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Purpose: The use of swimming goggles (SG) has demonstrated to alter different ocular parameters, however, the impact of wearing SG on the tear film stability remains unknown. The main objective of this study was to determine the short-term effects of wearing SG on tear film surface quality break-up time (TFSQ-BUT). Methods: Twenty-eight young healthy adults (14 men and 14 women) wore a drilled SG, and TFSQ-BUT was measured before, during and after SG use. Dynamic-area high-speed videokeratoscopy was used for the non-invasive assessment of TFSQ-BUT. Results: TFSQ-BUT was significantly reduced while SG wear in comparison to the baseline measurement (4.8 ± 4.5 s vs. 8.8 ± 6.9 s; corrected p-value = 0.017, d = 0.57, mean difference = 4.0 [0.6, 7.3]; 45% reduction). Immediately after SG removal, TFSQ-BUT rapidly recovered baseline levels (8.2 ± 5.9 s vs. 8.8 ± 6.9 s; corrected p-value = 0.744). The impact of wearing SG on TFSQ-BUT were independent of the gender of the participants (p = 0.934). Conclusion: The use of SG induces a TFSQ-BUT reduction, with these changes returning to baseline levels immediately after SG removal. These data may be of relevance for the management of dry eye patients, who need to avoid circumstances that exacerbate tear film instability. Nevertheless, these results must be interpreted with caution since the experiment did not entirely mimic real-life conditions (e.g., eye cup piece drilled, time of exposure, environmental conditions). Future studies should consider the inclusion of dry eye patients and older individual in order to explore the generalizability of these findings.

Purpose: We investigated the the effect of wearing a loose mask on tear-film break-up time using cross-sectional and experimental methods.Methods: This was a comparative analysis of non-invasive tear-film break-up time (NIBUT) after wearing no mask, loose mask, and tight mask for 10 minutes each in 60 eyes with or without dry eye syndrome. NIBUT measurements were performed using a keratograph.Results: The NIBUT values were 7.53 ± 0.83 seconds, 6.19 ± 0.78 seconds, and 7.36 ± 0.68 seconds for the no mask, loose mask, and tight mask groups, respectively. There was no significant difference between the no mask and tight mask groups (ρ-value = 0.517), but the loose mask group had a significantly reduced NIBUT compared with the other groups (ρ-value = 0.013 and 0.022, respectively).Conclusions: Wearing a loose mask reduced the tear-film break-up time regardless of the presence or absence of dry eyes and may cause or worsen dry eye symptoms.

Purpose: To evaluate the effects of the non-invasive keratograph break-up time on the repeatability of keratometric measurements derived using the Keratograph 5M in patients with dry eye syndrome.Methods: Thirty-six patients with dry eye and 30 controls were enrolled. We measured keratometric values twice in all subjects and explored whether the two measurements differed by more than 0.5 diopter (D) (the absolute value). We also evaluated the relationship between the absolute difference and the non-invasive keratograph break-up time (NIKBUT).Results: The intraclass correlation coefficients for astigmatism, flat keratometry (K), steep K, and mean K were all higher than 0.95 in patients, thus lower than in controls. The proportion of eyes with absolute differences over 0.5 D between the two keratometric values differed significantly between the dry eye and control groups in terms of the flat K and Kmax values (p = 0.033, 0.037). The average NIKBUT was negatively correlated with the absolute differences in Kmax and astigmatism (p = 0.030, R2 = 0.134 and p = 0.017, R2 = 0.160).Conclusions: In patients with dry eye syndrome, keratometric measurements are reliably repeatable, but slightly less so than in normal controls. The proportions of eyes exhibiting absolute keratometric differences over 0.5 D (two measurements) differed in the dry eye and control groups. The lower the non-invasive keratograph break-up time, the poorer the repeatability of keratometric measurements in the dry eye group. Therefore, care is required when obtaining keratometric values for such patients.

To evaluate pre-lens tear film volume, stability and lipid interferometry patterns with a silicone hydrogel water content contact lens, a novel, noninvasive, ocular-surface-analyzer technology was used. A prospective, longitudinal, single-center, self-control study was performed in daily or monthly replacement silicone hydrogel contact lens wearers. A tear film analysis was achieved with the Integrated Clinical Platform (ICP) Ocular Surface Analyzer (OSA) from SBM System. The subjects were reassessed, with the contact lens, after 30 min of wearing to quantify the volume, stability and lipid pattern of the short-term pre-lens tear film. Lipid layer thickness decreased from 2.05 ± 1.53 to 1.90 ± 1.73 Guillon patterns (p = 0.23). First pre-lens NIBUT decreased from 5.03 ± 1.04 to 4.63 ± 0.89 s (p = 0.01). Mean pre-lens NIBUT significantly increased from 15.19 ± 9.54 to 21.27 ± 11.97 s (p < 0.01). Lid opening time significantly increased from 26.36 ± 19.72 to 38.58 ± 21.78 s (p < 0.01). The silicone hydrogel contact lens with water gradient technology significantly increased the mean pre-lens NIBUT and lid opening time. Lehfilcon A suggested an improvement in contact lens wearers with tear film instability or decreased subjective symptoms of dry eye disease.

The goal of this study was to analyze the agreement between the Medmont E300 and the Visionix VX120+ systems in terms of non-invasive tear break-up time (NIBUT) and tear meniscus height (TMH) measurements. A total of 60 eyes (30 healthy subjects) were enrolled. NIBUT and TMH were evaluated with Medmont E300; first NIBUT, NIBUT50%, and TMH were evaluated with Visionix VX120+. Both evaluations were performed in a random order by the same clinician for right, left, and both eyes. The Medmont E300 provided significantly higher NIBUT than Visionix VX120+ for first NIBUT in right, left, and both eyes (p ≤ 0.003) and NIBUT50% in left and both eyes (p ≤ 0.042). The TMH measured with VX120+ was significantly higher than with Medmont E300 considering both eyes (p = 0.037). No significant correlations were found between both devices for either NIBUT (p ≥ 0.11) or TMH (p ≥ 0.09). Passing–Bablok regression analyses revealed poor agreement between devices for NIBUT and TMH outcomes. VX120+ is expected to provide substantial lower first NIBUT values than the NIBUT measured by Medmont E300. Clinicians should consider not using both instruments as interchangeable for dry eye diagnosis. The author D.P.P. has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471. This research received no external funding. E.M.P. has been supported by European Union-NextGenerationEU.

To compare fluorescein tear break-up time (BUT) and noninvasive BUT measured using interferometry and corneal topography.We investigated 34 eyes of 34 patients with dry eye (mean age 39.2±8.3 years) and 16 eyes of 16 non-dry eye subjects (33.5±6.5 years). Tear film stability was measured using fluorescein BUT, noninvasive BUT (NIBUT)-DR1 with an interferometer, and noninvasive keratographic BUT (NIKBUT)-first and average using corneal topography. Correlations between fluorescein BUT and noninvasive BUT parameters were determined statistically. The noninvasive BUTs were compared between the dry eye and non-dry eye groups. The agreement between fluorescein and noninvasive BUTs was described using Bland-Altman analysis.Fluorescein BUT was significantly correlated with NIBUT-DR1, NIKBUT-first, and NIKBUT-average. The Bland-Altman analysis revealed bias and 95% limits of agreement between fluorescein BUT and noninvasive BUTs as follows: NIBUT-DR1: 2.07 s, -5.33 to 9.46 s; NIKBUT-first: 3.39 s, -5.46 to 12.24 s; NIKBUT-average: 6.61 s, -1.58 to 14.79 s. The noninvasive BUTs were significantly different between the two groups. When NIBUT-DR1, NIKBUT-first, and NIKBUT-average with Bland-Altman correction were used as an index for dry eye, the cut-off values were 7.1, 8.4, and 11.6 s, respectively. The sensitivities were 0.735, 0.818, and 0.727 and specificities were 0.500, 0.437, and 0.562, respectively.Fluorescein BUT and noninvasive BUTs were significantly correlated, and noninvasive BUTs had higher values than fluorescein BUT. Considering the differences between fluorescein BUT and noninvasive BUTs, noninvasive methods can be used as effective tool for diagnosing dry eye.

Aims: In this study, we aimed to investigate the intercorrelations between tear film break up time, measured non-invasively using non-invasive keratographic break-up time (NIKBUT), higher order aberrations (HOA) and quality of vision (QoV) in pseudophakic patients. Study Design: Cross-sectional. Methods: Thirty-five pseudophakic aged patients aged 50 years or older, and 35 control phakic patients aged 17 to 23 years with corrected visual acuity of 20/20 were included in this study. All subjects underwent similar examination including QoV questionnaire, aberrometry to measure HOA, and NIKBUT. HOA was measured with the OPD-Scan/ ARK 10000 corneal analyzer (Nidek CO. Ltd), expressed as Root Mean Square (RMS) HOA and NIKBUT was assessed using non-invasive TF-Scan module Keratograph 5M (K5M), equipped with modified tear film scanning function (Oculus, Wetzlar, Germany). Statistical analysis was performed to find the correlation between NIKBUT, HOA and QoV. Results: Patients in the pseudophakic group were significantly older (median age 66 vs. 20 years; P

This study aimed to investigate the effect of day-long face mask wearing on non-invasive tear break-up time (NI-BUT) in health care staff due to working schedules.Seventy-four right eyes of 74 participants were included in the study. Participants completed the Ocular Surface Disease Index (OSDI) questionnaire, and NI-BUT measurements were performed between 08.30-09.00 and 16.30-17.00 h. Participants with an initial NI-BUT measurement below 17 s were classified as group-1, and those over 17 s were classified as group-2. NI-BUT changes during the day and correlation to age, gender, and OSDI results were evaluated.Thirty-eight women and 36 men, with a mean age of 30.9 ± 8.5 years, were included in the study. The mean OSDI score of the participants was 28.6 ± 17.1. NI-BUT means of group-1 at baseline and 8th hour were 11.4 ± 3.3 and 7.9 ± 3.6 s, respectively, and the mean NI-BUT at the 8th hour was statistically significantly lower than the baseline (p 0.0001). Also, 24.2% (8 people) of those in group-2 had the 8th-hour NI-BUT value fallen into the measurable range (below 17 s). No significant correlation was found between the decrease in NI-BUT value and age, gender, and OSDI (p = 0.08, p = 0.3, and p = 0.2, respectively).The use of face masks throughout the day leads to a significant reduction in NI-BUT, regardless of age, gender, and OSDI score. Prolonged use of face masks should be considered as a risk factor for evaporative dry eye disease.

Objective: To determine the efficacy of Schirmer’s I test and TBUT test in dry eye changes in type II diabetic patients. Subjects& Methods: In these prospective study 58 (116 eyes) dry eye patients with diabetesmellitus type II patients with minimum duration of 5 year, with BCVA of 6/12 to 6/6. After baseline examination, TBUT Test and Schirmer’s Test I were performed to measure dry eye changes occurred due to DM type II.As the data was not normally distributed therefore Wilcoxon sign rank test were applied using p-value ≤0.05 as significant. Results:In the current study on average duration of diabetes was 5.90±1.17 (Range 5-9)years. 30(50.8%) had 5 years history of diabetes, 15(25.4%) had 6years, 7(11.9%) has 7years, 4(6.8%) had 8years and 3(5.1%) had 9 years history of diabetes. Schirmer's Test I Ocular Dexter (OD) &Oculus Sinister (OS) were 12.90±3.65mm and 12.56±3.23mm. Mean difference was statistically significant (p-value 0.022). Whereas mean TBUT of Ocular Dexter (OD) &Oculus Sinister (OS) were 18.81±6.730 and 19.63±7.083 respectively, the mean difference was not statistically significant (p-value 0.342). Differences between TBUT & Schirmer’s I test of OD and TBUT & Schirmer’s I test of OS were statistically significant (p-value

To examine the effect of fluorescein on the tear film by measuring tear break-up time (BUT).In this prospective study, after determining the natural BUT value of the tear with the non-invasive break-up time (NI-BUT) method, we re-evaluated the changes in the tear film stained with fluorescein using the topographical method. The topographic evaluation of tears stained with fluorescein was called as Hybrid-BUT (H-BUT) test. The first BUT (BUTThe present study was conducted with 82 participants. Although the mean BUTFluorescein causes changes in the break-up time test, and depending on this, in the tear film pattern. These changes can be compared and detected quantitatively and objectively of the fluorescein-stained tear film with the NI-BUT test and the topographic devices by using the H-BUT test.

PurposeEnvironmentally-triggered dry eye disease (DED) or keratoconjunctivitis sicca (KCS), which constitutes the majority of DED cases, currently is palliatively treated with aqueous replacement solutions that do not target the dysfunction of the mucin and lipid components of tears. Herein, we tested whether a peptide that increased goblet cell numbers in a model of scleral chemical injury would also improve tear quality in environmental DED.MethodsEnvironmental DED was established by exposing New Zealand white rabbits (8 per group, female) to 20% humidity with rapid air replacement and b.i.d. atropine sulfate eyedrops for 3 weeks prior to test article administration; this continued for the subsequent 3 weeks of testing. Animals were dosed by (A) saline, (B) b.i.d. eyedrop of peptide in saline, (C) b.i.d. eyedrop of peptide in coacervate, or (D) weekly subconjunctival injection of peptide.ResultsThe environmental DED was established with both Schirmer and TBUT being reduced by from baseline at the start of test article; these levels were maintained as low through the testing period. All three treatment regimens increased TBUT approximately 3x to levels greater than prior to desiccation, with little effect on Schirmer. Corneal haze was present in all eyes after induction, and largely cleared up by all three treatments. End of study enucleation of the eye did not show any changes in goblet cells numbers, which remained high throughout the induction and treatment.ConclusionsThe treatment of environmental DED/KCS with a peptide that activates CXCR3 improved tear quality and reversed corneal pathology by promoting tear stability, while not affecting aqueous volume of the tears.

AIM: To evaluate the quantitative and qualitative results of the noninvasive tear film break-up time (NI-BUT) test and investigate the predictive ability of the new NI-BUT parameter in discriminating between normal Ocular Surface Disease Index (OSDI; scores ≤12) and abnormal OSDI (scores ≥13). METHODS: A total of 341 eyes of 341 volunteers who applied for routine eye outpatient control were included in the prospective study. All participants' noninvasive first tear film break-up time (NIF-BUT), noninvasive average tear film break-up time (NIAvg-BUT) and average value of the first three break-up time (A3F-BUT) were analyzed. A3F-BUT, the new NI-BUT parameter, is calculated by adding the NIF-BUT value to the 2(nd) break-up time value that has a difference of at most 1 second from the NIF-BUT value and to the 3(rd) break-up time and then dividing the respective sum by 3. Receiver operating characteristic (ROC) curve and forward logistic regression analyses were performed to determine the parameter that had the best predictive ability between the OSDI groups. RESULTS: The NI-BUT values of 255 eyes of 255 volunteers included in the study were analyzed statistically. The mean NIF-BUT, NIAvg-BUT, and A3F-BUT values were calculated as 5.3±3.0, 8±3.1, and 5.8±3.0 seconds, respectively. All three parameters were found to be significantly lower in the abnormal OSDI group (P=0.014, 0.034, and 0.011, respectively). The area under the curve (AUC) of the A3F-BUT to predict abnormal OSDI was AUC=0.625 (0.529-0.720), P=0.011 and NIF-BUT was AUC=0.599 (0.502-0.696), P=0.043. The A3F-BUT parameter and NIF-BUT parameters were found to be significantly efficient in discriminating abnormal OSDI. CONCLUSION: The new parameter for the NI-BUT test has more predictive ability in the discrimination of OSDI groups.

The aim of this retrospective chart review study was to evaluate the 5-year trend of ocular surface examination results in participants who visited the eye clinic from 2015 to 2019, underwent corneal and lacrimal examinations, refraction, and intra-ocular pressure measurements, and reported six dry eye-related symptoms. A total of 1468 patients were analyzed. Tear break-up time (BUT) decreased continuously for five consecutive years: 4.76 ± 1.84 s in 2015, 4.57 ± 1.70 s in 2016 (p = 0.999, vs 2015), 4.35 ± 2.06 s in 2017 (p = 0.662), 3.83 ± 2.18 s in 2018 (p

To measure tear osmolarity, Schirmer I test and tear break-up time (TBUT) values in the obstructed and non-obstructed fellow eye of unilateral primary acquired nasolacrimal duct obstruction (PANDO) patients and compare them with healthy controls.In this prospective noninterventional study, the tear osmolarity, Schirmer I test, and TBUT values from unilateral PANDO eyes, fellow eyes, and control eyes of all subjects were measured.The study included 114 eyes of 30 PANDO patients as well as 27 healthy controls. There was a significant difference between TBUT and Schirmer values of fellow eyes and PANDO eyes (p = 0,035; p = 0,001). There was no significant difference in any of the ocular surface parameters between PANDO eyes and control eyes (p 0.05). When fellow eyes were compared to control eyes, there was a significant difference in TBUT (p = 0.046).Decreased TBUT was exhibited by the fellow eye of unilateral PANDO patients, compared to the PANDO side and controls. Compensatory changes in PANDO eyes due to a decrease in the tear secretion reflex may lead to tear dysfunction of the fellow eye. Clinicians should assess tear stability in the fellow eye of PANDO patients as this could be leading to added symptomatic complaints.

This study aimed to evaluate the non-invasive and subjective symptoms associated with Lehfilcon A water gradient silicone hydrogel contact lenses with bacterial and lipid resistance technology. A prospective, longitudinal, single-centre, self-controlled study was conducted among silicone hydrogel contact lens wearers. Non-invasive analysis of the pre-lens tear film was performed using the Integrated Clinical Platform (ICP) Ocular Surface Analyzer (OSA), and the meibomian glands were evaluated with the Cobra® HD infrared meibographer. After 30 days of contact lens wear, the subjects were re-evaluated to determine the changes in conjunctival redness, subjective dry eye disease, tear meniscus height, lipid pattern, and non-invasive break-up time. Results showed that the lipid layer thickness decreased significantly from 2.05 ± 1.53 to 0.92 ± 1.09 Guillon patterns, and the tear meniscus height decreased from 0.21 ± 0.04 to 0.14 ± 0.03. The mean pre-lens non-invasive break-up time (NIBUT) significantly increased from 15.19 ± 9.54 to 25.31 ± 15.81 s. The standard Patient Evaluation of Eye Disease (SPEED) score also decreased from 7.39 ± 4.39 to 5.53 ± 4.83. The results suggest that Lehfilcon A significantly reduced lipid and aqueous tear film volume but improved break-up time and subjective dry eye symptoms.

Makale, WOS : 000901834600003, PubMed ID : 36138005, Purpose:To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on the ocular surface and conjunctival cytology and the relationship between the findings and disease severity.Methods:One hundred six eyes of 106 patients (77 patients with OSAS and 29 control subjects) were included in the study. Twenty-three patients with an apnea-hypopnea index (AHI) of 5 to 15 were classified as mild OSAS (group 1), 27 patients with an AHI of 15 to 30 were classified as moderate OSAS (group 2), and 27 patients with an AHI >= 30 were classified as severe OSAS (group 3). The following tests were used to evaluate the ocular surface: tear break-up time (TBUT), Schirmer I test, ocular surface disease index (OSDI), and conjunctival impression cytology (CIC). The results obtained from the tests were analyzed and compared between the groups.Results:The mean value of the Schirmer I test was 15.03 +/- 10.16 (1-35) mm in the control group, whereas it was found as 13.39 +/- 8.80 (3-35) mm, 9.85 +/- 7.81 (1-30) mm, and 9.41 +/- 7.53 (2-35) mm in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant (P=0.002). Although the mean TBUT score was 9.83 +/- 5.03 (3-23) seconds in the control group, it was 11.04 +/- 6.22 (3-20), 6.26 +/- 3.48 (1-16), and 5.44 +/- 3.09 (1-10) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant (P, Necmettin Erbakan University Meram Faculty of Medicine

Background: To examine firefighters (FFs) exposed to high levels of fire smoke and, as a result, to uncover risk factors for dry eye disorder (DED) compared to age-and gender-matched healthy individuals. Methods: In this cross-sectional study, 51 FFs from the Afyonkarahisar Municipality Fire Department were chosen at random (group 1). A control group (group 2) included 51 age- and gender-matched healthy individuals. The Ocular Surface Disease Index (OSDI) questionnaire was administered after all participants were thoroughly explained the study's objectives and procedures. Then, using a portable hand biomicroscope, an ocular exam was performed on-site. DED was defined as a non-anesthetic Schirmer test result of

The influence of dry eye disease (DED) on ocular biometric measurements is unclear. We aimed to investigate the effect of DED on the repeatability of ocular biometric measurements in cataract patients. Overall, 114 eyes scheduled for cataract surgery were enrolled. Before surgery, DED parameters including tear film break-up time (BUT), corneal and conjunctival staining scores, and subjective symptoms were examined. Corneal curvature radius and axial length were assessed twice on the same day using IOLMaster-500 (Carl Zeiss Meditec), and the absolute difference between the two measurements was calculated and used as an index of measurement repeatability. The measurement repeatability of the steep meridian of corneal curvature radius was significantly worse in eyes with DED than in those without DED (p = 0.044) and was significantly associated with BUT (r = −0.206, p = 0.031). The measurement repeatability of axial length was negatively correlated with BUT (r = −0.199, p = 0.041) and positively correlated with the corneal staining score (r = 0.253, p = 0.009). In conclusion, the measurement repeatability of corneal curvature radius declined in eyes with DED. Shortened BUTs were associated with a deterioration in the measurement repeatability of corneal curvature radius and axial length.

Background: Dry eye syndrome is a multifactorial disease of pre-corneal tear film that results in ocular discomfort, visual disturbance and tear film instability, with potential damage to the ocular surface. The aim of the work was to evaluate the ocular surface alterations related to cataract surgery either phacoemulsification or extracapsular cataract extraction surgeries. Methods: This prospective observational study included 60 patients with cataract. Patients were divided into 2 equal groups: Group1 included patients who had scheduled for phacoemulsification. Group 2 included patients who had scheduled for extracapsular cataract extraction surgery. All patients were subjected to full history taking, complete ophthalmic evaluation, OSDI score test, Schirmer tests, invasive break up time tests (IBUT), and non- invasive break up time tests (NIBUT). Results: Postoperative BCVA test in both groups was significantly better compared to preoperative tests after 1 week, 1 month, and 3 months while postoperative Schirmer test, IBUTT test, non IBUTT test, and OSDI test were significantly worse compared to preoperative in both groups after 1 week, 1month and 3 months (P value = 0.05). Conclusions: Patients who had scheduled for phacoemulsification showed a significantly better BCVA test, OSDI test, Schirmer test, IBUTT test, and non IBUTT test after 1 week, 1month and 3 months compared to extracapsular cataract extraction group.

Purpose To assess the tear film layers and Meibomian glands by a noninvasive ocular surface analyzer in patients with and without type 1 diabetes mellitus (T1DM). Methods Eighty-eight participants were enrolled in this study: 44 patients with T1DM without diabetic retinopathy, and 44 patients as a control group, between 18 and 49 years old. Limbal and bulbar redness classification, lipid layer thickness (LLT), tear meniscus height (TMH), first and mean noninvasive tear break-up time (FNIBUT and MNIBUT, respectively), and Meibomian glands loss (MGL) were assessment through the ICP Ocular Surface Analyzer (OSA). Schirmer’s I test (SIT), the fluorescein tear break-up time test (TFBUT), OSDI and SPEED questionnaires, and percentage of glycosylated hemoglobin (HbA1c) were also tested. Results The T1DM group showed higher limbal and bulbar redness (p = 0.010) and lower LLT (p p p p p = 0.001), and TFBUT (p p = 0.097) and lower (p Conclusion Patients with T1DM without signs of retinopathy showed involvement of the mucoaqueous and lipid layers of the tear film, as well as a higher percentage of MGL, using a noninvasive analyzer. Dry eye disease in people with T1DM cannot be ruled out by anamnesis and subjective symptom questionnaires alone; therefore, these patients should undergo regular anterior pole examinations.

Objectives: To evaluate the corneal subbasal nerve morphology, corneal sensitivity, and anterior segment alterations in short-term silicone hydrogel contact lens (SiHCL) users by confocal microscopy. Materials and methods: The study included 25 right eyes of 25 male volunteers aged 25-30 years who had never used SiHCLs before. ocular surface disease index (OSDI), tear break-up time, Schirmer test, tear meniscus area, strip meniscometry tube, corneal sensitivity, and corneal subbasal nerve morphology were evaluated before and after 1 month of CL use. Results: OSDI was 10.6±1.1 before CL use and 17.2±1.2 after 1 month of CL use (p0.05). Tear film break-up time was 7.1±0.4 s before and 6.2±0.3 s after CL use (p>0.05). The tear meniscus area was 0.026±0.002 mm2 before and 0.024±0.001 mm2 after 1 month of CL use (p>0.05). Strip meniscometry tube results were 5.4±0.9 mm before and 4.9±0.8 mm after 1 month of CL use (p>0.05). Corneal sensitivity values were 3.2±0.4 mm before and 2.95±0.3 mm after 1 month of CL use (p>0.05). Dendritic cell density evaluated by confocal microscopy was 14.84±3.1 cells/mm2 before and 32.57±4.2 cells/mm2 after 1 month of CL use (p0.05). Subbasal nerve density was measured as 4726±310 pixels/frame before and 4570±272 pixels/frame after 1 month of CL use (p>0.05). Conclusion: After a month of SiHCL use, no significant changes were observed in tear secretion, corneal sensitivity, tear meniscus volume, subbasal corneal nerve density, reflectivity, or tortuosity, while a significant increase was found in OSDI and dendritic cell density.

This study aimed to observe the changes in the ocular surface after phacoemulsification in patients with age-related cataracts with respect to the addition of varying concentrations of hyaluronate.Patients with dry eye syndrome were treated with 0.3% and 0.1% sodium hyaluronate eye drops to evaluate the clinical improvement in each treatment group. A total of 73 patients (91 eyes) with age-related cataracts suffering from dry eye syndrome after phacoemulsification were divided into treatment group A (30 eyes), undergoing conventional therapy and treatment with 0.3% sodium hyaluronate; treatment group B (31 eyes), undergoing conventional therapy and treatment with 0.1% sodium hyaluronate; and the control group (group C; 30 eyes), undergoing conventional therapy only. Two groups were given different concentrations of sodium hyaluronate eye drops four times a day (should be completed between 8 AM and 8 PM), one drop at a time.Seven days, 2 weeks, 1 month, and 2 months postoperatively, there were significant differences in the Schirmer I test (SIt), first noninvasive tear film break-up time (NIBUTf), average noninvasive tear film break-up time (NIBUTav), tear meniscus height (TMH), and irregularity (when the refractive force of different parts of different meridians on the same meridian is different. The main manifestation is that the two meridians on the anterior surface of the cornea do not show a 90-degree vertical distribution, which cannot be corrected by conventional astigmatism lenses) between the three groups (p 0.05). When compared with group C, there were significant differences in the SIt, NIBUTf, NIBUTav, TMH, and irregularity of group A and group B (p 0.05). When compared with group B, there were significant improvements in the SIt, NIBUTf, NIBUTav, and TMH in group A (p 0.05).In the early stage after phacoemulsification, the stability of the tear film is reduced. Adding sodium hyaluronate eye drops can restore tear film structure and improve corneal surface regularity, and a 0.3% solution of sodium hyaluronate eye drops is more effective than a 0.1% solution.

Francisco Pastor-Pascual,1 Rafael Pastor-Pascual,1 Patricia Gálvez-Perez,1 Rosa Dolz-Marco,2 Roberto Gallego-Pinazo2 1Anterior Segment Department, Valencia, Spain; 2Posterior Segment Department, Valencia, SpainCorrespondence: Francisco Pastor-Pascual, Clínica Oftalvist, Valencia, Spain, Tel +34 963 51 33 04, Email franciscopastorpascual@gmail.comPurpose: To analyze the use of artificial tears in patients undergoing treatment with anti-vascular endothelial growth (anti-VEGF) intravitreal injections.Methods: Thirty-four eyes undergoing anti-VEGF treatment were analyzed. Each patient underwent a subjective and objective evaluation of the ocular surface, using the Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ)-5, tear meniscus height (TMH), first and average non-invasive Keratograph Break-Up Time (NIKBUT), bulbar conjunctival redness, meibography and the Vision Break-Up Time (VBUT). Patients attended 5 visits (days 0, 7, 30, 37, and 60). All patients continued with their intravitreal injection treatment during the study (days 0, 30, and 60). Patients did not receive any artificial tear treatment during the first month of the study, and at the baseline visit they were randomly assigned to one of two study groups to receive either the Systane Hydration or the Viscofresh 10mg/mL formulation. Patients were instructed to instill one drop of the assigned study treatment 3 times a day for 30 days during the second month of the study.Results: According to the Mixed Models for Repeated Measures analysis, there is not enough statistical evidence for any of the parameters examined to determine significant differences between being treated with artificial tears and not being treated (p > 0.05). There is, however, a tendency toward improved outcomes in some parameters when artificial tears were used. OSDI, DEQ-5, TMH, and meibography were not affected by either the type of artificial tear used or by the time (from day 30 to day 60; p > 0.05), but the NIKBUT and VBUT values increased over time during this period regardless of which treatment the patient was receiving.Conclusion: The use of artificial tears may help to keep the tear film stable Future studies with larger samples should be conducted to elucidate whether the tendency reported in our study becomes significant.Keywords: ocular discomfort, artificial tears, intravitreal injection, anti-VEGF agents, dry eye

Purpose: Not much attention is given to evaluation of ocular surface abnormalities in diabetics. This study has been carried out to evaluate factors like age, sex, duration of diabetes in causing dry eye in type 2 diabetics along with evaluation of tear film stability using various tests like Schirmers test and Tear film break up time. Materials and Methods: In this observational cross-sectional study, 50 patients were examined, who were a diagnosed case of type 2 diabetes mellitus. Detailed history, anterior segment evaluation was done. Ocular surface evaluation was done using tear film break up time and Schirmers test. Ocular surface disease index Questionnaire was taken. Results:Among 50 patients with diabetes 46% of patients had dry eye. All patients who had diabetes for more than 20 years had dry eye and just 31.57% had dry eye who had diabetes for less than 5 years. It was found that Diabetics showed reduced Schirmer, TBUT measurements. Conclusion:Patients with type II diabetes have higher prevalence of dry eye.Evaluation of diabetic patients using the OSDI questionnaire canbe helpful in identifying dry eye in early stages.Significant reduction in TBUT and Schirmer test was found indiabetic patients.

IntroductionThe efficacy and safety of 3% diquafosol sodium eye drops in Chinese patients with dry eye in the real-world setting remains unclear.Methods3099 patients with dry eye symptoms were screened according to Asia Dry Eye Society latest recommendation. Among them, 3000 patients were enrolled for a phase IV study. We followed up with multiple clinical characteristics including corneal fluorescein staining, tear break up time, Schirmer’s tests, visual acuity, intraocular pressure, and others. The follow ups were performed at baseline, 2 weeks and 4 weeks after treatment.ResultsBased on the results of corneal fluorescein staining and tear break up time, all age and gender subgroups exhibited obvious alleviation of the symptoms among the patients with dry eye, and the data in elderly group showed the most significant alleviation. All the adverse drug reactions (ADRs, 6.17%) were recorded, among which 6% local ocular ADRs were included. Meanwhile, mild ADRs (91.8%) accounted for the most. Most of the ADRs (89.75%) got a quick and full recovery, with an average time at 15.6 days. 1.37% of patients dropped out of the study due to ADRs.DiscussionThe use of 3% diquafosol sodium eye drop is effective and safe in the treatment of dry eye, with a low incidence of ADRs showing mild symptoms. This trial was registered at Chinese Clinical Trial Registry ID: ChiCTR1900021999 (Registration Date: 19/03/2019).

The study aimed to assess the efficacy of hydroxypropyl guar (HP) formulation (Systane) to protect tear film parameters under desiccating environment using protection and relief treatment modalities. The subjects were exposed to adverse environmental conditions using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the ambient temperature was 21 °C and screened for Tear break-up time (TBUT), Tear film evaporation rate (TFER) and lipid layer thickness (LLT) using the HIRCAL grid, Servomed EP3 Evaporimeter and Keeler’s TearScope-Plus respectively. Significant improvement in LLT was noticed in the protection modality. The mean tear film evaporation rate doubled after exposure to the humidity of 5% to a value of 105.37 g/m2/h (0.29 µl/min). All subjects displayed a significant reduction in non-invasive tear break-up time (NITBUT) with a mean NITBUT of 7.7 s after exposure to a desiccating environment for 15 min. A significant increase in NITBUT after the instillation of the drops was recorded in both methods. The results obtained from this study showed that a solution containing HP-Guar significantly improves tear film parameters under a desiccating environment. Apart from the tear evaporation rate, all tear parameters showed improvement after the use of HP-Guar eye drops. It is evident that tear film parameters respond differently to the management modalities and using CEC has the potential to provide researchers with a readily available method to evaluate the efficiency of tear supplementation.

Objective: This meta-analysis aims to determine whether ocular surface alterations are associated with disease severity in patients with obstructive sleep apnea–hypopnea syndrome (OSAHS).Methods: The protocol for this systematic review and meta-analysis was registered in PROSPERO. We conducted the search in six electronic databases (China National Knowledge Infrastructure, EMBASE, Cochrane Library, Web of Science, Wanfang, and PubMed) from since the construction of the databases to 30 December 2022. The standard mean difference (SMD) and correlation coefficients are reported as measures of the effect size in the presence of retrieved data. In addition, the random effects model or fixed effects model was used in a combined analysis. Stata 11.0 and R 3.6.1 were used for statistical analyses of the data.Results: A total of 15 studies satisfied the inclusion criteria for this study. The prevalence of floppy eyelid syndrome (FES) and dry eye syndrome in patients with obstructive sleep apnea–hypopnea syndrome was 40 and 48%, respectively. In addition, the Schirmer 1 value and tear break-up time (TBUT) were remarkably reduced in patients with OSAHS when compared to that of the controls. The ocular surface disease index (OSDI) scores, Oxford corneal staining scores, and the rates of loss in the meibomian glands were elevated in patients with obstructive sleep apnea–hypopnea syndrome when compared to that of the controls, especially those with severe disease. Moreover, the Schirmer 1 value and tear break-up time exhibited a negative correlation with the apnea–hypopnea index (AHI), and the OSDI showed a positive association with the apnea–hypopnea index.Conclusion: Patients with OSAHS had a greater prevalence of FES than the healthy controls. They also showed lower Schirmer 1 value and tear break-up time but had a higher OSDI, Oxford corneal staining scores, and rates of loss in the meibomian glands than the healthy controls.Clinical Trial Registration: (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392527).

BACKGROUND 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. METHODS A comparative cross-sectional study was done on 100 diabetic and 100 non-diabetic patients > 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) & Schirmer test. RESULTS 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 & mean Schirmer test readings as compared to diabetic females. Mean Schirmer reading & Mean TBUT were lowest in a patients having > 20 years of DM and highest in patients having < 5 years of DM. No positive correlation was found between HbA1c (Glyosylated Haemoglobin) and diabetic retinopathy with TBUT/ Schirmer test readings. CONCLUSIONS 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.

Purpose: To investigate the clinical efficacy of MS-Amnion amniotic membrane contact lenses.Methods: MS-Amnion amniotic membrane contact lenses were placed for 1 week in patients with severe superficial punctate keratitis or corneal epithelial defects that did not respond to medical treatment. Eighteen eyes followed-up for ≥3 months were evaluated in terms of the best-corrected visual acuity, tear break-up time, and corneal sensation and opacity before and after application of the MS-Amnion amniotic membrane contact lens. The success and recurrence rates, and complications during follow-up, were recorded.Results: Out of 18 eyes, 15 (83.3%) healed within 2 weeks without any treatment other than the amniotic membrane; three eyes (16.7%) were unresponsive, and thus underwent temporary amniotic membrane transplantation. Recurrence developed in three eyes (20%). The amniotic membrane contact lens dropped out in five eyes (27.8%) and folded over in two (11.1%). The mean best-corrected visual acuity improved from 0.89 to 0.27 logarithm of the minimal angle of resolution after 3 months, while the mean corneal opacity decreased from 0.38 to 0.11 after 3 months; the changes were statistically significant. The tear break-up time and corneal sensation also improved, but they were not statistically significant. We encountered no significant complications.Conclusions: The MS-Amnion amniotic membrane contact lenses can heal the amniotic membrane and do not require suturing when applied in the outpatient clinic. This may be beneficial for patients with intractable ocular surface disorders.

Neurotrophic keratopathy (NTK) is an orphan, polyetiological disease that has recently been identified more frequently. Drug-resistant stages of NTC often require urgent surgical treatment. Subsequently, such patients need to be done keratoplasty, the consequences may be unsatisfactory in the presence of a significant impairment of innervation.Purpose: to evaluate the effectiveness of lamellar anterior keratoplasty in patients with the outcome of stage II and III NTK.Material and methods. The study included 22 patients (22 eyes) aged 21 to 88 years. All patients were divided into two main groups. The first group consisted of 12 patients with NTC as a result of damage to the main stem of n.trigeminus and its branch n.ophthalmicus, the second group consisted of 10 patients — NTC as a result of toxic damage due to uncontrolled instillation of local anesthetics and eyedrops with preservatives. Before inclusion in the study, 14 patients underwent autoconjunctivoplasty for the treatment of drug-resistant NTK stage II and III, 8 — corneoscleral flap coating. All patients underwent lamellar anterior keratoplasty. The following parameters were assessed: maximally corrected visual acuity (MCVA) and coefficient of corneal sensitivity reduction in an approximate way before and after 1 day, 2 weeks, 1 and 3 months after surgery; tear film break- up time (Norn test) and Schirmer’s I.Results. In the second group an increase in the level of BCVA and a clear graft was observed in all patients, while in the first group, the level of BCVA worsened, and the graft was with reduced transparency. Significant difference between the examined and the fellow eye in the compared groups according to the tear film break-up time test was not detected. In the first group statistically significant decrease of tear production according to the results of the Schirmer’s test was identified. A weak correlation was found between corneal sensitivity and BCVA after surgery in group II.Conclusion. We have demonstrated the high efficiency of automated layered anterior keratoplasty in the outcomes of advanced stages of NTK of toxic etiology. In patients with NTC outcome as a result of stem injury, surgical treatment led to a satisfactory cosmetic result, but visual acuity did not change significantly.

Purpose This study evaluated the clinical safety and efficacy of tanfanercept (HBM9036) ophthalmic solution as a novel treatment for dry eye disease (DED) in a controlled adverse environment (CAE) study conducted in China. Methods In a single-center, double-masked, randomized, placebo-controlled study, 100 patients received 0.25% tanfanercept, or placebo, twice daily for eight weeks. A mobile international CAE® DE Model was used for patient selection with a standardized challenge endpoint. Primary efficacy endpoint was fluorescein inferior corneal staining score (ICSS) pre- to post-CAE challenge from baseline. Secondary endpoints included Schirmer’s Tear Test, Tear-Film Break-Up Time, Ocular Discomfort Score, Ora Calibra® Ocular Discomfort and 4-Symptom Questionnaire, total corneal staining score (TCSS), and drop comfort. Signs and symptoms were assessed both pre- and post-CAE to evaluate the efficacy of tanfanercept on both environmental and CAE endpoints. Results The tanfanercept treatment group showed improvement in ICSS pre- to post-CAE change from baseline scores when compared to placebo (− 0.61 ± 0.11 and − 0.54 ± 0.11, respectively; mean difference = 0.07, p = 0.65). TCSS pre–post-CAE change from baseline scores was also in favor of active when compared to placebo (− 1.03 ± 0.21 and − 0.67 ± 0.21, respectively; mean difference = 0.37, p = 0.23). Schirmer’s score improvement was demonstrated in favor of active (1.87 ± 0.62 mm) as compared to placebo (1.28 ± 0.62 mm; mean difference = 0.59 mm, p = 0.50). Change from baseline in mean Tear-Film Break-up Time favored active treatment over placebo (mean difference = 1.21 s, p = 0.45). Notably, the tanfanercept showed more obvious benefits for each DED sign in a subgroup of subjects ≥ 35 years of age. Tanfanercept was well tolerated with no serious adverse events occurring during the study. Conclusion Tanfanercept demonstrated improvements in favor of active as compared to placebo in the signs of DED, being safe and well tolerated. These data support further evaluation of tanfanercept for the treatment of DED in China. Trial registration This study was retrospectively registered at ClinicalTrials.gov (NCT04092907) on September 17, 2019.

This multicenter (four institutions), randomized, investigator-masked, parallel-group clinical trial evaluated and compared the efficacy and safety of preservative-free and preserved brimonidine tartrate 0.15% in open-angle glaucoma and ocular hypertension. Sixty eyes of 60 patients with intraocular pressure (IOP) ≥ 15 mmHg diagnosed with open-angle glaucoma or ocular hypertension were randomized to preserved (n = 31) and preservative-free (n = 29) brimonidine groups. The enrolled eyes received brimonidine monotherapy three times daily. Main outcome measures were corneal/conjunctival staining score, ocular surface disease index, patient satisfaction score, drug tolerance, and drug adherence rate 12 weeks post first administration. Secondary outcome measurements included visual acuity, IOP, drug tolerance, tear-film break-up time, hemodynamic changes including blood pressure and heart rates, and ocular adverse events. After 12 weeks, both preserved and preservative-free groups showed similar IOP reduction, corneal and conjunctival staining scores, drug tolerance, and adherence rates. The preservative-free group showed significantly better tear-film break-up time and higher patient satisfaction regarding drug use and management. Systolic and diastolic blood pressure reductions during the 12 weeks were significantly lower in the preserved group than in the preservative-free group. Preservative-free brimonidine tartrate showed comparable efficacy and safety, better corneal tear film stability, and patient satisfaction than preserved brimonidine.

Background Orthokeratology lenses, which are worn overnight, are recommended for reducing myopia progression. They lie on the cornea and can influence the ocular surface by temporarily reshaping the corneal surface through a reverse geometry design. This study investigated the effect of overnight orthokeratology lenses on tear film stability and meibomian gland status in children aged 8–15 years. Methods This prospective, self-controlled study included 33 children with monocular myopia who were prescribed orthokeratology lenses for at least one year. The experimental group (ortho-k group) comprised 33 myopic eyes. The control group comprised the emmetropic eyes of the same participants. Tear film stability and meibomian gland status were measured using a Keratograph 5M (Oculus, Wetzlar, Germany). Paired t-tests and Wilcoxon signed-rank tests were used to compare the data between the two groups. Results At the one-year visit, the non-invasive first tear film break-up time (NIBUTf) values were 6.15 ± 2.56 s and 6.18 ± 2.61 s in the experimental and control groups, respectively. The lower tear meniscus height was 18.74 ± 0.05 μm and 18.65 ± 0.04 μm in these groups, respectively. No significant difference was observed in loss of meibomian glands or non-invasive average tear film break-up time between the experimental and control groups using Wilcoxon signed-rank tests. Conclusions The stability of the tear film and meibomian gland status were not significantly affected by wearing orthokeratology lenses overnight, indicating that continuous use of orthokeratology lenses for 12 months has a minimal effect on the ocular surface. This finding can help guide the clinical management of tear film quality with respect to the use of orthokeratology contact lenses.

Background To assess the effect of tear film instability in dry eye disease (DED) by measuring visual performance and tear film optical quality in a simultaneous real-time analysis system. Methods Thirty-seven DED participants and 20 normal controls were recruited. A simultaneous real-time analysis system was developed by adding a functional visual acuity (FVA) channel to a double-pass system. Repeated measurements of FVA and objective scatter index (OSI) were performed simultaneously with this system under blink suppression condition for 20 s. Patient-reported symptoms was evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Mean FVA, mean OSI, and visual acuity break-up time were defined. The OSI maintenance ratio was calculated as an evaluation index to assess the difference between dynamic OSI changes and baseline OSI. The visual maintenance ratio was also calculated in the same way. Results Moderate correlations were noted between mean OSI and FVA-related parameters (mean FVA, visual maintenance ratio, visual acuity break-up time: 0.53, − 0.56, − 0.53, respectively, P P P Conclusions OSI-related metrics were found to be potential indicators for assessing and diagnosing DED which correlated with both subjective visual performance and patient-reported symptoms; the FVA-related metrics were quantifiable indicators for evaluating visual acuity decline in DED. Trial registration number: Chinese Clinical Trial Registry, ChiCTR2100051650. Registered 29 September 2021, https://www.chictr.org.cn/showproj.aspx?proj=134612

BACKGROUND Dry eye disease is one of the most common presentation in hospital with varied presenting complaints and which can lead to various complications. Study is done on 200 eyes diagnosed with dry eyes in a tertiary centre in South India using Schirmer; and tear break up time test. Their central corneal thickness is measured using specular microscopy. The correlation of dry eye disease and central corneal thickness is assessed. Dry eye disease diagnosed using Schirmer test showed a strong correlation with the central corneal thickness. A significant reduction in central corneal thickness was observed in dry eyes disease diagnosed with Schirmer disease. The factors affecting dryness includes inflammatory component and evaporating component. Based on my study the results of dry eyes due to inflammation of eye can be considered to have more association to the pathogenesis in relation to central corneal thickness. Inflammation decreases the eyes’ ability to produce normal tear. METHODS 200 eyes of 100 patients who presented in hospitals diagnosed with dry eye disease were included in the study. The central corneal thickness of these patients was measured and corelated with the degree of dryness using Shermer’s test and tear film break up time. RESULTS A statistical significance was observed between the inflammatory component causing dry eyes and the CCT values. CONCLUSIONS There is a significant association between the central corneal thickness and dry eye diseases. KEY WORDS Central Corneal Thickness, Schirmer’s Test, TBUT.

Objective As digital display devices become more and more indispensable, associated health problems have started to increase. We aimed to investigate the frequency and relationship of digital display device usage behaviours and dry eye syndrome (DES) in medical students. Methods An observational, cross-sectional study was conducted on medical school students who voluntarily participated in our study online, about the duration and variety of their digital screen use, usage patterns, and protective measures, together with the Ocular Surface Disease Index (OSDI) questionnaire. Where necessary, the Schirmer-I, tear break-up time, and fluorescein staining tests were carried out. Results Of the 255 participants, 75.3% (n = 192) were female, 63.1% (n = 161) had no refractive vision defects, and 45.9% used smartphones for more than 5 h a day. According to the OSDI scores for DES screening, only 36.1% of the participants were normal, 17.3% had mild DES, 20.4% had moderate DES, and 26.3% had severe DES. A positive correlation was found between digital display usage time in hours per day and a high OSDI score. As the distance between the eye and the screen decreased, the DES score increased, which is significant for computer, e-book, and tablet use (P < 0.005). The DES rate of the 25 participants who underwent further evaluation was 40% for the tear break-up time test and 52% for the fluorescein staining test. Conclusion The high prevalence of DES due to digital screen use among medical school students highlights the importance of DES screening as a preventive measure in family medicine.

To compare the effect of intense pulsed light (IPL) therapy and conventional treatments in meibomian gland dysfunction (MGD)-related dry eye disease (DED). A literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, and China Biology Medicine (CBM) up to January 2022. Randomized controlled trials (RCTs) were included. Mean differences (MDs) and their 95% confidence intervals (CIs) were calculated. A meta-analysis concerning changes in tear break-up time (BUT), changes in Ocular Surface Disease Index (OSDI) scores, changes in non-invasively measured tear break-up time (NIBUT), changes in corneal and conjunctival fluorescein staining (CFS) scores, and changes in Standard Patient Evaluation of Eye Dryness (SPEED) scores was carried out. The initial search identified a total of 1842 records in the databases, and 11 studies were included in the final analysis. Compared to conventional therapies, IPL therapy was associated with significantly reduced OSDI (MD, - 7.49; 95% CI, - 12.47 to - 2.5) and SPEED (MD, - 3.28; 95% CI, - 5.64 to - 0.93) scores, while BUT (MD, 1.94; 95% CI, 1.19 ~ 2.69) and NIBUT (MD, 2.55; 95% CI, 1.07 ~ 4.04) significantly increased. No significant difference was found in the change in CFS between the two groups. Both IPL treatment and traditional treatments are effective in the treatment of MGD-related DED. IPL application seems to be superior to traditional treatments.

WM 2022: So sehen Sie Polen - Saudi-Arabien live im Free-TV und Stream Polen - Saudi-Arabien live Bei der WM in Katar spielt Polen gegen Saudi-Arabien. Alle Informationen zur Partie und der Übertragung im Free-TV und Live-Stream, den Termin und einen Live-Ticker gibt es hier. ARTIKEL ANHÖREN Das Spiel gegen Mexiko wird der polnischen Nationalmannschaft wohl noch lange im Gedächtnis bleiben, obwohl es für einen Spieler eher zum Vergessen war: Über ein 0:0 kam das Team rund um Robert Lewandowski nicht hinaus. Dieser verschoss sogar einen Elfmeter, was letztlich nur wieder das alte Fußball-Sprichwort bestätigt: Der Gefoulte sollte nicht selbst schießen. Während man zu Beginn der Fußball-Weltmeisterschaft in Katar davon ausgegangen war, dass Argentinien die größten Chancen aufs Weiterkommen haben würde, gefolgt von Mexiko und Polen im Kampf um Platz zwei, und Saudi-Arabien auf dem letzten Platz, ist das Gefüge in Gruppe C inzwischen etwas durcheinander gewirbelt worden: Mit dem überraschenden 2:1 Sieg gegen die Argentinier hat Saudi-Arabien für den ersten Underdog-Sieg im Turnier gesorgt. Ob Polen gegen Saudi-Arabien zurück auf Kurs in Richtung nächste Runde kommen wird oder ob Saudi-Arabien an den Achtungserfolg anknüpfen kann, wird nur das Spiel der beiden Nationen zeigen können. Alle Informationen zur Partie Polen - Saudi-Arabien und die Übertragung im Free-TV und Live-Stream, einen Live-Ticker, den Termin und vieles mehr finden Sie in unserem Artikel. Purpose: Not much attention is given to evaluation of ocular surface abnormalities in diabetics. This study has been carried out to evaluate factors like age, sex, duration of diabetes in causing dry eye in type 2 diabetics along with evaluation of tear film stability using various tests like Schirmers test and Tear film break up time. Materials and Methods: In this observational cross-sectional study, 50 patients were examined, who were a diagnosed case of type 2 diabetes mellitus. Detailed history, anterior segment evaluation was done. Ocular surface evaluation was done using tear film break up time and Schirmers test. Ocular surface disease index Questionnaire was taken. Results:Among 50 patients with diabetes 46% of patients had dry eye. All patients who had diabetes for more than 20 years had dry eye and just 31.57% had dry eye who had diabetes for less than 5 years. It was found that Diabetics showed reduced Schirmer, TBUT measurements. Conclusion:Patients with type II diabetes have higher prevalence of dry eye.Evaluation of diabetic patients using the OSDI questionnaire canbe helpful in identifying dry eye in early stages.Significant reduction in TBUT and Schirmer test was found indiabetic patients. Preview

PurposeObstructive sleep apnea (OSA) is related to an increased incidence of dry eye disease (DED). However, their exact relationship is unknown and requires further well-designed studies with advanced mechanisms detection.Patients and methodsThis case–control study included 125 OSA cases and 125 age–gender-matched controls enrolled in the hospital between 1 January and 1 October 2021. OSA diagnosis and classification were performed using a polysomnography (PSG) assay. Detailed ophthalmological examinations, including the Schirmer I test, corneal staining, and ocular surface disease index (OSDI), were used to detect DED-related parameters. A comprehensive ocular surface assay was performed to measure a series of parameters, including first non-invasive first tear film break-up time (f-NIBUT), average non-invasive first tear film break-up time (av-NIBUT), tear meniscus height (TMH), and loss of meibomian gland. In addition, the Pittsburgh Sleep Quality Index (PSQI) scale was used to assess sleep quality.ResultsCompared to the control, the OSA group showed an increased DED risk (P = 0.016) along with an increased PSQI score and a higher rate of poor quality sleep (P < 0.001 and P = 0.007, respectively). Stratification of OSA cases indicated that DED-related parameters were impaired in patients with severe OSA (P < 0.05). The analysis of DED-parameters-related factors showed significant correlations between OSA-related indexes and PSQI (P < 0.05). Moreover, the poor sleep quality group in the OSA cases showed worse DED-related parameters (P < 0.05), which was not observed in the control group.ConclusionOSA, especially the severe stage OSA, was related to an increased risk of DED. Also, sleep quality was correlated with the onset of both OSA and DED, where poor sleep quality revealed a relationship between OSA and the risk of DED. Overall, our findings provided evidence for advanced management of DED and OSA in future.

Purpose:Not much attention is given to evaluation of ocular surface abnormalities in diabetics. This study has been carried out to evaluate factors like age, sex, duration of diabetes in causing dry eye in type 2 diabetics along with evaluation of tear film stability using various tests like Schirmers test and Tear film break up time. Materials and Methods:In this observational cross-sectional study, 50 patients were examined, who were a diagnosed case of type 2 diabetes mellitus. Detailed history, anterior segment evaluation was done. Ocular surface evaluation was done using tear film break up time and Schirmers test. Ocular surface disease index Questionnaire was taken. Results:Among 50 patients with diabetes 46% of patients had dry eye. All patients who had diabetes for more than 20 years had dry eye and just 31.57% had dry eye who had diabetes for less than 5 years. It was found that Diabetics showed reduced Schirmer, TBUT measurements. Conclusion:Patients with type II diabetes have higher prevalence of dry eye.Evaluation of diabetic patients using the OSDI questionnaire canbe helpful in identifying dry eye in early stages.Significant reduction in TBUT and Schirmer test was found indiabetic patients. &nbsp

Purpose: To determine the frequency of dry eyes in patients after cataract surgery and to find out the effect of gender, duration of cataract and age on dry eye symptoms after phacoemulsification. Study Design: Descriptive Observational study. Place and Duration of Study: Layton Rehmatulla Benevolent Trust Free Eye and Cancer Hospital, Lahore from October 2015 to April 2016. Methods: One hundred and twenty patients between 40-80 years of age and suffering from cataract were included. Past medical history and current medical information was recorded. To control bias, only one experienced surgeon carried out the procedures. Follow-up was done at 1st post-operative day, one week, one month and 3 months. Tear film break up time was noted at each visit. Quantitative variables like age and tear film break-up time (TBUT) were presented as mean ± SD. The Qualitative variables were presented as frequency and percentages. Data was stratified according to age, gender and duration of cataract. Post-stratification Chi-square test was applied and p-value ≤0.05 was considered significant. Results: Out of 120 patients, there were 47 (39%) males and 73 (61%) females. A total of 35 (29.2%) patients had dry eyes. Mean age was 59.11 ± 12.358 years while mean TBUT was 11.27 ± 2.582 seconds. There was no relation of dry eye with gender, duration of cataract and different age groups (p > 0.05). Conclusion: Frequency of Dry eyes after cataract surgery was 29.2% (n = 35). There was no effect of gender, duration of cataract and age of the patient on the post-operative TBUT after phacoemulsification.

Original Research Paper A comparative study of dry eye in diabetic and non diabetic patients reported to ophthalmology opd AIMSR,Chittoor, Andhra Pradesh. Authors: Dr. S Vishnu Priya, Assistant Professor 1, Dr. N Sathish Kumar, Professor 2, Dr. Jagannath Challa, Professor 3, Dr. L Geeta Anusha, Senior Resident 4 , Dr. Keerthi Sri AS, Senior Resident 5 , Dr. Uzma Farhad, Post Graduate6 1,2,3,4,5,6Department of Ophthalmology, Apollo Institute of Medical Sciences & Research-Chittoor, Andhra Pradesh Corresponding Author: Dr Vishnu Priya , 6Department of Ophthalmology, Apollo Institute of Medical Sciences & Research-Chittoor, Andhra Pradesh Article Received: 10-08-2022 Revised: 31-08-2022 Accepted: 21-09-2022 ABSTRACT: Back ground: a comparative study of dry eye in diabetic and non diabetic patients reported to ophthalmology opd Methods: A total of 300 patients (600 eyes) who attended to our ophthalmology opd during the period September 2019 to February 2020 were included in the study. They were divided into 2 groups, group A consisting of 150 non diabetic patients, group B consisting of 150 diabetic patients. They were examined for visual acuity, slitlamp examination for anterior segment evaluation. Patients were given questionnaire to enquire regarding symptoms related to dry eye according to which dry eye disorder is identified. The patients with atleast one symptom related to dry eye were then investigated by various investigations like TBUT, Schirmer’s test 1, Fluorescein stain, Rose Bengal stain,and Lissamine green stain to confirm dry eye disorder. Positive result for atleast 1 test was taken as confirmatory test for dry eye disorder. Results: In our study, out of 300 patients, 158 patients were females (52.66%) and 142 were males(47.33%). Of the total 300 participants, 58% had outdoor occupation and 42% had indoor occupation. Dry eye disorder was seen in 39 out of 300 patients (13%), which is having significant co-relation with outdoor occupation. Among 39 patients with dry eye disorder, 28 patients were diabetic and 11 patients were non diabetic indicating that dry eye is more common among diabetic patients than non diabetic patients. Conclusion: In this study, dry eye disorder is present in 13% . Diabetes and dry eyes appear to have a common association. Further studies need to be undertaken to establish an etiologic relationship. However, examination for dry eye should be an integral part of the assessment of diabetic eye disease. Key words: diabetes mellitus, dry eye, TBUT, Schirmer’s test, dye tests. INTRODUCTION: The importance of cornea lies in its ability to refract light rays at air cornea interface and to allow passage of light rays into eye. Thus, corneal transparency is vital to the ability to see. Transparency is aided by the presence of pre corneal tear film which keeps the corneal surface in moist state. In the absence of a normal pre-corneal tear film, the cornea tends to dry out and becomes hazy leading to dry eye. Dry eye is fairly common clinical entity which tends to affect between 5% to 28% adults, among the general population globally[1]. It has been admitted that about 3.23 million women and 1.68 million men 50years or older have dry eye[2,3] Diabetes is one of the most common leading causes of blindness in 20–74year old persons.[4]Cataract and retinopathy are well-known as ocular complications of diabetes. Recently, problems involving the ocular surface, dry eyes in particular, have been reported in diabetic patients.[4] These patients suffer from a variety of corneal complications including superficial punctuate keratopathy, trophic ulceration, and persistent epithelial defect[5].Dry eye is an important contributor to these problems. Dry eye syndrome has many causes. One of the most common reasons for dryness is aging process [6]. The mechanism responsible for dry eyes is unclear[7], but autonomic dysfunction may be responsible[8]. MATERIAL AND METHODS: The present study was conducted on 300 patients attended to ophthalmology opd during the period September 2019 to February 2020, where they were divided into 2 groups i.e, non diabetics (group A) and diabetics (group B). Inclusion criteria: Age >40 years in both groups. Among diabetics, those with Random Blood Sugar >200mg/dl and HbA1c >6.5% were included in the study. Exclusion criteria: patients with other ocular disorders known to produce dry eye, patients suffering from any systemic disease (other than diabetes mellitus) associated with dry eye like connective tissue disorders, patients on any drug treatment which produce dry eye (MAO inhibitors, alpha agonists, beta blockers, NSAIDS), contact lens wearers. All the patients who were included in the study underwent visual acuity testing using Snellens chart. Distant and near visual acuity, both presenting and best corrected after refraction, were measured for each eye separately using Snellens chart. Detailed anterior segment evaluation was done using slitlamp. Patients were given a questionnaire which included symptoms related to dry eye disorder. Questionnaire: A validated eight item questionnaire[9] of ocular symptoms relating to dry eye was used which included the following questions Do your eyes ever feel dry? Do you ever feel a gritty or sandy sensation in your eye? Do your eyes ever have a burning sensation? Are your eyes ever red? Do your eyes ever feel sticky? Do your eyes ever feel watery or tearing? Do you notice much crusting on your lashes? And Do your eyes ever get stuck shut? Presence of a symptom from the dry eye questionnaire was further graded as rarely (at least once in 3 months), some times (once in 2 – 4 weeks), often (atleast once a week), or all the time. Presence of one or more symptoms often or all the time was taken as positive. Examination for dry eye 1. Corneal sensitivity test: Corneal sensation was tested using a wisp of cotton wool brought onto the cornea in order to elicit a blink response. Care was taken to avoid the menace reflex. Presence of a brisk blink response was indicative of normal corneal sensation. Presence of a weak blink response was indicative of reduced corneal sensation. An absent blink response indicated absence of corneal sensation. The cornea was tested in four different quadrants in each eye as well as in the centre of the cornea. 2. Tear film Break Up Time (TBUT) test: The tear film was stained using commercially available pre-sterilized strip impregnated with 1mg Fluorescein. The tear film was stained in an un-anaesthetised eye. The patient was instructed to blink once or twice and then stare straight ahead without blinking while the cornea was scanned under low slit lamp magnification using a blue cobalt filter. The end point of the test occurred with the time taken, in seconds, for the appearance of the first dry spot formation from the last blink. Normal Tear Film Break Up Time (TBUT) is taken to be around 10 seconds. In presence of dry eye TBUT is less than 10 seconds. 3.Schirmer’s test: This test was performed using a commercial Whatman 41 paperstrip. The strip was placed at the junction of the middle and lateral thirds of the lower eyelid and removed after 5 minutes. The amount of wetting of the strip was read off.Normal value is more than 15mm of wetting after 5 minutes. A value of 5 mm or less after 5 minutes is considered as abnormal 4. Dye tests: The following dye tests were also carried out and grading of the corneal and conjunctival staining was done based on the grading system of the National Eye Institute (NEI) industry Workshop on Clinical Trials in Dry Eyes. i) Fluorescein staining: A commercially available Fluorescein impregnated strip was introduced into the inferior conjunctival sac temporally. The patient was asked to gently close and roll the eyes around to adequately distribute the dye across the ocular surface. Each eye was then examined through the slit lamp using a cobalt blue filter and any areas of staining of the corneal surface were noted.It is used to delineate areas of epithelial discontinuity but does not pick up any dead or devitalized cells. Because Fluorescein diffuses rapidly into the corneal stroma it is essential to assess staining within 1-3 minutes of instillation ii) Lissamine green strip: A strip impregnated with lissamine green was used as above to detect areas of mucin deficiency in the ocular surface using a red barrier filter.Staining with Lissamine Green is both time and concentration dependent, so examination should be done at a standard time interval of one minute after dye placement. iii) Rose Bengal staining: A moistened commercial strip impregnated with 1.5mg Rose Bengal was applied to the inferior cul- de-sac, without anaesthesia. The eye was examined with the slit lamp using a green filter.Although widely thought to have the advantage of staining dead or degenerating cells, Rose Bengal does not normally stain the ocular surface epithelial cells due to the protective nature of mucin that serve as a diffusion barrier to the dye. It is thus thought to be an ideal dye for evaluating the ocular surface RESULTS: Table 1 : age and gender distribution Age Group a Group b Total M F M F 40-45 years 12 20 13 15 55 46-50 years 15 22 15 25 77 51-55 years 13 18 12 22 65 56-60 years 14 14 16 11 60 >60 years 15 7 17 4 43 Total 69 81 73 77 300 Table 2 : occupation Occupation Group A Group B Total M F M F Outdoor 49 34 47 44 174 Indoor 20 47 26 33 126 Total 69 81 73 77 300 Table 3 : duration of diabetes in group B Duration of diabetes No of individuals 15 years 16 Total 150 Table 4 : dry eye symptoms Symptoms No of individuals Burning sensation 13 Itching 21 Redness 11 Foreign body sensation 26 Table 5 : influence of occupation in dry eye Occupation Group A Group B Total M F M F Outdoor 5 4 13 4 26 Indoor 2 0 5 6 13 Total 7 4 18 10 39 Table 6 : cross tabulation – duration of DM DM Duration No dry eye Dry eye Total 15 years 10 6 16 Total 122 28 150 Table 7 : comparision of positive test results among group A and group B Test Group A Group B TBUT 12 18 Schirmers 1 11 26 Fluorescein stain 7 12 Rose Bengal stain 3 7 Lissamine green stain 3 7 DISCUSSION : In our study, out of 300 patients, 158 patients were females(52.66%) and 142 were males(47.33%). Most of the patients are in the age group between 46-50 years. Of the total 300 participants, 58% (96 male and 78 female patients)had outdoor occupation and 42% (46 male and 80 female patients)had indoor occupation. 83 patients of group A (49 male and 34 female patients) and 91 patients of group B (47 males and 44 females) had outdoor occupation. Environmental exposure is thought to play a role in the development of DED[10]. Of the total 300 patients, dry eye disorder was seen in 39 patients(13%)i.e.,78 eyes. Of these 39 patients, 26 patients had outdoor occupation, and 13 patients with indoor occupation. Among 26 patients, 9 patients (5 male and 4 female) were in group A and 17 patients (13 male and 4 female) were in group B. The influence of outdoor occupation in development of dry eye disorder is statistically significant p=0.006. Among these 39 patients with dry eye, 11 patients were in group A and 28 patients were in group B. Of these 28 patients, dry eye disorder is more seen in those having longer duration of diabetes. The prevalence of DED is significantly higher in diabetic individuals, affecting 20 % to 37% of all diabetics.[11] Seifart and associates reported that this was due to loss of conjunctival goblet cells, decreased corneal sensitivity and neuropathy involving the lacrimal glands.[12] The incidence of DED is higher with longer durations of diabetes.[13] The symptoms that are more commonly noted were burning sensation in 13 patients,itching in 21 patients, redness in 11 patients,and foreign body sensation in 26 patients. Normal TBUT time was taken as 10 seconds. According to which 12 patients in group A and 18 patients in group B has positive test result. Schirmer’s test 1 showed positive results in 11 patients in group A and 26 patients in group B. Other dye tests like fluorescein stain, rose Bengal stain and lissamine green stain showed positive results. CONCLUSION: This study shows that dry eye syndrome is an important manifestation of diabetes mellitus. It develops at an earlier age in diabetics, and the duration of diabetes correlate well with the occurrence and severity of tear film dysfunction. DED is easily detected and monitored by performing simple non invasive testing of the tear film and should be a part of routine check up at each ophthalmic visit, even if the patient is asymptomatic. Early diagnosis and timely treatment are important for preventing development of DED and its subsequent progression to vision threatening complications and to improve the quality

Original Research Paper A comparative study of dry eye in diabetic and non diabetic patients reported to ophthalmology opd AIMSR,Chittoor, Andhra Pradesh. Authors: Dr. S Vishnu Priya, Assistant Professor 1, Dr. N Sathish Kumar, Professor 2, Dr. Jagannath Challa, Professor 3, Dr. L Geeta Anusha, Senior Resident 4 , Dr. Keerthi Sri AS, Senior Resident 5 , Dr. Uzma Farhad, Post Graduate6 1,2,3,4,5,6Department of Ophthalmology, Apollo Institute of Medical Sciences & Research-Chittoor, Andhra Pradesh Corresponding Author: Dr Vishnu Priya , 6Department of Ophthalmology, Apollo Institute of Medical Sciences & Research-Chittoor, Andhra Pradesh Article Received: 10-08-2022 Revised: 31-08-2022 Accepted: 21-09-2022 ABSTRACT: Back ground: a comparative study of dry eye in diabetic and non diabetic patients reported to ophthalmology opd Methods: A total of 300 patients (600 eyes) who attended to our ophthalmology opd during the period September 2019 to February 2020 were included in the study. They were divided into 2 groups, group A consisting of 150 non diabetic patients, group B consisting of 150 diabetic patients. They were examined for visual acuity, slitlamp examination for anterior segment evaluation. Patients were given questionnaire to enquire regarding symptoms related to dry eye according to which dry eye disorder is identified. The patients with atleast one symptom related to dry eye were then investigated by various investigations like TBUT, Schirmer’s test 1, Fluorescein stain, Rose Bengal stain,and Lissamine green stain to confirm dry eye disorder. Positive result for atleast 1 test was taken as confirmatory test for dry eye disorder. Results: In our study, out of 300 patients, 158 patients were females (52.66%) and 142 were males(47.33%). Of the total 300 participants, 58% had outdoor occupation and 42% had indoor occupation. Dry eye disorder was seen in 39 out of 300 patients (13%), which is having significant co-relation with outdoor occupation. Among 39 patients with dry eye disorder, 28 patients were diabetic and 11 patients were non diabetic indicating that dry eye is more common among diabetic patients than non diabetic patients. Conclusion: In this study, dry eye disorder is present in 13% . Diabetes and dry eyes appear to have a common association. Further studies need to be undertaken to establish an etiologic relationship. However, examination for dry eye should be an integral part of the assessment of diabetic eye disease. Key words: diabetes mellitus, dry eye, TBUT, Schirmer’s test, dye tests. INTRODUCTION: The importance of cornea lies in its ability to refract light rays at air cornea interface and to allow passage of light rays into eye. Thus, corneal transparency is vital to the ability to see. Transparency is aided by the presence of pre corneal tear film which keeps the corneal surface in moist state. In the absence of a normal pre-corneal tear film, the cornea tends to dry out and becomes hazy leading to dry eye. Dry eye is fairly common clinical entity which tends to affect between 5% to 28% adults, among the general population globally[1]. It has been admitted that about 3.23 million women and 1.68 million men 50years or older have dry eye[2,3] Diabetes is one of the most common leading causes of blindness in 20–74year old persons.[4]Cataract and retinopathy are well-known as ocular complications of diabetes. Recently, problems involving the ocular surface, dry eyes in particular, have been reported in diabetic patients.[4] These patients suffer from a variety of corneal complications including superficial punctuate keratopathy, trophic ulceration, and persistent epithelial defect[5].Dry eye is an important contributor to these problems. Dry eye syndrome has many causes. One of the most common reasons for dryness is aging process [6]. The mechanism responsible for dry eyes is unclear[7], but autonomic dysfunction may be responsible[8]. MATERIAL AND METHODS: The present study was conducted on 300 patients attended to ophthalmology opd during the period September 2019 to February 2020, where they were divided into 2 groups i.e, non diabetics (group A) and diabetics (group B). Inclusion criteria: Age >40 years in both groups. Among diabetics, those with Random Blood Sugar >200mg/dl and HbA1c >6.5% were included in the study. Exclusion criteria: patients with other ocular disorders known to produce dry eye, patients suffering from any systemic disease (other than diabetes mellitus) associated with dry eye like connective tissue disorders, patients on any drug treatment which produce dry eye (MAO inhibitors, alpha agonists, beta blockers, NSAIDS), contact lens wearers. All the patients who were included in the study underwent visual acuity testing using Snellens chart. Distant and near visual acuity, both presenting and best corrected after refraction, were measured for each eye separately using Snellens chart. Detailed anterior segment evaluation was done using slitlamp. Patients were given a questionnaire which included symptoms related to dry eye disorder. Questionnaire: A validated eight item questionnaire[9] of ocular symptoms relating to dry eye was used which included the following questions Do your eyes ever feel dry? Do you ever feel a gritty or sandy sensation in your eye? Do your eyes ever have a burning sensation? Are your eyes ever red? Do your eyes ever feel sticky? Do your eyes ever feel watery or tearing? Do you notice much crusting on your lashes? And Do your eyes ever get stuck shut? Presence of a symptom from the dry eye questionnaire was further graded as rarely (at least once in 3 months), some times (once in 2 – 4 weeks), often (atleast once a week), or all the time. Presence of one or more symptoms often or all the time was taken as positive. Examination for dry eye 1. Corneal sensitivity test: Corneal sensation was tested using a wisp of cotton wool brought onto the cornea in order to elicit a blink response. Care was taken to avoid the menace reflex. Presence of a brisk blink response was indicative of normal corneal sensation. Presence of a weak blink response was indicative of reduced corneal sensation. An absent blink response indicated absence of corneal sensation. The cornea was tested in four different quadrants in each eye as well as in the centre of the cornea. 2. Tear film Break Up Time (TBUT) test: The tear film was stained using commercially available pre-sterilized strip impregnated with 1mg Fluorescein. The tear film was stained in an un-anaesthetised eye. The patient was instructed to blink once or twice and then stare straight ahead without blinking while the cornea was scanned under low slit lamp magnification using a blue cobalt filter. The end point of the test occurred with the time taken, in seconds, for the appearance of the first dry spot formation from the last blink. Normal Tear Film Break Up Time (TBUT) is taken to be around 10 seconds. In presence of dry eye TBUT is less than 10 seconds. 3.Schirmer’s test: This test was performed using a commercial Whatman 41 paperstrip. The strip was placed at the junction of the middle and lateral thirds of the lower eyelid and removed after 5 minutes. The amount of wetting of the strip was read off.Normal value is more than 15mm of wetting after 5 minutes. A value of 5 mm or less after 5 minutes is considered as abnormal 4. Dye tests: The following dye tests were also carried out and grading of the corneal and conjunctival staining was done based on the grading system of the National Eye Institute (NEI) industry Workshop on Clinical Trials in Dry Eyes. i) Fluorescein staining: A commercially available Fluorescein impregnated strip was introduced into the inferior conjunctival sac temporally. The patient was asked to gently close and roll the eyes around to adequately distribute the dye across the ocular surface. Each eye was then examined through the slit lamp using a cobalt blue filter and any areas of staining of the corneal surface were noted.It is used to delineate areas of epithelial discontinuity but does not pick up any dead or devitalized cells. Because Fluorescein diffuses rapidly into the corneal stroma it is essential to assess staining within 1-3 minutes of instillation ii) Lissamine green strip: A strip impregnated with lissamine green was used as above to detect areas of mucin deficiency in the ocular surface using a red barrier filter.Staining with Lissamine Green is both time and concentration dependent, so examination should be done at a standard time interval of one minute after dye placement. iii) Rose Bengal staining: A moistened commercial strip impregnated with 1.5mg Rose Bengal was applied to the inferior cul- de-sac, without anaesthesia. The eye was examined with the slit lamp using a green filter.Although widely thought to have the advantage of staining dead or degenerating cells, Rose Bengal does not normally stain the ocular surface epithelial cells due to the protective nature of mucin that serve as a diffusion barrier to the dye. It is thus thought to be an ideal dye for evaluating the ocular surface RESULTS: Table 1 : age and gender distribution Age Group a Group b Total M F M F 40-45 years 12 20 13 15 55 46-50 years 15 22 15 25 77 51-55 years 13 18 12 22 65 56-60 years 14 14 16 11 60 >60 years 15 7 17 4 43 Total 69 81 73 77 300 Table 2 : occupation Occupation Group A Group B Total M F M F Outdoor 49 34 47 44 174 Indoor 20 47 26 33 126 Total 69 81 73 77 300 Table 3 : duration of diabetes in group B Duration of diabetes No of individuals 44 6-10 years 52 11-15 years 38 >15 years 16 Total 150 Table 4 : dry eye symptoms Symptoms No of individuals Burning sensation 13 Itching 21 Redness 11 Foreign body sensation 26 Table 5 : influence of occupation in dry eye Occupation Group A Group B Total M F M F Outdoor 5 4 13 4 26 Indoor 2 0 5 6 13 Total 7 4 18 10 39 Table 6 : cross tabulation – duration of DM DM Duration No dry eye Dry eye Total 44 0 44 6-10 years 42 10 52 11-15 years 26 12 38 >15 years 10 6 16 Total 122 28 150 Table 7 : comparision of positive test results among group A and group B Test Group A Group B TBUT 12 18 Schirmers 1 11 26 Fluorescein stain 7 12 Rose Bengal stain 3 7 Lissamine green stain 3 7 DISCUSSION : In our study, out of 300 patients, 158 patients were females(52.66%) and 142 were males(47.33%). Most of the patients are in the age group between 46-50 years. Of the total 300 participants, 58% (96 male and 78 female patients)had outdoor occupation and 42% (46 male and 80 female patients)had indoor occupation. 83 patients of group A (49 male and 34 female patients) and 91 patients of group B (47 males and 44 females) had outdoor occupation. Environmental exposure is thought to play a role in the development of DED[10]. Of the total 300 patients, dry eye disorder was seen in 39 patients(13%)i.e.,78 eyes. Of these 39 patients, 26 patients had outdoor occupation, and 13 patients with indoor occupation. Among 26 patients, 9 patients (5 male and 4 female) were in group A and 17 patients (13 male and 4 female) were in group B. The influence of outdoor occupation in development of dry eye disorder is statistically significant p=0.006. Among these 39 patients with dry eye, 11 patients were in group A and 28 patients were in group B. Of these 28 patients, dry eye disorder is more seen in those having longer duration of diabetes. The prevalence of DED is significantly higher in diabetic individuals, affecting 20 % to 37% of all diabetics.[11] Seifart and associates reported that this was due to loss of conjunctival goblet cells, decreased corneal sensitivity and neuropathy involving the lacrimal glands.[12] The incidence of DED is higher with longer durations of diabetes.[13] The symptoms that are more commonly noted were burning sensation in 13 patients,itching in 21 patients, redness in 11 patients,and foreign body sensation in 26 patients. Normal TBUT time was taken as 10 seconds. According to which 12 patients in group A and 18 patients in group B has positive test result. Schirmer’s test 1 showed positive results in 11 patients in group A and 26 patients in group B. Other dye tests like fluorescein stain, rose Bengal stain and lissamine green stain showed positive results. CONCLUSION: This study shows that dry eye syndrome is an important manifestation of diabetes mellitus. It develops at an earlier age in diabetics, and the duration of diabetes correlate well with the occurrence and severity of tear film dysfunction. DED is easily detected and monitored by performing simple non invasive testing of the tear film and should be a part of routine check up at each ophthalmic visit, even if the patient is asymptomatic. Early diagnosis and timely treatment are important for preventing development of DED and its subsequent progression to vision threatening complications and to improve the quality

Purpose The study aims to evaluate the effect of proper rest during the long-time smartphone reading on DED and asthenopia. Methods Healthy participants over the age of 18 were randomly allocated to three groups and each individual accepted 2h smartphone reading task. After 1h each group took different rest methods: no rest (group A), eye-closed rest for 10mins (group B), eye-closed joint eye drops rest for 10mins (group C). Before and after the reading task, DED and asthenopia were evaluated by the Ocular Surface Disease Index (OSDI), critical flicker frequency (CFF), non-invasive break-up time (NIBUT), fluorescein break-up time (FBUT), corneal fluorescein staining (CFS), and the Schirmer I test (SIT). Results 90 qualified volunteers were recruited, including 29 males and 61 females, aged 22–30 years. After the reading task, all indexes in group A showed the degree of DED and asthenopia were worse than that before reading. Most indexes of DED and asthenopia had no obvious change in group B and group C, especially the CFS results improved (P > 0.05) in group C. Conclusions Our results suggested that taking proper rest during the long-time reading on smartphones may be a convenient and effective prevention strategy for DED and asthenopia.

PurposeTo investigate the ocular surface microbiome of patients with unilateral or asymmetric glaucoma being treated with topical ophthalmic medications in one eye and to determine whether microbial community changes were related to measures of ocular surface disease.MethodsV3-V4 16S rRNA sequencing was conducted on ocular surface swabs collected from both eyes of 17 subjects: 10 patients with asymmetric/unilateral glaucoma using topical glaucoma therapy on only one eye and seven age-matched, healthy controls with no history of ocular disease or eyedrop use. Samples were categorized into three groups: patients' glaucomatous eye treated with eyedrops, patients' contralateral eye without eyedrops, and healthy control eyes. Comparisons were made for microbial diversity and composition, with differences in composition tested for association with ocular surface disease measures including tear meniscus height, tear break-up time, and Dry Eye Questionnaire.ResultsSamples obtained from the patients' treated and untreated eyes both had significantly greater alpha-diversity and relative abundance of gram-negative organisms compared to healthy controls. The microbial composition of patient eyes was associated with decreased tear meniscus height and tear break-up time, whereas metagenomic predictions, based on 16S rRNA data, suggested increased synthesis of lipopolysaccharide.ConclusionsThe ocular surface microbiome of patients taking unilateral preserved glaucoma drops is characterized by a highly diverse array of gram-negative bacteria that is significantly different from the predominantly gram-positive microbes detected on healthy control eyes. These compositional differences were associated with decreased tear film measures and distinct inferred protein synthesis pathways, suggesting a potential link between microbial alterations and ocular surface inflammation.

This study evaluates the effectiveness of objective techniques in assessing dry eye disease (DED) treatment compared with the subjective assessment commonly used in clinical practice. Thirty subjects were recruited for two visits separated by 28(± 3) days of treatment with artificial tears. A buttery of common subjective assessment methods were accompanied by a set of objective techniques including measurement of noninvasive tear film break-up time (NIBUT), lipid layer thickness (LLT), and quantitative evaluation of tear film surface quality and dynamics (TFD). Additionally, meibography was performed. Two commercially available videokeratoscopes and a prototype of a lateral shearing interferometer were used for the measurements. Both subjective and objective techniques showed a positive effect of artificial tears in DED treatment. Statistically significant improvements were observed in subjective symptoms (from P p = 0.019 for tearing), conjunctival redness (P = 0.022), ocular staining (P = 0.012), fluorescein tear film break-up time (P = 0.015), NIBUT (P = 0.037), LLT (P P = 0.048). In general, weak or statistically insignificant correlations were observed between subjective and objective assessment methods. The apparent lack of correlation between these methods might indicate the complementary character of objective techniques that likely assess other characteristics of ocular surface health than those assessed subjectively.

Background Meibomian gland dysfunction is the most common etiology of dry eye disease worldwide and intense pulsed light appears to be a promising treatment with encouraging results. Lacrystim® is a new IPL device (CE marking in 2019) and no studies have yet been published on it. We propose the first study on this device with an objective assessment of its efficacy and an extended follow-up over 6 months. Methods Patients presenting with a dry eye disease (DED) with stable mild to moderate MGD and having received Lacrystim® treatment between june 2019 and june 2020 were included. 3 IPL sessions were performed at D0, D15 and D45 with 4 shots per side at a fluence of 8 mJ/cm2. DED clinical evaluation was performed at D0, D15, D45, 3rd month and 6th month: Oxford scale and break up time, Schirmer test and Ocular Surface Disease Index (OSDI) questionnaire. Lacrydiag® imaging device carried out an objective examination of tear film: interferometry, meibography, tear meniscus height and non-invasive break up time (NIBUT). The primary endpoint was the evolution in NIBUT between the first visit D0 and 3rd month. Data collection was done retrospectively. Statistical analysis was done using a linear mixed-effects model and a non-parametric linear mixed-effects model (R software). Results Forthy five consecutive patients were included. NIBUT significantly increased between D0 and 3rd month: mean difference of 1.63 seconds, IC95% [0.51; 2.62], (p = 0.002) with a prolonged effect at 6th month. OSDI and OXFORD scores and interferometry were also significantly improved at 3rd month and 6th month. There was no significant change in BUT, Schirmer test and tear meniscus height. No adverse event was noted. Conclusions IPL delivered by Lacrystim® appears effective and safe to treat MGD although a randomized controlled trial is needed to validate its results. Trial registration This work was approved by a local ethics committee “Terre d’éthique” (institutional review board number: IRBN672019/CHUSTE) and registered on the clinicaltrial.gov website (NCT04147962, 01/11/2019).

Purpose To evaluate morphological and functional state of the meibomian glands (MG) in keratoconus patients. Methods One hundred eyes of 100 keratoconus patients and 100 eyes of 100 age-matched control subjects were included into this study. Ocular Surface Disease Index (OSDI) scores, non-invasive break up time (NIBUT), findings of meibography, staining with fluorescein of the ocular surface, tear film break-up time (TBUT), and Schirmer I test were documented in all patients’ eyes and control eyes and were compared between the groups . Results The mean TBUT and NIBUT were significantly lower, corneal staining and OSDI scores were statistically greater in the keratoconus group (p Conclusion Our data suggests that corneal ectasia in keratoconus is related with alterations in ocular surface, tear film function and MG morphology. Early screening and treatment of MG dysfunction may improve ocular surface quality and allow better disease management in keratoconus patients.

Dry eye disease (DED) is a complex ocular surface inflammatory disease. Its occurrence varies widely over the world, ranging from 5% to 34%. The use of preservatives, specifically benzalkonium chloride, in the ocular drops worsens the DED conditions. Furthermore, the Covid-19 pandemic increased screen time and the use of face masks and shields. As a result, the number of people suffering from dry eye disease (DED) has increased significantly in recent years. The main objective of our study is to find a solution to manage the dry eye disease (DED) preferably from natural source without any adverse events. In this study, the beneficial effects of capsanthin from Capsicum annum (CCA) were evaluated on benzalkonium chloride (BAC)-induced dry eye disease (DED) in Albino Wistar rats. Oral supplementation of CCA resulted in a statistically significant decrease in intraocular pressure (IOP) (p .0001), increase in tear break-up time (TBUT) (p .01), decline in Schirmer test results (p .01), and decrease in corneal surface inflammation (p .01). Capsanthin ameliorated in reducing oxidative stress by increasing serum antioxidant levels such as glutathione peroxidase (GPX), nitric oxide (NO), and lactoferrin (LTF) and inhibiting matrix metalloproteinases 2 and 9 (MMP2 and MMP9) (p .0001). Capsanthin treatment significantly inhibited the expression of inflammatory cytokines, tumor necrosis factor-alpha (TNF-α), interleukins (IL-2, IL-4, IL-6), and pro-inflammatory mediator, matrix metalloproteinase-9 (MMP9). Furthermore, the lacrimal gland expressed vascular cell adhesion molecule (VCAM-1), and prostaglandin-endoperoxide synthase 2 (PTGS2) was suppressed by CCA treatment. PRACTICAL APPLICATIONS: Benzalkonium chloride (BAC), a preservative widely used in the topical ocular drug delivery system (ODDS), causes undesirable effects such as dry eye disease as well as ameliorating intraocular pressure leading to optical nerve damage and irreversible vision loss. Capsanthin from Capsicum annum (CCA) can be used to treat symptoms related to dry eye disease such as inflammation, eye irritation, visual disturbance, ocular discomfort with potential damage to the ocular surface. The CCA may be beneficial in the treatment of glaucoma, an elevated intraocular pressure. Capsanthin from C. annum can be useful in managing DED by increasing tear break-up time (TBUT), declining in Schirmer test results and decreasing in corneal surface inflammation.