Treatment Of Dry Eye Syndrome Research Articles

Autologous serum eye drops for treatment of dry eye syndrome

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The use of physiotherapeutic methods in the treatment of dry eye syndrome

The relevance of the treatment of dry eye syndrome is associated with the widespread prevalence of this disease. Along with the development of information technology and an increase in time spent in front of screens, the number of people suffering from this disease is steadily growing. The basis of treatment for dry eye syndrome is the use of “artificial tears” preparations, which are instilled into the conjunctival cavity to replenish moisture deficiency. But the effect of tear replacement therapy in case of dysfunction of the meibomian glands does not last long. In this regard, the use of physiotherapeutic methods for treating dry eye syndrome to prolong the effect of drug therapy for this pathology is of particular importance. Each of the methods of physiotherapeutic treatment of dry eye syndrome has its own unique mechanisms of action and indications for use. Physiotherapeutic methods are an effective tool in the treatment of dry eye syndrome, providing the opportunity to improve the quality of life of patients suffering from this common ophthalmic disease.

Rationale for the application of modern magnetotherapy technologies for dry eye syndrome, glaucoma and cataract

Abstract. Purpose of the study. The article outlines the basic terms and concepts of information interactions of structures and systems of living organisms, provides a modern approach to the problems of optimizing medical rehabilitation through various methods of magnetic therapy, taking into account the biological effect and characteristics of the impact of various types of magnetic fields, and presents the pathogenetic conditionality of the use of magnetic techniques by means of the Ophthalmag device for the treatment of dry eye syndrome, glaucoma, and cataract.

Silk Fibroin Formed Bioadhesive Ophthalmic Gel for Dry Eye Syndrome Treatment.

Dry eye syndrome (DES), arising from various etiologic factors, leads to tear film instability and ocular surface damage. Given its anti-inflammatory effects, cyclosporine A (CsA) has been widely used as a short-term treatment option for DES. However, poor bioavailability and solubility of CsA in aqueous phase make the development of a cyclosporine A-based eye drop for ocular topical application a huge challenge. In this study, a novel strategy for preparing cyclosporine A-loaded silk fibroin nanoemulsion gel (CsA NBGs) was proposed to address these barriers. Additionally, the rheological properties, ocular irritation potential, tear elimination kinetics, and pharmacodynamics based on a rabbit dry eye model were investigated for the prepared CsA NBGs. Furthermore, the transcorneal mechanism across the ocular barrier was also investigated. The pharmacodynamics and pharmacokinetics of CsA NBGs exhibited superior performance compared to cyclosporine eye drops, leading to a significant enhancement in the bioavailability of CsA NBGs. Furthermore, our investigation into the transcorneal mechanism of CsA NBGs revealed their ability to be absorbed by corneal epithelial cells via the paracellular pathway. The CsA NBG formulation exhibits promising potential for intraocular drug delivery, enabling safe, effective, and controlled administration of hydrophobic drugs into the eye. Moreover, it enhances drug retention within the ocular tissues and improves systemic bioavailability, thereby demonstrating significant clinical translational prospects.

Current treatment options for dry eye syndrome in children

AIM: To analyze personalized therapy for dry eye syndrome (DES) in children, depending on the etiopathogenesis and severity of the disease.
 MATERIAL AND METHODS: In total, 187 children aged 3–17 years with DES were treated. Ophthalmic medicines registered in Russia from the group of local rehydrants replacing tear fluid and stabilizing tear film were used, and a comparative analysis of their effectiveness was carried out.
 RESULTS: An individual approach was implemented, and personalized therapy focused on the individual tolerability and effectiveness of medicines was developed. The principle of DES therapy is to replenish the lacrimal fluid deficiency and stabilize all layers of the tear film, considering the etiopathogenesis and severity of clinical symptoms. At this stage, the lipid layer of the tear film was normalized with the help of hypotonic oil-based preparations that can stabilize the lipid layer. All rehydrants of low, medium, and high viscosities contributed to the restoration of the water layer of the joint venture. The deficiency of the mucin layer of the tear film was compensated by hyaluronic acid and carboxymethylcellulose, which are part of the preparations that replace the tear film. The severity of DES associated with the intensity of the clinical changes in the conjunctiva and cornea was considered when designing the DES treatment regimen in children. In cases of mild and extremely severe severity, tear-replacement medicines of low viscosity showed the greatest therapeutic effectiveness. High-viscosity preparations and gels have been proven to be effective in moderate to severe DES. During the desquamation of the conjunctival and corneal epithelium, medicines with regenerating pharmacological action related to tissue repair simulators were included in the treatment regimen. Reparants included in the combined composition of tear-replacement medicines or monopreparations were used.
 CONCLUSION: The effectiveness of the DES treatment algorithm in children with various nosologies and features of etiopathogenesis was analyzed considering disease severity. The proposed schemes of personalized tear-replacement and reparative therapy make it possible to prevent a chronic disease course and occurrence of complications and preserve or restore visual acuity.

Ayurvedic Management of Shushkakshipaka w.s.r. To Dry Eye Syndrome - A Single Case Study

Eyes are one of the most powerful tools that anyone can have; hence, all efforts should be made to protect the eyes. In today’s era, people depend more on machines like computers in all sectors of life. These cause some heat and radiation which certainly causes ill effects on the eyes. Tear (Ashru) secretion is an integral component of the ocular surface physiology; when compromised (quantitatively or qualitatively) leads to shushkakshipaka (dry eye syndrome) with various ocular discomfort symptoms and ultimately the patient may land in corneal blindness. Local, systemic, and environmental factors majorly affect its pathogenesis. Vata and Pitta/Rakta vitiation as per Ayurvedic viewpoint are the major contributing pathological factors in its manifestation. A 28-year-old female patient approached Shalakya OPD of SKGAC and H, Kurukshetra, complaining of irritation, foreign body sensation, eye fatigue, and pain in the periorbital region along with a feeling of dryness for 1 year. The patient had slight symptomatic relief but when medications were discontinued the condition used to reoccur, so she turned to Ayurvedic treatment for relief. In Ayurveda classics, specific treatment has been mentioned for Shushkakshipaka such as Snehana (~in-take of Ghee), Tarpana (~retention of ghee over eyes), Nasya (~Nasal medication), and Pariseka (~ocular irrigation). A patient of shushkakshipaka was treated with such treatment protocol, is presented as a case study in this article. Contrary to the available modern medical treatment Ayurveda propounds a systematic approach in the treatment of dry eye syndrome.

Role of Vitamin D3 Supplementation in the Treatment of Dry Eye Syndrome

Purpose: The aim of this study was to evaluate the role of vitamin D3 supplementation in treating non-Sjogren dry eye (NSDE) patients compared to the conventional treatment with artificial tears. Study Design: Non-randomized controlled Trial. Place and duration of study: Rural Health Centre (RHC) Buchaal Kalan from September 2021 to July 2022 Methods: This study allocated 108 patients with NSDE and hypovitaminosis D via two-arm parallel assignment. The sample was divided into two groups by non-probability purposive sampling. Group 1 received conventional treatment as artificial tears 4 times/day and group 2 was given oral vitamin D3 supplementation of 6000 IU daily along with artificial tears for a period of 90 days. The impact of oral vitamin D3 supplementation on NSDE was assessed by comparing means of ocular parameters of both groups over time. Tear break-up time (TBUT) in seconds and Schirmer’s test (ST) score in millimeters were primary outcome measures. The ocular surface disease index (OSDI) score and numerical pain rating scale (NPRS) were secondary outcome measures. Results: The mean age of patients in group 1 and group 2 was 34.98±8.64 and 34.87±8.79 respectively. Similarly, the mean serum 25 (OH) D level was 15.03±3.27 in group 1 and 14.93±3.26 in group 2. Results showed that OSDI and NPRS scores were decreased in both groups, however, TBUT and ST scores were improved in group 2. Conclusion: Oral vitamin D3 supplementation may serve as a new treatment option for NSDE patients having hypovitaminosis D.

Correlation between serum cytokine levels and the effect of allogeneic serum-based eye drops

IntroductionThe Institute of Hematology and Transfusion Medicine (IHTM) in Warsaw has produced autologous serum eye drops (ASEDs) for the treatment of Dry Eye Syndrome (DES) since 1991. In 2019, IHTM introduced allogeneic tears (alloSEDs) for patients on long-term treatment. Materials and methods114 patients who applied alloSEDs were included in the study.They were asked to complete the OSDI questionnaire before and after using ASEDs and 100 units of alloSEDs drops from each donation. The OSDI index rates DES severity (0 no symptoms; 100 severe). We also compared the content of IL-1β, IL-2, IL- 6, IL-10 and VEGF in ASEDs (38 samples) and alloSEDs (15 serum samples). The study data covered the 2019–2022 period. Results114 patients participated in the study. We compared the the effectiveness of ASEDs and alloSEDs. The average, OSDI dropped from 68.42 ± 5,86 (before application) to 51.05 ± 19,06 (after application). Data from the questionnaires (prepared at IHTM) completed and returned (41/114) present the most common indications for the use of serum drops, including DES with no underlying disease, DES secondary to GvHD (Graft versus Host Disease), Sjögren's Syndrome (SS). The study reported higher cytokine levels associated with disease entities such as SS. After application of drops with high cytokine levels, patients reported adverse reactions such as sand under the eyelids, impaired visual acuity, and worse eye lubrication. ConclusionsAlloSEDs with acceptably low values of pro-inflammatory cytokines and sufficiently high levels of VEGF growth factor may contribute to alleviation of inflammatory eye symptoms.

The evolution of artificial tears based on hyaluronic acid

In recent years, there has been growing interest in the use of tear substitutes, based on natural polysaccharides in the treatment of dry eye syndrome, the leader of which is hyaluronic acid (HA). It has sufficient biocompatibility, non-immunogenicity, high viscoelasticity, hydrophilic, mucus-adhesive and good moisturizing properties. At the same time, in order to improve artificial tear preparations, there is a need to improve the mechanical and rheological properties of HA, its hygroscopicity, swelling in an aqueous environment and reducing the rate of biodegradation. One of the ways to solve this problem was the chemical modification of HA, by cross-linking its chains with two or more covalent bonds, with the participation of various polyfunctional molecules: urea, HA-cysteine ethyl ester, polyfunctional diepoxides, glutaraldehyde, carbodiimide, and many others. At the same time, the rigidity of the three-dimensional polymer network increases, increasing its resistance to enzymatic decomposition at the site of burial. Cross-linked HA has a higher viscosity compared to native hyaluronic acid due to the binding of its chains, which determines longer retention on the corneal epithelium and naturally makes it possible to reduce the frequency of drug instillations. Convincing data were obtained on the effectiveness of the resulting cross-linked hydrogel with non-Newtonian properties in vitro – on cultures of corneal epithelial cells and in vivo – on models of mechanical trauma and chemical burns of the cornea, as well as in animals with torpid corneal ulcers. The clinical effectiveness of cross-linked hyaluronic acid in the treatment of patients with dry eye syndrome of varying severity, including those due to Sjögren’s syndrome, has also been established. The higher effectiveness of cross-linked HA compared to native HA preparations has been convincingly proven. Taking into account the available information, an official drug has been developed based on cross-linked 0.2% hyaluronic acid Ocutears® Hydro+ (Santen).

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.

Exploring the Efficacy of Omega-3 Fatty Acid Supplementation in Dry Eye Disease: A Comprehensive Review

Introduction 
 Dry eye syndrome, as defined by TFOS, is a multifactorial ocular surface disease with tear film instability, hyperosmolarity, inflammation, and neuro-sensory abnormalities. With a prevalence between 6.5% and 52.4%, it poses a substantial public health challenge, significantly affecting patients' quality of life. Omega-3 fatty acid supplementation is often suggested by clinicians as an adjunctive treatment, offering potential benefits across various levels.
 
 Aim of the study 
 The purpose of the study was to investigate the effect of oral supplementation of omega-3 fatty acids on the treatment of dry eye syndrome.
 Materials and methods 
 Literature selections of PubMed and Google Scholar databases from the last seven years (2016-2023) were performed. Articles were searched in English using the following keywords: dry eye disease; omega-3; fatty acid.
 Results 
 Omega-3 fatty acids may have benefits in the treatment of dry eye syndrome, as argued by a number of potential mechanisms of action. However, the literature does not agree on the efficacy of their use in the treatment of dry eye syndrome, and thus there is insufficient evidence to bring omega-3 acids into the standard of treatment for dry eye syndrome.
 Conclusion
 Studies on the effect of oral supplementation of omega-3 fatty acids on the treatment of dry eye syndrome are at an early stage and need to be continued to improve knowledge. There is a need for further long-term studies to standardize conclusions about the efficacy of these acids in reducing dry eye symptoms.

Клиническое течение и оптимизация лечения хронического конъюнктивита в регионе Южного Приаралья

Purpose. Optimization of treatment of chronic conjunctivitis in the Southern Aral Sea region. Material and Methods. The research included 62 patients (120 eyes) with chronic conjunctivitis, aged 35–62 years, who had been observed in a polyclinic for the last 3 years, with signs of DES. All studied patients were divided into 2 groups by random sampling after preliminary adequate antibacterial and anti-inflammatory therapy; The control group (20 patients, 40 eyes) was instilled with an antiseptic - Tsinosol (composition: zinc sulphate, boric acid, Aseptic), 2 drops 3 times a day, for 30 days. In the main group (40 patients, 80 eyes), patients were instilled with an antiseptic - Tsinosol (2 drops 3 times a day) and an artificial tear (AT) medicine - Keratrop (composition: sodium carmellose, glycerin, levocarnitine, erythrolfirma Aseptica), 2 drops 3 times a day for a month. All patients underwent standard ophthalmological tests, and special studies were carried out to verify DES, including tests by Schirmer, Norn, Jones, the height of the lower lacrimal meniscus and the severity of the conjunctival fold were determined. Results. Studies have shown that in the main group, both subjective and objective signs of the disease significantly decreased compared with the baseline and with the data of the control group, and a significant improvement in the stability of the tear film was noted. Conclusion. To optimize the therapy of secondary DES, it is necessary to include in the treatment regimen AT medicines in general and the domestic medicine Keratrop in particular, as the medicine of choice in this region. Keywords: Southern Aral Sea region, environment, chronic conjunctivitis, dry eye syndrome (DES), DES treatment, tear substitutes

Modern diagnosis of dry eye syndrome on MEDI WORKS S390L slit lamp

In recent years, in conditions of increased work with gadgets and computers, the prevalence of dry eye syndrome has increased dramatically. The presented article is devoted to the modern diagnosis of dry eye syndrome.25 patients (50 eyes) participated in the study, which was conducted at the ophthalmological center of Astana Vision Pavlodar LLP in Pavlodar. Of these, 7 patients after laser vision correction, 4 patients suffering from myopia, wore contact lenses, locally applied medications for the treatment of dry eye syndrome. The examination included a Schirmer test, a tear film rupture time test (NIBUT, VRSP), filling out the questionnaire «Ocular Surface Disease Index» (OSDI) and determining the height of the lacrimal meniscus.The author of the article concluded that noninvasive research methods used for the diagnosis of SSG are more acceptable, since they do not violate the integrity of the tear film.

REGENOPIA – PROMISING NEW TREATMENT FOR DRY EYE DISEASE

Dry eye syndrome is one of the main problems of modern ophthalmological pathology. Although the treatment of dry eye syndrome has made great strides, the development of new treatments continues to be a major challenge for scientists and ophthalmologists around the world. The development of highly effective and safe eye drops is especially important. The aim of the article is to conduct research on new eyedrops called Regenopia – the unique combination of three active substances: sodium hyaluronate, trehalose, and D-panthenol in the treatment of DED. Clinical observation of 128 patients (256 eyes) (85 women and 43 men 18-60 years age group with DED (patients with any chronic or autoimmune diseases were excluded from the research) treated with Regenopia was conducted from February 1-st to May 30-th, 2023. DED was diagnosed by anamnesis and instrumental clinical investigations (Visometry, Biomicroscopy, Schirmer’s test, Tear Break up time (TBUT)). Moderate dry eye - 75% (192 eyes), severe dry eye - 25% (64 eyes). In 24 eyes Superficial Punctate Keratitis (SPK) was determined after examination of the epithelial layer of the cornea and conjunctiva. One drop of Regenopia was instilled 3 times a day in both eyes by patients (in cases of SPK complex method of treatment was prescribed) and patients were called for a repeat visit in 3 weeks and 6 weeks after the start of treatment. The condition was assessed using the same methods as at the time of diagnosis. The bioprotective, osmoprotective, regenerative properties of trehalose significantly enhance hyaluronic acid’s ability to provide effective hydration and long-term symptom relief along with the regenerative action of dexpanthenol. Using Regenopia significantly reduced the intensity of symptoms, increased the patient’s ability to work, and improved the quality of life, which allows us to recommend Regenopia as an effective, safe and reliable treatment for moderate to severe dry eye disease.

Experience in the Treatment of Dry Eye Syndrome in Students with Myopic Refraction

Objective: to study the effectiveness of the hypromellose-based medicine Artificial Tears®, eye drops, in the treatment of dry eye syndrome in students with myopic refraction. Patients and methods. A total of 147 students of Academician E.A. Wagner Perm State Medical University with different types of clinical refraction were examined. Among them 63 students with myopic refraction of various degrees in 110 eyes were included in the study (mean age — 22.6 ± 0.16 years, 49 (78 %) women, 14 (22 %) men). Dry eye syndrome was detected in 49 (78 %) participants in 82 eyes (74.5 %). According to the myopia correction method, 3 groups were formed: Group 1 — students with eyeglasses; Group 2 — students constantly using soft contact lenses; Group 3 — students who had excimer laser correction by LASIK method. The remaining students (n = 14) had no dry eye syndrome. The study was conducted in two stages: at baseline and then repeated after 4 weeks in students with dry eye syndrome who used daily the medicine Artificial Tears®. Subjective assessment was based on the Ocular Surface Disease Index (OSDI) questionnaire. Оbjective assessment included function tests, characterizing the precorneal tear film stability and total tear production level. Results. In the process of treatment a good tolerance of the given medicine was reported. Analysis of the overall results showed that the mean OSDI score decreased statistically significantly from 26.92 to 20.29 seconds (p ≤ 0.0001). The mean tear film break-up time increased from 7.95 to 11.25 (p ≤ 0.0001). The mean Schirmer’s test score was slightly changed: from 13.98 to 14.07 mm due to the presence of increased tear production in some students, which is characteristic of the dry eye syndrome initial manifestations. Conclusion. The medicine Artificial Tears® in the form of eye drops is well tolerated and is sufficiently effective in eliminating the dry eye syndrome manifestations after only 4 weeks of use. The treatment with the medicine Artificial Tears® showed a statistically significant reduction in the disease severity (according to the OSDI questionnaire data) and an increase in the tear film break-up time. The received results allow us to recommend the medicine Artificial Tears® for medical use in patients with various degrees of myopic refraction, regardless of the myopia correction method used.

Combining MSC Exosomes and Cerium Oxide Nanocrystals for Enhanced Dry Eye Syndrome Therapy.

Dry eye syndrome (DES) is a prevalent ocular disorder involving diminishe·d tear production and increased tear evaporation, leading to ocular discomfort and potential surface damage. Inflammation and reactive oxygen species (ROS) have been implicated in the pathophysiology of DES. Inflammation is one core cause of the DES vicious cycle. Moreover, there are ROS that regulate inflammation in the cycle from the upstream, which leads to treatment failure in current therapies that merely target inflammation. In this study, we developed a novel therapeutic nanoparticle approach by growing cerium oxide (Ce) nanocrystals in situ on mesenchymal stem cell-derived exosomes (MSCExos), creating MSCExo-Ce. The combined properties of MSCExos and cerium oxide nanocrystals aim to target the "inflammation-ROS-injury" pathological mechanism in DES. We hypothesized that this approach would provide a new treatment option for patients with DES. Our analysis confirmed the successful in situ crystallization of cerium onto MSCExos, and MSCExo-Ce displayed excellent biocompatibility. In vitro and in vivo experiments have demonstrated that MSCExo-Ce promotes corneal cell growth, scavenges ROS, and more effectively suppresses inflammation compared with MSCExos alone. MSCExo-Ce also demonstrated the ability to alleviate DES symptoms and reverse pathological alterations at both the cellular and tissue levels. In conclusion, our findings highlight the potential of MSCExo-Ce as a promising therapeutic candidate for the treatment of DES.

Patient-reported outcomes of serum eye drops manufactured from Australian blood donations and packaged using Meise vials.

Serum eye drops (SED) are an effective treatment for dry eye syndrome. However, autologous serum collection can have challenges. Patient-tailored (allogeneic) SED (PT-SED) can be made from healthy blood donors. Australian Red Cross Lifeblood has manufactured both autologous SED (Auto-SED) and PT-SED and, in May 2021, introduced Meise vial packaging. This study aimed to explore SED patient-reported outcomes and vial packaging satisfaction. A prospective cohort study was conducted with recruitment between 1 November 2021 and 30 June 2022. Participants completed the dry eye questionnaire (DEQ5), health-related quality-of-life (SF-8™), functional assessment of chronic illness therapy-treatment satisfaction-general (FACIT-TS-G), and general wellbeing surveys. Existing patients completed these once, and new patients were surveyed at baseline, 3 months post-treatment, and 6 months post-treatment. Participants who completed all study requirements were 24 existing and 40 new Auto-SED and 10 existing and 8 new PT-SED patients. Auto-SED patients were younger [56.2 (±14.7) years] than PT-SED patients [71.4 (±10.0) years]. Participants used a mean of 1.8 (±1.1) SED, 5.3 (±2.9) times per day. In new patients, DEQ5 scores improved within 6 months from 14.0 (±2.9) to 10.6 (±3.4) for Auto-SED and from 12.9 (±3.7) to 11.4 (±2.8) for PT-SED. General wellbeing measures improved in the new Auto-SED from 7.0 (±1.9) to 7.8 (±1.7) but were reduced for new PT-SED from 6.7 (±2.9) to 6.1 (±2.9). SED improved dry eye symptoms in most patients, regardless of the serum source. Patients using PT-SED showed decreases in some quality-of-life measures; however, recruitment was reduced due to operational constraints, and concurrent comorbidities were not assessed. General feedback for SED and vial packaging was positive, with some improvements identified.

Development and evaluation of biodegradable nanofiber insert containing hyaluronic acid for treatment of dry eye syndrome

Development and evaluation of biodegradable nanofiber insert containing hyaluronic acid for treatment of dry eye syndrome

Clinical features, diagnosis, and treatment of dry eye syndrome in children

AIM: To investigate the etiopathogenesis and clinical features of dry eye syndrome in children, methods for diagnosing the disease, and the treatment algorithm.
 MATERIAL AND METHODS: One hundred eighty-seven children with dry eye syndrome aged 3 to 17 yr were examined. To diagnose dry eye syndrome in children, the following research methods were used: biomicroscopy of the anterior part of the eye under diffuse illumination and with a cobalt filter after instillation of vital dyes; examination of the height of the lacrimal meniscus; identification of a characteristic discharge in the conjunctival sac, xerosis of the ocular surface; and evaluation of tear production (Schirmer I test) and stability of the tear film.
 RESULTS: We found that the links in the pathogenesis of dry eye syndrome in children were as follows: diseases of the ocular surface and appendage of the eye, contact correction of ametropia, and surgical operations on the conjunctiva and oculomotor muscles; otogenic neuritis of the facial nerve; rheumatoid arthritis; endocrine ophthalmopathy; lagophthalmos; and thermal and chemical burns. It is now always possible to evaluate tear production and tear film stability in preschool and primary school-aged children. In this case, the main diagnostic method is biomicroscopy. We identified objective clinical symptoms of dry eye syndrome in children using biomicroscopy. Dry eye syndrome was classified into four degrees of severity: mild, moderate, severe, and extremely severe. The subjective and objective clinical signs of each disease severity are described.
 An individual approach and personalized therapy are required to treat dry eye syndrome in children, focusing on the individual tolerability and effectiveness of the drug. Maximum medical alertness and early and accurate clinical differential diagnosis between dry eye syndrome and infectious inflammatory pathology of the anterior part of the eye are required.
 CONCLUSION: The features of the etiopathogenesis of dry eye syndrome in children with various nosologies are examined, and the characteristic clinical symptoms and severity of dry eye syndrome, diagnostic methods, and algorithm for treating dry eye syndrome in children are described. The clinical and diagnostic features of dry eye syndrome in children described by us contribute to its early diagnosis, allowing for the initiation of personalized tear replacement and reparative therapy on time, preventing the development of a chronic course of the disease, the occurrence of complications, and the preservation and/or restoration of visual acuity.

Clinical features, diagnosis, and treatment of dry eye syndrome in children

Ptosis of the upper eyelid remains the most common pathology of the auxiliary apparatus of the eye in children and adults alike. Presently, there are no methods of pharmacological correction for the omission of the upper eyelid; hence, only surgical treatment is available. However, the recommended surgery has been associated with unsatisfactory outcomes in 826% of all patients. There are several directions of surgical treatment of blepharoptosis, depending on the main cause of its development and degree, such as operations on the muscle that raises the upper eyelid (levator resection, recession, levatoroplasty with the formation of a duplicate of the levator) and its tendons (aponeurosis); operations on the tarsal plate; and suspension type operations. Despite the large number of approaches to surgical treatment available for blepharoptosis they are associated with a high risk of hypo and hyper side effects. Therefore, it is not always possible to eliminate the existing changes or damage in different types of ptosis, which may raise the need for a reoperation, which is quite complicated. The standard linear methods for determining the biometric parameters of the mobility of the upper eyelid and degree of ptosis conducted in the preoperative period do not always result in good outcomes. In fact, no reliable criteria allow the prediction of the outcome of surgical treatment with a high degree of probability and planning the volume of surgery. Therefore, it is extremely likely that the addition of dynamometric analysis of the contractile activity of the upper eyelid lifting and tarsal muscles to the scheme of preoperative diagnosis of blepharoptosis, as well as the continuation and intensification of research aimed at creating the doctrine of the pathomorphology of upper eyelid prolapse in the future, will serve as the key factors contributing to the improvement of the results of surgical treatment of blepharoptosis.