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Purpose: Inter-eye variability is a recognized characteristic of Dry Eye Disease (DED) and has been proposed as a diagnostic indicator in clinical practice. This study aimed to assess the diagnostic potential of the absolute difference between eyes in three key diagnostic tests recommended by the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) Diagnostic Methodology report: tear film osmolarity, Fluorescein Break-Up Time (FBUT), and ocular surface staining. Methods: A total of 180 participants were included in a cross-sectional study. Before a dry eye examination, participants completed an online self-administered OSDI questionnaire. The TFOS DEWS II diagnostic criteria for DED assessment were used: along with OSDI, osmolarity, FBUT and ocular surface staining were measured in all participants in both eyes following standardized methodology. Based on signs and symptoms, participants were diagnosed as having No DED or DED. After diagnosis, the parameters were computed as the right and left eyes' absolute inter-eye difference (|OD-OS|). Results: Receiver Operating Characteristics analyses for computed parameters were used based on the previous diagnosis. ROC analyses showed that Osmolarity|OD-OS| have a diagnostic capability to differentiate between No DED and DED participants with a cut-off value of 9.5 mOsm/L (AUC = 0.745 ± 0.052, p < 0.003), whereas FBUT|OD-OS| and Corneal Stainning|OD-OS| have not (AUC, both p ≥ 0.160). Conclusion: The present study found that the Osmolarity|OD-OS| parameter could be used as a diagnostic indicator for DED assessment, while the FBUT|OD-OS| and the Corneal Staining|OD-OS| parameters do not have this capability. [ABSTRACT FROM AUTHOR]

Purpose: To determine the feasibility of non-invasive tear break-up time (NIBUT) assessment using the Handheld tear lipid layer thickness assessment instrument and compare it with the standard tear break-up time (TBUT) test and other dry eye tests. Subjects and methods: 108 subjects were enrolled, 56 with and 52 without dry eye symptoms. Schein questionnaire was used to determine the severity of dry eye symptoms. Ocular signs were assessed by NIBUT, TBUT, lipid layer thickness (LLT), lid-parallel conjunctival folds (LIPCOF), conjunctival hyperemia, and corneal staining. Results: Median NIBUT and TBUT, and other clinical test values significantly differed among the dry eye symptoms group and control group. NIBUT yielded the most significant difference between the groups (NIBUT: 7 sec vs. 17.5 sec, p <.001, Z = 5.94; TBUT: 5 sec vs. 10 sec, p <.001, Z = 4.38; LLT: p =.007; LIPCOF: p <.001, conjunctival hyperemia: p <.047, corneal staining: p <.010). Spearman's test showed a significant correlation between NIBUT and TBUT (p <.001), NIBUT and LLT (p =.001), NIBUT and LIPCOF (p =.019), NIBUT and conjunctival hyperemia (p =.002), and NIBUT and corneal staining (p =.012) in the dry eye symptoms group. NIBUT did not significantly differ among the three measurements in both groups of patients (p =.061, p =.096), while TBUT values did in the control group (p <.001). Short NIBUT values were the main predictors and indicators of dry eye complaints (AOR = 0.87, p <.001), superior to TBUT (AOR = 0.88, p =.008) and other tests even after adjustment for age and gender. Conclusion: NIBUT measured by Handheld instrument is a simple, accessible, practical, and, most of all, reproducible and objective method that might allow NIBUT assessment on a regular basis. [ABSTRACT FROM AUTHOR]

Several older studies on rabbits indicated that the pre-corneal tear film was unusually stable and this perspective was revisited recently. However, the methods used for these studies were very different from those generally used in human studies. A literature search was undertaken for the time period of 1965 through 2017, mainly using PubMed, to identify studies where values for the tear break up time (TBUT) were reported for the eyes of nominally normal (healthy) laboratory rabbits regardless of breed or age and where the methods were more similar to those routinely used in human clinical studies. For 20 reports identified where sodium fluorescein was used, the average TBUT values in any particular study ranged from 1.9 to 51 s, with a group mean of 21.8 ± 11.9 s (SD), with the inter-study variability in TBUT (as the coefficient of variation) being 19.4%. For four studies not using fluorescein, the mean break up time reported was 32.7 ± 16.2 s, while a separate study (also not using fluorescein) reported an average break up time of 1788 s. Most reports of the pre-corneal tear film stability in laboratory rabbits, especially as reported over the last 10 years, indicate break up times of less than 60 s have been observed, although has been little consistency in the methods used. Overall, this outcome is not consistent with a perspective that the rabbit (as routinely used in experimental studies) has an extraordinarily stable tear film. [ABSTRACT FROM AUTHOR]

Background Rabbits have a longer inter-blink time (approximately 10 minutes) compared with humans (five to eight seconds), suggesting that rabbits have a much more stable tear film. Using fluorescein, the tear break-up time of rabbits has been reported to be similar to that of humans. This study set out to measure the tear break-up time in rabbits using non-invasive methods and to establish the pattern of tear break-up compared to humans. Methods The tear break-up time was measured and the pattern of tear break-up was observed in six New Zealand White rabbits on two separate occasions using both the Keeler Tearscope-plusTM and a slitlamp biomicroscope. Results The mean rabbit tear break-up time was 29.8 ± 3.4 ( SD) minutes. This contrasts with the reports of human tear break-up time of eight to 30 seconds. The tear breaking spread very slowly and was often restricted to the area of the initial break. Conclusion Rabbit tears have a significantly higher tear break-up time than humans and this aligns with previously demonstrated differences in inter-blink time between rabbits and humans. Understanding the underlying mechanisms of tear stability may lead to novel ways of increasing human tear film stability. [ABSTRACT FROM AUTHOR]

Aim: To compare the outcomes of non-invasive break-up time (NI-BUT) test and the other conventional dry eye tests.Methods: The right eyes of 170 subjects were included in the study. In order to evaluate the tear quality of the patients, NI-BUT levels were measured by the Scheimplug-Placido disk system (Sirius topography). Tear osmolarity test was performed with TearLab Osmolarity System. Topical anesthesia-assisted type I Schirmer test and topical anesthesia-assisted BUT were lastly applied to all patients in order not to affect other measurements.Results: The mean NI-BUT value was 9.59 ± 4.37 sec, tear osmolarity was 292.93 ± 9.30 mOsm/L, Schirmer test was 15.32 ± 6.05 mm/5 min, and biomicroscopic BUT value was 8.98 ± 3.79 sec. The Schirmer test results were statistically significantly correlated with biomicroscopic BUT and NI-BUT values (p = .019, r = 0.180 and p = .030, r = 0.166; respectively). It was also found that tear osmolarity was strongly and inversely correlated with biomicroscopic BUT and topographic NI-BUT values (p < .001, r = -0.554 and p < .001, r = -0.528; respectively). There was no significant correlation between Schirmer test and tear osmolarity.Conclusion: It is important to use a sensitive, reproducible and non-invasive method in the evaluation of tear functions. We think that the objective and noninvasive topographic NI-BUT measurements and the minimally invasive osmolarity measurements should be used more frequently in practice because they are correlated with the measurements obtained by invasive methods and should be widespread in clinics. [ABSTRACT FROM AUTHOR]

Clinical Relevance: Variation with time in the tear film parameters should be considered by the clinician since the time when measurements are made can influence proper diagnosis.Background: A hallmark of dry eye is an unstable tear film associated with variability in objective daily measures. The purpose of the present study was to evaluate the inter-week repeatability of meibometry, break-up time (BUT) and maximum blink interval (MBI) in healthy subjects.Methods: Forty healthy subjects were recruited for the study. Meibometry, BUT and MBI were performed twice in two sessions, one-week apart. Meibum from the lower eyelid was collected and quantified with the Meibometer MB550. Five meibomian curves were generated by tape and each peak value was averaged as a mean value per session. BUT and MBI were determined three times after fluorescein instillation and recorded by a DV-3 camera attached to the slit lamp. BUT and MBI videos were analysed by a second masked observer. Both BUT and MBI values were calculated by averaging the two most similar measurements of the three evaluated.Results: No statistical difference between inter-week sessions was obtained for the meibometry (p > 0.340; Wilcoxon test), BUT (p > 0.326; Wilcoxon test) and MBI values (p ≥ 0.248; Wilcoxon test). Inter-week differences were low for BUT and MBI when time intervals were no longer than 15 seconds (both p ≥ 0.586; Wilcoxon test). A correlation between BUT and MBI was found (r ≥ 0.668, p < 0.001; Spearman Rho), while a no statistical correlation was obtained between meibometry results and BUT or MBI (all p ≥ 0.194; Spearman Rho).Conclusion: Meibum secretion and the tear film stability present good intersession repeatability, and are stable along with sessions in healthy patients. [ABSTRACT FROM AUTHOR]

Purpose. The effect of different phospholipids in stabilising the tear film was investigated to determine if particular polar head groups gave greater stability than others. Methods. Purified phosphatidylcholine (PC), lysophosphatidylcholine (LPC), phosphatidylethanolamine (PE), phosphatidylglycerol (PG), phosphatidylserine (PS) and cardiolipin (CL) were used. These were applied to a model eye loaded with an artificial tear fluid and the tear breakup time (TBUT) was measured. Three variants of the artificial tear fluid were utilised: buffered saline alone; one with proteins and mucins; and one containing proteins, mucins and lipids. Results. TBUT was improved by the presence of phospholipids. In particular, the best performance was with PI applied to artificial tear fluid containing proteins mucins and lipids. Use of buffered saline as the artificial tear fluid gave very short break-up times. Conclusion. Increase in tear film stability by phospholipids is probably not due to the charge carried by the polar head group, but more likely due to the charge distribution, and the presence of hydroxyl groups in the head group also tends to increase stability, possibly through specific interactions with proteins and mucins in the subphase. [ABSTRACT FROM AUTHOR]

Background: This study was designed to examine diurnal variations in tear film break-up time (BUT) and maximum blink interval (MBI) and to assess two different ways of calculating these variables on video recordings of the BUT test interpreted with the help of especially designed software. The repeatability of interpreting BUT video recordings was also addressed.Methods: Twenty-six healthy young adults were enrolled after ruling out dry eye according to a battery of tests (ocular surface disease index, McMonnies questionnaire, Schirmer test, phenol red test and corneal staining). BUT and maximum blink interval were determined on video-recordings of the BUT test conducted over a day in four sessions (9.30 am, 12.30 pm, 3.30 pm and 6.30 pm). In each session, the test was repeated three times to give three videos in which three BUT and MBI values were obtained by a masked observer. BUT and MBI were determined by averaging the three measurements and by averaging only the two closest measurements. Finally, two further experienced observers re-examined the videos to assess the repeatability of the BUT measurements made.Results: No diurnal variation in BUT was observed regardless of whether three or two video measurements were averaged. Significant correlation was detected between BUT and MBI. Inter-observer repeatability was better when BUT times were no longer than 15 seconds.Conclusions: Tear film BUT was not influenced by the time of day and moderate to strong correlation with MBI was observed in all four sessions. The software-assisted method proved useful and identified the need to clarify the BUT end-point and to limit the test to 15 seconds to improve observer repeatability. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusion\nSUMMARYWhat was known beforeWhat this study addsTo assess the tear film parameters associated with photophobia in dry eye disease (DED).Three hundred seventy-four patients with DED (mean age, 42.2 ± 12.8 years) had their tear film and OSDI scores evaluated using Oculus keratograph 5 M (TMH, NIBUT, Meibography), Lipiview interferometer (LLT), and TearLab osmolarity system. Photophobia scoring from OSDI sheets was used to calculate the odds ratio via multivariate logistic regression analysis. Data from the eye with severely affected NIBUT was used.Of 374, 127 had aqueous deficient dry eye disease (ADDE), and 247 had evaporative DED. The mean age, female sex, Schirmer I, TMH, NIBUT, LLT, and tear osmolarity values in patients with photophobia versus no or mild photophobia were 42.2. vs. 40.9 years, 42% vs. 40%, 11.6 vs. 10.5 mm, 0.27 vs. 0.29 mm, 4.6 vs. 4.7s, 60.3 vs. 60.9 nm and 305 vs. 307 mOsm/L, respectively. Multivariate analysis revealed no tear film parameters predictive of photophobia in evaporative DED, whereas tear osmolarity had a weak negative association with photophobia (odds ratio of 0.96, 95% C.I, 0.92–1, p = .04) in ADDE patients.Tear film parameters do not predict the presence or absence of photophobia in DED except for a weak inverse association with tear osmolarity in ADDE. This suggests the role of central sensitization in regulating photophobia in DED patients.Photophobia is a common dry eye symptom. The severity of photophobia correlates with dry eye severity and improves with treatment.1. Tear film parameters, such as tear break-up time, tear volume, meibomian gland loss and lipid layer thickness do not predict photophobia risk in dry eye disease.2. This study provides the basis for future research in understanding the central neural sensitization in DED patients with photophobia. [ABSTRACT FROM AUTHOR]

Purpose: To extend cross-sectional data on cytokine ratios (CRs) in dry eye disease (DED) signs by investigating longitudinal change in pro- to anti-inflammatory CRs and associations with change in DED signs and symptoms. Methods: Secondary analysis of fifty-four subjects [mean age 57.3 (SD 13.2) years, 85.2% female; 68.5% white] with ≥ 4 uL pooled tear volumes at months 0, 6, and 12. Pro-inflammatory (IL-1b, IL-6, IL-8, IL-17A, IFN-g, and TNF-a) to anti-inflammatory (IL-6, IL-10) cytokine ratios (CR) were calculated. DED signs (corneal and conjunctival staining scores, tear break-up time, Schirmer test, Meibomian gland plugging, tear osmolarity, composite sign severity score) and symptoms [Ocular Surface Disease Index (OSDI)] were measured. Changes over time in DED signs, symptoms, and CRs were evaluated using longitudinal models. Correlations between changes in CR and changes in DED signs and symptoms were evaluated using Spearman correlation coefficients (rho). Results: DED signs which improved over time (p < 0.001) included corneal and conjunctival staining score, tear break-up time, tear osmolarity, and composite sign severity score. Using IL-10 as anti-inflammatory, changes in corneal and conjunctival staining and composite severity score significantly correlated with changes in pro- to anti-inflammatory CRs from month 0 to 6 (|rho|: 0.29-0.45, p: 0.003-0.04) but not between month 0 to 12 (|rho|: 0.01 to 0.24, all p > 0.08). DED symptoms decreased across one year (p < = 0.001) for all OSDI measures; these changes did not correlate with changes in CRs (|rho|: 0.00 to 0.29, all p > 0.04). Conclusions: Improvement in some DED signs across one year correlated weakly with decreases in pro- to anti-inflammatory CRs, in alignment with the understanding of DED as inflammatory. CRs may provide greater insight than absolute tear cytokine concentrations as possible DED biomarkers. Additional studies that provide standardized clinical information and tear collection and analysis are needed to validate CRs in DED. [ABSTRACT FROM AUTHOR]

The current study investigated the normative data values and repeatability of non-invasive tear film tests using Oculus Keratograph 5M in rabbit eyes. Triplicate analysis of tear film parameters [tear meniscus height (TMH), non-invasive tear break up time (NIBUT), bulbar congestion, meibography] of 38 healthy adults New Zealand white rabbits (mean age, 13 ± 4.7 months) was performed using Oculus keratograph 5M (K5M). Bland-Altman analysis was used for testing repeatability. Thirty-eight rabbits (N = 76 eyes) weighing 2.5 ± 0.4 kg were studied. The mean NIBUT values of the right and left eye were 14.3 ± 5.8 and 12.3 ± 5.8 s, respectively. The mean central TMH values were 0.43 ± 0.23 and 0.33 ± 0.14 mm in the right and left eye, respectively. Meibography showed closely placed, wide meibomian glands running vertically with no distorted or gland loss areas. There were no differences between the eyes for the above parameters. Bland-Altman plot showed good repeatability for both NIBUT and TMH values. The non-invasive tear film parameters show good repeatability using keratograph 5M and can be used as an objective parameter for rabbit ocular surface experiments. [ABSTRACT FROM AUTHOR]

To clarify the ocular surface features of patients with recent history of epidemic keratoconjunctivitis (EKC) and the relation between corneal dendritic cells (DCs) and ocular discomfort. Normal controls (NC) and dry eye (DE) patients without EKC were recruited. Patients with recent EKC history (onset >4 weeks, but <20 weeks) were recruited as EKC + DE group (with dry eye) or EKC–DE group (without dry eye). Ocular surface disease index (OSDI) questionnaire, tear film parameters including lipid layer thickness, first tear break-up time (fBUT), average tear break-up time (aBUT), tear meniscus height and Schirmer I test, meibomian gland parameters, and in vivo corneal confocal microscopy were evaluated. 50 subjects in the NC group, 83 patients in the DE group, 76 patients in the EKC + DE group, and 38 patients in the EKC–DE group were included. Compared with the NC, DE, and EKC–DE groups, the EKC + DE group represented higher OSDI, lid margin, and meibum score (p < 0.05). In the EKC + DE group, the tear volume (10.5 ± 3.7 mm) was significantly higher than in the DE group (8.1 ± 2.8 mm, p < 0.001). The DC density in the EKC + DE group (29.98 ± 15.38 cells/image) was significantly higher than in NC, DE, and EKC–DE groups (4.68 ± 4.05 cells/image) (p < 0.001). The DC density was positively correlated with OSDI, lid margin, and meibum score (all p < 0.01) while inversely correlated with fBUT, aBUT (all p < 0.001) in the EKC + DE group. Corneal DC density significantly correlates to ocular discomfort and tear film instability in patients with recent EKC history who suffer from DE without aqueous tear deficiency. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the factors associated with anterior location of Marx's line in ocular surface and living habits, especially in tear film. This cross-sectional study enlisted 483 participants with meibomian gland dysfunction, who were divided into two groups: 160 participants with mild anterior location of Marx's line and 323 participants with moderate-to-severe anterior location. Participants completed a survey of demographic characteristics (sex, age, length of visual terminal use, sleep duration, skin property), and the Ocular Surface Disease Index and Standard Patient Evaluation of Eye Dryness questionnaires. They also underwent slit-lamp examinations of the lids, and measurements of non-invasive tear break up time, tear meniscus height, fluorescein tear break up time, lipid layer thickness, partial blink rate, lid wiper epitheliopathy, and meibomian gland dropout. The tear meniscus height (mild:0.21(0.18–0.25), moderate-to-severe:0.19(0.16–0.23), p = 0.004), fluorescein tear break up time(mild:3(2–4),moderate to severe:2(1–3), p = 0.000), max LLT(mild:87(62–100), moderate-to-severe:99(69–100), p = 0.04), average LLT(mild:64.5(47.5–96.75), moderate-to-severe:74(53–100), p = 0.012), min LLT(mild:52(38–75), moderate-to-severe:59(41–85), p = 0.029) differed significantly between mild and moderate-to-severe anterior location of Marx's line, and associated to the anterior location of Marx's line(r=-0.134, p = 0.03; r=-0.194, p = 0.000; r = 0.093, p = 0.041; r = 0.119, p = 0.009; r = 0.105, p = 0.022) However, no statistical significance was observed in the OSDI, SPEED, partial blink rate, non-invasive tear breakup time, lipid layer thickness, meibomian gland dropout and lid wiper epitheliopathy(p > 0.05). Meanwhile, in the demographic characteristics, statistically significant correlations were associated with skin property(r = 0.154, p = 0.001) and sleep duration(r=-0.124, p = 0.006), but not with age, sex, and the length of visual terminal use (p > 0.05). Lower TMH and shorter TBUT positively correlated with anterior location of the Marx's line, and were risk factors. Meanwhile, participants with oily skin and shorter sleep duration were more likely to exhibit anterior location of Marx's line. [ABSTRACT FROM AUTHOR]

Meibomian gland dysfunction and dry eye disease are closely related conditions that often coexist and can contribute to the development of each other. Understanding the similarities and differences between these diseases can assist clinicians in implementing effective treatments for both conditions in a clinical setting. Dry eye disease is a multifactorial disease of the tears and ocular surface. This study aimed to evaluate the demographic characteristics of patients with meibomian gland dysfunction in Taiwan, investigate the association between meibomian gland dysfunction and dry eye parameters, and estimate the prevalence of meibomian gland dysfunction among patients with dry eye symptoms at a tertiary referral centre. This cross-sectional study enrolled patients aged ≥20 years who complained of dry eye symptoms and visited a tertiary centre between September 2019 and March 2020. The patients completed the Ocular Surface Disease Index and Standard Patient Evaluation of Eye Dryness questionnaires before undergoing ocular examination. The lipid layer thickness and meiboscale scores were recorded. In addition, the study measured tear film break-up time, examined corneal staining, and evaluated the number of meibomian glands yielding liquid secretions using a slit lamp. The study evaluated 202 eyes of 202 patients with a mean age of 58.05 ± 13.34 years. The prevalence of meibomian gland dysfunction was 93%. Mean meiboscale score and age were negatively associated, and tear film break-up time was positively associated with the mean number of meibomian glands yielding liquid secretions. Hyperlipidaemia and smoking were the main risk factors for Meibomian gland dysfunction. The prevalence of meibomian gland dysfunction among patients with dry eye symptoms was extremely high at the tertiary centre, highlighting the strong relationship between Meibomian gland dysfunction and dry eye disease. Clinicians should consider meibomian gland dysfunction as a possible cause of dry eye. [ABSTRACT FROM AUTHOR]

Electronic displays, including laptops, tablets, and smartphones, have dramatically altered the way information is accessed and become significant factors in human daily life. They interfere with the blink rate and increase dry eye symptoms, which lead to more discomfort compared to hard copy while reading. Digital eye strain occurs when an individual suffers from symptoms, or they are exacerbated, while performing a task requiring digital screen viewing. This study assessed the tear film status immediately following reading on a laptop computer screen versus an identical hard copy. Thirty young adults with normal ocular health and reporting no significant symptoms of dry eye (ocular surface disease index (OSDI) score < 13 and non-invasive tear break-up time (NITBUT) > 10 seconds) read a text as hard copy and on a laptop computer screen for 30 min on separate days in a random sequence in a controlled reading experimental condition. The texts were matched in size and contrast and presented at a viewing distance of 40 cm. The NITBUT and strip meniscometry tube tests were administered at baseline and after reading in both conditions. The median baseline NITBUT decreased from 13.0 s to 10.0 s (P < 0.001) after hardcopy reading and to 7.0 (P < 0.001) after reading from a laptop computer screen, with a significant difference between the task medium (P = 0.001). The baseline strip meniscometry tube results decreased from 6.7 mm to 5.0 mm (P < 0.001) after hardcopy reading and to 5.0 mm (P < 0.001) after reading from a laptop computer screen, but there was no significant difference with the task medium (P = 0.085). Reading in both conditions led to tear film instability in terms of the tear film quality and quantity. Additionally, the computer screen has a greater impact on the TBUT compared to hardcopy reading, while these two reading mediums had a similar effect on the tear volume. [ABSTRACT FROM AUTHOR]

To evaluate the preclinical efficacy of eye drops based on an extract of Artemia salina on the ocular surface of rabbits. Tear secretion, tear break-up time and corneal staining were measured. A preclinical and short-term prospective study was performed. Twenty New Zealand white rabbits were divided into five groups, with four rabbits per group, each receiving a different concentration of Artemia salina. In each rabbit, an extract of Artemia salina (2%, 4%, 6%, 8% or 10%) was randomly instilled in one eye and saline solution (negative control) in the other eye. Tear secretion, tear break-up time and corneal staining were measured before and after the instillation of five drops per eye (one drop per hour) on the same day. In tear secretion, there was an increase of 43.88 ± 6.73% with 4% Artemia salina in comparison with its baseline measurement (P =.049). The rest of the groups did not show differences (P ≥ 0.05). For tear break-up time, none of the groups showed differences (P ≥ 0.05), while for corneal staining score, there was an improvement of 0.88 ± 0.83 with 4% Artemia salina (P =.038) and a deterioration of 0.50 ± 0.83 with control solution (P =.008). Short-term instillation of eye drops with 4% Artemia salina produced both stimulation of tear secretion and a slight improvement of physiological corneal staining. Besides, all the doses of up to 10% Artemia salina did not produce undesirable side effects on the ocular surface. Therefore, these eye drops are presented as a possible new treatment for dry eye due to their secretagogue properties and ocular surface regeneration. [ABSTRACT FROM AUTHOR]

The aim of study was to evaluate the effects of oral isotretinoin on meibomian gland (MG) morphology detected with non-contact meibography and to investigate its relation with clinical dry eye tests. Forty-five acne patients treated with isotretinoin underwent a full ophthalmological examination at baseline and in the fourth month as follows: ocular surface disease index (OSDI) questionnaire, assessments of tear film break-up time (TFBUT), corneal fluorescein staining, Schirmer test, meibum expression, and lid margin abnormalities. Non-contact meibography imaging and noninvasive tear break up time (NI-BUT) assessments were also performed. The changes in MGs were scored (meibography score) as grade 0, no change; grade 1, mild; grade 2, moderate; and grade 3, marked. There was a statistically significant change in OSDI, corneal fluorescein staining, lid margin abnormality, and meibum expression score during the treatment compared to baseline values (p <.001, p =.02, p <.001, and p <.001, respectively). All meibography scores showed a positive correlation with the lid margin abnormality and meibum expression score but did not correlate with the TFBUT, NI-BUT, Schirmer test, or the corneal fluorescein staining score. The morphologic analysis using non-contact meibography is a useful method for assessing isotretinoin-related changes in MGs. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) and vitamin D deficiency are both common clinical entities. Vitamin D has been reported to play a significant role in ocular surface homeostasis. This study aimed to determine the therapeutic effect of oral vitamin D supplementation in dry eye disease patients with vitamin D deficiency. A randomized, controlled study was completed in 100 patients with dry eye disease and concurrent vitamin D deficiency (< 20 ng/ml). Participants were randomly allocated to 8 weeks of oral vitamin D supplementation with both groups receiving conventional dry eye treatment with artificial tears. Schirmer's, tear break-up time (TBUT) and osmolarity tests were measured before and after eight weeks of treatment. The mean age of participants was 36.8 ± 8.56 years in the treatment group (n: 50) and 34.8 ± 10.13 year in the control group (n: 50). After eight weeks of treatment the mean differences in Schirmer's, TBUT and tear osmolarity were 2.38 ± 1.55 mm, 3.95 ± 1.48 s and −16.9 ± 6.28 mOsm/L, respectively in the treatment group, and 0.7 ± 0.86 mm, 0.92 ± 1.57s and −3.34 ± 2.0 mOsm/L respectively in the control group (p < 0.001 for all parameters). The treatment group demonstrated a more significant improvement than the control group in Schirmer's, TBUT and osmolarity values (p < 0.001). Vitamin D supplementation as an adjuvant to routine dry eye treatment improves ocular surface hemostasis parameters, results in better tear stability and a more improved tear osmolarity in patients with vitamin D deficiency. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of punctal plugs combined with cyclosporine eye drops on dry eye disease (DED) and ocular surface inflammation. Methods: In a clinical trial, 73 patients were randomly allocated into three groups: punctal plug group, combination therapy group, and cyclosporine group. At the baseline and four weeks after treatment, the Schirmer I test score, fluorescein tear film break-up time (FBUT), ocular surface staining score and dry eye symptoms were assessed. Tear samples were collected to detect the level of inflammatory factors (interleukins, matrix metalloproteinase 9 (MMP-9) and tumor necrosis factor alpha (TNF-α)). In an animal experiment, a New Zealand rabbit dry eye model was induced. The rabbits were randomly divided into control group, punctal plug group, and combination therapy group (n = 6). Conjunctival goblet cell density, protein level of MMP-9 in conjunctiva and mRNA levels of inflammatory factors in conjunctiva and cornea were measured before and after treatment. Results: In combination therapy group of the clinical trial, the following results were observed: significant improvement in Schirmer I test scores and FBUT compared to the cyclosporine group and punctal plug group, respectively; a decrease in the tear levels of IL-6, IL-1, and MMP-9 compared to the punctal plug group; and a decrease in the tear levels of IL-1α, IL-6, and IL-17 compared to the baseline (all p < 0.05). In the animal experiment, rabbits in combination therapy group had a higher goblet cell density (p < 0.01) and lower mRNA levels of IL-16 (p < 0.05), IL-17 (p < 0.05), and MMP-9 (p < 0.01) in conjunctiva and that of MMP-9 (p < 0.01) in cornea compared to punctal plug group. Conclusion: Cyclosporine eye drops combined with degradable punctal plugs is a more optimized clinical treatment strategy for DED compared with degradable punctal plugs or cyclosporine eye drops alone, considering the influence of comprehensive clinical efficacy and ocular surface inflammation. [ABSTRACT FROM AUTHOR]

Clinical relevance: The interaction between contact lenses and tear film plays a critical role in lens biocompatibility and can influence discomfort during wear. Early detection of biochemical changes is important for improving ocular surface health, preventing complications, and developing advanced lens materials to enhance long-term comfort. Background: The pursuit of biocompatible lens materials requires a thorough understanding of their interaction with tear environment. The aim of this study is to evaluate different approaches to investigate early alterations in tear biomolecular profiles induced by lens wear. Methods: Two participants wore different CLs and underwent ocular analysis before CL insertion (T0), after 2-hour wear (T2), and two hours after removing the CL (T4), evaluating non-invasive tear break-up time (NIBUT), tear meniscus height (TMH), and osmolarity. Forty CLs were used. At the same time points, tears were collected and analysed by Raman spectroscopy. Results: Tear film stability, as measured by NIBUT, decreased post-lens wear (T0 vs T2, p = 0.034 and 0.025 for S1 and S2, respectively) but showed recovery within 2 hours (T0 vs T4, p > 0.05 for both S1 and S2), while TMH and osmolarity remained unchanged (T0 vs T2 vs T4, p > 0.05 for both S1 and S2). Raman spectroscopy highlighted notable changes in the biomolecular profile of tears after lens wear, particularly in the 2700–3200 cm−1 spectral window related to C-H stretching, which is sensitive to CH, CH2 and CH3 groups, their functional chemistry group, and the surrounding microenvironment. Conclusions: Contact lens wear induces subtle biochemical, subclinical alterations in tears that can be detected early by Raman spectroscopy. The method is promising for analysing the subject-specific responses to lenses, also with possible individual variability in the timing of these changes. In addition, this approach can provide insights for designing biocompatible materials and for the early detection of subclinical biomarkers. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the structural and functional impact of vernal keratoconjunctivitis (VKC) on meibomian glands (MGs) using a combination of noncontact meibography and lipid layer interferometry. Methods: In this observational study 50 patients with moderate persistent or severe VKC and 50 age-matched controls underwent MG imaging and lipid layer thickness (LLT) measurements with Lipiview II. Image J software was used to assess MG loss (meibograde) in both lids. All patients underwent dry eye evaluation comprising tear break-up time (TBUT), ocular surface staining (OSS), Schirmer I scoring, and meiboscoring (expressibility and quality of meibum secreted). Results: Meibograde, OSS score, and meiboscore was higher in cases (2.68 ± 0.96, 0.580 ± 1.07, and 0.56 ± 0.95 respectively) than controls (1.80 ± 0.67, 0.00 ± 0.00, 0.22 ± 0.47 respectively) (p < 0.001, 0.001, 0.025 respectively). LLT and TBUT was lower in cases (54.58 ± 9.43 nm and 4.92 ± 3.09 sec respectively) than controls (70.14 ± 22.50 nm and 12.02 ± 2.73 sec respectively) (both p's = 0.001). Both groups had comparable Schirmer I scores. Conclusion: Children with VKC have significant MG dropouts, deterioration in meibum quality and a thinner and less stable tear film. VKC patients are thus prone to a vicious cycle of inflammation attributable both to the allergic component and to deterioration in MG structure and function. Co-management of MG dysfunction warrants as much attention as the allergic component itself. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between corneal temperature on ocular surface and stability of tear film, and define the normal reference range of corneal surface temperature in the population of Pudong New Area, Shanghai, China. Methods: Temperature of cornea (TOC) and tear film break-up time (BUT) were measured among 515 volunteers with or without dry eye. The association between TOC and tear film stability was analyzed, and the normal reference range of TOC was determined. Results: TOC was 32.6 ± 0.97°C among the 318 subjects without dry eye including 147 males (TOC = 32.6 ± 0.70°C) and 171 females (TOC = 32.64± 1.16°C). Significant differences existed in TOC on ocular surface among three separated groups according to BUT measurement. Age was positively related to TOC, whereas BUT was negatively correlated with TOC. Conclusion: It is recommended to consider 32.6 ± 0.70°C as the normal reference value for human central corneal temperature. Instability of tear film is concomitant with elevated TOC in the population of Pudong New Area, Shanghai. [ABSTRACT FROM AUTHOR]

To assess the relationship between tear inflammatory cytokine ratios (CRs) and signs and symptoms of dry eye disease (DED) to investigate the possible use of tear CRs, which may better address the complexity of cytokine interactions than absolute cytokine levels, as a DED biomarker. Tear concentrations of IL-1b, IL-6, IL-8, IL-10, IL-17A, IFN-g, and TNF-a were measured using standardized procedures, as were DED signs (corneal and conjunctival staining scores, tear break-up time, Schirmer test, Meibomian gland plugging, tear osmolarity, composite sign severity score) and symptoms [Ocular Surface Disease Index (OSDI)]. Ratios between pro-inflammatory (IL-1b, IL-8, IL-17A, IFN-g, and TNF-a) and anti-inflammatory (IL-10) cytokines were calculated. Given its opposing roles in inflammation, IL-6 was tested as both a pro- and anti-inflammatory cytokine. Correlations between CR and DED symptoms and signs were calculated using Spearman correlation coefficients (rho). At baseline, 131 patients, 80.2% female and mean age 54.2 years (SD 14.1, range 20–82), from 10 sites of the Dry Eye Assessment and Management study had sufficient tear volumes ≥4 μL for analysis. IL-6:IL-10, IL-8:IL-10, and TNF-a:IL-10 had some significant correlations, mostly with conjunctival or corneal staining or the composite sign severity score (IL-8:IL-10 and conjunctival staining: rho = 0.19, p = 0.03; IL-6:IL-10 and corneal staining: rho = 0.31, p < 0.001; IL-8:IL-10 and corneal staining: rho = 0.21, p = 0.01; IL-6:IL-10 and composite sign severity score: rho = 0.26, p = 0.003; IL-8:IL-10 and composite sign severity score: rho = 0.26, p = 0.003; TNF-a:IL-10 and corneal staining: rho = 0.29, p < 0.001; TNF-a:IL-10 and Schirmer test: rho = −0.23, p = 0.009). CRs had no significant correlation with DED symptoms. All significant correlations using IL-6 in the denominator (anti-inflammatory) produced counterintuitive results based on clinical understanding of the disease. Pro- to anti-inflammatory CR was weakly correlated with some DED signs and not with symptoms, as measured by OSDI. Future studies in different dry eye populations are needed and should address sampling biases and tear collection techniques. [ABSTRACT FROM AUTHOR]

We sought to evaluate the expression of matrix metalloproteinase-9 (MMP-9) in dry eyes treated with 0.05% cyclosporin A and 3.0% diquafosol tetrasodium. One-hundred ninety-five eyes of 195 patients with dry eye were divided into three groups as follows: group 1, cyclosporin group (n = 69); group 2, diquafosol group (n = 59); and group 3, artificial tears eyes (n = 67). All eyes were treated and followed up for three months. Schirmer I Test, corneal staining, tear-film break-up time (TBUT), and tear-film MMP-9 content were measured at three months and compared between groups. The expression of MMP-9 was confirmed using a point-of-care test device (InflammaDry®; RPS Diagnostics, Sarasota, FL, USA) and graded as zero to four points. At the third month, MMP-9 expression was lower in group 1 as compared with in groups 2 and 3 (p = 0.020 and 0.006, respectively). The mean MMP-9 grade according to point-of-care testing was also lower in group 1 than in groups 2 or 3 (p = 0.002 and 0.038, respectively). MMP-9 showed a correlation with corneal staining in both groups 1 and 2 (all p < 0.001) and with Schirmer I Test and TBUT in group 1 (p = 0.018 and 0.015, respectively). MMP-9 expression and grade were lower after treatment with cyclosporin than after treatment with diquafosol in the dry eye disease. Anti-inflammatory treatment can decrease ocular MMP-9 levels in dry eye disease. MMP-9 expression and grade were lower after treatment with cyclosporin than after treatment with diquafosol in the dry eye disease. Anti-inflammatory treatment can decrease ocular MMP-9 levels in dry eye disease. [ABSTRACT FROM AUTHOR]

Purpose/Aim: Wink glass (WG), an invention to stimulate blinking at interval of 5 s was designed to reduce dry eye symptoms during visual display unit (VDU) use. The objective of this study is to investigate the effect of WG on visual functions that include blink rate, ocular surface symptoms (OSS) and tear stability during VDU use. Materials and methods: A total of 26 young and asymptomatic subjects were instructed to read articles in Malay language with a computer for 20 min with WG whereby their blink rate, pre- and post-task tear break-up time, and OSS were recorded. The results were compared to another reading session of the subjects wearing a transparent plastic sheet as a control. Results: Non-invasive tear break-up time was reduced after reading session with transparent plastic sheet (pre-task = 5.97 s, post-task = 5.14 s, z = −2.426, p = 0.015, Wilcoxon), but remained stable (pre-task = 5.62 s, post-task = 5.35 s, z = −0.67, p = 0.501) during the reading session with WG. The blink rate recorded during reading session with plastic sheet was 9 blinks/min (median) and this increased to 15 blinks/min (z = −3.315, p = 0.001) with WG. The reading task caused OSS (maximum scores = 20) with median score of 1 (0-8) reduced to median score of 0 (0-3) after wearing WG (z = −2.417, p = 0.016). Conclusion: WG was found to increase post-task tear stability, increased blinking rate and reduced OSS during video display unit use among young and healthy adults. Although it may be considered as an option to improve dry eye symptoms among VDU users, further studies are warranted to establish its stability and its effect on subjects with dry eyes. [ABSTRACT FROM AUTHOR]

Application of the electric field to water-in-oil system can accelerate the coalescence of droplets. However, when an excessively high electric field is applied, droplets will exhibit break-up behavior. In addition to the strength of the electric field, the salt type in droplets significantly affects their break-up behavior. However, the break-up behavior of droplets containing the same valence cation is rarely investigated, and the mechanism underlying the influence of ionic type remains unclear. In this study, the break-up behavior of droplets containing chlorine salt with the same valence cation is studied by molecular dynamics simulations. The influences of electric field strength and ionic type on the break-up behavior of droplets are analyzed. Simulation results demonstrate that the droplet deformation increases with the increase in the electric field, and the droplets break when the degree of deformation exceeds a critical value. The ionic type mainly affects the break-up time of droplets through drift velocity, which is proportional to the electric field strength and ionic mobility. Moreover, from Na+ to Cs+, the cationic mobility increases first and then decreases with the increase of crystallographic radius. [ABSTRACT FROM AUTHOR]

Purpose: Dry eye disease (DED) is a common condition that significantly lowers the quality of life. As the disease grows more prevalent, multiple commercial instruments have been developed to measure the ocular surface of dry eyes, but no single device has yet been successful in comprehensive measurements. The current study aimed to investigate the clinical accuracy and utility of the Antares topographer in the diagnosis of DED.Methods: Thirty-three consecutive patients underwent analyses of their non-invasive first tear-film break-up time (NIF-BUT), tear meniscus height (TMH) and meibography with the Antares topographer. The meibography with the LipiView scan was conducted. Slit-lamp examinations were done for assessments of meibomian glands (MG) and fluorescein tear-film break-up time (FBUT). Schirmer 1 test was done. The Ocular Surface Disease Index (OSDI) scores were graded.Results: Thirty-three eyes of 33 patients (mean age 61.5 ± 10.6 years, range 37.5-76.4 years, 27.3% males) completed the study. According to the Antares measurements, the NIF-BUT of the patient population was 5.0 ± 3.4 seconds on average (1.1-15.0 seconds), and the TMH was 0.2 ± 0.1 mm at center (0.1-0.5 mm). The average OSDI score was 22.4 ± 16.6 points (0.0-79.5 points). When correlations were calculated, significant correlations were found between the NIF-BUT from the Antares topographer and FBUT (r = 0.538, P = .001), and between MG dropout from the Antares topographer and that from the LipiView interferometer (r = 0.446, P=.009). Antares NIF BUT and FBUT were in agreement with one another (95% limits of agreement (LOA) -5.04 ± 6.37, P=.198) as were the infrared images from the Antares topographer and those from the LipiView interferometer (95% LOA -0.25 ± 0.35, P=.073).Conclusion: The Antares topographer is useful in the diagnosis of DED. Among its outputs, the NIF-BUT and MG dropout most closely correlated with currently accepted modes of diagnosis. However, concurrent clinical examinations are recommended for clinical follow-up. [ABSTRACT FROM AUTHOR]

Aim: To assess the relationship between systemic inflammation markers and ocular surface parameters in hazelnut harvesters. Material and Method: This prospective study included 30 patients presenting with moderate ocular surface diseases during the hazelnut harvesting season. A detailed ophthalmological examination was performed during the harvesting season and the first month after the end of treatment (control). Schirmer test, tear break-up time (TBUT), and ocular surface disease index (OSDI) scores were determined. In complete blood count analysis, in addition to the evaluation of inflammatory cells, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated. Results: Eosinophil percentage had a high level of negative correlation with the TBUT and Schirmer values and a high level of positive correlation with the OSDI score during the hazelnut picking season (r = –0.727, r = –0.735, r = 0.750, respectively). During the hazelnut harvesting season, the NLR and SII parameters had a moderate level of negative correlation with the TBUT (r = –0.29 and r = −0.276) and Schirmer (r = –0.33 and r = −0.298) values and a moderate level of positive correlation with the OSDI score (r = 0.389 and r = 0.264). Conclusion: In hazelnut harvesters, ocular allergy and inflammation may be associated with systemic biomarkers. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to illustrate the changes in ocular findings, meibography, and tear break-up time (TBUT) values in pediatric patients with ocular rosacea following a standardized treatment. Methods: The study included consecutive patients diagnosed with ocular rosacea, referred to a tertiary hospital between 2021 and 2023. Each patient underwent biomicroscopic examinations, non-invasive TBUT assessments, corneal fluorescein staining (evaluated using the Oxford scoring system), and meibography. The standard treatment protocol involved warm compresses, eyelid hygiene, preservative-free sodium hyaluronate eye drops (administered four times daily), topical azithromycin 1.5% (twice daily for 3 days), topical steroids (loteprednol 0.5%, four times daily for 2 weeks), and either doxycycline 100 mg/day for 14 days or oral suspension of azithromycin 10 mg/kg for 3 days followed by an additional three-day course of treatment administered 10 days later (for patients above and below 14 years of age, respectively). Results: The study included 18 patients, with 10 (55.5%) being female and 8 (44.4%) being male, with a mean age of 9.7 ± 4.5 years (range: 3–18). Four patients displayed cutaneous involvement. The treatments resulted in significant improvements in the Oxford scores, reduction in corneal neovascularization, and increased TBUT (p < 0.001, p = 0.016, p < 0.001, respectively). Meibomian gland loss area also significantly improved post-treatment (27.4 ± 6.7% vs 39.2 ± 13.4%, p = 0.001). Conclusion: This study demonstrated that pediatric ocular rosacea patients may exhibit improved meibomian gland function, regression of corneal neovascularization, and enhanced tear film parameters following a standardized treatment protocol that includes both topical and systemic approaches. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to investigate changes in tear function, meibomian glands and corneal endothelium in patients receiving systemic isotretinoin therapy. Materials and methods: This prospective study included 38 eyes from 38 patients (23 females and 15 males) treated with systemic isotretinoin (0.5–1 mg/kg/day) following the diagnosis of acne vulgaris. All patients underwent a comprehensive ophthalmologic examination at baseline, 1st month, and third month of treatment. Subjective complaints were assessed using the Ocular Surface Disease Index (OSDI). Tear functions were evaluated through non-invasive tear break up time (NIBUT) and Schirmer I test. Meibomian gland (MG) changes were examined using meibography. Corneal parameters, including endothelial cell density (ECD), coefficient of variation (CV), the number of cells with a hexagonal shape (6A), average cell area (AVG), and central corneal thickness (CCT) were assessed using non-contact specular microscopy. Results: The mean age of the patients was 19.29 ± 2.83 years. Ocular surface-related discomfort, measured with OSDI scores, significantly worsened at the third month measurements compared to the pre-treatment values (p < 0.001). In the 1st month of treatment, there was a significant decrease in NIBUT (p < 0.05). No statistically significant difference was found in the Schirmer test results at each visit. According to the 1st and third-month analysis, there was a significant increase in MG loss compared to the pre-treatment period (p < 0.001). ECD, CV, 6 A, AVG measurements at the first and third months showed a significant change compared to the pre-treatment values (p < 0.001). No significant difference was observed in the CCT measurements during the treatment. Conclusion: Systemic isotretinoin disrupted tear stability, caused MG loss, deterioration in corneal endothelium, and led to symptomatic complaints in patients. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy and safety of 0.05% cyclosporine eye drops (II) for the treatment of primary Sjögren's syndrome-associated dry eye (PSSDE). Sixty patients with PSSDE were randomly divided into three groups, received treatment with 0.05% cyclosporine (C group), artificial tears (S group) or their combination (CS group). The evaluation indicators were evaluated at baseline and at weeks 2, 4 and 12. The symptoms of C and CS groups were reduced significantly. The signs [schirmer I test (F = 4.838, p =.011), ocular staining score (F = 7.961, p =.001) and tear break-up time (F = 9.283, p <.001)] were significantly different between S and C groups as well as S and CS groups. The tear meniscus height (F = 3.197, p =.048) was significantly different between S and CS groups. No serious adverse events occurred. 0.05% cyclosporine is an effective and safe treatment for patients with PSSDE. [ABSTRACT FROM AUTHOR]

A clinical trial was conducted to evaluate the activity of a new artificial tear containing hyaluronic acid (HA) and low-dose hydrocortisone to control dry-eye disease (DED) symptoms. a randomized, controlled, double-masked study was carried out at the Ocular Surface and Dry Eye Center, "Luigi Sacco" University Hospital (Milan, Italy), between June 2020 and June 2021. The study involved patients with DED for at least 6 months. After an initial 7-day treatment with corticosteroid, the treatment with the new artificial tear (four-times a day for 6 months) was compared with a control HA solution. A total of 40 patients were considered. We observed a significant improvement in the frequency and intensity of DED symptoms in both groups. After corticosteroid discontinuation, the maintenance of the therapeutic advantage was observed only in the treatment group, which also showed a significant improvement of the tear film break-up time (p ≤ 0.05) and infiltrated macrophages (p < 0.05). A significant reduction in fluorescein and Lissamine staining (p < 0.05) was observed in the treatment group, suggesting damage reduction at both corneal and conjunctival levels. Intraocular pressure did not change at the end of the treatment period and was maintained within the normal range, sustaining the product's safety. Our findings support the prolonged use of the new eye drop with low-dose hydrocortisone, also in the DED initial stages, to prevent the degenerating towards a chronic condition (). [ABSTRACT FROM AUTHOR]

Purpose: This is a collaborative study from the ophthalmology and gastroenterology departments of a tertiary care hospital, designed to investigate the ocular features in patients with autoimmune liver disease (ALD). Methods: Seventy-two eyes of 36 patients with ALD, and 40 eyes of 20 controls with normal ocular findings were evaluated. Schirmer test, tear film break-up time, pachymetry, macular thickness with optic coherence tomography, and optic nerve head analysis with the HRT III were performed in addition to complete ophthalmologic examination. Results: Of the 36 patients, 31 were female (86.1%) and 5 were male (13.9%). The average age of patients was 47.7 ± 13.3 years (21-76 years). Autoimmune hepatitis in 22 patients (61.1%), primary biliary cirrhosis in 10 patients (27.8%), and primary sclerosing cholangitis in 4 patients (11.1%) were detected as etiologic causes. Cataract was seen more often in the study group. Tear film break-up time and Schirmer test results were significantly lower in the study group than in the controls. Other parameters were not different from control group. Conclusions: ALD showed a marked preponderance of females, with sex ratios of 6 females per male supportive to literature. The basal tear secretion and tear film stability are lower, and the dry eye symptoms are more common among the cases with ALD. [ABSTRACT FROM AUTHOR]

Purpose. To compare non-invasive break-up time (NIBUT) when measured with the Tearscope-Plus™ and the Oculus® Keratograph 5M, and to compare lipid layer thicknesses (LLT) when measured with the Tearscope-Plus™ and the LipiView®. This study also set out to establish the repeatability of these methods. Methods. The following measurements were taken from both eyes of 24 participants on two occasions: non-invasive keratograph break-up time using the Oculus® (NIKBUT-1 and NIKBUT-average), NIBUT using the Tearscope-Plus™, and LLT using the LipiView® (minimum, maximum, and average) and Tearscope- Plus™. The Tearscope-Plus™ grades were converted to nanometers. Results. There were no significant differences between eyes (Tearscope-Plus™ NIBUT: p = 0.52; NIKBUT-1: p = 0.052; NIKBUT-average: p = 0.73; Tearscope-Plus™ LLT: p = 0.13; LipiView® average, maximum, or minimum: p = 0.68, 0.39 and 0.50, respectively) or days (Tearscope-Plus™ NIBUT: p = 0.32; NIKBUT-1: p = 0.65; NIKBUT-average: p = 0.54; Tearscope-Plus™ LLT: p = 0.26; LipiView® average, maximum, or minimum: p = 0.20, 0.09, and 0.10, respectively). LLT was significantly greater with the Tearscope-Plus™ (80.4 ± 34.0 nm) compared with the LipiView® average (56.3 ± 16.1 nm, p = 0.007), minimum (50.1 ± 15.8 nm, p < 0.001) but not maximum (67.2 ± 19.6 nm, p = 0.55). NIBUT was significantly greater with the Tearscope-Plus™ (15.9 ± 10.7 seconds) compared to the NIKBUT-1 (8.2 ± 3.5 seconds, p = 0.006) but not NIKBUT-average (10.9 ± 3.9 seconds, p = 0.08). Conclusions. The Tearscope-Plus™ is not interchangeable with either the Oculus® K5M measurement of tear stability (NIKBUT-1) or the LipiView® maximum and minimum lipid thickness. [ABSTRACT FROM AUTHOR]

Background: Measurement of tear film stability is commonly used to give an indication of tear film quality but a number of non-invasive techniques exists within the clinical setting. This study sought to compare three non-invasive tear film stability measurement techniques: instrument-mounted wide-field white light clinical interferometry, instrument-mounted keratoscopy and hand-held keratoscopy.Methods: Twenty-two subjects were recruited in a prospective, randomised, masked, cross-over study. Tear film break-up or thinning time was measured non-invasively by independent experienced examiners, with each of the three devices, in a randomised order, within an hour.Results: Significant correlation was observed between instrument-mounted interferometric and keratoscopic measurements (p < 0.001) but not between the hand-held device and the instrument-mounted techniques (all p > 0.05). Tear film stability values obtained from the hand-held device were significantly shorter and demonstrated narrower spread than the other two instruments (all p < 0.05), while no significant differences were observed between the two instrument-mounted devices (all p > 0.05).Conclusion: Good clinical agreement exists between the instrument-mounted interferometric and keratoscopic measurements but not between the hand-held device and either of the instrument-mounted techniques. The results highlight the importance of specifying the instrument employed to record non-invasive tear film stability. [ABSTRACT FROM AUTHOR]

To determine the effect of unilateral primary acquired nasolacrimal obstruction (PANDO) on ocular surface parameters in PANDOeyes and fellow eyes and changes in these parameters after dacryocystorhinostomy. Tear osmolarity, tear break-up time (TBUT), Schirmer's test, Meibomian gland score, and Lissamine Green staining of PANDO eyes and fellow eyes were measured preoperatively and postoperatively at Day 15, 1 month, and 3 months. Lacrimal irrigation and epiphora symptomatology were evaluated at all follow-up visits, and patients who did not meet surgical success criteria were excluded from the study. Twenty-nine patients who underwent successful dacryocystorhinostomy surgery were included in the study. Preoperative and postoperative Day 15 Schirmer (p =.019, p =.001) and TBUT (p =.039, p =.043) were significantly lower in the fellow eye compared to PANDO eyes. The differences observed between PANDO eyes and fellow eyes in all other parameters were not significant (p >.05). Preoperatively PANDO eye parameters were normal, whereas TBUT (7.59 ± 5.39 s) and tear osmolarity (308.59 ± 17.32 mOsm/L) values of the fellow eye may be indicative of tear film instability. TBUT and tear osmolarity of the fellow eye showed significant improvement 3 months postoperatively compared to preoperative values (p =.010; p =.027 respectively). Schirmer and TBUT values of the fellow eye were significantly lower than PANDO eyes preoperatively, one month after surgery there was no significant difference. TBUT and tear osmolarity of the fellow eyes may be indicative of tear instability preoperatively with improvement 3 months after dacryocystorhinostomy. [ABSTRACT FROM AUTHOR]

Laryngopharyngeal reflux (LPR) is a common worldwide disease. LPR symptoms may involve distant organs and tissues including the ocular surface with manifestations of a Dry Eye-like disease. We evaluated the concomitant involvement of the ocular surface in patients with LPR. We also defined the clinical signs and the roles of chemical and neuro-inflammatory mediators in the tears of LPR patients. Seventy-seven patients with LPR (mean age 65.8 ± 16.8 SD) and 25 healthy controls (mean age 56.5 ± 16.3 SD) were recruited from the otorhinolaryngology unit. Each subject was evaluated for the presence of concomitant ocular surface disease through clinical examination, including the measurement of tear break-up time (TBUT) and the Ocular Surface Disease Index (OSDI) questionnaire. Tears and conjunctival imprints were collected. The presence of pepsin in tears was detected by ELISA. HLA-DR in conjunctival imprints were imaged by immunofluorescence microscopy. RT-PCR quantified conjunctival mRNA transcripts of HLA-DR, IL-8, MUC5AC, NADPH, VIP, and NPY. Patients with LPR had significantly increased OSDI and reduced TBUT scores compared to control subjects (p < 0.05 each). Pepsin was detected in 51% of patient tears while it was not measurable in the controls (p < 0.01). Immunoreactivity for HLA-DR in the conjunctival impressions was greater than for the controls with an increased mRNA expression (p < 0.05). mRNA transcripts for IL-8, NADPH, and VIP were significantly increased in LPR patients (p < 0.05 each), but neither MUC5AC nor NPY was different from controls. LPR can adversely affect the ocular surface, leading to moderate signs and symptoms of dry eye. This study provides evidence that the presence of pepsin, HLA-DR immunoreactivity, and increased mRNA expression of neuro-inflammatory markers in the tears and conjunctival imprints of LPR patients suggests a potential link between LPR inflammation and ocular surface disease. [ABSTRACT FROM AUTHOR]

To compare effect of topical cyclosporine-A 0.05% (CsA) and chloroquine phosphate 0.03% (CHQ) as an adjunct to standard therapy in maintaining post-laser assisted in situ keratomileusis (LASIK) ocular surface stability. Randomized controlled trial on 100 eyes undergoing femtosecond-LASIK randomized into three groups: 33 eyes in Group I (Standard Treatment group), 34 eyes in Group II (CsA group) and 33 eyes in Group III (CHQ group). Standard treatment included topical moxifloxacin, topical prednisolone and carboxymethyl cellulose. Group II received topical CsA 0.05% twice daily for three months and group III received topical CHQ 0.03% twice daily for three months in addition to standard treatment. Primary outcome measure was change in ocular surface disease index (OSDI) at 6 months. Secondary outcome measures were tear break up time (TBUT), Schirmer-I score, tear film osmolarity, tear film MMP-9 and visual acuity. Follow-up was performed at postoperative 1, 3 and 6 months. At 6 months, OSDI score, MMP-9, tear osmolarity, TBUT and Schirmer score were significantly better in both CsA and CHQ groups as compared with controls (p < 0.001). OSDI, Tear osmolarity, TBUT, MMP-9 levels were comparable in CsA and CHQ group (p > 0.05). In CsA group, tear film MMP-9 levels at 6 months were comparable to preoperative baseline (p = 0.09). There was no significant change in the Schirmer score from baseline in the CsA group; in addition, the Schirmer score was significantly better than the CHQ group at 6 months (p = 0.02). Visual acuity was comparable in all three groups. Adverse effects including burning sensation, stinging, pain and redness were reported by ten patients (CsA group- 3, CHQ group-7; p = 0.28). Both CsA and CHQ are useful adjuncts to standard therapy in maintaining ocular surface stability after refractive surgery. Cyclosporine A has more potent and sustained anti-inflammatory effect with less ocular irritative effects. [ABSTRACT FROM AUTHOR]

This study aims to assess whether an individual's chronotype (i.e. morningness versus eveningness) has an impact on tear film. Eighty-six dry eye patients not having any underlying systemic or metabolic diseases and either a morning or evening chronotype were included in the study. Tear film break-up time (BUT) and Schirmer tests are common objective tests that are used to diagnose the eye dryness. Using multivariate analysis of covariance (MANCOVA), we investigated the interaction effect of chronotype x sex on insomnia, Schirmer (mm) and BUT (sec) measurements after adjusting for age. We found that the participants who were more prone to evening chronotype characteristics reported to have more severe dry eye signs which monitor with the aid of the Schirmer and tear film break-up time test. In addition, those with higher scores in insomnia severity index had lower Schirmer test and tear film break-up time scores. These findings suggest that chronobiological factors may play a crucial role in the dry eye symptom severity. [ABSTRACT FROM AUTHOR]

To evaluate and compare the prevalence and severity of dry eye disease (DED) among patients on atypical antipsychotics with controls. This cross-sectional study was conducted on patients who were on atypical antipsychotic therapy (study group) and matched controls (control group). Prevalence of DED was assessed using tear break up time. Statistical analysis was done using SPSS. Chi-square test and t-test were used. p < 0.05 was taken as the level of statistical significance. Prevalence of DED was significantly more in study group. Polytherapy group has significantly high DED compared with monotherapy. Among monotherapy, clozapine had highest prevalence of DED (p-0.013) and among the polytherapy, clozapine-quetiapine had highest prevalence of dry eye. Prevalence of DED was higher among antipsychotics than the normal population, and in polytherapy than monotherapy group. The patients on clozapine (monotherapy) and clozapine with quetiapine (polytherapy) had highest prevalence of DED. [ABSTRACT FROM AUTHOR]

To determine the correlations among symptoms and signs of dry eye disease (DED) in the Dry Eye Assessment and Management (DREAM) study. A total of 535 patients with moderate-to-severe DED were assessed for symptoms using the Ocular Surface Disease Index (OSDI) and four DED signs in both eyes (conjunctival lissamine green staining, corneal fluorescein staining, Schirmer's testing, and tear break-up time (TBUT)) following standardized protocols at baseline and follow-up visits (months 3, 6, and 12). Spearman correlation coefficients (rho) were calculated for correlations among symptoms and signs of DED at baseline and among changes in symptoms and signs from baseline at 12 months. The confidence intervals and p-values for correlation coefficients were calculated using a cluster bootstrapping to account for inter-eye correlation. At baseline, OSDI total score was not correlated with signs; however, OSDI subscale score of ocular symptoms was weakly correlated with corneal staining score (rho = 0.14, p =.002) and Schirmer test score (rho = 0.11, p =.01). There were statistically significant correlations among the four signs (p <.001), with absolute correlation coefficient ranging from 0.14 (conjunctival staining score vs. TBUT) to 0.33 (conjunctival staining score vs. cornea staining score). The correlations among changes in symptoms and signs were weaker, with the highest correlation between change in conjunctival staining and corneal staining (rho = 0.21, p <.001). Consistent with previous studies, among DREAM participants with moderate-to-severe DED at baseline, correlations of DED symptoms with signs were low and correlations among four objective signs were low to moderate. The correlations among changes in symptoms and signs were even weaker. [ABSTRACT FROM AUTHOR]

To describe tear concentrations of IL-1β, Il-6, IL-8, IL-10, IL-17A, IFNγ and TNFα in tears, collected by microcapillaries, and their correlation with symptoms and signs in subjects with dry eye disease (DED) in the DREAM Study. Cytokine levels of patients with moderate to severe DED were determined using a magnetic bead assay. Scores for Ocular Surface Disease Index, corneal and conjunctival staining, tear break-up time (TBUT), and Schirmer's test were obtained using standardized procedures. Associations of cytokines with each other and signs/symptoms were assessed with Spearman correlation coefficients (r). Assay results from 131 patient samples from 10 sites with tear volumes ≥ 4 ul were analyzed. Cytokine concentrations did not correlate with each other in a generally acknowledged pro-inflammatory/anti-inflammatory pattern, such as proinflammatory IL-17A and IFNγ were not inversely correlated to anti-inflammatory cytokine IL-10, and cytokines did not correlate with DED symptoms. Lower corneal staining was correlated with higher concentrations of IL-17A (r= −0.24, p = 0.006), IL-10 (r= −0.25, p = 0.005) and IFNγ (r= −0.33, p = 0.0001). Higher concentrations of IFNγ were associated with lower conjunctival staining (r= −0.18, p = 0.03). Higher concentrations of IL-17A were associated with higher TBUT scores (r = 0.19 p = 0.02). Cytokines IL-10, IL-17A and IFNγ were highly correlated with each other but weakly correlated with some DED signs. No key cytokines or definitive expression patterns were identified in this study of moderate to severe DED patients. Further studies addressing various biases, including methodological and sampling biases, and standardization of methodology for inter-laboratory consistency are needed to confirm and establish pathological and clinical relevance of tear cytokines in DED. [ABSTRACT FROM AUTHOR]

To evaluate dry eye parameters, corneal topographic features, corneal densitometric changes, and anterior segment parameters in patients receiving systemic isotretinoin treatment. This prospective cross-sectional study included 66 eyes of 33 patients who were started on oral isotretinoin therapy for severe acne vulgaris. All patients were evaluated in terms of ocular surface tests such as tear break-up time (TBUT) and Schirmer-1 and were asked to fill in the ocular surface disease index (OSDI) questionnaire. Corneal densitometric and topographic measurements were obtained using the Scheimpflug imaging system. The mean age of the patients was 19.9 ± 1.6 years, and 21 (63.6%) of the participants were female. The mean OSDI score was significantly higher in the third month than before treatment (20.05 ± 19.38, vs. 26.96 ± 22.94, p = 0.00, respectively). The mean values of the TBUT test were significantly lower in the third month than before treatment (9.06 ± 4.40 sec, vs. 10.71 ± 4.61 sec, p = 0.02, respectively). Mean scores of the Schirmer 1 test showed no statistically significant difference between before treatment and the third month (16.08 ± 8.40 mm, vs. 16.08 ± 8.50 mm, p = 1, respectively). There was no statistically significant difference between before treatment and the third month in the majority of the densitometry measurements in concentric zones. However, the difference tended to be significant between the groups concerning posterior zone 0–2 mm (11.01 ± 0.85 GSU vs. 10.62 ± 0.89 GSU, p = 0.006). The RMS LOAs (front), RMS Total (Total), RMS LOAs Total (Total), RMS HOAs Total (Total), Kmax, CCT, and CoV values were significantly higher in the third month than before treatment (p < 0.05 for all). The dermatology specialists should be aware of the ocular complications of systemic isotretinoin therapy. Therefore, a complete ophthalmologic examination for the prompt apprehension and management of ocular involvement is essential in patients under isotretinoin therapy to increase ocular comfort and adherence to the therapy. [ABSTRACT FROM AUTHOR]

To evaluate the effects of lipid-containing Rohto Dry Aid eye drops and sodium hyaluronate eye drops on the ocular surface and in vivo confocal microscopy (IVCM) findings in patients using systemic isotretinoin. This retrospective study included 71 patients using systemic isotretinoin for acne vulgaris. Ocular surface and tear functions were evaluated with the tear break-up time (TBUT), corneal fluorescein staining (CFS), and the ocular surface disease index questionnaire (OSDI). Meibography was used for the staging of Meibomian gland dysfunction (MGD) while IVCM was used for the analysis of corneal micro-structural changes. The data of 36 patients using Rohto Dry Aid (the Rohto group) and 35 patients using sodium hyaluronate (the SH group) were recorded. Pre-treatment, first month and third month data were analyzed. Longer TBUT, lower OSDI score, and less CFS were observed in the first and third months after treatment in the Rohto group (p < 0.001). There was no significant change in TBUT and CFS in the first month (p > 0.05) in the SH group (p < 0.05) but lower TBUT and more CFS were observed in the third month. There was no significant change in the OSDI score in the SH group. There was a significant decrease in dendritic cells, activated keratocytes, and nerve tortuosity with IVCM in both groups. However, no significant difference was found between the two groups. Rohto Dry Aid, with its support of the lipid layer, is an effective and safe treatment agent that can improve both ocular surface and IVCM findings in evaporative dry eye cases with MGD. [ABSTRACT FROM AUTHOR]

To make appropriate therapeutic decisions of intense pulsed light (IPL) for meibomian gland dysfunction (MGD) patients. Sixty patients with MGD stage 2–3 were enrolled in IPL Group1 and Self-hygiene Group; 110 patients with MGD stage 3–4 were included in IPL + MGX Group and IPL Group2. Patients in IPL groups received IPL treatment once a month for three times. Meibomian gland expression (MGX) was combined with IPL treatment in IPL + MGX Group. Meibomian gland (MG) functions, MGD stage, associated ocular-surface indexes, and response rate were evaluated. Population characteristics and clinical conditions were comparable between groups. In patients with MGD stage 2–3, both IPL Group1 and Self-hygiene Group improved in MG functions, ocular surface disease index (OSDI) and tear break-up time (TBUT). No statistical difference was found in improvements. Posttreatment response rate was 64.3–66.7% in two groups. In patients with MGD stage 3–4, IPL + MGX Group achieved better improvements in MG expressibility and higher response rate (75.5%) than IPL Group2 (63.3%). Referring to IPL treatment, no statistical difference in MG functions and OSDI improvements was found among MGD patients with different ages, genders, and IPL energy exposure. Patients with higher Fitzpatrick scale improved more in MG expressibility. Self-eyelid hygiene is cost-effective for milder MGD stages. Combining MGX with IPL is necessary in more severe stages. Adult patients with all age and different genders can benefit from IPL treatment. Patients with darker skin can benefit more in expressiblity. [ABSTRACT FROM AUTHOR]

To review the most recent studies in the literature regarding the ocular surface in glaucoma patients and treatment options aimed to reduce ocular surface disease in this population We performed a literature search in the electronic databases of PubMed CENT RAL, Google Scholar, EMBASE the Register of Controlled Trials, and Ovid MEDLINE using the following terms: "ocular surface", "dry eye", "glaucoma", "selective laser trabeculoplasty", "glaucoma surgery", "preservatives", "preservative free", "ocular surface disease index", "tear break up time", "MMP-9" and "conjunctival hyperemia". Over the last several years, several studies have demonstrated the changes to the ocular surface in the setting of glaucoma, the best tests for markers of dry eye, and how management can be altered to help address ocular surface disease routinely or in preparation for glaucoma surgery. Ocular surface disease in the glaucoma patient population is widely recognized. It should be addressed to maximize patient compliance and quality of life. [ABSTRACT FROM AUTHOR]

Purpose : To investigate the changes in tear secretion and tear film stability after upper lid blepharoplasty in patients that had previously undergone excimer laser in situ keratomileusis (LASIK). Methods : We performed carbon dioxide (CO2) laser upper lid blepharoplasty to 18 eyes of 9 patients that had undergone bilateral LASIK at least 18 months before the surgery. Six women and 3 men aged 35 to 52 were included in this group. An additional control group of 18 eyes of similar age patients with no history of LASIK, contact lens usage or dry eye symptoms were studied. We studied the Schirmer tear test values without anesthesia at 5 minutes in both groups before and after the upper lid blepharoplasty procedure. Tear break-up time values were also measured before and 4 weeks after (CO2) laser upper lid blepharoplasty. The Schirmer tear test and tear break-up time values were analyzed statistically using the independent t-test. Results : The mean Schirmer tear test value was 19.07 ± 4.03 mm in both eyes of the patients who had undergone LASIK and upper lid blepharoplasty, and it was 21.07 ± 7.03 mm in the eyes of the control group that only had (CO2) laser upper lid blepharoplasty. The mean tear break-up time value was 21.0 ± 3.55 seconds in the eyes that had LASİK treatment, and it was 21.27 ± 6.79 seconds in the eyes of the control group. There was no statistical difference between the two groups. Conclusion : Because LASIK and blepharoplasty both may cause dry eye symptoms, the possible cumulative effect of these surgeries is a serious consideration. However, dry eye symptoms after LASIK is usually temporary, and we may perform upper lid blepharoplasty to these patients after a certain time interval by closely monitoring their preoperative and postoperative tear function. [ABSTRACT FROM AUTHOR]