Tear Film Parameters Research Articles

Tear Film and Dry Eye Characteristics as Predictors of Photophobia in 374 Patients with Dry Eye Disease

ABSTRACT Purpose To assess the tear film parameters associated with photophobia in dry eye disease (DED). Methods Three hundred seventy-four patients with DED (mean age, 42.2 ± 12.8 years) had their tear film and OSDI scores evaluated using Oculus keratograph 5 M (TMH, NIBUT, Meibography), Lipiview interferometer (LLT), and TearLab osmolarity system. Photophobia scoring from OSDI sheets was used to calculate the odds ratio via multivariate logistic regression analysis. Data from the eye with severely affected NIBUT was used. Results Of 374, 127 had aqueous deficient dry eye disease (ADDE), and 247 had evaporative DED. The mean age, female sex, Schirmer I, TMH, NIBUT, LLT, and tear osmolarity values in patients with photophobia versus no or mild photophobia were 42.2. vs. 40.9 years, 42% vs. 40%, 11.6 vs. 10.5 mm, 0.27 vs. 0.29 mm, 4.6 vs. 4.7s, 60.3 vs. 60.9 nm and 305 vs. 307 mOsm/L, respectively. Multivariate analysis revealed no tear film parameters predictive of photophobia in evaporative DED, whereas tear osmolarity had a weak negative association with photophobia (odds ratio of 0.96, 95% C.I, 0.92–1, p = .04) in ADDE patients. Conclusion Tear film parameters do not predict the presence or absence of photophobia in DED except for a weak inverse association with tear osmolarity in ADDE. This suggests the role of central sensitization in regulating photophobia in DED patients.

Effect of Heating and Massaging of Meibomian Glands on Their Imaging

Background and Objectives: Infrared light is used to image the Meibomian glands through their thermal profile. This study aimed to investigate the effects of a combination of heating and an eyelid massage on Meibomian gland visibility and tear film parameters. Materials and Methods: Twenty-four participants (26 ± 6.9 years) were enrolled in this prospective study, which involved imaging the Meibomian glands of both the lower and upper eyelid and assessing the non-invasive breakup time (NIBUT), tear meniscus height (TMH), and blink rate (using the CA-800, Topcon) at baseline after five minutes of eyelid warming followed by a five-minute eyelid massage. The second session, which was randomised in sequence, repeated the same measurements but without the inclusion of any eyelid warming or massage as the control condition. Results: While there was no change in lower lid Meibomian gland appearance as a result of eyelid heating, eyelid massage, or multiple lid eversion (median 2.0, range 0.0 to 4.0; p = 0.782), there was a change in upper lid appearance 5 min after heating and lid massage (p = 0.025), but again, multiple lid eversion had no effect (p > 0.05). The NIBUT decreased on second lid eversion (p = 0.049), although this was not evident on the third lid eversion (p = 0.090). The effect on NIBUT was also apparent with heating (p = 0.034 immediately after) but was sustained with 5 min of eyelid massage (p = 0.031). The TMH increased with heating (p < 0.001), and this effect was sustained with 5 min of eyelid massage (p = 0.011), but there was no lid eversion effect (p > 0.05). The blink rate was unaffected by heating, eyelid massage, or multiple eversions of the eyelids (median 24 blinks/min, range 8 to 59 blinks/min; p = 0.61). Conclusions: Eyelid warming can increase the visibility of the Meibomian glands, although this effect was only observed with upper lid imaging and the effect dissipated after 5 min of eyelid massage. Warming and massage also disrupt the tear film, as does multiple lid eversion, emphasising the need to use the least invasive tear film assessment techniques first.

Evaluation of ocular surface parameters before and after cryo- and laser therapy for distichiasis in dogs: A pilot study.

The aim of this pilot study was to establish a satisfactory, scientific approach to effectively compare quantitative measurements of various ocular surface parameters before and after surgical treatment in dogs suffering from distichiasis. An ophthalmic examination was conducted on 12 dogs (23 eyes) before and after surgical treatments for distichiasis, at four different time points, (t0 = before surgery, t1 = 1-2 h after surgery, t2 = 1 week after surgery, t3 = 1 month after surgery, and t4 = 6 months after surgery) between 2021 and 2022, and analyzed retrospectively. The examination included Schirmer tear test-1 (STT-1), interferometry, noninvasive tear film break-up time (NIBUT), tear meniscus size (TMS), and meibography. No statistically significant changes were found in STT-1 (t0: 22.2 ± 6.5 mm, t2: 22.5 ± 5.7 mm, t3: 20.8 ± 5.1 mm, and t4: 22.6 mm ± 4.8 mm) before and after surgery. Mean interferometry scores showed a slight, not statistically significant, decrease from t0 to t3 and t4 (t0: 2.1 ± 0.8, t1: 2.1 ± 0.7, t2: 2.1 ± 0.9, t3: 1.8 ± 0.6, and t4: 1.9 ± 1.1). Mean NIBUT did not change significantly between time points (t0: 3.9 ± 1.3 s, t1: 4.0 ± 1.3 s, t2: 4.0 ± 1.4 s, t3: 3.5 ± 0.7 s, and t4: 3.5 ± 0.9 s). TMS showed a slight, not statistically significant increase (t0: 0.5 ± 0.3 mm, t1: 0.5 ± 0.3, t2: 0.5 ± 0.3 mm, t3: 0.6 ± 0.2 mm, and t4: 0.7 ± 0.3 mm). There were no changes in the gross morphology of the meibomian glands (MG). This pilot study could not detect a negative effect of different forms of treatment of distichiasis on the precorneal tear film parameters in dogs. However, due to the study's retrospective nature and small sample size, no definitive conclusion can be drawn regarding the changes at the different time points.

Tear film parameters and meibography in eyes of children with vernal keratoconjunctivitis.

To study tear film parameters and Meibomian glands in pediatric patients with vernal keratoconjunctivitis (VKC). Forty-four eyes of 22 patients with VKC and 44 eyes of 22 age-matched controls were studied in a hospital-based cross-sectional study. Each subject underwent a complete ophthalmological examination including slit-lamp biomicroscopy, non-invasive break-up time (NIBUT), fluorescein break-up time (FBUT), corneal fluorescein staining, and Schirmer's test. Non-contact meibography was performed using a Sirius topographer. All patients had VKC grades between 1 and 3 (Bonini scale). The mean NIBUT for cases was 8.83 ± 4.02 s and in controls, it was 15 ± 2.8 s (P value < 0.001). The mean FBUT for cases was 9.41 ± 3.45 s and in controls, it was 16.7 ± 2.5 s (P value < 0.001). Schirmer's values were 32 ± 3.1 mm in cases and 21.4 ± 4.1 mm in controls, which were significantly higher (P value < 0.001). Also, 22.72% of the cases had corneal fluorescein staining in the form of superficial punctuate keratitis, whereas none of the control groups showed corneal staining. The examination of Meibomian glands using non-contact meibography showed a mean Meibomian gland dropout in the upper lid to be 29.7 ± 14.4% in VKC cases and 10.5 ± 3.2% in controls (P value < 0.001). Meibography of the lower lid showed 25.9 ± 10.2% dropout in cases and 20.5 ± 6.1% in controls (P value = 0.004). Tear film parameters were significantly deranged in children with VKC in the active stage as compared to age-matched controls. Children with VKC also had a higher Meibomian gland dropout.

The effect of cyclosporine a in pterygium surgery using fibrin glue.

To evaluate the effect of topical cyclosporine A (CsA) 0.05% in patients with pterygium surgery using fibrin glue (FG). Patients with primary nasal pterygium were retrospectically analyzed and categorized into two groups: Group 1 with 41 eyes from 38 patients as a control group and group 2 with 39 eyes from 36 patients who received topical CsA twice a day for 6months. Patients were assessed for recurrence rate, tear film parameters, side effects, and complications at postoperative intervals of 1-7days; 1st, 3rd, 6th and 12th months. The follow-up period was 1year. The two groups were age (p = 0.934) and sex (p = 0.996) matched. CsA drop was discontinued in one patient due to burning sensation and conjunctival hyperemia after 1 week. There was no statistically significant difference between the mean preoperative and postoperative 1st year Schirmer I and tear break-up time (TBUT) values in group 1 (p = 0.136; p = 0.069). Although the difference between the mean preoperative and postoperative 1st year TBUT values in group 2 was not statistically different (p = 0.249), Schirmer I results were higher postoperatively (p = 0.003). There was no statistically significant difference between preoperative Schirmer (p = 0.496), postoperative Schirmer (p = 0.661), preoperative TBUT (p = 0.240) and postoperative TBUT (p = 0.238) results of the two groups. Recurrence was observed in only one patient from group 1. No recurrent pterygium cases were observed in group 2. Schirmer I values were higher postoperatively in group 2; thus,topical CsA treatment may improve lacrimal secretion and be effective after pterygium surgery with FG.

Safety and Efficacy of Photocatalytic Micro-Mist Desktop Humidifier for Dry Eye Caused by Digital Environment: A Randomized Controlled Trial.

Background/Objectives: Modern life is inconceivable without visual display terminal (VDT) work, including smartphones, computers, and games for both children and adults. VDT work under air conditioning and low humidity poses a high risk of dry eye and digital eye strain. Methods: Thirty-one participants were randomly divided into two groups using a desktop humidifier with photocatalytic technology, namely the "with mist" (humidifier) group and "without mist" (control) group. Participants performed VDT tasks using the humidifier with or without mist for 1 h. Ocular subjective symptoms and objective tear film parameters were assessed before, immediately after, and 1.5 h after the VDT task with or without mist. (Registry ID: UMIN000054379) Results: Ocular symptom scores improved significantly in the humidifier group immediately after the VDT task and up to 1.5 h later compared to before the task (p < 0.001, =0.006, respectively). Immediately after the VDT task, tear meniscus height was significantly higher and non-invasive breakup time was significantly longer in the humidifier group than in the control group (p < 0.001, =0.040, respectively). Plugging of the meibomian gland orifices was significantly reduced only in the humidifier group immediately after the VDT task compared to before the VDT task and remained significantly reduced up to 1.5 h later (p = 0.004, 0.016, respectively). Conclusions: The use of the photocatalytic desktop humidifier during VDT task resulted in significant improvements in the tear film parameters and subjective symptoms. The photocatalytic desktop humidifier could be effective in alleviating dry eye and eye strain in computer users in a modern office environment.

Systematic review of ocular surface treatments in the setting of thyroid eye disease.

Approximately 85% of patients with thyroid eye disease experience ocular surface symptoms. Although corneal exposure plays a role in inducing inflammatory changes to the ocular surface, multiple studies reveal more complexity to the abnormal tear film composition and parameters in thyroid eye disease patients including those who do not have proptosis or increased corneal exposure. Currently, a majority of cases of thyroid associated dry eye symptoms are given treatments intended for ocular surface disease arising from different etiologies. Medline via Ovid, Cochrane CENTRAL, PubMed, and Google Scholar were systematically searched for articles evaluating the efficacy of treatments for dry eye symptoms in patients with thyroid eye disease. Articles were from all geographic regions and dates ranged from inception until October 2023. Seven papers ultimately met inclusion criteria and were included in this review. These papers revealed that multiple topical and non-topical treatment modalities address dry eye symptoms in thyroid eye disease and improve subjective and objective ocular surface parameters. However, due to the few studies that exist and due to disparities in sample size and study design, no overwhelming best practices were identified that could influence clinical practice. This systematic review identifies the current treatments that exist and highlights the clear unmet need for a large population suffering with dry eye symptoms. Ideally, further well-designed investigations into this area would target topical, non-invasive modalities to develop first line options for thyroid eye disease patients.

Assessment of tear film parameters post-treatment with commercial eyelid cleaning wipes: a pilot study.

To investigate the short-term effects of commercially available eyelid-cleaning wipes on film parameters. This study enrolled 48 healthy participants aged 20-35y (both males and females). Clinical assessment included the Ocular Surface Disease Index (OSDI) questionnaire, non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), and lipid layer pattern (LLP). Based on these initial results, participants were categorized as either non-dry eye or dry eye. Participants in each group were randomly allocated to either Blephaclean® or Systane® treatments. Changes in NITBUT, TMH, and LLP levels before and after lid wipe treatment were assessed. The dry eye group exhibited significantly higher OSDI scores and lower NITBUT and TMH levels than in the non-dry eye group (P<0.001). Following the application of eyelid wipes (Systane® wipes), dry eye subjects experienced a significant improvement in NITBUT levels (P=0.0014) compared to the non-dry eye individuals. Although the remaining participants showed a marginal increase in TMH and NITBUT levels, these changes did not achieve statistical significance (P>0.05). Similarly, the LLP levels were significantly improved with Systane® (P<0.001) post-treatment compared to individuals in the non-dry eye group. However, the dry eye subjects showed higher post-treatment LLP levels than the untreated group (P<0.02). The short-term effects of Systane® eyelid wipes on tear film parameters suggest their effectiveness in dry eye disease. Nonetheless, further exploration of their long-term impact is essential to justify their cost effectiveness and efficacy in treating both aqueous deficiency and evaporative dryness.

Efficacy ofhydroxypropyl-guar dropsin improving tear film index and ocular surface dynamicsusing two treatment methods under a controlled desiccating environment.

This study aimed to assess the efficacy of hp-guar eye drops on tear film index and ocular surface dynamics under desiccating conditions using protection and relief treatment modalities. The 12 normal, non-dry eye participants were subjected to adverse environmental conditions using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the ambient temperature was 21°C. The participants were screened for ocular symptoms, tear osmolarity, ocular surface temperature (OST), tear production using the Ocular Surface Disease Index questionnaire (OSDI), OcuSense TearLab Osmometer, FLIR System ThermaCAM P620, and Schirmer strips. Tear production was calculated by the Tear Function Index test (TFI). The mean tear film osmolarity decreased significantly from 296mOsm/L at 40% RH to 285mOsm/L at 5% RH (p = 0.01). Conflicting responses were seen for osmolarity in protection and relief. Mean tear osmolarity was significantly higher in the protection method in comparison to the relief method (p = 0.005). The mean TFI increased from 557 at 40% to 854 at 5% (p = 0.02). A significant increase in TFI was observed in the relief method in comparison with both 40% (p = 0.001) and 5% (p = 0.04). In the relief method, the mean TFI score went up to 1139 when hp-guar was installed. A significant improvement in ocular comfort was experienced in both the protection (p = 0.041) and relief (p = 0.010) methods at 5% RH. The instillation of hp-guar drops in the relief method resulted in a significant reduction in OST. The mean OST dropped to 33.01 ºC, significantly lower than the recorded OST for both normal (p = 0.040) and dry (p = 0.014) environmental conditions. Hp-guar drops significantly improve tear film parameters under a desiccating environment, however, tear film parameters respond differently to the management modalities. In the protection method, tear film osmolarity was protected against a dry environment, while in the relief mode, an improvement in tear production and a decrease in ocular surface temperature were seen. Hp-guar performance could be maximized for the management of exposure to adverse environments by using a treatment protocol that targets the most affected parameters in each group of patients. Using CEC has the potential to provide researchers with a readily available method to evaluate the efficiency of tear supplementation.

Predictive performance of corneal and lid margin sensitivity for dry eye disease: An investigator-masked, prospective, prognostic accuracy study

PurposeTo evaluate the prognostic ability of non-contact esthesiometry corneal and lid margin sensitivity measurements in detecting symptoms and signs of dry eye disease, as defined by the global consensus TFOS DEWS II criteria. MethodsA total of 87 community residents (58 females; mean ± SD age, 53 ± 16 years) were recruited in an investigator-masked, prospective, prognostic accuracy study. Dry eye symptomology, tear film parameters, and ocular surface characteristics were evaluated in a single clinical session, and non-contact esthesiometry corneal and lid margin sensitivity measurements performed by an independent masked assessor. ResultsOverall, 49 (56%) participants fulfilled the TFOS DEWS II criteria for dry eye disease, while 57 (66%) exhibited clinical symptoms, and 67 (77%) had positive signs. The prognostic abilities of corneal and lid margin sensitivity measurements were significantly greater than chance for the detection dry eye signs (both p ≤ 0.03), but not for symptoms or overall disease diagnosis (all p > 0.10). The Youden-optimal prognostic cut-offs for corneal and lid margin sensitivity thresholds were both ≥0.8 mbar for the detection of clinical dry eye signs. Lid margin sensitivity demonstrated marginally higher predictive performance than corneal sensitivity (C-statistic, 0.688 versus 0.658), and was significantly correlated with tear film stability, corneal, conjunctival and lid wiper staining (all p < 0.05). ConclusionsCorneal and lid margin sensitivity demonstrated moderate prognostic utility for detecting clinical dry eye signs. Future research is warranted to investigate the utility of incorporating non-contact esthesiometry in the workup for dry eye disease and neurotrophic keratopathy.

Evaluation of therapeutic efficacy of Emustil drops for ocular discomfort and tear film osmolarity using different treatment management modes under dry environmental conditions

BackgroundWe aimed to check the efficacy of Emustil (oil in water emulsion) drops on tear film index and ocular surface dynamics in dry environments through protection and relief treatment modalities.MethodsThe subjects were exposed to a dry environment using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the temperature was 21 °C and screened for ocular symptoms, tear osmolarity, ocular surface temperature (OST) and tear production using ocular Surface Disease Index questionnaire (OSDI), OcuSense TearLab Osmometer, FLIR System ThermaCAM P620 and Schirmer strips/phenol red test respectively. Tear production was calculated by the Tear Function Index test (TFI).ResultsThe mean tear film osmolarity decreased significantly from 296.8 mOsm/l at 40% RH to 291 mOsm/l at 5%. (p = 0.01). Instillation of Emustil resulted in a significant increase in tear osmolarity in the relief method compared with osmolarity seen at 5% RH when no drop was used. The mean PRT value decreased from 26 ± 9 in normal conditions (40% RH) to 22 ± 4 mm in dry conditions (5% RH). Emustil drops did not induce any significant change in tear production in the PRT test. No significant change was found in OST following exposure to 5% RH. OST did not show a statistically significant change with the emulsion when used for relief (p > 0.05). The mean score of ocular discomfort observed was 70 at 5% RH. Still, the instillation of the oil-in-water emulsion (Emustil) resulted in a noticeable decrease in visual discomfort to 37 (p = 0.00) in protection and 59 in relief (p = 0.05). Emustil drops substantially improved tear film parameters under a desiccating environment, however, tear film parameters respond differently to the management modalities. In the protection method, tear film osmolarity was protected against a dry environment, while in the relief mode, tear production was improved.ConclusionCEC allows for a thorough evaluation of tear film parameters and dry eye treatment protocols in labs, providing greater confidence when applying them to patients. In addition, our study showed that Emustil not only provides protection and relief for dry eyes but also helps to maintain ocular homeostasis in desiccating environments. This indicates a promising potential for improving dry eye treatment protocols.

Improvement of Clinical Findings, Meibography and Tear Film Parameters in Pediatric Ocular Rosacea Patients After a Standard Treatment Protocol

ABSTRACT Purpose The objective of this study was to illustrate the changes in ocular findings, meibography, and tear break-up time (TBUT) values in pediatric patients with ocular rosacea following a standardized treatment. Methods The study included consecutive patients diagnosed with ocular rosacea, referred to a tertiary hospital between 2021 and 2023. Each patient underwent biomicroscopic examinations, non-invasive TBUT assessments, corneal fluorescein staining (evaluated using the Oxford scoring system), and meibography. The standard treatment protocol involved warm compresses, eyelid hygiene, preservative-free sodium hyaluronate eye drops (administered four times daily), topical azithromycin 1.5% (twice daily for 3 days), topical steroids (loteprednol 0.5%, four times daily for 2 weeks), and either doxycycline 100 mg/day for 14 days or oral suspension of azithromycin 10 mg/kg for 3 days followed by an additional three-day course of treatment administered 10 days later (for patients above and below 14 years of age, respectively). Results The study included 18 patients, with 10 (55.5%) being female and 8 (44.4%) being male, with a mean age of 9.7 ± 4.5 years (range: 3–18). Four patients displayed cutaneous involvement. The treatments resulted in significant improvements in the Oxford scores, reduction in corneal neovascularization, and increased TBUT (p < 0.001, p = 0.016, p < 0.001, respectively). Meibomian gland loss area also significantly improved post-treatment (27.4 ± 6.7% vs 39.2 ± 13.4%, p = 0.001). Conclusion This study demonstrated that pediatric ocular rosacea patients may exhibit improved meibomian gland function, regression of corneal neovascularization, and enhanced tear film parameters following a standardized treatment protocol that includes both topical and systemic approaches.

Tear cytokine levels are reduced in patients treated with intravitreal injections

PurposeTo investigate cytokine levels in the tear fluid of patients receiving serial intravitreal injections (IVI) with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD). MethodsConcentrations of six cytokines (IFN-γ, IL-1β, IL-6, IL-8, TNF and VEGF) in tears of patients receiving anti-VEGF in one eye were assayed using multiplex cytometric bead array. The fellow untreated eye served as control. Tear sampling was performed on a single occasion at a minimum of four weeks after IVI. Patients underwent a pre-IVI antisepsis protocol with povidone-iodine. ResultsTear fluid from thirty patients with a mean age of 78.8 years (range 58–90) was assayed. Subjects received a median of 43.5 (range 22–106) IVI in one eye. The median level of IFN-γ was 0.33 (interquartile range (IQR) 0.22–0.52) pg/mg of total protein in injected eyes versus 0.41 (IQR 0.21–1.05) pg/mg in fellow eyes (p = 0.017). For TNF, a median level of 0.12 (IQR 0.08–0.18) pg/mg of total protein was found in injected eyes versus 0.14 (IQR 0.07–0.33) pg/mg of total protein in fellow eyes (p = 0.019). There were no differences between injected and fellow eyes regarding the levels of IL-1β, IL-6, IL-8 and VEGF. ConclusionTear fluid in eyes receiving serial IVI with anti-VEGF and preoperative povidone-iodine antisepsis constitutes lower levels of the pro-inflammatory cytokines IFN-γ and TNF compared to fellow eyes. This provides biochemical support of previous findings of reduced signs of inflammation and healthier tear film parameters in patients treated with serial IVI.

Daytime Changes in Tear Film Parameters and Visual Acuity with New-Generation Daily Disposable Silicone Hydrogel Contact Lenses-A Double-Masked Study in Symptomatic Subjects.

This prospective, double-masked, contralateral study aimed to analyze and compare daytime changes in pre-lens tear film (PLTF) stability and optical quality in symptomatic subjects wearing two contact lenses (CL). A secondary goal was to assess the performance of the PLTF by using dynamic topography techniques and analyzing surface asymmetry and irregularity indexes (SAI and SRI, respectively). Measurements were conducted on 20 symptomatic subjects (OSDI score > 13). Participants were fitted contralaterally and randomly with spherical Delefilcon A and Stenfilcon A CLs and underwent a series of measurements over 3 consecutive days: three in the morning (after 1-2 h of CL wear) and three in the afternoon (after 7-9 h of CL wear). High- and low-contrast visual acuity (HCVA and LCVA, respectively), pre-lens NIBUT, and dynamic topography were assessed. The contralateral fit of the two lenses allowed a direct and better comparison between them since they were exposed to the same conditions during the day. Consequently, both lenses demonstrated similar performance in HCVA, LCVA, and PLTF stability, with no statistically significant differences between them, although some fluctuations were observed throughout the day. Dynamic topography proved sensitive in evaluating temporal changes in the PLTF. The SRI index showed greater sensitivity to topographic changes due to lacrimal destabilization, making it potentially valuable for evaluating dry eye patients.

Evaluation of tear film in patients with AIDS without opportunistic ocular infections in the era of COVID-19: A case-control study.

The assessment of tear film and ocular surface conditions in patients with acquired immunodeficiency syndrome (AIDS) has been poorly studied thus far. We aim to assess tear film parameters, ocular surface characteristics, and dry eye disease (DED) symptoms of patients with AIDS who did not undergo highly active antiretroviral treatment (HAART). This case-control study included 154 age-, sex-, and ethnicity-matched healthy controls and patients with AIDS. All participants underwent comprehensive ocular surface assessment and subjective DED symptomology evaluation. Data were collected between March 2022 and July 2022. HAART-naïve patients with AIDS had a shorter noninvasive tear film breakup time (median 3.76 vs. 8.54 s), thinner tear film lipid layer thickness (median 73.00 vs. 91.00 nm), and lower Schirmer I test values (median 5.00 mm/5 min vs. 12.00 mm/5 min) (all P < 0.001). Moreover, higher corneal fluorescein staining scores (median 1.00 vs. 0.00) and higher upper, lower, and total meibomian gland grades were observed in AIDS patients (all P < 0.05). Negative correlations between the blood viral load and the Ocular Surface Disease Index score ( r = -3.50, P = 0.027) and the Schirmer I test score ( r = -0.374, P = 0.017) were detected in patients with AIDS. Altered tear film status was observed in individuals with HAART-naïve AIDS, even when there were no other ocular symptoms present. Therefore, patients with AIDS should be encouraged to undergo comprehensive ocular surface examinations to detect any subclinical tear film alterations occurring.

A Preservative-Free Approach - Effects on Dry Eye Signs and Symptoms After Cataract Surgery.

To compare the effect of treatment with preservative-free dexamethasone, NSAIDs and trehalose/hyaluronic acid eye drops with the preservative benzalkonium chloride containing dexamethasone and NSAIDs after cataract surgery in dry versus non-dry eyes. In this prospective randomized intervention study, dry eye tests were performed before and 6 weeks after cataract surgery. Patients were considered as having dry eye, SDE (sign of dry eye), if at least one of the following dry eye tests were abnormal; corneal fluorescein staining (CFS), non-invasive keratograph breakup time (NIKBUT) or tear osmolarity. Patients with SDE were randomly assigned to one of two groups. Group 1 patients were treated with dexamethasone and bromfenac eye drops with the preservative benzalkonium chloride (BAC). Group 2 patients were treated with preservative-free dexamethasone and preservative-free diclofenac, as well as a preservative-free lubricant with trehalose and hyaluronic acid both before and after surgery. Patients with normal tear film status acted as the control group (group 3) and received same treatment as group 1. A total of 215 patients were enrolled six weeks after surgery, the number of patients with SDE decreased significantly in groups 1 and 2 (p <0.001). Subjective symptoms and objective measures including osmolarity, NIKBUT, CFS, and tear film thickness (TFT) improved after surgery, tear production remained unchanged, while corneal sensitivity and meibomian gland dysfunction (MGD) parameters worsened. In the control group with normal tear-film status, SDE increased significantly after the surgery (p <0.001). There were no statistically significant differences in tear film parameters between the three groups after surgery. After cataract surgery, patients with mild to moderate dry eyes may experience improved tear film status and reduced symptoms. However, we found no additional beneficial effect on dry eye parameters with treatment with preservative-free dexamethasone, NSAIDs, and lubricants compared to preservative-containing eye drops.

Complex therapy of the evaporative form of dry eye syndrome in patients after keratorefractive surgery

Introduction. Meibomian gland dysfunction (MGD) is considered as the leading cause of the evaporative dry eye syndrome (DES). At the same time the standard methods of DES treatment often allow to achieve only a short-term effect and the search of alternative methods to achieve remission for a longer period is required.Aim. To evaluate the effectiveness of a combined treatment of DES with MGD using transdermal Intense Pulsed Light (IPL) method combined with preservative-free sodium hyaluronate 0.18% eyedrops.Materials and methods. The study involved 60 patients (120 eyes) after refractive surgery (femtoLASIK) with DES and MGD aged 20 to 40 years with a follow-up period of 3 months. The patients were divided into two groups: main (30 patients) and control (30 patients). Patients of both groups were administered a preservative-free form of 0.18% sodium hyaluronate four times a day for 3 months. All studied patients underwent standard examination methods, indicators of DES were assessed along with an objective valuation of tear film parameters and the meibomian glands condition by mean of digital biomicroscopy using a MediWorks slit lamp before surgery and 7 days, 1, 2 and 3 months after refractive surgery.Results and discussion. A comparative analysis of therapy effectiveness in the main and control groups showed that OSDI scores (ocular surface disease index), non-invasive tear breakup time (NITBUT) and meibomian gland function improved after treatment in both groups, but in the main group (IPL) positive dynamics of indicators were more pronounced with a cumulative increase of effectiveness after subsequent sessions.Conclusion. A course of IPL therapy in combination with a course of sodium hyaluronate 0.18% for dry eye syndrome due to MGD reduces the time, allows for longer-term results of therapy and promotes earlier elimination of discomfort.

Evaluation of tear meniscus height and lipid layer patterns in the tear film in domestic cats: An observational study.

Healthy vision in humans and animals requires a stable tear film. The environmental factor could affect the status of the tear film. Therefore, assessing the tear film in animals is essential to avoid visual system disturbance. The current research used a noninvasive device to evaluate the tear meniscus height (TMH) and lipid layer pattern (LLP) in domestic cats. In addition, the scores were compared with those of humans with healthy eyes. Fifty-four domestic cats (28 males and 26 females; mean ± SD = 13.9 ± 18.2 months) were randomly selected and included in the study. The cats were healthy, without any ocular disorders or diseases. Fifty-four healthy eye subjects (27 males and 27 females; mean ± SD = 25.6 ± 5.1 years) were randomly recruited and took part in the study for comparison. EASYTEAR View+ was used, for the first time, to assess the tear film parameters on the right eye of each subject. The examiner allowed a 5-minute gap between the tests. Each test was performed by the same examiner three times, followed by calculating the mean scores. Significant differences (Mann-Whitney U test) were found in the median scores of LLP (p = 0.009) between cats and subjects with healthy eyes. The median TMH score was higher in cats (0.18 mm) than in humans (0.14). However, no significant difference (Mann-Whitney U Test, p = 0.210) exists in the TMH scores between cats and humans. The LLP analysis indicated that a dense white-blue lipid layer (grade 4 or D; lipid layer thickness, LLT, = approximately 80 nm) was predominant in both cats (N = 24, 44.4%) and humans (N = 29, 53.7%). In comparison, variable colors lipid layer (grade 5 or E; LLT = 90-140 nm) was a minority in cats (N = 5, 9.3%) and common in humans (N = 16, 29.6%). The statistical analysis indicated medium correlations between cats' TMH and LLP scores (r = 0.431, p < 0.01) and between age and TMH scores in humans (r = 0.440, p < 0.01). In addition, it indicated a weak correlation (r = 0.291, p < 0.05) between the LLP scores in cats and humans. Assessing animals' tear film is essential to avoid any ocular disorders. EASYTEAR View+ is efficiently used to evaluate domestic cats' TMH and LLP. Cats have thicker lipid layers and longer TMH comparable to those reported for humans with healthy eyes.

Effects of topical ketorolac tromethamine on tear parameters, meibography, goblet cell density, and conjunctival oxidative stress in healthy dogs.

The objective of the study was to evaluate whether a twice-daily instillation of 0.45% preservative-free ketorolac tromethamine (FKT) or 0.4% benzalkonium chloride-preserved ketorolac tromethamine (BACKT), every 12 h for 30 days may affect tear film parameters and the meibography in healthy dogs. Additionally, we assessed whether the same treatments irritated the ocular surface, affected goblet cell density (GCD), and the levels of oxidative stress biomarkers (OSB) in the conjunctiva of the same dogs. Experimental and masked comparison study. In 11 healthy dogs baseline values of the lipid layer thickness, tear meniscus height, non-invasive tear breakup time (NI-TFBT), and the meibomian gland (MG) loss were assessed by OSAvet®. For each dog, one eye received 40 μL of BACKT, while the other received 40 μL FKT, every 12 h for 30 consecutive days. Tear parameters and meibography were repeated 15, 30, and 60 days post-treatments. Conjunctival hyperemia and blepharospasm were monitored at the same time points. At baseline and Day 30, a conjunctival biopsy was collected for GCD and OSB determination. Conjunctival hyperemia and blepharospasm were not observed. At Day 15, the MG loss increased only in FKT-treated eyes (p < .001). On Day 30, both treatment groups showed increased MG loss, shortened NI-TFBT, and reduced GCD and catalase (p < .05). At Day 30, BACKT-treated eyes showed lower levels of superoxide dismutase (SOD) (p = .006) and higher levels of malondialdehyde (MDA) (p = .02). Differences between treatments were not observed for any parameter at any time point (p > .05). 60 days after treatment, OSAvet® parameters tended to return to values assessed at baseline; however, significant differences remained for MG loss (p < .05). Twice-daily instillation of KT, containing or not BAC, for 30 consecutive days shortened NI-TFBT, decreased GCD, and increased the MG loss in healthy dogs. KT should be used with caution when prescribed for long periods, particularly in patients with tear film abnormalities. However, future controlled studies using KT, BAC, and other topical NSAIDs are indicated to further support this finding.

Analysis of the ocular surface functional unit in episodic migraine

AimMigraine is a chronic neurovascular disease that affects the trigeminovascular system. The purpose of this study was to evaluate corneal subbasal nerve fibers, dendritic cells and to measure tear film parameters in migraine.Patients and methods87 eyes of 44 patients suffering from migraine with a mean age of 33.23 ± 11.41 years were included in our study. 25 age-matched controls (mean age of 30.16 ± 12.59 years; P = 0.162) were recruited. The corneal subbasal plexus and the dendritic cells (DC) were analyzed using in vivo confocal microscopy (Heidelberg Retina Tomograph II Rostock Cornea Module; Heidelberg Engineering GmbH), and the tear film was imaged using LacryDiag (Quantel Medical, France).ResultsRegarding the subbasal nerve fibers of the cornea, none of the examined parameters differed significantly in migraine patients from controls. We found a significant increase in the corneal DC density (P < 0.0001) and DC area (P < 0.0001) in migraine patients compared to healthy volunteers. DC density showed a positive correlation with the monthly attack frequency (r = 0.32, P = 0.041) and the DC area a negative correlation with corneal nerve branch density (r = -0.233, P = 0.039), nerve fiber length (r = -0.232, P = 0.04) and total branch density (r = -0.233, P = 0.039). Using LacryDiag a significant loss of Meibomian gland area could be detected on the superior eyelid (P = 0.005) in migraine.ConclusionsOur results suggest the presence of neuroinflammation in the cornea of migraine patients affecting the peripheral trigeminal system. Dendritic cells surrounding the subbasal plexus may be involved in the activation and modulation of pain in migraine.