Tear Film Stability Research Articles

Diquafosol sodium reduces neuronal activity in trigeminal subnucleus caudalis in a rat model of chronic dry eye disease

Patients with persistent and severe dry eye disease (DED) have corneal hypersensitivity, resulting in ocular pain, and diquafosol sodium, a potent P2Y2 receptor agonist, is commonly used to improve the resultant tear film stability. This study determined the effects of diquafosol instillation on the suppression of trigeminal subnucleus caudalis (Vc) neuronal activity and ocular pain by enhancing tear film stability in the model for chronic DED. The effects of diquafosol on the ocular surface were assessed by the topical application for 28 days, starting from the 14th day since unilateral exorbital gland removal (chronic DED). Loss of tear volume secretion in chronic DED rats was significantly reversed by diquafosol instillation after 28 days, compared with saline treatment. The number of eyeblinks and pERK-IR neurons in the superficial laminae of Vc following hypertonic saline administration to the ocular surface was lower in diquafosol-treated chronic DED rats than in saline-treated rats. The neuronal activity evoked by hypertonic saline and mechanical stimulation along with the spontaneous neuronal activity in the superficial laminae of the Vc were suppressed in diquafosol-treated chronic DED rats. These findings suggest that ocular surface instillation of diquafosol for 28 days attenuates the neuronal hyperactivity in the Vc and the ocular pain that often occurs in chronic DED.

Quercetin improves lacrimal gland function through its anti-oxidant actions: Evidence from animal studies, and a pilot study in healthy human volunteers

Anti-oxidant properties of polyphenols have been gaining medical attention as a preventive factor against aging and/or lifestyle diseases. In this study, we examined the anti-oxidant activity of quercetin improved tear function through its effects on the lacrimal gland in mice and humans. Six week-old diabetic mice, a model for decreased tear production, were fed for 12 weeks ad libitum with an experimental diet containing 0.5% quercetin. As a result, the tear volume was significantly improved compared to the control, despite no changes in body weight, food intake, lacrimal gland morphology or biochemical serum parameters. Moreover, significantly higher SOD-1 and SOD-2 protein levels were detected in the lacrimal glands of quercetin-treated mice by western blot. In addition, quercetin treatment of mouse corneal cell lines exposed to oxidative stress resulted in dose-dependent inhibition of ROS production and enhanced cell survival. Finally, we examined quercetin pharmacokinetics, specifically its presence in serum and tears subsequent to onion consumption in healthy volunteers, and found that the distribution of quercetin and its metabolite shifted from serum to tear following onion intake. An improvement in tear film stability also resulted following the intake by these healthy volunteers of a new, quercetin-rich onion cultivar (”Quergold”) in powder form. These results suggested that quercetin improved tear function through its effects on the lacrimal gland in mice and humans.

Comparison of the Pre-Lens Tear Film Stability and Visual Performance of a Novel and Two Other Daily Disposable Contact Lenses in Healthcare Professionals Wearing Facial Masks for Prolonged Time.

ObjectiveTo compare a novel daily disposable contact lens (DDCL) verofilcon A with other DDCL materials in terms of pre-lens tear film (PLTF) stabilization and visual performance for prolonged use in healthcare professionals with the use of masks.MethodsSubjects aged 20–40 years old were prospectively randomized into three study groups. Group 1: verofilcon A, group 2: nesofilcon A and group 3: senofilcon A. The subjects were evaluated at baseline with best corrected visual acuity (BCVA), non-invasive tear break up time (NIBUT) of pre-lens tear film, and high order aberrations (HoAs). After 28 days of CL use, NIBUT at 1, 4, 8, and 12 h, HoAs, contrast sensitivity (CS) with CVS100-E and contact lens dry eye questionnaire-8 (CLDEQ-8) were evaluated.ResultsBetween August and September 2021, 147 eyes of 77 subjects were included in the three study groups. At day 28, the CS scores at 18 cycles per degree, spatial frequencies, and the mean NIBUT scores at 4, 8, and 12 h were higher in the verofilcon A group compared to the nesofilcon A and at 12 h were higher compared to the senofilcon A (p < 0.05). The mean HoAs and CLDEQ-8 test scores were higher in the nesofilcon A group (p < 0.001).ConclusionThe results of this study suggest the superiority of the PLTF stabilization ability of verofilcon A in healthcare professionals with prolonged use of mask. The improved CS and NIBUT scores of this lens could be explained by a new and unique surface technology with greater than 80% water content.

Предоперационная оценка риска развития синдрома сухого глаза путем сравнительной эффективности методов корнеотопографии и пробы норна перед фоторефракционной хирургией у пациентов с миопией

Purpose. To conduct a comparative analysis of the effectiveness of assessing the stability of the tear film using corneotopography and the classic Norn test in patients with myopia and myopic astigmatism before keratorefractive surgery. Material and methods. The study included 26 patients planned for keratorefractive surgery for myopia and myopic astigmatism, aged 18 to 47 years. 7 people there was a mild degree of myopia, in 14 people – medium degree, in 5 people – high degree. The average degree of corneal astigmatism was 2.25 diopters. The stability of the pre-corneal tear film was assessed using computed keratotopography and Norn's test – the tear film rupture time (TFRT) was determined. A standard questionnaire was also used to assess the severity of symptoms of dry eye syndrome. A comparison was made of the indicators of the stability of the tear film obtained by the methods of corneotopography and the Norn's test, with their subsequent comparison with the data of the questionnaire. Results. In 17 patients (65.4 %), the TFRT index corresponded to the age norm. In the remaining 9 people (34.6 %), indicators of stability of the tear film were reduced both by corneotopography (12 ± 4 sec) and by Norn's test (13.5 ± 4.5 sec), and there were also subjective signs of dry eye syndrome according to data questionnaire. The data turned out to be comparable. Conclusions. 1. Among the total population of patients, 34.6 % were persons with impaired tear film stability and subjective manifestations of dry eye syndrome. 2. Assessment of the stability of the tear film, determined using the method of corneal topography, showed a high degree of comparability with the results of Norn's test. A significant advantage of the keratotopography method is its non-invasiveness. 3. It is necessary to pay attention to the condition of the ocular surface and identify risk groups to avoid chronicity or aggravation of existing disorders. Keywords: dry eye syndrome, tear film, keratotopography, Norn's test.

Effect of Recombinant Human Epidermal Growth Factor Associated with Conventional Drug Therapy on the Dry Eye Symptom Score in Patients with Dry Eyes after Cataract Surgery: A Systematic Review and Meta-Analysis.

Objective This study aimed to systematically assess the effect of recombinant human epidermal growth factor (rhEGF) associated with conventional drugs on the score of dry eye symptoms in patients with dry eyes after cataract surgery. Methods The online database was searched for the clinical controlled trials of rhEGF associated with conventional drugs in the therapy of dry eyes after cataract surgery. Until now, the retrieval timeframe is based on the establishment of the database. Separately, two researchers extracted the data. The bias risk of each included literature was assessed. Results Eight clinical controlled studies were finally included, with 878 samples. The success rate of the study group was greatly higher, and the difference was statistically significant (P < 0.05). The fluorescein staining (FL) score of the research group after treatment was lower, and the difference was statistically significant (P < 0.05). Compared with the control group, the tear break up time (BUT) of the study group after treatment was notably prolonged. The dry eye symptom score of the research group after treatment was notably lower, and the difference was statistically significant (P < 0.05). Conclusion Sodium hyaluronate associated with rhEGF eye drops is successful to treat xerophthalmia after cataract operation. It successfully promotes corneal healing, promotes tear film stability, and increases basic tear secretion. This treatment scheme is worth popularizing and applying in clinics.

The effectiveness of additional medical management of patients in the early stages after reconstructive interventions on the auxiliary apparatus of the eye: assessment of changes in the tissues of the ocular surface and eyelids

Purpose: to evaluate the effectiveness and safety of combination therapy using the moisturizing ophthalmic solution, Hyloparin-Comod®, and the lubricating ophthalmic agent Parin-Pos® in complex medical management in the early stages after reconstructive interventions on the auxiliary apparatus of the eye.Material and methods. The clinical group consisted of 30 patients (40 eyes) aged 18 to 75 (m = 58.46 ± 7.31), of which 7 (23.3 %) were men; and 23 (74.7 %) women. Of these, 18 patients had ptosis of the upper eyelid (of which 10 had bilateral ptosis), 8 had inversion of the eyelids and 4 had eversion. All patients underwent reconstructive plastic surgery on the auxiliary apparatus of the eye: ptosis of the upper eyelid was treated by various methods depending on its type: 18 patients received plastic surgery of the levator aponeurosis (in 8 cases on both eyes; simultaneously, blepharochalasis resection was performed), 4 patients underwent levator shortening, 4 patients underwent eyebrow suspension (of these, 2 patients had the procedure on both eyes, hanging to the eyebrow – 4 operations (both eyes were operated on in two patients), 2 had tarzomyectomy; 8 had elimination of inversion, and 4 had elimination of eversion. In the postoperative period, instillations of antiseptics and antibiotics were supplemented by tear replacement and keratoprotective therapy: Hyloparin-Comod® was instilled 3 times during the day, while Parin-Pos® ointment was placed under and on the eyelids before going to bed. The course of treatment lasted 1 month. All patients underwent a standard ophthalmological examination before surgery as well as 2 weeks, 1 month and 3 months after surgery. The criteria for evaluating the effectiveness of treatment were the condition of the eyelid skin on a pointwise scale (Manchester scar scale), the result of biomicroscopy / biomicroscopy with fluorescein staining of the conjunctiva and cornea, Norn test.Results. In all cases of the use of Hyloparin-Comod® and Parin-Pos® combination, good subjective tolerability was noted, the patients had no complaints of discomfort due to the use of drops or ointment.Conclusion. The results obtained demonstrate that the proposed combination of drugs contributes to improving the favorable condition of eyelid skin and wound healing with the formation of a delicate scar, rapid resolution of conjunctival and eyelid swelling, prevention of corneal microerosions, minimization of corneal epithelial edema and tear film stability.

Long-term changes in the ocular surface during orthokeratology lens wear and their correlations with ocular discomfort symptoms

PurposeTo evaluate the changes in ocular surface parameters during orthokeratology lens wear and determine their correlations with ocular discomfort symptoms. MethodsFifty individuals were enrolled in this prospective pilot study. Clinical evaluation of the ocular surface included the ocular surface disease index, slit-lamp examination, Keratograph 5M, optical quality analysis system, and corneal staining. After baseline examinations, clinical tests were performed at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after orthokeratology lens wear. Correlations between ocular discomfort symptoms and signs of ocular discomfort were evaluated. ResultsOverall ocular surface disease index score and two subscale scores (ocular symptoms and vision-related function) significantly increased at the 3-month visit (P < 0.05), and decreased to levels close to baseline at the12-month visit (P > 0.05). The basic objective scatter index and the mean tear film objective scatter index increased, peaking at 3-month visit (P < 0.05) and gradually decreased thereafter. The modulation transfer function cut-off significantly decreased at the 3-month visit (P < 0.05). During the 12-month study period, the overall ocular surface disease index score and vision-related function score were significantly and positively correlated with the basic objective scatter index and mean tear film objective scatter index (P < 0.05). After 1 week of lens wear, Grade 1 corneal staining increased to 16.4 %, mostly involving the central and inferior cornea. ConclusionsOrthokeratology lens wear increased ocular discomfort symptoms and decreased the function of tear film, mainly within 3 months of lens wear. Tear-related visual function parameters were correlated with ocular discomfort. A new parameter, tear film objective scatter index, measured with the optical quality analysis system, was more sensitive in detecting the quality and stability of tear film than traditional indicators.

Effect of Recombinant Human Lubricin on Model Tear Film Stability.

PurposeTo investigate and quantify the effect of recombinant human lubricin (rh-lubricin) on model tear film stability.MethodsA custom-built, interferometry-based instrument called the Interfacial Dewetting and Drainage Optical Platform was used to create and record the spatiotemporal evolution of model acellular tear films. Image segmentation and analysis was performed in MATLAB to extract the most essential features from the wet area fraction versus time curve, namely the evaporative break-up time and the final wet area fraction (A10). These two parameters indicate the tear film stability in the presence of rh-lubricin in its unstressed and stressed forms.ResultsOur parameters successfully captured the trend of increasing tear film stability with increasing rh-lubricin concentration, and captured differences in rh-lubricin efficacy after various industrially relevant stresses. Specifically, aggregation and fragmentation caused by a 4-week, high temperature stress condition negatively impacted rh-lubricin's ability to maintain model tear film stability. Adsorbed rh-lubricin alone was not sufficient to resist break-up and maintain full area coverage of the model tear film surface.ConclusionsOur results demonstrate that fragmentation and aggregation can negatively impact rh-lubricin's ability to maintain a stable tear film. In addition, the ability of rh-lubricin to maintain wetted area coverage is due to both freely dispersed and adsorbed rh-lubricin.Translational RelevanceOur platform and analysis method provide a facile, intuitive, and clinically relevant means to quantify the effect of ophthalmic drugs and formulations intended for improving tear film stability, as well as capture differences between variants related to drug stability and efficacy.

Tear film impairment and meibomian gland loss in patients with polycystic ovary syndrome.

The aim of this prospective study is to comparatively assess the tear film, meibomian gland (MG), cornea and anterior chamber parameters and also subjective ocular complaints in patients with polycystic ovary syndrome (PCOS) and healthy control subjects. We included 53 eyes of the 53 patients diagnosed with PCOS and 57 eyes of the 57 healthy control subjects (who are non-pregnant, none of the following clinical findings of male pattern hair loss, hirsutism or acne and with regular menstrual cycles, who have no laboratory findings in her medical history that indicate hyperandrogenism, and who have ovaries that appear to be normal ultrasonographically. All subjects were referred to the masked ophthalmologist by the obstetrician and gynecologist. Participants underwent evaluation of the non-invasive tear film break-up time test (NI-BUT); loss of MGs by non-contact meibography, evaluation of cornea and anterior chamber parameters, and evaluation of subjective ocular complaints using the ocular surface disease index (OSDI). The mean age of PCOS group and controls was 25.08 ± 4.88 and 25.44 ± 5.00years, respectively. There was no statistically significant difference between the PCOS and control groups in terms of age (p = 0.732). Mean non-invasive first tear film breakup times (NIF-BUT) values of PCOS group and controls were 6.15 ± 4.99 and 10.48 ± 5.81s, and mean non-invasive average tear film breakup times (NIAvg-BUT) values of PCOS group and controls were 8.48 ± 4.27 and 11.94 ± 4.64s, respectively; both cases refer to a significant difference between the groups (p = 0.000). In PCOS group, loss of MG in the upper lids was 40.21%, in the lower lids was 53.45%; on the other hand, in control group 15.76% and 21.47%, respectively; both cases refer to a significant difference between the groups (p = 0.000). The number of patients with abnormal OSDI scores (scores ≥ 13 points) was significantly higher in PCOS group (54.7%) than in controls (19.3%) (p = 0.000). Anterior chamber volume (ACV) measured by the topography device in PCOS group was significantly lower (156.5 and 167.4) (p = 0.024). Findings of this study indicated that tear film stability impaired in patients with PCOS and that this impairment was accompanied by the loss of MG, which play a key role in tear film stability.

Evaluation of Tear Secretion and Tear Film Stability in Patients with Pterygium and Normal Individuals

Introduction: Abnormalities of any of the components of lacrimal function unit can lead to dysfunctional tear film and development of dry eye. Dry eye is a commonly encountered problem in general population.&#x0D; Materials and Methods: A hospital-based, case-control study was conducted at National Medical College and Teaching Hospital, Nepal from 1st August 2018 to 30th July 2019. A total of 279 participants: 93 cases of pterygium (Group A: case) and186 (Group B: control) normal individuals with no ocular surface disorder were enrolled. Objective analysis was done by Schirmer’s (SCH) without and with anesthesia and Tear Break up Time (TBUT). Dependent t test was used to analyze the data. P value &lt;0.05 was considered statistically significant.&#x0D; Results: The mean age of the patients was 47.82 ±11.09 years (range 26-71) with male being 48 (51.6%) in Group A and in Group B, 101 (54.3%) were male with mean age being 42.16 ±13.13 years (range 32-75). The mean SCH without and with anesthesia and TBUT values were 16.94±5.61mm, 13.81±5.06mm, 10.14± 4.06 sec in Group A whereas in Group B, 20.39 ±6.08mm, 16.74 ±5.25mm and 13.05 ±4.32 sec respectively which was statistically significant (p &lt; 0.05). Patients with pterygium had higher risk of having dry eye than normal individuals (Odd ratios: 2.69, 2.44 and 2.27 respectively).&#x0D; Conclusion: Pterygium is a common ocular surface disorder which could result in instability of tear film indices, dysfunctional tear film and thus dry eye.

Tear Film Stability as a Function of Tunable Mucin Concentration Attached to Supported Lipid Bilayers.

In this work, we describe the development of a tunable, acellular in vitro model of the mucin layer of the human tear film. First, supported lipid bilayers (SLBs) comprised of the phospholipid DOPC (1,2-dioleoyl-sn-glycero-3-phosphocholine) and biotinyl cap PE (1,2-dioleoyl-sn-glycero-3-phosphoethanolamine-N-(cap biotinyl)) are created on the surface of a glass dome with radius of curvature comparable to the human eye. Next, biotinylated bovine submaxillary mucins (BSM) are tethered onto the SLB using streptavidin protein. The mucin presentation can be tuned by altering the concentration of biotinylated BSM, which we confirm using fluorescence microscopy. Due to the optically smooth surface that results, this model is compatible with interferometry for monitoring film thickness. Below a certain level of mucin coverage, we observe short model tear film breakup times, mimicking a deficiency in membrane-associated mucins. In contrast, the breakup time is significantly delayed for SLBs with high mucin coverage. Because no differences in mobility or wettability were observed, we hypothesize that higher mucin coverage provides a thicker hydrated layer that can protect against external disturbances to thin film stability. This advance paves the way for a more physiological, interferometry-based in vitro model for investigating tear film breakup.

The Efficacy and Safety of New-Generation Intense Pulsed Light in the Treatment of Meibomian Gland Dysfunction-Related Dry Eye: A Multicenter, Randomized, Patients-Blind, Parallel-Control, Non-Inferiority Clinical Trial.

IntroductionThis study aimed to evaluate the efficacy and safety of a new-generation intense pulsed light (IPL) device in improving the symptoms and signs of meibomian gland dysfunction (MGD)-related dry eye, and compare it with a traditional IPL device.MethodsThis multicenter randomized controlled trial enrolled 132 patients with MGD-related dry eye from two centers. Patients were randomly assigned into the new-generation IPL (Eyesis) group or traditional IPL (E-Eye) group, and then blinded to receive treatment on days 0 and 7. Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear breakup time (TBUT), corneal fluorescein staining (CFS), Schirmer test, and meibomian gland signs were evaluated on days 0, 7, and 14. The primary outcome was defined as the effective rate of treating MGD at day 14. Any adverse events were recorded for safety assessment. Intergroup comparisons and non-inferiority analysis were performed. p values less than 0.05 were considered statistically significant.ResultsBasic information showed no significant difference between treatment groups. The intergroup difference of the effective rate was − 1.7% in the left eye and 1.6% in right eye, verifying the non-inferiority of the Eyesis device (p = 0.927). Significant improvements in OSDI, TBUT, Schirmer test, TMH, CFS, and meibomian gland signs were observed in Eyesis group on days 7 and 14 (all p < 0.05). Compared to the E-Eye group, the Eyesis group achieved more significant improvements in OSDI, TBUT, Schirmer test, TMH, and meibum quality (all p < 0.05). There was no significant difference in the incidences of adverse events between groups (p = 1.000).ConclusionsThe new-generation IPL was effective and safe in relieving the symptoms and signs of MGD-related dry eye, exhibiting a non-inferior effective rate compared to the traditional IPL. Additionally, Eyesis showed more clinical benefits over E-Eye in alleviating symptoms, increasing tear film stability and improving meibomian gland function.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-022-00556-1.

What is Important in Diagnosing Dry Eye Disease - Recommendations According to current Guidelines (DEWS II, DOG/BVA)

Dry Eye is one of the most common ocular diseases worldwide with an increasing number of patients. The pathogenesis of this disease is multifactorial and complex and the basis for diagnostic strategies and therapies. The current definition of dry eye disease as described in DEWS II includes inflammatory mechanisms at the ocular surface, a loss of homeostasis, hyperosmolarity of the tear film and neurosensory abnormalities. Subject symptom scores, a detailed patient history, certain diagnostic tools, and interdisciplinary interactions are necessary to enable an efficient, individualized and successful therapy. Important diagnostics include risk factor analysis, slit lamp examination, tear secretion tests, tearfilm stability tests, and tests for measuring the ocular surface inflammation.

Emphasis on heat strain to the ocular surface: A functional and clinical study of a modified goggle.

PurposeThe limitations of conventional goggles have caused immense inconvenience, and even damage, to the physical and mental health of healthcare workers. Hence, this study aimed to build a modified goggle (MG) with better physical performance. The temperature-humidity index (THI) was used as an indicator to investigate the impact of goggle-related heat strain on the ocular surface.MethodsThe basic functions of antifog, anti-ultraviolet (UV), and anti-blue-light radiation capabilities were evaluated. Furthermore, the clinical impact on noninvasive keratography tear film break-up time (NIKBUT), intraocular pressure, central corneal thickness, Schirmer test I, and the Dry Eye-related Quality of life Score (DEQS) were assessed in 40 healthcare workers by comparing MG with standard goggles (SG). The relationships between THI and the above parameters were explored.ResultsMG had a significantly longer antifog time than SG (212.75 ± 23.95 vs. 138.35 ± 5.54 min, p < 0.05), stronger antiultraviolet ability at 400 nm (99.99 vs. 45.55%), and optimal anti-blue-light performance at 440 nm (33.32 vs. 13.31%). Tear film stability after wearing the goggle was significantly worse than that before wearing them (p < 0.05). Both goggles achieved moderate to strong heat strain, with a THI of >80 at all timepoints. The MG group showed lower THI and DEQS and higher NIKBUT than the SG group (p < 0.05). THI was significantly correlated with DEQS, NIKBUT, and real fogging time (r = 0.876, −0.532, −0.406; all p < 0.05).ConclusionWearing goggles for a long time may cause heat strain to the eyes, thereby leading to eye discomfort and changes in the microenvironment of the ocular surface. Our MG exhibited better antifog, antiultraviolet, and optimal anti-blue-light performance and lower heat strain than SG, thus making it ideally suited for healthcare workers.

Prolonged Computer Use by Office Workers Induces Ocular Symptoms Associated With Tear Film Alterations and Overexpression of Mucin 5 AC and Catalase.

The aim of the study was to evaluate office workers for symptoms of computer vision syndrome (CVS) and alterations in the tear film relate to the hours of daily computer use. Sixty-seven volunteers were divided into 2 groups: 2 to 6 and 7 to 12 hours of daily computer use. Computer vision syndrome symptoms, tear film stability by tear film break-up time test, and composition of mucin 5 AC, catalase, and IL-6 was assessed by relative gene expression of conjunctival impression cytology samples were examined. All participants exhibited moderate symptoms of CVS, whereas 90% showed reduced tear film stability. For the 7- to 12-hour (vs 2- to 6-hour) group, these effects were more pronounced and overexpression of mucin 5 AC and catalase was detected. Prolonged computer use induced an overexpression of mucin 5 AC and catalase and instability of the tear film, associated with ocular symptoms.

Tear film instability is associated with weakened colocalization between occludin and MUC5AC in scopolamine-induced dry eye disease (DED) rats.

Dry eye disease (DED) is a disease with tear film instability because of multiple factors. This study was conducted to explore roles of occludin and MUC5AC in tear film instability in DED rat model. A total of 20 SD rats were divided into DED group (n = 10) and normal control (NC) group (n = 10). DED rat model was established by subcutaneously injecting with scopolamine hydrobromide. Clinical examinations, including tear breakup time (tBUT), Schirmer's test and corneal fluorescein staining, were conducted to determine corneal functions. Transmission electron microscopy was used to measure the ultrastructures of corneal epithelial cells. Western blotting assay was used to identify occludin expression in corneal tissues of DED rats. Real-time PCR (RT-PCR) was performed to verify gene transcription of occludin and MUC5AC. Colocalization between occludin and MUC5AC was identified with confocal fluorescence microscopy. Tear breakup time was significantly shorter, and corneal fluorescein staining score was predominantly higher in DED rats compared to those in normal rats (P < 0.05). Normal rats showed a steady tear secretion throughout the whole experiments, while DED rats showed a dramatic reduction on day 14. DED rats demonstrated ultrastructural damage of Golgi apparatus and endoplasmic reticulum in corneal epithelial cells. Occludin and MUC5AC expressions were significantly downregulated in corneal tissue of DED rats compared with those of normal rats (P < 0.05). Percentage of occludin-MUC5AC-colocalized corneal epithelial cells in DED rats was significantly less compared with those in normal rats (P < 0.01). Tear film stability was damaged in scopolamine-induced DED rats because of the weakened colocalization between occludin and MUC5AC molecule. This study would provide a potential clue for the pathogenesis and a promising theoretical basis for clinical work of DED.

Case Control Study to Evaluate Tear Film Function and Ocular Surface Disorder in Diabetic Patients

BACKGROUND&#x0D; Diabetic retinopathy and early development of cataracts are well-known ocular complications of long-standing diabetes. In recent years various researchers have reported ocular surface disorders, particularly dry eyes in diabetic patients which if left untreated may result in a variety of corneal complications. These ocular surface disorders can be clinically diagnosed by performing a detailed slit lamp examination, Schirmer's test and tear film break-up time. Our study intended at assessing tear film and ocular surface disorders in diabetic patients and study tear film function in them and compare it with non-diabetic patients.&#x0D; METHODS&#x0D; A comparative cross-sectional study was done on 100 diabetic and 100 non-diabetic patients &gt; 30 years of age visiting OPD of health centre of tertiary care hospital of Central India. Clinical data and detailed clinical history were obtained from all subjects through direct patient interviews and reviewing of their medical records followed by a comprehensive ocular examination that included best-corrected vision, slit lamp examination, and Tear Film break up time (TBUT) &amp; Schirmer test.&#x0D; RESULTS&#x0D; In our study, mean TBUT was found to be significantly reduced in diabetics (15.94 ± 3.8) as compared to non-diabetics (20.13 ± 6.6). No significant difference was found in the Schirmer test reading between diabetics (17.13 ± 3.20) and non-diabetics (19.20 ± 6.23). Diabetic male patients had significantly decreased mean TBUT &amp; mean Schirmer test readings as compared to diabetic females. Mean Schirmer reading &amp; Mean TBUT were lowest in a patients having &gt; 20 years of DM and highest in patients having &lt; 5 years of DM. No positive correlation was found between HbA1c (Glyosylated Haemoglobin) and diabetic retinopathy with TBUT/ Schirmer test readings.&#x0D; CONCLUSIONS&#x0D; Our study showed that the tear film stability was found to be affected in diabetic patients, as compared to non-diabetic subjects as evident by the lower level of TBUT in diabetic patients. Significantly reduced TBUT with no significant difference in Schirmer test reading in diabetic as compared to non-diabetic subjects might be due to a decrease in basal secretion with normal overall tear secretion. The absence of subjective symptoms of dryness in spite of decreased TBUT in the diabetic group might be due to a decrease in corneal sensitivity caused by diabetic peripheral neuropathy in diabetic patients. There was an increase in the prevalence of DES with an increasing duration of DM. Rheumatoid arthritis was found to be a risk factor for DES. Diabetic males were found to be at risk for developing dry eye syndrome. Hence it can be concluded from our study that every diabetic patient should undergo a comprehensive eye examination which should include various tests for dry eye assessing multiple tear parameters.

Short- and Long-Term Effects of a Multi-Component, Artificial Tear on Preocular Tear Film Stability, Tear Evaporation and Tear Film Optical Dynamic: A Prospective Randomized Double-Phase Study

Purpose To evaluate the short- (within 90 min) and long-term (after 21 days of treatment) effects of an artificial tear containing carbomer, hyaluronic acid, glycerol, and medium-chain triglycerides in patients with mild-to-moderate dry eye symptoms. Methods Subjects received the tested artificial tears in the right eye and control artificial tears in the left eye and were assessed 10, 30, 60, and 90 min after instillation in the short-term study phase. They received the study product in both eyes in the long-term phase. Non-invasive break-up time (NIBUT), tear lipid layer pattern, tear evaporation, and tear film objective optical dynamics (TFOOD) were measured in controlled environmental conditions. Results In total, 32 patients (10 males, mean age 42 ± 11 years) were enrolled. During the short-term phase, NIBUT increased significantly in the right eyes at all time points compared with baseline (all p < 0.05). Conversely, in the left eyes, NIBUT increased significantly at 10 and 30 min (p < 0.05). The tear evaporation values increased at 10 min and decreased at 30 and 60 min (p < 0.05) in the right eyes, while they increased only at 10 min (p < 0.05) in the left eyes. Compared with baseline, the TFOOD was significantly more stable at all time points in the right eyes (p < 0.05), while it was more stable at 10 and 30 min in the left eyes (p < 0.05). In the long-term phase, treated eyes showed a significant increase in NIBUT values, a significant reduction of tear evaporation, a significant improvement of tear lipid layer pattern, and a more stable TFOOD compared with baseline (all p < 0.05). Symptoms, measured with the Ocular Surface Disease Index questionnaire, were also significantly reduced compared with baseline (p < 0.05). Conclusion The tested product increased tear film stability and reduced tear evaporation, normalizing lipid layer pattern and reducing symptoms in the short- and long-term observation.

Short-term tolerability of commercial eyelid cleansers: A randomised crossover study

PurposeTo evaluate the short-term tolerability of five commercially available anti-demodectic eyelid cleansers; OCuSOFT Oust Demodex (OD), I-MED I-Lid’n Lash Plus (ILL+), Labtician BlephaDex (BD), Chrissanthe Eye Cleanse (EC), and Théa Blephademodex (BDdx). MethodsThirty healthy non-contact lens wearers (18 female; mean ± SD age, 33 ± 12 years) were enrolled in a prospective randomised crossover study. On separate visits, spaced at least 48 h apart, participants were randomised to receive topical application of one of five eyelid cleansers or saline. Participants rated subjective ocular discomfort during the 10-minute post-application period. Visual acuity, non-invasive tear film stability, conjunctival hyperaemia, and ocular surface staining were assessed at baseline and 10 min. ResultsNo inter-group differences in ocular parameters were noted at baseline (all p > 0.05). Ocular discomfort scores significantly exceeded baseline scores for 60 s following BD application, 120 s with OD, 135 s with BDdx, 150 s with ILL+, and 195 s with EC (all p < 0.05). Deterioration in non-invasive tear film stability, limbal conjunctival hyperaemia, as well as corneal, conjunctival, and lid margin staining was detected following EC application (all p < 0.05), and increased bulbar conjunctival hyperaemia was observed following both EC and ILL+ treatment (both p < 0.05). ConclusionsStudy outcomes highlight varying tolerability profiles with different anti-demodectic lid cleanser preparations, and the potential to induce tear film instability, conjunctival hyperaemia and ocular surface staining on application. Awareness of possible adverse effects arising from topical application of commercial anti-demodectic lid cleanser formulations may help clinicians set realistic patient expectations and encourage better compliance in their use of lid hygiene therapies.

Short-term tear film stability, optical quality and visual performance in two dual-focus contact lenses for myopia control with different optical designs.

PurposeTo assess and compare short‐term visual and optical quality and tear film stability between two dual‐focus (DF) prototype myopia control contact lenses (CLs) having different inner zone diameters.MethodsTwenty‐eight myopic subjects were included in this randomised, double‐masked crossover study. Refraction, best‐corrected visual acuity (VA) and tear film stability were measured at baseline (i.e., when uncorrected). Subjects were then binocularly fitted with the DF CLs, with only the sensorial dominant eye being assessed. Lenses were of the same material and had inner zone diameters of either 2.1 mm (S design) or 4.0 mm (M design). Visual and physical short‐term lens comfort, over‐refraction, best‐corrected VA, stereopsis at 40 cm, best‐corrected photopic and mesopic contrast sensitivity (CS), size and shape of light disturbance (LD), wavefront aberrations, subjective quality of vision (QoV Questionnaire) and tear film stability were measured for each lens.ResultsBoth CL designs decreased tear film stability compared with baseline (p < 0.05). VA and photopic CS were within normal values for the subjects' age with each CL. When comparing lenses, the M design promoted better photopic CS for the 18 cycles per degree spatial frequency (p < 0.001) and better LD (p < 0.02). However, higher‐order aberrations were improved with the S design (p = 0.02). No significant difference between the two CLs was found for QoV scores and tear film stability.ConclusionsBoth DF CLs provided acceptable visual performance under photopic conditions. The 4.0 mm inner zone gave better contrast sensitivity at high frequencies and lower light disturbance, while the 2.1 mm central diameter induced fewer higher‐order aberrations for a 5 mm pupil diameter. Both CLs produced the same subjective visual short‐term lens comfort.