minimizing PTF instability-related artifacts. Implementing standardized PTF assessment and correction in the diagnostic algorithm for KC patients enhances data reproducibility and clinical decision-making reliability.

A Novel Comparative Study of Inflammatory Cytokines Through Noninvasive Tear Analysis in Children With Myopia Versus Emmetropia.

BackgroundPostoperative dry eye disease (DED) is a common complication following cataract surgery with intraocular lens (IOL) implantation, adversely affecting ocular comfort and visual outcomes. Identifying risk factors and developing predictive models may facilitate targeted interventions and improved patient management.MethodsA retrospective analysis was conducted involving 376 cataract patients who underwent phacoemulsification with IOL implantation between January 2021 and December 2024. Patients were divided into a DED group (n = 158) and a non- DED group (n = 218) based on clinical evaluation, including the Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear film break-up time (BUT), Schirmer I test (SIt), and fluorescein staining (FL) scores. Risk factors were identified using univariate and multivariate logistic regression analyses. A nomogram was constructed from significant predictors and assessed by receiver operating characteristic (ROC) analysis, bootstrap internal validation, and decision curve analysis (DCA).ResultsThe incidence of postoperative DED was 42.02% (Among the DED patients, 66.46% had mild DED, and 33.54% had moderate DED). Univariate analysis revealed that patients with DED were significantly older and had a higher prevalence of orthokeratology lens wear, diabetes, and rheumatoid arthritis, along with worse nuclear hardness grading, prolonged surgical time, abnormal ocular surface stress test (OSST) results, and impaired ocular surface parameters (all p < 0.05). Multivariate analysis identified orthokeratology lens wear (OR 3.472, p = 0.018), diabetes (OR 3.193, p = 0.016), diminished meibomian gland secretion (OR 3.228, p = 0.033), increased meibum viscosity (OR 3.548, p = 0.018), and elevated conjunctivochalasis grade (OR 3.092, p = 0.027) as independent predictors. The nomogram demonstrated an AUC of 0.761, with a sensitivity of 71.67% and specificity of 82.18%. Internal validation yielded a corrected C-index of 0.785, and DCA confirmed its clinical utility.ConclusionsIn this study, orthokeratology lens wear, diabetes, and adverse ocular surface parameters, including diminished meibomian gland secretion, increased meibum viscosity, and elevated conjunctivochalasis grades were statistically associated with the occurrence of postoperative DED following IOL implantation. The nomogram developed from these associations demonstrated moderate discriminatory ability (AUC = 0.761) and good calibration. Prospective studies and external validation in diverse populations are warranted to confirm the model’s generalizability and predictive performance.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12886-025-04369-1.

Postoperative dry eye disease (DED) remains a frequent complication that can reduce patient satisfaction and surgical outcomes. Low-level light therapy (LLLT) is a non-invasive technology that has shown positive outcomes in managing DED. This study aimed to assess the prophylactic application of perioperative LLLT for improving ocular surface parameters and symptoms in consecutive patients undergoing cataract surgery. In this prospective, double-masked, randomized sham-controlled study, patients scheduled for cataract surgery were randomized to receive either periocular LLLT or sham treatment 1week before and 1week after surgery. Ocular surface assessments, including Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (BUT), Schirmer test type I, tear osmolarity, and corneal fluorescein staining (Oxford score), were performed preoperatively before the first treatment/sham session (T0), and postoperatively 1week (T1) and 1month postoperatively (T2). All patients received the same postoperative therapy. Out of 98 patients randomized to LLLT (50 patients) or sham treatment (48 patients), 89 patients (45 males, 44 females; mean age of 73.75 ± 7.95years) completed the study. Unlike controls, the LLLT group showed significant improvements from T0 to T1 and T2 for OSDI scores (respectively, from 26.62 ± 15.42 to 15.53 ± 12.04 and 13.36 ± 11.69; p < 0.001) and BUT values (respectively, from 5.76 ± 3.99 to 6.69 ± 4.48 and 8.38 ± 4.53; p = 0.002), and from T0 to T2 for tear osmolarity (respectively, from 300.69 ± 14.19mOsm/l to 296.11 ± 12.30mOsm/l; p = 0.048). No significant differences were found in Schirmer test values within or between the two groups. No adverse effects were reported. Perioperative LLLT is a safe, well-tolerated, and effective treatment for preventing iatrogenic DED in cataract surgery. Integrating LLLT into the routine perioperative care may enhance patient satisfaction and overall outcomes in the setting of cataract surgery. NCT07067294, retrospectively registered on 05.07.2025.

Prostaglandin F2α exacerbated dry eye by promoting lacrimal gland fibrosis progression through the activation of the RhoA/ROCKs signaling pathway.

Repurposing schirmer strips for tear biomarker profiling using infrared spectroscopy.

Fenofibrate ameliorates ocular surface inflammation in diabetic keratopathy.