Search

Traditional beta-blocking eye drops preserved with benzalkonium chloride show an adverse effect on the precorneal tear film, which can be measured by checking the break-up-time (BUT). To decide, whether this adverse effect is caused more by the beta-blocking drug or the preservative, we tested the influence of timolol eye drops without preservative in single dose units Timosine) on the BUT in a prospective, open study. These eyedrops caused no significant shortening of the BUT in persons, which where untreated before. Patients using preserved beta-blocking eye drops and having irritations of their eyes showed significant prolongation of the BUT after changing the therapy to Timosine. Preservative-free beta-blocking eye drops are a real improvement in the therapy of glaucoma patients with irritated eyes.

The tear film break-up time is usually measured with the lacrimal fluid stained with fluorescein. With the staining methods currently recommended the break-up time is difficult to reproduce. In the study described here, the break-up times with different staining methods were compared. The reproducibility of the break-up time was measured shortly after staining and one minute thereafter. The best reproducibility achieved in this study was when the tear fluid was stained with 1 microliter of 5% Na-fluorescein solution.

Tear film break-up time was measured on 6 consecutive workdays in 6 subjects without eye disease selected at random. The reasons for the wide range of scatter in the values measured were investigated by variance component estimation. It was found that intraindividual variance is by far the most important factor influencing the overall variance of the measured values. Therefore, caution is called for when judging the stability of the precorneal tear film by the tear film break-up time in healthy individuals.

In earlier studies, an irregular tear film could be responsible for artifacts in imaging procedures in ophthalmology. As a result, this study will investigate the influence of hyaluronic acid-containing tear substitutes of different viscosities on the measurement results of optical coherence tomography and on the non-invasive tear film break-up time.The study included three sessions in which three hyaluronic acid tear substitutes of different viscosities (Hylo-Vision 0.1%, 0.2%, 0.3%, OmniVision GmbH, Puchheim, Germany) were applied to each subject. In 20 healthy volunteers, the non-invasive tear film break-up time was measured before and after the application of the tear substitutes using Keratograph 5M (Oculus GmbH, Wetzlar, Germany) and optical coherence tomography using 3D OCT-2000 (Topcon, Hamburg, Germany).The median age of the volunteers was 28.5 years. 11 women (55%) and 9 men (45%) were examined. The non-invasive tear film break-up time improved significantly (p = 0.027) after the application of 0.3% hyaluronic acid. In the study, no significant difference was found in all OCT parameters used before and after application of the different viscous hyaluronic acid-containing tear substitutes.In this study, no influence of tear substitutes containing different viscosities of hyaluronic acid on the measurement results of optical coherence tomography could be determined. Therefore, 0.1%, 0.2% and 0.3% hyaluronic acid can be applied to the patient to improve the corneal surface before the examination with optical coherence tomography, without influencing the measurement results of optical coherence tomography.In früheren Studien konnte ein unregelmäßiger Tränenfilm für Artefakte in den bildgebenden Verfahren in der Augenheilkunde verantwortlich gemacht werden. Infolgedessen soll in dieser Arbeit die Einflussnahme von hyaluronsäurehaltigen Tränenersatzmitteln unterschiedlicher Viskosität auf die Messergebnisse der optischen Kohärenztomografie sowie auf die Tränenfilmaufreißzeit untersucht werden.Die Studie umfasste 3 Sitzungen, in denen den Probanden jeweils 3 hyaluronsäurehaltige Tränenersatzmittel unterschiedlicher Viskosität (Hylo-Vision 0,1%, 0,2%, 0,3%, OmniVision GmbH, Puchheim, Deutschland) appliziert wurden. Bei 20 gesunden Probanden wurde vor und nach der Applikation der Tränenersatzmittel eine Messung der nicht invasiven Tränenfilmaufreißzeit mittels Keratograph 5M (Oculus GmbH, Wetzlar, Deutschland) sowie mit der optischen Kohärenztomografie mittels 3D OCT-2000 (Topcon, Hamburg, Deutschland) durchgeführt.Das Alter der Probanden lag im Median bei 28,5 Jahren. 11 Frauen (55%) und 9 Männer (45%) wurden untersucht. Die nicht invasive Tränenfilmaufreißzeit hat sich nach Applikation der 0,3%-Hyaluronsäure signifikant (p = 0,027) verbessert. In der Studie wurde bei allen verwendeten OCT-Parametern kein signifikanter Unterschied vor und nach Applikation der unterschiedlich viskosen hyaluronsäurehaltigen Tränenersatzmittel festgestellt.In der Studie konnte kein Einfluss unterschiedlich viskoser hyaluronsäurehaltiger Tränenersatzmittel auf die Messergebnisse der optischen Kohärenztomografie festgestellt werden. Demzufolge können dem Patienten zur Verbesserung der kornealen Oberfläche vor der Untersuchung mit der optischen Kohärenztomografie 0,1%-, 0,2%- und 0,3%-Hyaluronsäure appliziert werden, ohne die Messergebnisse der optischen Kohärenztomografie negativ zu beeinflussen.

The quantitative measurement of the tear film lipid layer thickness is a relatively new and promising method. However, so far it has not been investigated whether there is a diurnal or a day to day variability and whether certain factors are confounding the measurement of the lipid layer thickness.In three different experimental settings, 10 subjects without known sicca syndrome were examined at three different time points on one day, on three different days and before and after therapeutic expression of the Meibomian glands. As a comparison, the parameters tear film break-up time, tear meniscus height, diagnostic expression of the Meibomian glands and subjective symptoms, determined using the OSDI (ocular surface disease index) questionnaire, were measured.The results of the study showed a smaller variation of the lipid layer thickness measurements during the day and from day to day compared to the tear film break-up time. The expression of the Meibomian glands significantly increased the lipid layer thickness. There was a correlation between the baseline values of tear film break-up time and the lipid layer thickness.Our data showed that the lipid layer thickness as measured with the Lipiview® interferometer appears to be a relatively constant parameter over time. In addition, the expression of the Meibomian glands could be identified as a potential confounding factor. In this study we included only healthy subjects without known sicca syndrome. For the future our findings need to be validated in dry eye patients.

Evaporative dry eye is the most common form of tear film dysfunction. The present trial aims to evaluate the efficacy of two established treatment options with different modes of action by comparison.216 patients suffering from evaporative dry eye were included in this prospective, randomised two-centre trial. Divided into two treatment groups, patients either received treatment with hyaluronate artificial tears (Vismed light) or a phospholipid-liposome eye spray (Tears Again), each for three months. Tests (lid-parallel conjunctival folds [LIPCOF], non-invasive break-up time [NIBUT], Schirmer's test, inspection of lids and subjective assessment) were performed before as well as 4 and 12 weeks after initiation of this study.In the patients of the eye spray group there was a significantly greater reduction of the LIPCOF grade (p0.02) and the grade of inflammation of the lid margin (p0.002). With respect to the tear film break-up time (NIBUT) there was a significant difference between the results of both groups (p0.003). The improvement of the break-up time in patients of the eye spray group turned out to be more than twice as high as that in the artificial tears group.Both therapies improved evaporative dry eye, but patients on phospholipid-liposomal eye spray demonstrated greater clinical benefit from their therapy, particularly regarding the degree of inflammation of the lid margins as well as the grade of LIPCOF. When compared to hyaluronate artificial tears, NIBUT more than doubled in the phospholipid-liposome eye spray group. Clinical severity of dry eye is more pronounced when evaporative dry eye and aqueous tear deficiency coincide. A combination of the phospholipid-liposome eye spray and artificial tears appears to represent a considerable advancement in tear replacement therapy for severe cases of dry eye.

In absolute dry eyes the use of pharmaceutical lubricants can be insufficient to prevent progressive conjunctival and corneal epitheliopathy and the severe symptoms associated. In this situation a microvascular autologous submandibular gland transplant can be used to continuously provide a natural tear substitute. We studied the effect of this salivary tear film on the ocular surface in a prospective controlled clinical study.We examined 20 eyes with a viable submandibular gland transplant and 20 severely dry eyes without or with a nonviable transplant as a control for the first postoperative year. Visual acuity, baseline-tear secretion, fluorescein break-up time and slit-lamp microscopical grading of ocular surface features, Rose Bengal staining and conjunctival impression cytology were evaluated.Postoperatively baseline-tear secretion and break-up time were significantly better in the group with a viable submandibular gland transplant than in the controls. The biomicroscopical staging of eyes with a salivary tear film was stable or showed a trend to improvement, while controls showed a trend to deteriorate. A successful submandibular gland transplant reduced the conjunctival and corneal neovascular hyperaemia. However, in 6 eyes with an excessive salivary epiphora, a microcystic epithelial oedema was observed. The epiphora and the associated oedema could be successfully controlled by means of a surgical reduction of the transplant.Following successful autologous submandibular gland transplantation lubrication and comfort are significantly improved and the ocular surface is stabilised during the first postoperative year. Severe preoperative morphological alterations and the salivary character of the new tear film prevent a more obvious improvement of the ocular surface.

The hyperosmolarity of the tear film is an important clinical sign of dry eye disease. It is the most important diagnostic parameter. In addition to the TearLab osmometer (TearLab Corp, San Diego, CA), which has been available for several years, the I-Pen osmometer (I-MED Pharma Inc, Dollard-des-Ormeaux, Quebec, Canada) has been recently marketed. The intention of our study was to compare tear film osmolarities in normal individuals as measured by TearLab and I-Pen.51 healthy subjects (mean age 40.6 years, range 17 - 63 years, 66.7% females) without dry eye disease (ocular surface disease index 13, tear film break-up time 7 s, normal Schirmer test 10 mm/5 min) were included in this study. Tear film osmolarity was measured in the tear meniscus (TearLab) and the palpebral conjunctiva (I-Pen) with a 30 min interval. The osmolarity testing techniques were alternated. Statistical analysis was performed using Wilcoxon tests and Spearman correlations.Mean TearLab osmolarities were 295.1 mosmol/l (right eye), 294.0 mosmol/l (left eye), and 294.6 mosmol/l (mean of both eyes) with a range of 268 to 394 mosmol/l. I-Pen measured mean osmolarites of 301.6 mosmol/l (right eye), 302.5 mosmol/l (left eye), and 302.1 mosmol/l (mean of both eyes) with a range of 276 to 394 mosmol/l. There was a significant difference in tear film osmolarities for the two techniques for both single eyes (p 0.02) and the mean value of both eyes (p 0.001). TearLab and I-Pen measurements did not correlate significantly in any eye (r = 0.27 and r = 0.08 for right and left eye, respectively). With a cut-off value of 308 mosmol/l (as suggested for TearLab), 98.0% of TearLab values and 68.6% of I-Pen values were in the normal range.I-Pen measured significantly higher tear film osmolarities than TearLab. The location of the measurement site in the palpebral conjunctiva could be responsible for this difference. Our results indicate that cut-off values should be changed when using I-Pen for evaluation of tear film osmolarity. Further examinations and studies with greater cohorts of healthy subjects and patients suffering from dry eye disease are necessary.Die Hyperosmolarität des Tränenfilms gilt als bedeutendes klinisches Zeichen des trockenen Auges und als wichtigster singulärer diagnostischer Parameter. Neben dem seit einigen Jahren verfügbaren Ocusense TearLab-Osmometer (TearLab Corp, San Diego, CA) ist seit Kurzem auch das I-Pen-Osmometer (I-MED Pharma Inc., Dollard-des-Ormeaux, Quebec, Kanada) verfügbar. Das Ziel unserer Studie war die Vergleichbarkeit der mittels TearLab- und I-Pen-Osmometer erhobenen Tränenfilmosmolarität bei gesunden Probanden zu untersuchen.51 gesunde Probanden (mittleres Alter 40,6 Jahre, Altersspanne 17 – 63 Jahre, 66,7% weiblich) ohne Beschwerden und Zeichen eines trockenen Auges (Ocular Surface Disease Index 13, Tränenfilmaufrisszeit 7 s, unauffälliger Schirmer-Test 10 mm/5 min) wurden eingeschlossen. Die Tränenfilmosmolarität wurde im Tränenfilmmeniskus (TearLab) und an der subtarsalen Bindehaut (I-Pen) mit einem Zeitintervall von 30 min erhoben. Die Reihenfolge der beiden Osmolaritätsuntersuchungen erfolgte im alternierenden Wechsel. Die statistische Analyse erfolgte mittels Wilcoxon- und Spearman-Tests.Die mittlere TearLab-Osmolarität war 295,1 mosmol/l (rechtes Auge), 294,0 mosmol/l (linkes Auge) sowie 294,6 mosmol/l (bilateral) mit einer Variationsbreite von 268 – 394 mosmol/l. Mittels I-Pen-Osmometer erhobene mittlere Osmolaritätswerte lagen bei 301,6 mosmol/l (rechtes Auge), 302,5 mosmol/l (linkes Auge) und 302,1 mosmol/l bilateral mit einer Variationsbreite von 276 – 394 mosmol/l. Es zeigte sich ein signifikanter Unterschied in den erhobenen Tränenfilmosmolaritäten mit den beiden Techniken für beide Augen einzeln (p 0,02) und beim Mittelwert beider Augen (p 0,001). Die Messungen mit beiden Geräten korrelierten nicht signifikant (r = 0,27 rechts und r = 0,08 links). Bei einem – wie von TearLab vorgeschlagenen – Grenzwert von 308 mosmol/l lagen 98,0% der TearLab-Werte, aber nur 68,6% der I-Pen-Werte im Normbereich.Die mittels I-Pen gemessenen Osmolaritätswerte zeigten sich signifikant höher im Vergleich zu den mit TearLab erhobenen Messwerten. Für diesen Unterschied verantwortlich könnte u. a. die Lokalisation der Messung an der subtarsalen Konjunktiva mit dem I-Pen im Vergleich zur Messung im Tränenfilmmeniskus mit dem TearLab sein. Es könnte daher notwendig sein, den Grenzwert zur Unterscheidung pathologischer Werte von physiologischen Werten bei Messungen der Tränenfilmosmolarität mit dem I-Pen-Osmometer zu ändern. Weiterführende Untersuchungen an einer größeren Kohorte von Normalprobanden sowie bei Patienten mit trockenem Auge sind hierfür notwendig.

In severe zoster keratitis many pathogenic factors are involved. In addition to viral manifestations, the cornea is often affected by anterior uveitis or secondary glaucoma. Neuroparalytic keratitis causes lowered blinking frequency and decreased tear secretion. In addition, zoster ulcerations of the upper lid margin mechanically disturb reformation of the tear film and weaken the lipid layer by necrosis of the Meibomian glands. Ointments reduce break-up time and parasympathicolytic mydriatics further decrease tear secretion. When the average time between two blinks is shorter than the tear film break-up time, a "dry eye" condition usually develops. The appropriate treatment in such cases is thorough prevention of evaporation.

In 30 healthy volunteers the tear-film break-up times of both eyes were determined, comparing one eye with a cut-off filter (customarily used in fluorescein angiography (Schott OG 530, thickness 3 mm] with the common method, not using this filter, in the other eye. By using the filter the variance of observed break-up times is decreased, and the time elapsing after the administration of the dye no longer influences the break-up time significantly. The filter described here is therefore recommended for determining the tear-film break-up time.

The current understanding of the pathogenesis of dry eye disease has proceeded to recognition of inflammation as the key pathogenetic mechanism. The purpose of this study was to evaluate the effect of cyclosporine 0.05% eye drops on subjective symptoms and objective signs of patients with keratoconjunctivitis sicca.In this clinical trial 62 patients with severe keratoconjunctivitis sicca (DEWS grade 3) were included. Over a time period of 3 months all patients received treatment with preservative-free hyaluronic acid artificial tears at one drop 5 times per day and in addition 31 patients received one drop of cyclosporine 0.05% twice daily. Screening parameters were LIPCOF, tear break-up time (BUT), fluorescein and rose bengal staining, the intraocular pressure (IOP) and the OSDI score.In the cyclosporine A group BUT, Jones test and OSDI score improved significantly after 3 months in contrast to the controls. Moreover the values of BUT and Jones test in the cyclosporine A group were significantly higher after 3 months compared to the healthy controls. Fluorescein and rose bengal staining improved only in the cyclosporine A group after 3 months.Anti-inflammatory therapy with cyclosporine A 0.05% eye drops as off label use significantly improves subjective symptoms and objective signs in patients with severe dry eye disease providing a good safety profile. These findings suggest a widespread use of cyclosporine A 0.05% eye drops in patients with moderate to severe keratoconjunctivitis sicca.

The aim of this study was to evaluate ocular changes in patients with xeroderma pigmentosum (XP) and Cockayne syndrome (CS). Both diseases belong to the progeroid syndromes caused by single gene mutations with premature aging. Both syndromes are very rare autosomal recessive diseases caused by a gene defect leading to deficient DNA repair.12 patients (4 female, 8 male) with XP between 3 and 67 years old and a 39-year-old female patient with CS were examined. The examination included visual acuity testing, slit lamp biomicroscopy, funduscopy and performance of a Schirmer test.Changes of the lids in the XP group included blepharitis in 7 patients, distichiasis in 2, and madarosis in 3 patients. 8 patients had multiple lentigines solares of the lids. One patient showed scars of the lower lids after excision of a squamous cell carcinoma and a basal cell carcinoma. Conjunctival lesions comprised a tumour of unknown origin of the conjunctiva in 1 patient, teleangiectasia of the conjunctiva in 5 patients, pterygia in 4, and pinguecula in 1 patient. Two patients had an intraepithelial melanosis of the conjunctiva, and one showed conjunctival nevi. Two patients had corneal scars and corneal vascularisation, another a significant conjunctivalisation of the cornea. A Schirmer test was feasible only in 3 patients. Tear production was markedly reduced in all these patients. Break-up time was shortened significantly in 6 patients examined. The patient with the CS showed atrophy of the pupillary rim and a subcapsular cataract. Funduscopically there were pigment epithelial changes.Patients with XP often exhibit ocular changes. Beside the light-dependent degenerative and inflammatory manifestations at the lids, the conjunctiva and the cornea patients with XP also develop malignancies early in life. The majority of patients suffer from dry eye symptoms.

The local application of drugs is an efficient method for treating diseases of the external eye. However, some active substances can also cause a chronic toxic reaction at the ocular surface. No results from clinical experiments on the local tolerance of kanamycin which would meet the requirements of evidence-based medicine are as yet available.Thus, the cytomorphological processes of the treatment with kanamycin were examined in a prospective randomised placebo-controlled double blind cross-over study. The effect of the topical application (5 times a day for 7 days) of Kanamycin POS® eye ointment on the conjunctival epithelial barrier was studied in comparison with an eye ointment base (placebo) in 25 healthy subjects. To detect cytopathological microchanges of the epithelium, we carried out a standardised impression cytology (primary compatibility parameter). Biomicroscopy, Schirmer II test and non-invasive measurement of the break-up-time (tearscope) were also examined. The subjective compatibility parameters (itching, tearing, foreign body sensation, burning sensation, mucus) were measured on a 0 - 10 visual analogue scale.The cytological findings of 23 subjects were included in the final evaluation of the study. The impression cytology did not reveal a different effect of kanamycin ophthalmic ointment on the conjunctival ocular surface in comparison with the placebo. Only in one subject was a marked shift found in the nuclear-cytoplasmic ratio after application of verum. No signs of increased apoptosis ("snake-like chromatin") were found at the conjunctival epithelial barrier. The mean goblet cell count was 109 goblet cells per mm (2). No significant reduction of the goblet cell density was found in any treatment group. Among the subjective compatibility parameters, only the mean for itching constantly remained above the placebo group after application of kanamycin. Statistically significant differences were not found by the Wilcoxon test.In contrast to the clinical experience with the systematic application of kanamycin, the standardised evaluation of this study confirmed the very good topical tolerability of the tested kanamycin eye ointment. In view of the continuing clinically relevant aspect of the availability of a wide spectrum of antibiotics to avoid the development of resistance while at the same time keeping within what is reasonable economically, Kanamycin POS® for topical application supplements the options of ophthalmological antibacterial chemotherapy.

A deficiency in the tear film lipid layer is aetiological in about 80 % of the patients suffering from dry eye, which results in excessive evaporation (so-called hyperevaporative dry eye). The treatment with conventional artificial tears did not prove to be successful here. In this study the treatment with two tear substitutes containing lipids were set in contrast with each other.The randomised, controlled, multicentre cross-over study included 74 patients suffering from dry eye caused by a deficiency of the tear film lipid layer, which were organised into two groups. Group A (n = 38) was treated for the first 6 weeks with a liposomal eye spray (Tears Again), while the patients of the group of B (n = 36) were treated with an eye gel containing triglycerides (Liposic) in the same period. After 6 weeks the crossover was performed. The patients were treated in the following 6 weeks with the product which was not used before. Control examinations by masked examiners took place at the beginning of the study as well as after 6 and 12 weeks, considering the following parameters: eyelid edge-parallel conjunctival folds (LIPCOF), BREAK UP time (BUT), Schimer-I test, measurement of the tear meniscus, investigation of the edges of eyelid and visual acuity. In addition. the subjective feelings of the patients were also determined by means of questionnaires.At the beginning of the study the two groups did not differ significantly with respect to the initial values. After the first treatment period the improvement of the examined parameters LIPCOF, BUT, Schirmer, visual acuity and inflammation of the lid margin in group A (eye spray) proved to be significantly superior in comparison to group B (eye gel). The results of the second treatment period after the crossover were similar and showed an analogous supremacy of the liposomal eye spray. The interviews with the patients revealed that the subjective evaluation concerning efficacy and compatibility of the eye spray turned out to be explicitly more favourable than that concerning the eye gel. 74.6 % of the patients favoured the application as an eye spray onto the closed eyelids over the eye gel into the conjunctival sac. 62.5 % of the patients rated the liposomal eye spray to be better all in all, 12.5 % rated that both preparations are equal and 25 % favoured the eye gel.The treatment with phospholipids liposomes shows statistically significant clinical advantages and proves to be favourably and explicitly superior compared to the conventional standard treatment all in all.

The aim of this observation study was to determine whether regression of lid-parallel conjunctival folds (LIPCOF) can be induced by repeated and intensive treatment with a gel-forming tear substitute.In cooperation with the referring ophthalmologists, patients suffering from advanced dry eye condition were recruited. LIPCOF grades from 1 to 3 were included. Tear film break-up time (BUT) had to be less than 10 sec and the Schirmer-I test less than 10 mm. All patients recruited had been using watery tear substitutes. Examinations including visual acuity, slit lamp, fluorescein test, Schirmer-I test, BUT, LIPCOF were performed at baseline and after 2 weeks and 2 months. All examinations were done by the same physician at the Dietrich-Bonhoeffer Eye Hospital of Neubrandenburg. Exclusion criteria were severe eye diseases such as glaucoma, cataract, retinal detachment, history of intraocular or conjunctival surgery and disorders of the eye lids. Pretreatment with gels was not allowed. In the study, patients were treated with Liposic Eye Gel at least three times a day for a period of two months.LIPCOFs regressed in 10 eyes of 5 patients (1 x male, 4 x female) from a mean grade of 2.58 at baseline to 2.29 after 2 months under Liposic treatment. This improvement is statistically significant (n = 10, p = 0.04). Schirmer-I test results had improved in the same time period from a mean of 6.4 mm at baseline to a mean of 8.1 mm after 2 months (n. s., n = 10, p = 0.73). BUT improved from a mean of 12.5 sec at baseline to a mean of 17.5 sec at the 2-month follow-up (n. s., n = 10, p = 0,085). In one patient the cornea was fluorescein-positive at baseline and stayed so throughout the follow-up. Liposic Gel was used by the patients between 3 to 8 times per day. Tolerance was excellent.The study results show that the morphological signs of the dry-eye condition like LIPCOFs can be reversed by intensive treatment with Liposic Gel. The improvements in BUT and Schirmer-I test results confirm the adherence of the patients to the treatment schedule.This pilot study provides the statistical data necessary for designing a major treatment study to prove not only the reversibility of LIPCOF, but also the dependence of the possible improvement on the grade of LIPCOF stage on the age of the patient and on other criteria.

This study was designed to examine if patients undergoing the same operative procedure (blepharochalasis operation) have different subjective recognition of dry eye problems depending n whether they had he operation for cosmetic or medical reasons.The study included 32 patients (25 women, 7 men, mean age 57.8 +/- 12.1 years), who underwent blepharochalasis operation between 1/2005 and 5/2005. In 17 patients (group 1) the operation was done for cosmetic reasons, in 15 patients we found a medical indication (group 2). We evaluated the subjective discomfort from the lid problems as well as the satisfaction with the operation in general and pre- or postoperative recognition of dry eye problems (all done by scales). Additionally we measured tear secretion by Schirmer's test and break-up time before and after operation.The subjective recognition of a dry eye was stronger in group 1 than in group 2 before and after operation (p0.005), but objective data were nearly identically (BUT, Schirmer's test).When operated due to cosmetic reasons the stronger recognition of sicca problems (while objectively lacking) is may be caused by a stronger fixation on the lid disease itself. It seems necessary to document objective data for that reason.

Most of the eye drops currently used replace only the aqueous phase of the tear film. But, due to the fact that, with approximately 80 % of the patients with a dry eye, a disturbance of the lipid phase is present, an approach for new treatment methods needed to be found. We examined a new therapy concept with an eye spray containing liposomes for the therapy of the "dry eye" in a long-term study.An examination of the effectiveness of a liposome eye spray (TEARS AGAIN, Optima Pharmaceutical GmbH, Germany) in patients with "dry eye" compared with a spray containing a balanced salt solution was carried out.Between August 2003 and May 2004 a double-blind study with 382 patients was accomplished. The treatment group (V; n = 191) was compared with the control group (K; n = 191) for a period of 6 months regarding the following examination criteria: eyelid edge parallel conjunctival folds (LIPCOF), BREAK UP time (BUT), Schirmer I test, best corrected visual acuity, as well as slit lamp findings of the cornea and conjunctiva. Follow-up was after 4 weeks and 6 months. The statistical analysis was performed with the statistical program SPSS v.11.5.The examined parameters such as LIPCOF, BUT and Schirmer were significantly better in the treatment group than in the control group. We found likewise significant improvements of the inflammations of the edge of eyelid with a remarkable decrease of around 89.5 %. Questioning of the patients resulted in, among other things, the belief that the liposome eye spray led altogether to a clear subjective improvement of the symptoms in 72 % of the cases, although an initial burning sensation was mentioned after the application. All patients were of the opinion that application with a spray is more favourably and more pleasant than teardrops.The liposome tear substitute shows statistically significant advantages against a balanced salt solution. This new liposome eye spray represents a new, revolutionary and effective procedure in the therapy of the "dry eye". Considering the disturbance of the lipid phase in 80 % of the patients, TEARS AGAIN ought to be a first choice treatment.