Tear Film Break-up Time Research Articles

EFFECTS OF COMPUTER VISION SYNDROME ON TEAR FILM QUALITY OF INDIVIDUALS ACROSS VARIOUS AGE GROUPS AND OCCUPATIONS

Objective: Computers become a part of everyday life because it has to a greater extent, revolutionized most professions and their work performance. Spending uninterrupted and excessive time in computers and other display devices without taking precautions and prevention leads to significant ocular problems, which are being grouped together as - computer vision syndrome (CVS). The present study was conducted in a tertiary care center to evaluate the effects of CVS on tear film quality in individuals across various age groups and occupations. Methods: A cross-sectional study was conducted at a teaching institute from August 2021 to September 2022, in which 600 patients who worked on computers or digital devices for at least 3 h daily were included in this study. In all patients, a complete ocular examination was performed, including visual acuity, refraction, Schirmer’s test 1, tear film breakup, slit-lamp examination, intraocular pressure, and fundus examination by indirect ophthalmoscopy. Results: In the present study, most of the participants in this study belonged to 21–30 years of age. Among study participants with CVS and screen time of more than 8 h, 88% had moderate and severe dry eyes. On comparison of mean values of the Schirmer’s test between participants with CVS, it was observed that mean Schimers (4.5 mm in the right eye and 5 mm in the left eye) and tear film breakup time (4.9) were much lower among study participants with CVS whose screen usage time was more than 8 h. Conclusion: The present study found that computer vision conditions are very common. In addition, the likelihood of developing the same was higher among IT employees and engineering students.

Diagnosing dry-eye: Which tests are most accurate?

PurposeTo demonstrate how the likelihood of making a correct diagnosis of dry eye disease varies according to the clinical test methods used. MethodsThe probability of a person having dry eye, given that they return a positive test, was calculated for a range of standard tests, using the Bayes-Price rule. Global specificity and sensitivity values for each test were estimated by employing the Beta distribution to combine all relevant data obtained from a literature review. ResultsAt an assumed prevalence of 11.6%, the single test with the highest probability of a correct diagnosis was corneal staining (probability = 0.28) and the lowest was the ocular surface disease index - OSDI (0.14). The best combination of symptoms with a single test of tear film homeostasis was the 5-item dry eye questionnaire (DEQ-5) + corneal staining (0.42) while OSDI + tear film break up time (TBUT) was the worst (0.23). The simultaneous observation of conjunctival and corneal staining was associated with a probability of 0.49. The probability of a correct diagnosis increased with the number of positive tests, up to a maximum of 0.90 when all of DEQ-5, conjunctival and corneal staining, osmolarity and TBUT were positive. ConclusionA significant risk of misdiagnosis is associated with using any single test for dry eye disease, or the minimum TFOS DEWS II criterion of symptoms plus any single test of tear film homeostasis. To minimize this risk, the maximum number of tests available should be performed and the results used to inform diagnosis. The simultaneous occurrence of conjunctival and corneal staining should be considered a key outcome and be specified in future guidelines.

Efficacy and safety of 1% and 2% rebamipide clear solution in dry eye disease: a multicenter randomized trial

BackgroundTo evaluate the efficacy of 1% and 2% rebamipide clear solution in the treatment of dry eye disease (DED).MethodsTwo hundred twenty patients with DED were randomly assigned to one of three groups: the 1% rebamipide, 2% rebamipide, or placebo (eye drops containing the same ingredients, except for the active components). Each eye drop was instilled four times daily for 12 weeks. Changes in tear film break-up time (TBUT), corneal and conjunctival staining score, Schirmer 1 test, and the Ocular Surface Disease Index (OSDI) from baseline to 12-week visit between the study groups were compared for efficacy assessment.ResultsThe mean age of study patients was 43.8±14.2 years. The 1% and 2% rebamipide groups showed greater improvement in TBUT (1.99±1.87 and 2.02±2.21 s) at 12 weeks from baseline than the placebo group (1.25±2.93 s). The 2% rebamipide group showed greater improvement in the corneal staining score (− 3.15±2.00) at 12 weeks from baseline than the placebo group (− 2.85±1.80). The 1% and 2% rebamipide groups showed improvement in Schirmer 1 test (1.27±3.86 and 1.50±4.14 mm) at 12 weeks of treatment, but not the placebo group (0.55±2.99 mm). Both the rebamipide groups and the placebo group showed significantly improved OSDI after treatment for 12 weeks; however, there was no significant difference among the three groups.Conclusions1% and 2% rebamipide clear solutions are an effective therapeutic option for improving TBUT and tear volume, and stabilizing the corneal staining score in DED.

Clinical Profile of Vernal Keratoconjunctivitis (VKC) Patients: A Retrospective Study at a Peripheral Combined Military Hospital in Bangladesh

Background: Vernal keratoconjunctivitis (VKC) is an allergic eye disease that especially affects young boys. The most common symptoms are itching, photophobia, burning, and redness. This study was conducted to assess the clinical profile of vernal keratoconjunctivitis (VKC) among the local population reported at a peripheral combined military hospital over 1 year. This study aimed to analyze the cases of vernal keratoconjunctivitis at a peripheral combined military hospital. Material & Methods: This is a retrospective study carried out in the Department of Ophthalmology at Combined Military Hospital, Saidpur. A total number of 110 patients with VKC were diagnosed based on their history, clinical features, and characteristic symptoms and sign over a period of 1 year from Jan 2021 to Dec 2021. Best-corrected visual acuity (VCVA) was assessed and each patient was thoroughly examined with a Slit Lamp Bi microscope, Fluorescein staining, and Tear film break-up time. Follow-up was done every 4 weeks, 3 months, and 6 months for 01 year. A purposive sampling technique was used in this study. Data was collected by a pre-designed questionnaire. All data were analyzed using SPSS version 20 (IBM Corp, Armonk, NY, USA) results were compiled in the frequency distribution table. Informed written consent was taken from all participants. Ethical clearance was obtained by the ethical committee of CMH. Results: Out of 110 patients, 80 (72.72%) were male and 30 (27.27%) were female. The highest incidence of VKC occurred in the age group of 11–15 years. In maximum cases 70 (63.63%) had palpebral form followed by mixed form 25 (22.72%) and then bulbar form 15 (13.63%). Corneal complications occurred in 27 (24.54%) patients; Out of 27, 25 patients had minor complications and 2 had major complications. The minor complications were usually superficial punctate keratopathy (SPK) or other epithelial disturbance. Major complications were superior pannus and pseudogerontoxon. Although patients with VKC often give a history of allergies or atopic diseases such as allergic rhinitis, asthma, or hay fever, in the present study, coexisting allergic conditions could be detected only 40 (36.36%) patients. Conclusion: VKC is a common form of allergic conjunctivitis among the age group of 11–15 years of male patients. The most common is the palpebral form followed by mixed and then bulbar forms. Some cases showed a history of atopy and other allergic conditions.

Novel treatment of chalazion using light-guided-tip intense pulsed light

We assessed the effectiveness of light-guided-tip intense pulsed light (IPL) with meibomian gland expression (MGX) in chalazion treatment. Ninety-five eyes with chalazion received a light-guided-tip IPL-MGX treatment (IPL-MGX group), and another 95 eyes with chalazion received incision with curettage treatment (Control group). Prior to IPL or incision, as well as 1 month after the final treatment, data were gathered pertaining to the lesion location and size, hyperemia, lesions regression or recurrence, and a comprehensive ophthalmic examination. The total size of the chalazia in the IPL-MGX group was significantly reduced after the final treatment, with an average resolution rate of 70.5%, which is comparable to excision surgery. A significant decrease in chalazion recurrence rate was apparent after treatment in the IPL-MGX group compared with control. Moreover, the IPL-MGX demonstrated significant advancements throughout noninvasive tear film breakup time (NIBUT) as well as meibum grade in comparison to baseline and those in the the Control group. The use of IPL-MGX was found to be an efficient therapy for reducing the size and recurring frequency of chalazia, as well as for improving the meibomian gland function. It may be considered as a first-line treatment for cases of primary or recurrent chalazia with inflammation.

The efficacy and safety of 0.01% atropine alone or combined with orthokeratology for children with myopia: A meta-analysis.

To evaluate the efficacy and safety of 0.01% atropine alone and in combination with orthokeratology for myopia control using a meta-analysis. PubMed, Cochrane Library, and EMBASE were searched. We included eligible randomized controlled trials (RCTs), non-RCTs, and retrospective cohort studies, published up to August 1, 2022. We calculated the weighted mean difference (WMD) and 95% confidence interval (CI) for all outcomes and plotted them in forest plots. Fourteen studies were included; 4 and 11 in the 0.01% atropine monotherapy and atropine-orthokeratology (AOK) groups, respectively. Compared with orthokeratology (OK) alone, 0.01% atropine alone had similar effects on slowing the axial elongation (WMD: -0.00 mm; 95% CI: -0.05-0.04, p<0.31), while AOK significantly lowered axial growth. Moreover, the baseline myopic degree and duration of treatment were influential for the change in axial elongation (WMD: -0.12 mm; 95% CI: -0.17--0.07, p = 0.00001 and WMD: -0.11 mm; 95% CI: -0.15--0.108, p<0.00001, respectively). Additionally, the AOK may reduce the change rate of the spherical equivalent refraction and the accommodation amplitude (WMD: -0.13 D; 95% CI: 0.07-0.19, p<0.001 and WMD: -1.08 mm; 95% CI: -1.73--0.43, p<0.0001, respectively), and cause a slight increase in the diameter of the pupil (WMD: 0.56 mm; 95% CI: 0.43-0.70, p = 0.007). No significant differences in the uncorrected distant visual acuity, best corrected visual acuity, intraocular pressure, tear film break-up time, lipid layer thickness, and corneal endothelial cell density were found between the OK and AOK groups. In slowing the axial elongation, 0.01% atropine alone and OK alone have similar effects, while AOK is more effective than OK alone in slowing down the axial elongation. Furthermore, the baseline degree of myopia and treatment duration may affect changes in axial elongation.

Ocular manifestations and quality of life in patients after hematopoietic stem cell transplantation.

To explore the relationship between ocular and systemic conditions and the impact of ocular complications on the quality of life (QOL) in patients after allogeneic hematopoietic stem cell transplantation (ALLO-HSCT). Forty-four patients with severe hematopoietic disease were enrolled after ALLO-HSCT at our center from July 2018 to October 2020. They completed two questionnaires: the Ocular Surface Disease Index (OSDI) and the quality-of-life scale for Chinese patients with visual impairment (SQOL-DV1). Ocular conditions and systemic conditions were also assessed. Eye damage was correlated with total bilirubin (P=0.005), and gamma-glutamyl transferase (GGT) (P=0.021). There was no significant correlation between the overall QOL score and OSDI (P=0.8226) or SQOL-DV1 (P=0.9526) scores. The OSDI and the overall QOL score were not correlated with ocular conditions, including best-corrected visual acuity (BCVA), intraocular pressure, Schirmer tear test II, sodium fluorescein staining, tear film breakup time, and tear meniscus height. SQOL-DV1 was correlated with BCVA (P=0.0007), sodium fluorescein staining (P=0.007), and tear film breakup time (P=0.0146). In some patients, early ocular symptoms are not evident after ALLO-HSCT, while ocular surface complications can be observed after a comprehensive ophthalmological examination. Especially for those with elevated total bilirubin or GGT, regular ophthalmic follow-up visits are essential to diagnose and treat ocular graft versus host disease (oGVHD), especially for patients with elevated total bilirubin or GGT.

Loss of Blink Regularity and Its Impact on Ocular Surface Exposure.

(1) Background: Changes in blink parameters have been found to influence ocular surface exposure, eliciting symptoms of dry eye and ocular signs. The aim of the study was to highlight the relevance of including blink regularity as a new parameter to fully characterize blinking; (2) Methods: A novel characterization of blink parameters is described, including spontaneous eyeblink rate (SEBR), percentage of incomplete blinks, and blink regularity. A pilot study was designed in which tear film break-up time (TFBUT), blink parameters, and the time percentage of ocular surface exposure were determined in eight subjects (52.0 ± 16.6 years, 4 females) in three experimental conditions (baseline, reading a hard-copy text, and reading from an electronic display). Blink parameters were monitored through asynchronous image analysis of one minute video segments; (3) Results: All blink parameters were influenced by experimental conditions. A trend was observed in which both reading tasks resulted in an increase in ocular surface exposure, mainly related to a combination of reduced SEBR, increased percentage of incomplete blinks, and loss of blink regularity; (4) Conclusions: A complete characterization of blink parameters is relevant to better understand ocular dryness related to surface exposure and to advice patients towards a reeducation of their blinking habits.

Short-term application of diquafosol ophthalmic solution benefits children with dry eye wearing orthokeratology lens.

This aim of this study was to evaluate the effect of 3% Diquafosol Ophthalmic Solution (DQS) on children with dry eye from wearing overnight orthokeratology (OrthoK) lenses. Myopic children aged 8-18 years with dry eye syndrome were enrolled in this prospective observational study, and they were grouped according to their OrthoK treatment history for at least 1 year. All participants received DQS 4 times per day for 1 month. The following indicators were measured at baseline 1 month after treatment: the Dry Eye Questionnaire-5 (DEQ-5), non-invasive tear meniscus height (TMH), non-invasive tear film break-up time (first and average, NIBUT-F and NIBUT-A), meibomian gland score (MG score), conjunctival hyperemia redness score (R-scan), and blink pattern analysis. A total of 104 participants (189 eyes) including 40 OrthoK wearers (72 eyes) and 64 Orthok candidates (117 eyes) completed the study. Of all, after DQS treatment for 1 month, DEQ-5 scores reduced from 5.54 ± 3.25 to 3.85 ± 2.98 (t = -3.36, p = 0.00). TMH increased from 0.20 ± 0.05 mm to 0.21 ± 0.05 mm (t = 2.59, p = 0.01), NIBUT-F and NIBUT-A were prolonged from 6.67 ± 4.71 s to 10.32 ± 6.19 s and from 8.86 ± 5.25 s to 13.30 ± 6.03 s (all p = 0.00), respectively. R-scan decreased from 0.69 ± 0.28 to 0.50 ± 0.25 (t = -9.01, p = 0.00). Upper MG scores decreased from 1.04 ± 0.32 to 0.97 ± 0.36 (t = -2.14, p = 0.03). Lower MG scores, partial blink rate, partial blinks, and total blinks did not change significantly. Both break-up time (BUT) and R-scan improved significantly after DQS treatment for 1 month (all p = 0.00) in OrthoK candidates and OrthoK wearers. Among the OrthoK wearers, TMH and dry eye symptoms increased significantly (all p = 0.00) but did not increase in OrthoK candidates (p > 0.05). There were no adverse events related to DQS. Diquafosol Ophthalmic Solution was effective for children wearing overnight orthokeratology in relieving dry eye symptoms and improving ocular surface parameters, which may help improve children's OrthoK wearing tolerance and compliance.

Vitamin D Status Among Patients With Dry Eye Syndrome Attended In Bangabandhu Sheikh Mujib Medical University (BSMMU)

Background: Dry eye syndrome (DES) is a common ocular manifestation. Artificial tears provide relief of eye irritation in patients with aqueous tear deficiency, but do not treat the underlying inflammation in Dry eye syndrome. Aim: To assess the vitamin D status of the dry eye syndrome patients. Methodology: This cross-sectional study was conducted in the Department of Community Ophthalmology, BSMMU, Shahbag, Dhaka, from July 2019 to June 2020. Within the period a total of 50 cases of dry eye syndrome patients that met the inclusion criteria were taken as samples after receiving their informed consent. Detailed history, physical examination and Ophthalmological examination including Tear film Breakup Time (TBUT) of each patient was performed and recorded. Eye discomfort was assessed by the Ocular Surface Disease Index (OSDI) the score of which ranges from 0 to 100. A score of 12 was used as a cutoff for normal, 13–22 for mild dry eye, 23–32 for moderate dry eye, and ≥ 33 for severe dry eye. Tear film Breakup Time (TBUT) &lt;10 s was taken as abnormal. Results: In this study, mean (±SD) fluorescein Tear film Breakup Time (TBUT) was 5.89±1.31 sec, Schirmer test without anesthesia was 7.45±2.31mm/5 min, Schirmer test with anesthesia was 9.06±2.06mm/5 min and Ocular Surface Disease Index (OSDI) was 34.44±5.64. Mean (±SD) serum vitamin D level ng/mL was 5.89±1.31 ng/mL. 14 (28%) cases were found as insufficient, 33 (66%) cases were deficient and only 3 (6%) cases found to have normal Vitamin D status. Vitamin D level was positively correlated with Tear Breakup Time (TBUT), Schirmer test1 and Schirmer test2 and negatively correlated with OSDI. This correlation was statistically significant for Tear film Breakup Time (TBUT), Schirmer test2 and Ocular Surface Disease Index (OSDI). Conclusion: Vitamin-D deficiency appears to have an effect on ocular surface parameters in patients with dry eye syndrome. The Journal of Ad-din Women's Medical College; Vol. 11 (2), July 2023; p 3-8

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.

A Clinical Study on Severity of Dry Eye in Individuals with Pterygium at a Tertiary Hospital in South Kerala.

To assess the severity of dry eye in individuals with pterygium in a tertiary care hospital. This cross-sectional study was done on 70 individuals with pterygium who were attending the outpatient department of ophthalmology. Objective dry eye tests were done, including Schirmer's tests 1 and 2, tear film breakup time, and tear meniscus height (TMH). In this study, patients with one or more positive clinical tests were diagnosed to have dry eyes. Dry eye was graded as mild, moderate, severe, or severe disabling. Among 140 eyes, 79 eyes had pterygium. According to Schirmer's test 1 in eyes with pterygium, 29.1% of the eyes had mild dry eyes, and 26.6% had moderate dry eyes. According to Schirmer's test 2 in eyes with pterygium, 25.3% of the eyes had mild dry eyes, and 26.6% had moderate dry eyes. Tear film breakup time in eyes with pterygium showed a mild dry eye in 25.3% and moderate dry eye in 17.7%. TMH in eyes with pterygium was low at 7.6%. The majority of eyes with pterygium have mild or moderate dry eye according to Schirmer's test 1, Schirmer's test 2, and tear film breakup time. No eyes with pterygium have severe dry eyes. TMH was also low in a small proportion of eyes with pterygium. Dry eye evaluation by Schirmer's test and tear breakup time is, therefore, a crucial clinical tool for early detection and prompt management of dry eye syndrome in pterygium patients.

Serum androgen level in association with dry eye in elderly male and postmenopausal female patients

Purpose The aim of this study was to assess the association between objective and subjective indicators of dry eye syndrome (DES) and androgen level in elderly patients. Patients and methods This is a comparative cross-sectional study that included 80 Egyptian patients with DES. They were divided into two groups: Group A which consisted of 40 postmenopausal females and elderly males, and Group B which included 40 males and females under the age of 40 years. Each patient provided a medical history. The dry eye symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, which inquired about the presence, intensity, and frequency of symptoms of DES. Additionally, the tear film break-up time (TBUT) and Schirmer’s test were conducted. Serum androgen levels were measured using the ELISA test. Results The serum androgen was significantly lower in group A (12.6±8.19 ng/dl) than in group B (24±4.44 ng/dl), (P&lt;0.001). There was a strong significant negative correlation between androgen level and age (r=−0.60, P&lt;0.001). In addition, there was a significant positive correlation between the TBUT and Schirmer’s test values and the amount of testosterone (T) (r=0.62, P&lt;0.001 and r=1.0, P&lt;0.001, respectively). The Schirmer’s test was significantly lower in postmenopausal female patients compared to male patients (mean=10.21±1.05 mm versus 12.46±1.13 mm, respectively, P&lt;0.001). Conclusion The serum androgen level was significantly lower in postmenopausal females and elderly males with DES compared to males and females under the age of 40 years, with a significant negative correlation between androgen level and age. Moreover, the TBUT and Schirmer’s test showed a significant positive association with T level. The Schirmer’s test results were significantly lower in postmenopausal females compared to males.

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.

Effect of Screen Time on Eye Dryness

Purpose: To determine the relationship between screen time and dry eye: A hospital based study. Study Design: Cross sectional, observational. Place and Duration of Study: Helper’s eye hospital, Quetta from June 2020 to August 2021. Methods: There were 62 subjects, age 13 – 71 years, either gender with dry eye symptoms, normal anterior and posterior segment and daily use of screen devices such as mobile and laptop. Tear film break-up time was performed in all the patients to confirm dry eye using fluorescein strip. Screen time per day was graded as mild (&lt; 2 hours), moderate (2 – 6 hours) and marked (&gt; 6 hours). Chi square test was performed for data analysis on SPSS version 23 and P≤0.05 was considered statistically significant. Results: Mean age of the patients was 44.34 ± 16.43. There were 66.1% females and 33.9% males. The commonest symptom was itching (35.5%). Tear film break up time test was positive in 37 (59.7%). Out of 18 patients with mild screen time, 10 (55.5 %) subjects had dry eye. Out of the 23 subjects with moderate screen time, 17 (73.9%) had dry eye while out of 21 subjects with severe screen time, 10 (47.6%) had dry eye. The results of our study were not statistically significant with p value 0.189. Conclusion: There is no association between increased screen time and the dry eye. However, care must be taken to prevent the discomfort arising from excessive screen time.

Diagnosis of Photokeratitis by Tear Ferning Using a Novel Set of SK Grading Criteria in a UVB-Induced Mouse Model.

Current ocular surface diagnostic methods may not totally meet and implement the clinical demands for early and precise treatments. The tear ferning (TF) test has been known as a quick, simple, and inexpensive procedure. This study aimed to validate the TF test as an alternative method for early determination of photokeratitis status. The tear sample was collected from the UVB-induced photokeratitis eyes and processed for TF formation. The TF patterns were graded by both the Masmali and a Sophie-Kevin (SK) grading criteria, a new set of criteria modified from the Masmali grading, for differential diagnoses. In addition, the TF test results were correlated with three clinical ocular surface indicators, including tear volume (TV), tear film break-up time (TBUT), and cornea staining, to evaluate the diagnostic capacity. Differential diagnosis between the normal and the photokeratitis status was achieved by the TF test. The SK grading reflected earlier photokeratitis status than the Masmali grading criteria. The TF results were strongly correlated with the three clinical ocular surface indicators, particularly for the TBUT and cornea staining. The TF test was proven to have a capacity to distinguish photokeratitis from the normal status at an early stage by using the SK grading criteria. It is therefore potentially useful for photokeratitis diagnosis in the clinical settings. The TF test may fulfill the demands of precise and early diagnosis to facilitate in time the intervention for photokeratitis.

Comparison of matrix metallopeptidase-9 expression following cyclosporine and diquafosol treatment in dry eye

Purpose We sought to evaluate the expression of matrix metalloproteinase-9 (MMP-9) in dry eyes treated with 0.05% cyclosporin A and 3.0% diquafosol tetrasodium. Methods One-hundred ninety-five eyes of 195 patients with dry eye were divided into three groups as follows: group 1, cyclosporin group (n = 69); group 2, diquafosol group (n = 59); and group 3, artificial tears eyes (n = 67). All eyes were treated and followed up for three months. Schirmer I Test, corneal staining, tear-film break-up time (TBUT), and tear-film MMP-9 content were measured at three months and compared between groups. The expression of MMP-9 was confirmed using a point-of-care test device (InflammaDry®; RPS Diagnostics, Sarasota, FL, USA) and graded as zero to four points. Results At the third month, MMP-9 expression was lower in group 1 as compared with in groups 2 and 3 (p = 0.020 and 0.006, respectively). The mean MMP-9 grade according to point-of-care testing was also lower in group 1 than in groups 2 or 3 (p = 0.002 and 0.038, respectively). MMP-9 showed a correlation with corneal staining in both groups 1 and 2 (all p < 0.001) and with Schirmer I Test and TBUT in group 1 (p = 0.018 and 0.015, respectively). Conclusions MMP-9 expression and grade were lower after treatment with cyclosporin than after treatment with diquafosol in the dry eye disease. Anti-inflammatory treatment can decrease ocular MMP-9 levels in dry eye disease.

Effects of orthokeratology lenses on tear film and tarsal glands and control of unilateral myopia in children.

Introduction: To investigate the effects of an orthokeratology lens on the tear film and tarsal glands and myopia control in children with unilateral myopia using an intelligent analysis model. Methods: We retrospectively reviewed the medical records from November 2020 to November 2022 of 68 pediatric patients with unilateral myopia in Fujian Provincial Hospital who had been wearing an orthokeratology lens for more than 1year. The 68 myopic eyes were included in the treatment group, while the 68 healthy, untreated contralateral eyes were included in the control group. Tear film break-up times (TBUTs) were compared between the two groups at various intervals, and an intelligent analysis model was used to compare the deformation coefficients of 10 meibomian glands in the central area and the different positions of the glands in the two groups after 12months of treatment. Changes in axial length and equivalent spherical power were also compared between the groups before and after 12months of treatment. Results: In the treatment group, TBUTs differed significantly between 1 and 12months after treatment, although no significant differences from baseline were observed at 3 or 6months. No significant differences in TBUTs were observed at any time point in the control group. After 12months of treatment, significant between-group differences were observed for glands 2, 3, 4, 5, 6, 7, 8, and 10 (numbered from the temporal to nasal regions). The treatment group also exhibited significant differences in deformation coefficients at different detection positions in the central region, with glands 5 and 6 exhibiting the highest deformation coefficients. Increases in axial length and equivalent spherical power were significantly greater in the control group than in the treatment group after 12months of treatment. Discussion: Wearing orthokeratology lenses at night can effectively control myopia progression in children with unilateral myopia. However, long-term use of these lenses may lead to meibomian gland deformation and impact tear film function, and the extent of deformation may vary at different positions in the central region.

Comparison between Placement of an Amniotic Membrane Contact Lens and Temporary Amniotic Membrane Transplantation

Purpose: We compared the clinical utilities of an amniotic contact lens and temporary amniotic membrane transplantation in patients with persistent corneal epithelial defects.Methods: Patients diagnosed with persistent corneal epithelial defects from November 2019 to July 2022 were randomly assigned to either lens placement for 2 weeks or temporary transplantation for 1 week, and the outcomes were retrospectively analyzed. The best-corrected visual acuity, corneal sensation, tear film break-up time, and corneal opacity were measured before and after the interventions. The treatment success rates, recurrences, and other complications were analyzed during the follow-up period.Results: We placed lenses in 32 patients (32 eyes) and 20 patients (20 eyes) underwent transplantation. In both groups, significant differences in best-corrected visual acuity, corneal sensation, tear film break-up time, and corneal opacity were apparent after intervention vs. before. None of the parameters showed any significant differences in terms of their rates of change.Conclusions: In patients with persistent corneal epithelial defects, amniotic contact lens placement is an effective outpatient procedure and is not inferior to temporary amniotic membrane transplantation.

Long-Term Activity and Safety of a Low-Dose Hydrocortisone Tear Substitute in Patients with Dry Eye Disease

Purpose A clinical trial was conducted to evaluate the activity of a new artificial tear containing hyaluronic acid (HA) and low-dose hydrocortisone to control dry-eye disease (DED) symptoms. Methods a randomized, controlled, double-masked study was carried out at the Ocular Surface and Dry Eye Center, “Luigi Sacco” University Hospital (Milan, Italy), between June 2020 and June 2021. The study involved patients with DED for at least 6 months. After an initial 7-day treatment with corticosteroid, the treatment with the new artificial tear (four-times a day for 6 months) was compared with a control HA solution. Results A total of 40 patients were considered. We observed a significant improvement in the frequency and intensity of DED symptoms in both groups. After corticosteroid discontinuation, the maintenance of the therapeutic advantage was observed only in the treatment group, which also showed a significant improvement of the tear film break-up time (p ≤ 0.05) and infiltrated macrophages (p < 0.05). A significant reduction in fluorescein and Lissamine staining (p < 0.05) was observed in the treatment group, suggesting damage reduction at both corneal and conjunctival levels. Intraocular pressure did not change at the end of the treatment period and was maintained within the normal range, sustaining the product’s safety. Conclusions Our findings support the prolonged use of the new eye drop with low-dose hydrocortisone, also in the DED initial stages, to prevent the degenerating towards a chronic condition (http://www.isrctn.com/ISRCTN16288419).