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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.

This study aims to investigate the reliability and efficacy of maximum fluorescein tear break-up time (FTBUTmax) in diagnosing dry eye disease (DED). 147 participants were enrolled in this study. Ocular symptoms were assessed by Ocular Surface Disease Index (OSDI). The fluorescein tear break-up time (FTBUT) examination, corneal fluorescein staining (CFS), and Schirmer I test were performed on both eyes. Each participant underwent 3 consecutive FTBUT tests, and five types of FTBUT values including FTBUTmax, the minimum FTBUT (FTBUTmin), the first FTBUT (FTBUT1), the average of three FTBUTs (FTBUT123) and the average of the first and second FTBUT (FTBUT12) were recorded. FTBUTmax was larger than the other FTBUT values, but no differences were found among the values of FTBUT1, FTBUT123, FTBUT12 and FTBUTmin. In the ROC analysis, FTBUTmax had the largest or the second largest area under the ROC (AUROC) in all three DED diagnostic criteria, while FTBUTmin had the least AUROC of them. ROC efficacy of FTBUTmax was significantly higher than that of FTBUT123, FTBUT12, FTBUT1 and FTBUTmin in the OSDI criteria and higher than that of FTBUT1 and FTBUTmin in Schirmer I test and CFS tests. FTBUTmax has a close correlation with OSDI, Schirmer I test and CFS, and is an effective tool for the DED diagnosis.

Purpose To evaluate the impact of prolonged surgical face mask wearing on dry eye symptoms and tear film break-up time (T-BUT) in health care professionals. Materials and Methods A total of 33 health care professionals were included in this cross sectional, prospective study. T-BUT measurements were performed twice for all participants in the morning (8 am) and in the afternoon (5 pm) in addition to a complete ophthalmological examination. The subjects also filled-in the ocular surface disease index (OSDI) questionnaire twice, before and after wearing the face mask, on the same day. Results Sixty six eyes of 33 participants (17 female and 16 male) were evaluated. The mean age was 33.6 ± 7.55 (24–48) years and mean total duration with mask on between the two evaluations was 514 ± 12.5 (495–526) minutes. The mean T-BUT was 9.3 ± 1.0 (3–16) seconds at 8 am and 8.3 ± 1.5 (3–14) seconds at 5 pm (p = 0.01). The mean OSDI score was 20.1 ± 8.3 (0-68.75) at 8 am and 27.4 ± 10.4 (0-81.25) at 5 pm (p

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.

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.

This study evaluated to what extent tear film break-up time (TFBUT) could discriminate pathological scores for other clinical tests and explore the associations between them. Dry eye patients (n = 2094) were examined for ocular surface disease index (OSDI), tear film osmolarity (Osm), TFBUT, blink interval, ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test, meibomian expressibility, meibomian quality, and meibomian gland dysfunction. The results were grouped into eight levels of break-up time (≤2, ≥3, ≤5, ≥6, ≤10, ≥11, ≤15, and ≥16) with or without sex stratification. Receiver-operating characteristic curve (ROC) analysis and Pearson’s correlation coefficients were used to study TFBUT’s discriminative power and the associations among the tests, respectively. Above and below each TFBUT’s cut-off, all of the parameters indicated significant difference between groups, except OSDI (cut-off 15 s) and Osm (cut-offs 5 s–15 s). At TFBUT cut-off of 2 s, sex difference could be detected for OSDI, Osm, and OSS. OPI presented the strongest discriminative power and association with TFBUT in sharp contrast to Osm, holding the poorest discriminative power with no significant correlation. The remaining parameters were within the poor to very poor categories, both with regard to discrimination and correlation. In conclusion, patients with lower TFBUT presented with more severe DED parameters at all four defined cut-off values.

Aims: To evaluate and compare the diagnostic values and clinical utility of the Ocular Surface Disease Index (OSDI) questionnaire, the tear film break-up time test (TBUT), and the Schirmer’s test in diagnosing dry eye disease in patients presenting with dry eye symptoms. Study Design: A prospective observational study. Place and Duration of Study: Department of Ophthalmology, AIIMS Jodhpur, Rajasthan, India. Two-month period between July 2016 and September 2016. Methodology: We have included 100 patients aged >20 years having foreign body sensations, burning sensations, pain, dryness, blurred vision, photophobia, redness in the study. Routine ophthalmological examination was performed after OSDI questionnaire, followed by TBUT and Schirmer’s test and outcomes were evaluated. Results: The mean age of 100 participants was 43 ± 15.97years (range 20–78 years). The mean OSDI, TBUT, and Schirmer’s test scores were 58.67± 12.12 (range 30.0–88.9), 5.77 ± 3.49 seconds (range 0–17 seconds), and 09.78 ± 7.93 mm (range 0–32.5 mm), respectively. There was a statistically highly significant inverse correlation between the OSDI and TBUT (r = −0.597, P =

Resume Introduction La secheresse oculaire, motif frequent de consultation peut etre evaluee cliniquement par la mesure du temps de rupture du film lacrymal ou break up time (BUT). Il existe souvent une discordance entre signes fonctionnels evocateurs de secheresse oculaire et mesures cliniques du BUT. Nous avons donc voulu evaluer la fiabilite du BUT dans le diagnostic et la prise en charge du syndrome sec chez le noir Africain. Materiel et methode Les auteurs ont realise une etude prospective de 6 mois sur des patients adultes melanodermes qui ont presente des signes fonctionnels evocateurs de secheresse oculaire selon un questionnaire a 7 items. Le BUT est mesure apres instillation d’une goutte de fluoresceine a l’aide d’un chronometre entre le dernier clignement palpebral et la premiere rupture du film lacrymal corneen. Les patients ayant un syndrome sec fonctionnel et un temps de rupture du film lacrymal inferieur a 10 secondes ont ete retenus comme souffrant d’un syndrome sec et ont ete designes concordants. Les discordants etaient ceux dont le temps de mesure du BUT etait superieur a 10 secondes bien qu’ayant repondu positivement au questionnaire. Resultats Notre etude a porte sur 234 patients et la moyenne d’âge etait de 49,1 ans. Le sex-ratio de la population d’etude etait de 0,68 et on notait une predominance de temps de rupture compris entre 5 et 10 secondes soit 42,3 % des cas. Le syndrome sec fonctionnel a ete confirme cliniquement par un BUT inferieur a 10 secondes chez 149 personnes portant la fiabilite du BUT comme outil de diagnostic clinique apres une symptomatologie fonctionnelle evocatrice a 63,7 %. Parmi ces concordants, les femmes etaient plus sujettes a presenter une secheresse oculaire par rapport aux hommes avec une difference significative (p = 0,0005). L’âge superieur a 50 ans et l’usage de l’ordinateur etaient des facteurs de risque de la secheresse oculaire (p Discussion La secheresse oculaire est une affection multifactorielle des larmes et de la surface oculaire beaucoup plus frequente chez le sujet feminin, de plus de 50 ans et utilisant frequemment l’ordinateur. La fiabilite du BUT avoisinant les 65 % nous autorise a le preconiser en pratique clinique. Conclusion Le temps de rupture du film lacrymal ou BUT est un test clinique fiable de realisation simple qui peut etre utilise pour confirmer le diagnostic de secheresse oculaire.

Background: Phacoemulsification is a technique of modern cataract surgery with smaller corneal incision than conventional techniques but uses various effects on springs that cause dry eye syndrome (DES). DES is a multifactorial defect of tears and ocular surfaces characterized by eye discomfort. Examination of DES can be done by examining Schirmer 1 and Tear Break Up Time (TBUT). Purpose: To determine the accuracy, sensitivity and specificity of the Schirmer test dan TBUT in postoperative patients with phacoemulsification techniques at the Rumah Sakit Khusus Mata Province of South Sumatra. Method: Diagnostic test has been done in order to the accuracy, sensitivity and specificity of the Schirmer test dan TBUT on DES in post operative cataract surgery with phacoemulsification techniques. This study has been conduct Schirmer 1 test and TBUT was done periodically from 1 week, 2 weeks and 1 month after cataract surgery. The data analysis has been done with diagnostic research by SPSS version 20.0 (SPSS, Inc Chicago, Illinois). Result: 40 study samples of post operative cataract surgery with phacoemulsification technique obtained by female sex with 22 out of samples were (55%), with an average age of patients between of 60-70 years.The accuracy of Shirmer 1 and TBUT test was 0,425 and the sensitivity value was 39.5% and also the specificity value was 100%. Conclusion: Schirmer 1 test and TBUT in patients of post cataract surgery with phacoemulsification techniques are specific (100%) but less sensitive (39,5%)

Purpose To evaluate the performance of precorneal and prelens non-invasive tear break-up time (NIBUT) measurements to determine tear instability in contact lens (CL) wearers.Methods In this study 50 eyes of CL wearers were evaluated. Precorneal first and average NIBUTs and fluorescein tear break-up time (FBUT) were measured before wearing CLs in the morning. Those with FBUT less than 10 seconds were considered to have tear instability. After wearing CL, first and average prelens NIBUTs were measured at the 30th minute. The receiver operating characteristic (ROC) curve was analyzed to evaluate the performance of NIBUT measurements in the diagnosis of tear instability.Results The FBUT value had a significant correlation with first and average precorneal NIBUT values (p 0.05).The area under curve (AUC) in ROC curve for the first and average precorneal NIBUTs were 0.842 (pth minute of CL wear were 0.586 and 0.619 respectively (p=0.317 and p=0.166, respectively). Conclusions: Precorneal NIBUT measurements may be useful in diagnosing tear instability in CL wearers. Prelens NIBUT values are not yet capable of adequately defining the tear film dynamics.

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

Purpose To evaluate the intrasession repeatability for non-invasive break-up time (NIBUT) and tear meniscus height (TMH) measurements provided by a new multi-diagnostic platform, and to assess the interobserver reproducibility of TMH measures. Methods Twenty-one healthy eyes of 21 patients (age, 23–65 years) were enrolled. A complete eye examination was performed in all cases with the VX120+ device (Visionix-Luneau Technologies), including an analysis with the new Dry Eye module, performing three consecutive measurements. The within-subject standard deviation (Sw) and Bland–Altman plots were used to assess intersession repeatability. Differences between examiners for TMH were also analysed. Results No statistically significant differences were found between repeated measures of NIBUT (time associated with the first break) and TMH (p > 0.05). However, significant differences were found for NIBUT50% (time associated with half of breaks of the tear film) (p

Purpose: To evaluate seasonal variation in intraocular pressure (IOP) with and without short tear break-up time (SBUT, BUT &le, 5 s) since dry eye and IOP are known to have seasonal variation. Methods: This study enrolled 176 patients who visited one of six eye clinics, in Japan, four times for IOP measurement, in every season. The mean patient age was 67.9 years, including 79 males. Participants were divided into four groups based on the presence of glaucoma and/or SBUT and we compared the seasonal variation in IOP (winter and summer) among the four groups. Results: The IOP (mmHg) in winter and summer, respectively, was 12.8 &plusmn, 3.7 and 12.8 &plusmn, 3.1 for non-glaucoma patients without SBUT (n = 47, p = 0.964), 14.8 &plusmn, 3.4 and 13.3 &plusmn, 3.4 for non-glaucoma patients with SBUT (n = 57, p &lt, 0.001), 14.3 &plusmn, 3.2 and 14.1 &plusmn, 3.4 for glaucoma patients without SBUT (n = 36, p = 0.489), and 13.3 &plusmn, 3.0 and 11.6 &plusmn, 2.9 for glaucoma with SBUT (n = 36, p &lt, 0.001). Seasonal variation was largest across the seasons in the glaucoma with the SBUT group, and the magnitude of seasonal variation correlated with BUT (&beta, = 0.228, p = 0.003). Conclusions: Seasonal variation tended to be larger in patients with SBUT than those without SBUT.

Purpose: To see the effect of soft contact lens wears on tear breakup time. Study Design: Descriptive Observational study. Place and Duration of Study: College of Ophthalmology and Allied Vision Sciences, King Edward Medical University, Mayo Hospital, Lahore. From January to March 2016. Material and Methods: Students of King Edward Medical University Lahore wearing soft contact lens for more than 3 months with no known ocular pathology were selected by non-probability convenient sampling technique. Subjects with history of using any eye drops, history of oral drugs, which could cause dry eye and individuals any ocular disease, were excluded from the study. Tear film BUT was tested by using Fluorescein sodium dye and examinig under cobalt blue filter of slit lamp.SPSS version 20 is used to analyze the data. Results: There were 30 participants with mean age of 24.5 ± 5 years. All were females. Sixty percent were wearing corrective lenses, and 40% were wearing cosmetic lenses. Out of 30 patients wearing contact lenses, only 6.67% had marginal tear film BUT and none of the patients has shown dry eyes. Individuals using contact lenses for 9 – 12 years had decreased BUT as compared to subjects using lenses for 3 – 6 months. 33.33% of extended lens wearers had reduced BUT as compared to disposable and daily wearers of contact lenses. Discomfort with contact lenses was observed in only 4 patients. Conclusion: As the duration of contact lens wear increases, the tear film break up time decreases. Individuals using extended wear contact lenses are more prone to develop decreased TFBUT.

Tear film instability is one of the major characteristics of dry eye syndrome. However, traditional diagnostic methods, such as the fluorescein tear film break-up time (FTBUT) test, are limited by the subjective interpretation of results. The test needs to manually identify break-up areas in the fluorescent image, thus producing variable diagnosis results. This paper proposes an automatic method to detect the fluorescent tear film break-up area using a deep convolutional neural network (CNN) model and to define its appearance as CNN-BUT. A digital slit-lamp recorded the standard FTBUT measurement for each of 80 study participants. Fifty participants were used to train the CNN model to identify the tear film break-up area, while the remaining 30 were used to validate the proposed CNN-BUT test. Among six normal controls and 24 dry eye patients enrolled in this paper, CNN-BUT was significantly lower in dry eye patients ( ${p} ). The correlation between CNN-BUT and FTBUT was also significant ( ${r} =0.9$ ; ${p} ). Using 5 s as the cutoff value, the CNN-BUT offered acceptable sensitivity and specificity to screen dry eye patients (0.83 and 0.95, respectively). These results indicate that CNN-BUT may be used to evaluate tear film stability and to assess the status of dry eye syndrome automatically.

Complex mechanisms underlie dry eye (DE) symptom provocation. In particular, corneal hypersensitivity may provoke symptoms in short tear break-up time (BUT) DE characterized by tear film instability. We hypothesized that improved tear film stability may alleviate corneal sensitivity in patients with short tear BUT DE. Therefore, we investigated the effect of topical diquafosol tetrasodium (DQS) on corneal sensitivity in unstable tear film DE. This prospective, randomized study included 27 subjects (age: 39.1 ± 8.4 years; range: 25–59 years) with short tear BUT DE, defined based on the presence of DE symptoms and tear film instability. Subjects were randomly divided into DQS (3% DQS, 12 subjects) and artificial tear (AT; preservative-free AT, 15 subjects) groups. Subjects applied the medication 6 times a day for 5 weeks. The perception of touch (S-touch) and pain (S-pain) sensitivity was measured using a Cochet—Bonnet esthesiometer. Tear evaluation, corneal sensitivity, and DE symptoms were compared before and after DQS or AT administration. The correlation between the improvement degrees of corneal sensitivity and DE symptoms following medication was analyzed. DQS significantly improved tear BUT and tear meniscus height (TMH) scores (p

Dry eye disease may develop and persist after cataract surgery, however, unilateral cases have not been fully documented. This cross-sectional, observational study was conducted in five eye clinics in Japan. A total of 1023 outpatients were initially enrolled, and 89 unilateral pseudophakic subjects with 1+ year of follow-up after uncomplicated cataract surgery were included. The tear break-up times (TBUTs) and keratoconjunctival staining results were compared between phakic and pseudophakic eyes. The mean age of the patients was 69.3 &plusmn, 10.4 years (32 men, 36.0%), and the mean postoperative period was 4.6 &plusmn, 4.4 (1&ndash, 20) years. For the ophthalmic parameters, the TBUTs were 4.4 &plusmn, 1.9 and 3.8 &plusmn, 1.9 s (p &lt, 0.001), the keratoconjunctival staining scores were 0.11 &plusmn, 0.38 and 0.22 &plusmn, 0.56 (p = 0.02), the spherical equivalents were &minus, 1.27 &plusmn, 2.51 and &minus, 0.99 &plusmn, 1.45 D (p = 0.21), the astigmatic errors were 0.79 &plusmn, 0.66 and 0.78 &plusmn, 0.58 D (p = 0.80), and the intraocular pressures were 13.6 &plusmn, 2.9 and 13.5 &plusmn, 2.6 mmHg (p = 0.62) for the phakic and pseudophakic eyes, respectively. The corneal status was significantly worse in the pseudophakic eyes than in the contralateral phakic eyes, even after more than one year after implant surgery. The present results suggested that long-term ocular surface problems should be examined further since they may not originate only from surgery or postoperative ocular surface diseases.

Minako Kaido,1,2 Motoko Kawashima,1 Reiko Ishida,1,3 Kazuo Tsubota1 1Department of Ophthalmology, KeioUniversity School of Medicine, Tokyo, 2Wada Eye Clinic, Chiba, 3IshidaEye Clinic, Shizuoka, Japan Aim: Validating the hypothesis that accommodative microfluctuations (AMFs) may be associated with severe symptoms in short tear break-up time (BUT) dry eye (DE). Methods: This study included 12 subjects with short BUT DE (age: 49.6±18.3 years). Diagnoses were performed based on the presence of DE symptoms, BUT ≤5 s, Schirmer score >5 mm, and negative keratoconjunctival epithelial damage. Tear evaluation, AMF, and functional visual acuity (VA) examinations were conducted before and after DE treatment. The AMF parameters evaluated were: total high-frequency component (HFC), HFC with low accommodation for the task of staring into the distance (HFC1), HFC with high accommodation for deskwork (HFC2). A subjective questionnaire of DE symptoms was also performed. Results: Mean BUT increased from 1.9±2.0 to 6.4±2.5 s after treatment (P0.05). Subjective DE symptoms were reduced in nine patients. Conclusion: Along with the improvement of BUT after treatment, DE symptoms diminished and HFC1 and functional VA improved, suggesting that tear film instability is associated with deterioration of functional VA, AMF, and DE symptoms. Keywords: accommodative microfluctuation, ciliary muscle spasm, dry eye, ocular fatigue, tear break-up time, functional visual acuity&nbsp

Background: The effects of electronic cigarettes on the ocular surface has yet to be shown. The purpose of the study was to assess the impact of e-cigarette use on the anterior corneal surface integrity.Methods: Forty three males and 21 females with an average of 21years were required to vape 0.05ml of e-liquid of 8mg nicotine concentration. Corneal epithelial thickness (CET) and Non Invasive Keratograph Tear Break up Time (NIKBUT) measurements were obtained prior to and post vaping. The Optovue iVue optical coherence topographer was used to measure central; superior; inferior; nasal and temporal CET and NIKBUT was assessed using the Oculus Keratograph 5M.Results: There was a mean increase for central corneal epithelial thickness of 0.3448 microns. The superior CET increased by 0.2414 microns. The inferior CET increased by 0.2931microns. The nasal CET increased by 0.2069 microns. The temporal CET increased by 0.2759 microns. The mean change in NIKBUT post-vaping was an increase of 1.40 seconds. All observations occurred at p > 0.05.Conclusion: The acute effect of e-cigarette use does not impact corneal epithelial thickness and non-invasive keratography tear break up time after 10 puffs mild exposure but more research is needed to assess if this remains the case with more frequent, higher exposure.Keywords: Pre-test post-test assessment, non-invasive keratograph breakup time, corneal epithelial thickness, vaping.

Background: The aim of the study was to evaluate the dynamic changes of tear film optical quality in a short tear break-up time (TBUT) dry eye by using a double-pass system. Methods: Thirty-five short TBUT dry eye participants and 43 control subjects without dry eye were included in this study. One eye for each subject was analyzed. The Objective Scatter Index (OSI), modulation transfer function (MTF), and strehl ratio (SR) were recorded within a 20-second period with the participants asked to blink freely, and 10 successive seconds of nonblinking immediately after a blink was recorded to analyze the tear film OSI. The mean tear film OSI in 10 successive seconds, ΔOSI, and ΔOSI/time were evaluated. The correlation between tear film OSI and MTF, and the correlation between tear film OSI and MIT were also analysed. Results: Short TBUT dry eye participants showed significant deterioration of MTF and SR compared to control subjects. The mean tear film OSI in 10 successive seconds was significantly higher in dry eye participants than in control subjects. The mean OSI of the tear film (0–5 seconds) and the mean OSI of the tear film (6–10 seconds) were significantly higher in dry eye participants than in control participants. Moreover, the ΔOSI was significantly higher in dry eye participants than in control participants. The tear film OSI was significantly correlated with the MTF and the SR. Conclusions: The tear film OSI of short TBUT dry eye participants is significantly increased in the early stage. Tear film instability in short TBUT dry eye participants has a significant effect on optical quality.

Background: There are few studies on ocular effects of indoor mould exposure in schools, especially in the tropics. Objective: To study associations between eye symptoms and tear film break up time (BUT) in students and demographic data and fungal DNA in schools. Methods: A school environment study was performed among randomly selected students in eight randomly selected secondary schools in Penang, Malaysia. Information on eye symptoms and demographic data was collected by a standardised questionnaire. BUT was measured by two methods, self-reported BUT (SBUT) and by the non-invasive Tearscope (NIBUT). Dust was collected by vacuuming in 32 classrooms and analysed for five fungal DNA sequences. Geometric mean (GM) for total fungal DNA was 7.31*104 target copies per gram dust and for aspergillus/Penicillium DNA 3.34*104 target copies per gram dust. Linear mixed models and 3-level multiple logistic regression were applied adjusting for demographic factors. Results: A total of 368 students (58%) participated and 17.4% reported weekly eye symptoms the last 3 months. The median SBUT and TBUT were 15 and 12 s, respectively. Students wearing glasses (OR 2.41, p = 0.01) and with a history of atopy (OR = 2.67; p = 0.008) had more eye symptoms. Girls had less eye symptoms than boys (OR = 0.34; p = 0.006) Indoor carbon dioxide in the classrooms was low (range 380–720 ppm), temperature was 25–30 ◦C and relative air humidity 70–88%. Total fungal DNA in vacuumed dust was associated with shorter SBUT (4 s shorter per 105 target copies per gram dust; p = 0.04) and NIBUT (4 s shorter per 105 target copies per gram dust; p < 0.001). Aspergillus/Penicillium DNA was associated with shorter NIBUT (5 s shorter per 105 target copies per gram dust; p = 0.01). Conclusion: Fungal contamination in schools in a tropical country can be a risk factor for impaired tear film stability among students.

Purpose: To evaluate seasonal variation in intra-ocular pressure (IOP) with and without short tear break-up time (SBUT, BUT ≤ 5 s). Methods: This study enrolled 176 patients who visited one of six eye clinics in Japan for IOP measurement at every season. The mean patient age was 67.9 years, including 79 males. We compared the seasonal variation in IOP (mean ± SD) across spring (Mar-May), summer (Jun-Aug), fall (Sep-Nov), and winter (Dec-Feb). Results: The IOP (mmHg) in winter and summer, respectively, was 12.8 ± 3.7 and 12.8 ± 3.1 for non-glaucoma patients without SBUT (n = 47, P = 0.964), 14.8 ± 3.4 and 13.3 ± 3.4 for non-glaucoma patients with SBUT (n = 57, P < 0.001), 14.3 ± 3.2 and 14.1 ± 3.4 for glaucoma patients without SBUT (n = 36, P = 0.489), and 13.3 ± 3.0 and 11.6 ± 2.9 for glaucoma with SBUT (n = 36, P < 0.001). Seasonal variation was largest across the seasons in the glaucoma with SBUT group, and the magnitude of seasonal variation correlated with BUT (β = 0.228, P = 0.003). Conclusions: Seasonal variation tended to be larger in patients with SBUT than those without SBUT.

To evaluate transient receptor potential vanilloid 1 (TRPV1)-mediated pain sensitivity in patients with short tear break-up time (TBUT) dry eye (DE) by using the capsaicin stimulus test.This prospective cross-sectional comparative study included 22 eyes of 22 patients with short TBUT DE and 11 eyes of 11 non-DE control subjects. Patients were divided into two groups based on response to standard DE treatments: 10 non-responders (intractable DE) and 12 responders (responsive DE). Mechanical touch (M-touch) and mechanical pain (M-pain) were measured using a Cochet-Bonnet esthesiometer. Capsaicin-induced pain (C-pain) and C-pain duration (C-pain DT) were measured using a capsaicin stimulus test. Psychological distress was also assessed.M-touch sensitivity was similar among all three groups. M-pain sensitivity was higher in the responsive DE group than in the intractable DE and control groups (P .001). C-pain sensitivity was lower (P .001) in the intractable DE group than in the responsive DE and control groups, and C-pain DT was shorter (P = .006) in the intractable DE group than in the responsive DE group. Psychological distress was higher in the intractable DE group than in the control group (P .001).Patients with intractable short TBUT DE were less sensitive to the effects of capsaicin than patients with responsive short TBUT DE and controls. Altered neural activation may contribute to the development of DE symptoms in the short TBUT DE subjects. The capsaicin stimulus test may be used to better understand pain sensitivity in short TBUT DE patients.

Purpose: To investigate the relationship between tear ferning patterns (TFP) and non-invasive tear break-up time (NIBUT) in normal Asian subjects. Methods: One hundred and forty-five adults with no ocular surface disorders were recruited. TFP and NIBUT were determined. Tears were collected using a capillary tube and allowed to air dry at room temperature for 10 min. TFP was later observed using a light microscope and classified according to Rolando's classification. Measurement for NIBUT was obtained using a Tearscope with the slit lamp magnification. Results: It was found that there is no significant difference between gender in TFP (Z=−1.77, P>.05) and NIBUT (Z=−1.475, P>.05). There is also no significant difference between Malay, Chinese, Indian, and other races in TFP, (H(3)=4.85, P>.05) and NIBUT (H(3)=2.18, P>.05). However, there is a significant difference between age groups of 20–29, 30–39, 40–49,and 50–60 years old in both TFP (H(3)=28.25, P

The aim was to determine feasibility and reliability of noninvasive tear break-up time (NIBUT) assessment using handheld lipid layer examination instrument, and to compare it with standard tear break-up time (TBUT) test. Fifty patients were enrolled, 31 with and 19 without dry eye symptoms. Schein questionnaire was used to assess dry eye symptoms. During examination, three NIBUT measurements were performed on each eye using handheld instrument, followed by three TBUT measurements. Receiver operating characteristic curves, sensitivity, specificity and logistic regression analysis were generated. Median NIBUT values were significantly shorter in dry eye symptom group than in control group in all three measurements (9, 8 and 8 s vs. 21, 22 and 21 s; p, Cilj ovoga istraživanja bio je ispitati pouzdanost mjerenja neinvazivnog testa pucanja suznog filma (NIBUT) pomoću ručnog instrumenta za procjenu debljine lipidnog sloja suza te ovu metodu usporediti sa standardnim invazivnim testom (TBUT). U istraživanje je bilo uključeno 50 ispitanika, 31 sa simptomima suhog oka i 19 bez njih. Za procjenu simptoma suhog oka rabio se standardni Scheinov upitnik. Za vrijeme pregleda provedena su tri mjerenja NIBUT-a pomoću ručnog instrumenta, potom tri mjerenja TBUT-a. Statističkom obradom podataka generirane su ROC krivulje, osjetljivost, specifičnost i regresijska analiza. Prosječna vrijednost NIBUT-a bila je značajno kraća u skupini bolesnika sa simptomima suhog oka nego u kontrolnoj skupini u sva tri mjerenja (9, 8, 8 s prema 21, 22, 21s; p

Background To investigate therapeutic effects of topical diquafosol tetrasodium 3% ophthalmic solution in patients with short tear film break-up time (TFBUT)-type dry eye (DE). Methods The prospective study was performed in 70 eyes of 70 patients with short TFBUT-type DE. Diagnosis of short TFBUT-type DE was made based on the presence of DE symptoms, TFBUT value ≤5 s, corneoconjunctival staining score ≤ 2 (on a scale of 0 to 4), and Schirmer I value > 5 mm. Patients with systemic immunologic disorders or ocular graft-versus-host disease were excluded. Before and after instillation of 3% diquafosol ophthalmic solution six times per day for 4 weeks, subjective DE symptoms, TFBUT, corneoconjunctival staining score, and Schirmer I value were examined and compared. Also, demographic factors were compared between patients who showed improvement in each DE parameter by treatment and those who did not. Results Four-week treatment with 3% diquafosol ophthalmic solution significantly improved DE symptoms (p

AIM: To investigate the association between tear film break up time (TBUT) and blinking interval in visual display terminal (VDT) users. METHODS: Nine hundred and thirty VDT users underwent dry eye testing, and functional visual acuity (FVA) test. The blinking interval during FVA was compared with TBUT. Subjects with longer blinking interval than TBUT were considered as unstable tear film. Logistic regression analysis revealed the risk factors for unstable tear group. RESULTS: Among 930 workers, 858 subjects (92.3%) participated in this study. Almost 80% of the subjects were categorized into the unstable tear group. Unstable tear group has significantly lower Schirmer values and TBUT (17.5±11.6 vs 21.1±11.5 mm, 3.7±2.6 vs 5.7±2.7s, both P

Tear film instability is one of the major characteristics of dry eye syndrome. However, traditional diagnostic method like fluorescein tear film break-up time (FTBUT) test is limited by its invasiveness, the necessity to use fluorescein sodium and thus variable result. In this study, we proposed a noninvasive method to demonstrate thermal break-up area (Thermal BUA) by thermography, and defined its appearance as thermal break-up time (Thermal BUT). Among 31 normal controls and 42 dry eye patients enrolled in this study, Thermal BUT was significantly lower in dry eye patients (P

Thokozani Mzumara, Joseph Afonne Department of Optometry, Faculty of Health Sciences, Mzuzu University, Mzuzu, Malawi Purpose: To assess the relationship between non-invasive tear break-up time (NITBUT) and maximum blink interval (MBI) values among young adults. Method: The study was conducted at Mzuzu University and involved 98 subjects (55 females and 43 males) aged between 18 and 40 years. All subjects were screened under the slit lamp, and were also asked questions to determine their eligibility to participate in the study. NITBUT measurements were taken by checking the discontinuity of the mires on the keratometer. MBI measurements were taken by observing the time period the subject could keep their eyes open without blinking. Results: There was a positive correlation (r=0.64, r2=0.418, P

Purpose To determine the repeatability of tear ferning (TF) grading analysed by subjective and objective techniques, and its correlation with lipid layer thickness (LLT), non-invasive keratograph break-up time (NIKBUT), and ocular surface disease index (OSDI) comfort scores with and without ocular lubricants. Methods A prospective, randomised, controlled clinical study was conducted. Eighteen healthy non-contact lens wearers aged between 18 to 45 years attended a total of three visits. They were randomly allocated to receive no drops on two occasions to examine method repeatability (visits A and B) or a 60 μL drop of Refresh® (visit C). At each visit, LLT and NIKBUT were assessed followed by basal tear collection. The TF pattern was established by pipetting one μL volume of tears onto a glass slide that was allowed to air-dry and imaged under a microscope. The resulting tear ferning pattern was determined using subjective grading and a novel computerized objective analysis technique that measured the local contrast of ferning contours. Results Paired t-tests found that all measurements collected between eyes, on different days for visit A and B were not significantly different (p >0.05). Eyes and days were averaged and compared to visit C. Paired t-tests between the averaged baseline visits and visit C for LLT, NIKBUT including subjective and objective TF scores showed no significant difference (p>0.05). No significant correlation was shown between the TF scoring and OSDI, LLT or NITBUT (p>0.05). There was however a high significant correlation and agreement between the subjective and objective analysis techniques for TF grading. Conclusions TF grade, LLT and NITBUT are repeatable. As with other ocular surface assessments, subjective and objective TF gradings did not significantly correlate with the measures of tear film stability or comfort. Lubricants had no effect on TF grade, LLT or NITBUT. The novel objective analysis technique is a promising candidate for a repeatable and unbiased assessment of tear ferning.

Purpose To evaluate corneal tactile and pain sensations in patients with short tear film break-up time dry eye (sBUT DE). Methods This study enrolled 60 patients with sBUT DE and 46 healthy volunteers from Japan. We evaluated corneal tactile and pain sensations using a modified method with the Cochet-Bonnet corneal esthesiometer. Results Patients with sBUT DE had higher corneal pain sensitivity (26.3 ± 23.1 mm) than healthy subjects (6.9 ± 16.4 mm), but similar corneal tactile sensation (52.0 ± 15.5 mm and 52.9 ± 14.9 mm, respectively). In patients with sBUT DE and corneal hyperalgesia (n = 22, 36.7%), defined as a pain sensitivity ≥40 mm (i.e., the cutoff value at the 95th percentile of corneal pain sensitivity in healthy subjects), a strong significant correlation was found between the subjective pain score and objective corneal pain sensation (R = 0.79). However, for the entire cohort, we found a weak positive correlation between the subjective pain score and objective corneal pain sensation. Conclusions Patients with sBUT DE were hypersensitive to corneal pain, which suggested that corneal hyperalgesia partly accounted for subjective symptoms in patients with sBUT DE.

Background: The purpose of this study is examining the correlation between clinical tests in patients of dry eye. Methods: Medical records of all cases of clinically diagnosed dry eye syndrome [DES] attending the corneal clinic of department of Ophthalmology, L.N. medical college Bhopal, India from September 2015 to December 2015 were retrospectively analyzed. Parameters such as OSDI (Ocular surface disease index), TBUT (Tear film breakup time), ST (Schirmer’s test), age, sex were evaluated. Result: One hundred and two patients were included in the study. Patients were predominantly males (51.92%) in group 1 and females (52 %) in group 2.Average female: male ratio was 0.92:1 in group 1 and 1.08: 1 in group 2. Mean age in group 1 was 41.1 years, in group 2 was 44.54 years. The OSDI was not correlated with TBUT and ST in group 1 and in group 2. The TBUT and ST test was not correlated in group 1 and group 2 (p> 0.05%). Conclusion: At present there is no diagnostic test available that can be considered as a gold standard test for DES. Which represents further studies may be necessary to increase our understanding and diagnosis.

To investigate the effect of vitamin D deficiency on tear break-up time (TBUT) and Schirmer test scores and to assess their relationship in non-Sjogren dry-eye patients. Thirty-four patients with serum vitamin D deficiency and 21 control subjects with normal vitamin D levels were included in this study. The TBUT and Schirmer-1 test without topical anesthesia were performed to all patients. The mean TBUT were 5.18±2.15 and 7.36±3.10 s and Schirmer scores were 12.18±6.44 and 18.57±8.99 mm in the study and control groups, respectively. TBUT scores and Schirmer-1 results of the study group were significantly lower than the control group (P=0.01 and 0.007, respectively). The mean vitamin D levels were 11.50±1.8 ng/ml in the study group and 32.8±8.72 ng/ml in control group (P=0.001). Dry-eye symptoms were detected in all patients in the study group and 15% of the patients in the control group. We demonstrated that vitamin D deficiency decreases the TBUT and Schirmer test values and may be associated with dry-eye symptoms in non-Sjogren syndrome.

Hormone replacement therapy (HRT) for dry eye syndrome (DES) is controversial in clinical practice. The goal of this study was to review relevant studies and analyze the pooled data to determine whether HRT is effective for DES. In this study, a literature search of PubMed, Embase, and Cochrane databases up to May 2015 was performed, with the search restricted to English language publications. The studies were screened after reading the abstract and full text. Only studies related to the effect of HRT on DES were included in the meta-analysis. Results of Schirmer tests with and without anesthetics and tear break-up time (BUT) values data were extracted and entered into RevMan software to meta-analyze the overall effect of HRT on DES. A total of 43 studies were identified, and 21 of these studies were found to be related to the effect of HRT on DES. Ultimately, 5 studies were included in the final meta-analysis. The pooled results revealed that HRT can affect Schirmer test results without anesthetics but does not affect Schirmer test results with anesthetics and BUT. The results indicate that HRT might improve DES symptoms when measuring basal tear production without anesthesia.

Dry eye syndrome is affecting a remarkable percentage of population. The prevalence is 10-15% of normal population, and 18-30% of contact lenses users. The break-up time (BUT) is a clinical test used for the diagnosis of this disease. In this work, we perform an analysis of parameters for a global and a local automatic computation of the BUT measure, based on criteria of specificity and sensitivity. We have tested our methodology on a dataset composed of 18 videos annotated by 4 different experts. The local analysis preserves the results of the global approach providing useful additional information about the break-up tear zone.

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.

Ryan Lee,1,2 Sharon Yeo,1 Han Tun Aung,3 Louis Tong1,2,4,5 1Ocular Surface Research Group, Singapore Eye Research Institute, 2Yong Loo Lin School of Medicine, National University of Singapore, 3School of Health Sciences, Ngee Ann Polytechnic, 4Duke-NUS Medical School, Singapore; 5Cornea and External Eye Disease Service, Singapore National Eye Centre, Singapore Background: It is difficult to standardize assessment of dry eye in different clinical settings. Increasingly, tear stability is recognized to be important for the definition and assessment of patients with dry eye. Recently, two commercially available instruments have been made available for objectively measuring noninvasive tear break-up time (NIBUT), as an indicator of tear stability: the Tomey RT-7000 Auto Refractor-Keratometer and Oculus Keratograph (K)5M. We aim to assess the agreement of NIBUT measurements using these modalities.Methods: This prospective cross-sectional study was carried out in a tertiary referral eye center and involved 126 consecutive dry eye patients. NIBUT assessment was performed on the right eyes of participants with both the RT-7000 and the K5M techniques, with the order of assessment randomized. The Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaires were administered to assess dry eye symptoms in the 2 weeks before assessment.Results: The age of the participants was 56.0±14.3 years (69.84% females). Measurements for both modalities were non-normally distributed (right-skewed). The median RT-7000 and K5M readings were 4.2 (range 0.1–10.0) and 6.4 (0.1–24.9) seconds, respectively. RT-7000 and K5M readings were poorly correlated (ρ=0.061, P=0.495). Intraclass correlation coefficient between the modalities was 0.187 (95% confidence interval -0.097 to 0.406). The Bland–Altman plot showed no systematic differences between the readings with these machines. The agreement between machines was not different in different SPEED categories.Conclusion: While there are theoretical and practical benefits of NIBUT for assessment of tear stability over dye-based methods, the agreement between the two modalities was poor. Hence, studies and trials assessing NIBUT should avoid using these modalities interchangeably for NIBUT assessment. More research is needed to improve consensus on how to determineNIBUT. Keywords: tear break-up time, tear film, Oculus Keratograph, Tomey RT-7000, dry eye

Purpose To evaluate the clinical value of non-invasive keratograph tear film breakup time (NIKBUT) in the assessment of pre-corneal and pre-lens tear film quality for prescribing contact lenses (CLs). Methods Forty-six subjects aged 25.5 ± 4.3 (mean ± standard deviation) years were recruited. Visual acuity (VA), anterior eye health checks and NIKBUT were evaluated. On the following day, subjects were fitted with a daily Silicon Hydrogel (SiHy) CL in one eye and a Hydrogel (Hy) CL in the other. After four hours one material for both eyes was chosen based on a qualitative analysis which included VA, CL fitting and comfort. Information about the first and the mean NIKBUT was then contrasted against the prescription decision. Results Thirty-four subjects were fitted with SiHy and twelve with Hy CL. No statistically significant differences were found for both NIKBUT parameters between left and right eye at baseline (p = 0.38 and p = 0.50, respectively) and post four hours of CL wear (p = 0.61 and p = 0.06). The chosen lens did not always correspond to longer NIKBUT. In 39.1% and 34.8% of cases (i.e., 18 and 16 out of 46), there was a match between prescription decision and the first and the mean NIKBUT results, respectively. Conclusions Although there is no evidence whether tear film surface quality measurement has a superior diagnostic values compared to other traditional clinical measures used in practice, NIKBUT measurements have provided additional information that could be of interest during CL fit.

Keratoconus is a debilitating condition where the cornea develops a conical shape rather than the characteristic round shape due to various physiological and structural changes taking place within the layers of the cornea. As a result of the pathogenesis of keratoconus, there are numerous changes that may occur within the tears of these patients. Research has shown changes in the tear metabolome, the presence of degradation products as well as loss of goblet cells into the tears. Could the changes occurring within the tear structure of these patients affect the results of various tear quantity and quality tests? Non-invasive tear break up time (NTBUT) is a diagnostic test used to determine the quality of the tear film and has been used extensively when diagnosing dry eye disease. This test is utilised in order to determine the time taken for the tear film to begin breaking apart, signalling thinning of the tears. Shorter break up times are therefore indicative of instability or changes occurring within the tear film which could be diagnostic of dry eye disease. Tear meniscus height (TMH) measurements have also been utilised in clinical practice, where these measurements provide an indication of the volume of tears contained within the upper and lower menisci. Lower tear volumes have been shown to be present in cases of dry eye disease where either tear production or tear drainage may be affected. Changes in the quality and quantity of the tear film in subjects with dry eye disease have been thoroughly investigated; however, the same cannot be said for subjects with keratoconus. Could the same findings be possible in subjects with keratoconus? Is it possible that the changes occurring within the tears of keratoconic subjects could lead to abnormal NTBUT and TMH measurements when compared to those of control subjects? Could the results of the NTBUT and TMH tests be related to one another? This study compares the NTBUT and TMH measurements of both keratoconic and control subjects by making use of a single type of instrumentation, namely the Oculus Keratograph 4 (OK4). The results of this study reveal that the values obtained for each of the two subject groups are not shown to be statistically significantly different and that there is no significant correlation between the NTBUT and TMH measurements when comparing keratoconic and control subjects.

To (i) analyze the repeatability of fluorescein instillation from a modified fluorescein strip (MFS) compared to a standard fluorescein strip (FS), and to (ii) observe its usefulness in the measurement of the fluorescein break-up time (FBUT) in comparison to the Tearscope (NIBUT).In-vitro: Intra- and inter-observer repeatability in fluorescein instillation from the MFS and FS was evaluated by fluorescence analysis (n=10, each). In-vivo: BUT of the right eye of 20 randomly selected subjects (mean age 43.3±11.5, range=21-60 years, 8 males, 12 females) was measured by use of the Tearscope and MFS. Subjects were grouped by the Ocular Surface Disease Index (OSDI) score into 8 OSDI+ and 12 OSDI- by a cut-off value of 15.In-vitro: Intra-observer 95% limit of agreement (LoA) of the MFS was similar to the FS LoA in observer 1 (O1), but better than the FS LoA in observer (O2) (MFS: O1: LoA=±1.98 mW; p=0.179; O2: ±2.71; 0.442; FS: O1: ±1.71; 0.246; O2: ±4.11; 0.512). Inter-observer LoA in fluorescence was better in MFS (±1.42; 0.111) than in FS (±3.71; 0.003). In-vivo: MFS-BUT was significantly shorter than the NIBUT (p=0.002), but significantly correlated (r=0.864, p0.001). NIBUT and MFS-BUT were significant discriminators (p0.001) of OSDI±(0.948/8s and 0.938/5s [AUC/cut-off value]; NIBUT and MFS-BUT, respectively).The MFS was better in the repeatability of fluorescein instillation than the FS. NIBUT and MFS-BUT were good discriminators of dry eye symptoms, but differ in their cut-off values.

Background: Dry eye syndrome (DES) is common after upper lid blepharoplasty (ULB), but tends to be self-limiting over the course of days to weeks. This occurs because the blink mechanism and tear film spread over the cornea are disrupted temporarily. More aggressive surgical techniques and over-excision of skin and orbicularis oculi muscle (OOM) appeared to increase the risk of dry eye following ULB. Objectives: to study the impact of OOM strip excision during ULB on the tear film break up time (TFBUT) and postoperative occurrence and severity of dry eye symptoms. Paitents and Methods: This interventional comparative study included 40 eyes of 20 patients (14 females and 6 males, the mean (M) age was 57.05 ± 4.80 years old. All patients had bilateral aesthetic ULB. Patients were divided into two groups: Group A: 8 patients (5 females and 3 males, M age was 58.38 ± 5.53 years old) who had bilateral ULB surgeries including OOM strip excision. And Group B: 12 patients (9 females and 3 males, M age was 56.17 ± 4.26 years old) who had bilateral ULB surgeries with preservation of OOM. Preoperative evaluation: General medical history and full ophthalmologic history were taken. Full ophthalmologic examination was performed including corneal and tear film examination, TFBUT and Schirmer's tests. Lid crease height, palpebral fissure and marginal reflex distance were measured. Patients with uncontrolled chronic systemic diseases were excluded. Patients with exophthalmos, lid retraction, ptosis, brow ptosis, entropion or ectropion were also excluded. Follow up: TFBUT and dry eye symptoms were assessed for each patient at one week and at one month postoperatively. Patients with continuous symptoms of dry eye postoperatively were followed up until three months. The changes of TFBUT of participants were statistically analyzed using the paired t-test. The M and standard deviation (SD) were used to obtain probability (P) value which was considered statistically significant when it was ≤ 0.05. Results: As regard changes of TFBUT; there was statistically significant decrease in TFBUT M values in group A from 11 ± 1.37 seconds (s) preoperatively to be 9.69 ± 2.18 s at one week postoperatively. This decrease in TFBUT M value was temporary and reversible as there was statistically significant increase of TFBUT M value from 9.69 ± 2.18 s at one week postoperatively to be 10.56 ± 1.86 s at one month postoperatively which was near to the preoperative value As regard group B, there were non-statistically significant changes in TFBUT M values. Dry eye symptoms had been recorded by four patients from group A (50%) and two patients from group B (16.7%). These symptoms were more severe in patients of group A. All these symptoms were reversible and frequent use of lubricating eye drops and gels for one week was enough to reduce the patients' discomfort in most of cases, but 2 female cases from group A with multiple combined risk factors had needed to use low dose steroid eye drops and night eye anti-inflammatory ointments in addition to relatively longer period of lubricating eye drops using to reduce dry eye symptoms. According to the present study results, the most important risk factor for postoperative dry eye symptoms was excision of OOM strip during ULB. History of lubricating eye drops using was also associated with increased incidence of postoperative dry eye symptoms. Hypothyroidism and diabetes mellitus (DM) were suspected risk factors which have needed to be proven by further specific studies. Changes of TFBUT and reported dry eye symptoms following ULB were temporary and reversible in all cases of the present study. Conclusion: Excision of OOM strip during ULB was associated with temporary statistically significant decrease in TFBUT and was also associated with more occurrences of reversible dry eye symptoms. Avoiding excision of OOM strip during ULB (if not indicated) was proven to minimize the occurrence of postoperative dry eye symptoms especially for patients with history of DES, for patient with repeated ULB, and those with systemic risk factors such as DM and thyroid dysfunctions.

To determine the effect of rebamipide ophthalmic suspension on optical quality in patients with dry eye with short break-up time (BUT) of the tear film.Twenty-six eyes of 16 patients with the short BUT type of dry eye were enrolled and treated with 2% rebamipide ophthalmic suspension. At baseline and at 2 and 4 weeks after initiating the treatment, the serial corneal higher-order aberrations (HOAs), BUT, fluorescein staining, and Schirmer test were measured. Patients were asked to complete questionnaires about the changes in dry eye-related ocular symptoms after the treatment.Before the treatment, the pattern of postblink corneal HOAs for 10 seconds showed a sawtooth pattern, with a marked upward curve that increased after blinking. Treatment with rebamipide for 4 weeks significantly (P0.05) improved the postblink corneal HOAs and stabilized the pattern of the corneal HOAs. Significant increases in the tear film BUT were seen 2 and 4 weeks after the treatment (P0.001 for both comparisons).Rebamipide administered to treat the short BUT type of dry eye significantly improved optical quality because of the improvement in tear stability.

Purpose To investigate accommodative microfluctuations (AMFs) and visual function in short tear break-up time (BUT)-type dry eye (DE) and non-DE subjects. Methods This prospective comparative study included 48 volunteers with DE symptoms (mean age 34.8 ± 5.5 years, age range 25–42 years) and 73 without DE symptoms (mean age 30.6 ± 4.7 years, age range 25–42 years). The eyes were divided into two groups: (1) DE group with DE symptoms and BUT ≤ 5 s and (2) non-DE group without DE symptoms and BUT > 5 s. We excluded eyes with Schirmer score ≤ 5 mm and positive keratoconjunctival epithelial damage. Tear evaluation, AMF, and functional visual acuity (VA) examinations were performed. AMF parameters included total high-frequency component (HFC), HFC with low accommodation for the task of staring into the distance (HFC1), and HFC with high accommodation for deskwork (HFC2). Functional VA parameters included starting VA, functional VA, visual maintenance ratio, and blink frequency. Results A total of 33 and 34 eyes were categorized in the DE and non-DE groups, respectively. Mean blink frequency and HFC1 values were significantly higher in the DE group than they were in the non-DE group. Conclusions DEs with symptoms showed abnormal AMF and visual function, which may be associated with DE symptoms.

PURPOSE To evaluate the efficacy of punctum plug insertion on tear and dynamic visual function in dry eye patients with short break-up time (s-BUT) of the tears. METHODS A prospective comparative case series design was used. Twenty-seven eyes of 27 dry eye patients with a s-BUT seen at Keio University School of Medicine, Department of Ophthalmology, were studied. Functional visual acuity (FVA) measurements, tear function examinations and ocular surface evaluations including Schirmer test, tear break-up time, fluorescein and Rose Bengal vital staining scores were performed before and 1 month after insertion of punctum plugs (PP) in dry eye patients with s-BUT. Degree of satisfaction with the PP treatment was also graded. RESULTS Nineteen out of 27 eyes (70.4%) showed a satisfactory outcome with the PP treatment because of decreased subjective dry eye symptoms. On the other hand, six out of eight eyes with an unsatisfactory outcome had epiphora. The visual maintenance ratio value was observed to significantly increase from 0.87 +/- 0.09 to 0.91 +/- 0.07 in eyes with no epiphora, whereas the visual maintenance ratio value significantly decreased from 0.98 +/- 0.10 to 0.86 +/- 0.13 in the group of eyes with epiphora after PP treatment. (p < 0.05) Likewise, FVA significantly improved after PP insertion in the group with no epiphora and decreased in eyes with epiphora. Visual acuity in the conventional Landolt visual testing remained significantly unchanged in both group of eyes with or without epiphora. CONCLUSIONS FVA was useful in assessing and quantifying vision related symptomatology in s-BUT type of dry eye treated with PP occlusion.

A possible correlation between break-up time (BUT) and blink frequency was investigated in 32 healthy persons (17 females and 15 males) and in 29 patients suffering from primary Sjogren's syndrome (27 females and 2 males). A significant negative correlation, was found between BUT and blink frequency. In persons with high BUT, the blink frequency is low, probably just sufficient to prevent spontaneous tear breaks. In persons with low BUT, i.e. the Sjogren patients, the blink frequency is high, and tear fluid breaks are mostly prevented.