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Jonathan Lilley,1 Erin C O’Neil,1 Vatinee Y Bunya,1 Kennedy Johnson,1 Gui-Shuang Ying,2 Peiying Hua,2 Mina Massaro-Giordano1 1Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; 2Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USACorrespondence: Mina Massaro-GiordanoDepartment of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USATel +1 215-662-9393Email mina@pennmedicine.upenn.eduPurpose: To assess the efficacy and safety of an intranasal tear neurostimulator (ITN) device in Sjögren syndrome (SS) patients.Methods: This was a two-visit prospective, randomized, controlled, same-day crossover study in participants with SS. Inclusion criteria were assessed at a baseline screening visit and included an Ocular Surface Disease Index (OSDI) score ≥ 13, and a Schirmer with anesthesia ≤ 10 mm/5 min (in at least one eye), with a cotton swab stimulation induced increase of ≥ 4 mm in the same eye. Participants returned for the application visit, where they received intranasal and extranasal applications of the ITN in random sequence, separated by at least 60 min. Schirmer scores were measured in both eyes after each application and compared to baseline values. Generalized linear models were performed to compare the change in Schirmer scores from baseline, and generalized estimating equations were used to account for correlations from repeated measurements in the same eye and measurements from two eyes of the same patient.Results: Fifty-five participants were screened and 35 were enrolled (all female), ranging in age from 31 to 72 years (mean, 57 years). The baseline OSDI score ranged from 14 to 91 (mean, 50.5), and the baseline Schirmer score had a mean (SD) of 6.4 (3.5) ranging from 0 to 20 (mm/5min). Improvement in Schirmer scores was significantly greater for intranasal device application (13.5 mm/5min, 95% CI: 10.4, 16.5) compared to extranasal device application (0.8mm/5min, 95% CI: − 0.9, 2.4) (p< 0.0001). The effects of the intranasal device application were significant regardless of the participant’s baseline Schirmer score and systemic SS medication usage (p< 0.05).Conclusion: Intranasal application of the ITN device significantly increased tear production in a subset of SS patients compared to baseline and was more effective than extranasal application. While production of the ITN device was recently discontinued, our findings suggest that other therapies that neurostimulate the lacrimal function unit may be effective in a subset of SS patients.Keywords: Sjögren syndrome, intranasal tear neurostimulation, tear production

Nicole Fuerst,1 Nicole Langelier,1 Mina Massaro-Giordano,1 Maxwell Pistilli,1 Kalliopi Stasi,1 Carrie Burns,2 Serena Cardillo,2 Vatinee Y Bunya1 1Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Purpose: To assess the relationship between tear osmolarity and dry eye symptoms in patients with diabetes. Patients and methods: Fifty patients with diabetes were enrolled. Demographic information and past medical history were recorded. Symptoms were assessed using the ocular surface disease index (OSDI). Tear osmolarity of each eye was measured with the TearLab® Osmolarity System. Results: The majority of the subjects were female (76%), African American (56%), and/or had a diagnosis of type 2 diabetes (82%). The mean ± standard deviation (SD) for age was 54.6±13.4, and maximum tear osmolarity was 304.6±12.7 mOsm/L. Men had higher osmolarity than women (mean ± standard error (SE) 311.8±4.0 mOsm/L versus 302.3±1.9 mOsm/L, P=0.02). Age, race, use of artificial tears, years of diabetes, and hemoglobin A1c did not have a statistically significant association with tear osmolarity. Longer duration of diabetes was associated with lower (less severe) OSDI scores (r=-0.35, P=0.01). Higher tear osmolarity was associated with lower (less severe) OSDI scores (r=-0.29, P=0.04). Conclusion: Approximately half of the diabetic subjects in our study had elevated tear osmolarity, and half of our population also reported symptoms consistent with dry eye disease. However, the two were slightly inversely related in that those with higher osmolarity reported fewer symptoms. Subjects with a longer duration of diabetes also reported fewer dry eye symptoms. Therefore, health care providers should be aware that patients who are most likely to have ocular surface disease, including those with long-standing diabetes, may not experience symptoms and seek care in a timely manner. Keywords: dry eye, osmolarity, diabetes

In industrialized nations, corneal lacerations are one of the most common reason for hospitalization. This study was designed to study visual and clinical outcome in patients presenting with full thickness corneal lacerations in Indian population and to ascertain the impact of various preoperative and operative factors influencing prognosis after repair of corneal lacerations. Males in third decade with injuries at work with metallic objects were common. Lens damage, hyphema, vitreous hemorrhage, retinal detachment and endophthalmitis were seen. All the patients underwent primary repair within first 24 hours of presentation. At 3 months, 74.3% had a good visual outcome. About 5.7% of patients had no perception of light.In conclusion, various demographic and preoperative factors like age, time of presentation, vision at presentation, length of corneal wound, involvement of visual axis, associated ocular features like hyphaema, lenticular changes, vitreous haemorrhage and retinal detachment are significant prognostic indicators for final visual outcome., {"references":["Charles C. Barr. Prognostic Factors in Corneoscleral Lacerations. Arch Ophthalmol 1983 Jun;101(6):919-924.","Dannenberg AL, Parver LM, Brechner RJ, Khoo L. Penetrating eye injury in the work place; the national eye trauma system registry. Arch Ophthalmol.1992 Jun;110(6):843-848.","Bunya VY, Cohen EJ, Rapuano CJ and Hammmersmith KM. A Review of Corneal Lacerations. Invest Ophthalmol Vis Sci 2004; 45. E-Abstract 4859.","Smith D, Wrenn K, Stack LB. The epidemiology and diagnosis of penetrating eye injuries. Academic Emergency 2002 Mar;9(3):209-213.","Shoja MR, Manaviat M, Baradaranfar MH. Outcome of cornealscleral lacerations in Yazd. MJIH January 2004;6(2): 45-49.","Macewen CJ. Eye injuries: a prospective survey of 5671 cases. Br J Ophthalmol 1989 Nov;73(1):888-894.","Nik-Eghbally A. Scleral rupture due to trauma in The prophet Mohamad Hospital. Iranian Ophthalmol Seas 1995; 7; 1-7.","Sternberg P Jr, De Juan E, Michels RG, Auer C. Multivariate analysis of prognostic factors in penetrating ocular injuries. Am J Ophthalmol 1984 Oct; 98(4):467-72.","Lavanya G Rao, Anju Ninan, Krishna A Rao. Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries. IJO 2010 Jul-Aug;58(4): 321-23.\n[10]\tAdhikary HP, Taylor P, Fitzmaurice DJ. Prognosis of perforating eye injury. Br J Ophthalmol 1976 Nov;60(11):737-739.\n[11]\tEdmund J. The prognosis of perforating eye injuries. Acta Ophthalmol 1968 may;46 (6):1165-1174.\n[12]\tEagling EM. Perforating injuries of the eye. Br J Ophthalmol 1976 Nov;60(11):732-736"]}