Search

Background The Schirmer tear test (STT) is widely used in both human and veterinary ophthalmology. Two types of STTs have been developed: STT I and SST II. The STT I measures the basal and reflex tear production and is the most widely used STT. However, several factors influence the STT results such as the person performing the test and the location of the strip placement within the conjunctival sac. The aim of this study was to measure the basal and reflex tear production (STT I) in clinically normal horses with open versus closed eyes. Results Forty clinically healthy horses without any ocular diseases were included. On day 1, the STT I was first performed on all the horses with the eyes open followed by an STT I with closed eyes performed 30 min later. On day 2, all horses had their eyes closed during the first STT and the eyes open during the second test performed 30 min later. The mean value of the STTs performed on open eye was significantly less than the STT performed on closed eye on both days of examination. Conclusion This study showed a small but statistically significant difference between STT values obtained with open versus closed eyes in clinically normal horses.

Background: Dyslipidemia may be linked to meibomian gland dysfunction (MGD) and altered meibum lipid composition. The purpose was to determine if plasma and meibum cholesteryl esters (CE), triglycerides (TG), ceramides (Cer) and sphingomyelins (SM) change in a mouse model of diet-induced obesity where mice develop dyslipidemia. Methods: Male C57/BL6 mice (8/group, age = 6 wks) were fed a normal (ND, 15% kcal fat) or an obesogenic high-fat diet (HFD, 42% kcal fat) for 10 wks. Tear production was measured and meibography was performed. Body and epididymal adipose tissue (eAT) weights were determined. Nano-ESI-MS/MS and LC-ESI-MS/MS were used to detect CE, TG, Cer and SM species. Data were analyzed by principal component analysis, Pearson&rsquo, s correlation and unpaired t-tests adjusted for multiple comparisons, significance set at p &le, 0.05. Results: Compared to ND mice, HFD mice gained more weight and showed heavier eAT and dyslipidemia with higher levels of plasma CE, TG, Cer and SM. HFD mice had hypertrophic meibomian glands, increased levels of lipid species acylated by saturated fatty acids in plasma and meibum and excessive tear production. Conclusions: The majority of meibum lipid species with saturated fatty acids increased with HFD feeding with evidence of meibomian gland hypertrophy and excessive tearing. The dyslipidemia is associated with altered meibum composition, a key feature of MGD.

Eyes are the windows to the soul. Ayurvedic classical texts have mentioned about eye and its diseases since Vedic and Samhita kala, thus showing the importance of eye and ways to protect it. That is why eye care has been one of the priorities since the ages. In Ayurveda clinical features related to Dry eye are generally seen in Suskaksipaka. Over use of Video Display Terminals (V.D.T) like Computer, Mobiles, and Television & faulty lifestyle are some of the causes. Among these disorders, many are related to Indriya (Sensory Organ) especially Caksurindriya (Eye). In metro city, more than 50% cases from ophthalmic OPD are of Dry Eye Syndrome. Dry Eye Syndrome is a common ophthalmic condition, in its real sense is a problem for eye care practitioners due to its variegated etiologies, multi factorial physiopathology, lack of gold standard for diagnostic procedure. No curative treatment modalities are available and the palliative measures are inadequate too. It presents a great challenge to physicians. That’s why its prevalence is very high. It is 5% to 35% worldwide, while in India it is 29.25%. Dry Eye Syndrome also known as Kerato-Conjunctivitis Sicca (KCS) is considered a disease of the modern era. Dry eye syndrome, one of the most frequently encountered ocular morbidities, a growing public health problem and one of the most common conditions seen by the eye care practitioners. Tear secretion provides continuous moisture and lubrication on the ocular surface and provides oxygen to the corneal- epithelium. When the normal tear production is compromised, it leads to dry eyes.

Background:Sjögren Syndrome (SS) is a multifaceted disease with variable symptoms, but the SS associated keratoconjunctivitis is one of the most frequent disease manifestations of the syndrome and the manifestation that has the greatest impact on the quality of life for these patients.Objectives:To report the clinical efficacy of MC2-03 eyedrops in Sjögren’s patients with moderate-to-severe keratitis from a 6-month trial looking at the Schirmer score which assess the tear production by the lacrimal gland. A Schirmer score of ≤5mm/5 min is one of the criteria used in the 2016 final classification of ACR/EULAR to diagnose Sjögren`s syndrome.Methods:The NORTHERN LIGHTS trial is a randomized, double masked, controlled multicentre European trial that assessed MC2-03 eyedrops (ciclosporin 0.03% and 0.06%) for the treatment of moderate-to-severe dry eye disease in 255 patients having corneal fluorescein staining score 3 or 4 at baseline. The Schirmer score (per 5 min) was assessed during this trial. A total of 66 patients (25.9%) with medical history of Sjögren’s syndrome were randomized in the trial.Results:Demographics and baseline disease characteristics were comparable between treatment arms: mean age 60.4 years, 90.9% were females (n=60) and the mean Schirmer score in the worst eye was ~3mm (2.8mm – 3.2mm, except for the vehicle, mean Schirmer score of 5.5mm).The mean Schirmer score improved rapidly from baseline to month 1 for MC2-03 0.03% eye drops (+2.4mm) reaching statistical significance versus vehicle (-0.5mm, p=0.028) and lubricant therapy (-0.6mm, p=0.020). This improvement was maintained at month 6 where the change was +2.5mm for MC2-03 0.03% eye drops compared to -1.1mm for vehicle (p=0.028). Statistical significance was also achieved at Month 6 comparing the higher strength MC2-03 0.06% eye drops (+2.8mm) to vehicle (-1.1mm, p=0.005) and lubricant alone (-0.5mm, p=0.009).Three in eleven (27.3%) Sjögren`s patients treated with MC2-03 0.03% eye drops improved from a diagnostically low Schirmer ≤5mm at baseline (10/12, 83.3% ≤5mm) to Schirmer >5mm at month 3 and month 6 (6/11, 54.5% ≤5mm), while on the other hand 1 in 14 (7.1%) patients worsened in the vehicle group. A similar response was seen for MC2-03 eye drops 0.06%.For Sjögren´s patients with Schirmer ≤5mm at baseline, a greater proportion of patients improved ≥3mm at month 6 when treated with MC2-03 eye drops 0.03% (44.4%, 4/9) and 0.06% (53.8%, 7/13) compared to vehicle (0%, 0/9) and lubricant (7.7%, 1/12). At month 6, a statistically significantly higher proportion of patients achieved clinically meaningful improvements in both corneal staining (≥2 grades improvement) and Schirmer score (≥3mm/5 min) when treated with MC2-03 0.03% eye drops (45.5%, 5/11) compared to both vehicle (0%, 0/14, p=0.009) and lubricant (0%, 0/15, p= 0.007). A higher number of patients treated with MC2-03 0.06% was observed without statistical significance.Conclusion:MC2-03 eye drops once daily rapidly increased tear production and further improved corneal staining in Sjögren´s patients with moderate to severe keratitis, which both are objectives included as diagnostic criteria for Sjögren’s disease. MC2-03 eye drops were well tolerated with no unexpected safety findings.Disclosure of Interests: :Frederic Gomez Consultant of: MC2 Therapeutics, Morten Præstegaard Employee of: MC2 Therapeutics, Johan Selmer Employee of: MC2 Therapeutics, Jutta Horwath-Winter Consultant of: CromaPharma, Omnivision, MC2 Therapeutics, Speakers bureau: Allergan, Bausch&Lomb, Cromapharma, Ursapharma, Thea, TRB-Chemedica, Santen, Maite Sainz de la Maza: None declared, Steffen Heegaard Consultant of: Sanofi, MC2 Therapeutics, Speakers bureau: Santen, Sanofi, Thea, Leo

This study aimed to describe strip meniscometry test values for Amazona aestiva (turquoise-fronted amazon), Ara ararauna (blue-and-yellow macaw) and Caiman latirostris (broad-snouted caiman). Twenty-one Amazona aestiva and 11 Ara ararauna, healthy, adults of unknown sex, and 37 healthy adult Caiman latirostris (27 males and 10 females), were used in this investigation. All animals were manually restrained and I-Tear® Test strip was inserted for 5 s at the edge of the lower tear meniscus, without touching the eyelid or ocular surface, immediately followed by measurement (millimeter per 5 seconds). No differences were reported between left and right eyes for Amazona aestiva (P = 0.824), Ara ararauna (P = 0.262) and Caiman latirostris (P = 0.679). Median and confidence interval were 2.0 (2.25-3.56) mm/5s for Amazona aestiva, 3.0 (2.93-4.15) mm/5s for Ara ararauna and 3.0 (2.55-4.90) mm/5 s for Caiman latirostris. These values for strip meniscometry tear test can be used as parameters for each species and may be helpful for diagnosis and treatment of tear-production disorders in birds and reptiles. RESUMO: O objetivo deste estudo foi descrever os valores do teste de meniscometria lacrimal para Amazona aestiva (papagaio-verdadeiro), Ara ararauna (arara-canindé) e Caiman latirostris (jacaré-de-papo-amarelo). Vinte e um Amazona aestiva, 11 Ara ararauna adultos, de sexo desconhecido, e 37 Caiman latirostris adultos (27 machos e 10 fêmeas), foram utilizados nesta investigação. Todos os animais foram contidos manualmente e uma tira do I-Tear® test foi inserida por 5 segundos na borda do menisco inferior, sem tocar a pálpebra ou a superfície ocular, e imediatamente mensurada (milímetro por 5 segundos). Não foram encontradas diferenças entre os olhos esquerdos e direitos para Amazona aestiva (P = 0,824), Ara ararauna (P = 0,262) e Caiman latirostris (P = 0,679). Mediana e intervalo de confiança foram de 2,0 (2,25-3,56) mm/5 s para Amazona aestiva, 3,0 (2,93-4,15) mm/5 s para Ara ararauna e 3,0 (2,55-4,90) mm/5 s para Caiman latirostris. Estes valores para o teste de meniscometria podem ser utilizados como parâmetros para estas espécies e podem ser úteis para diagnosticar e tratar distúrbios de produção lacrimal em aves e répteis.

Среди звеньев патогенеза синдрома «сухого глаза» особо выделяют гипоксию и оксидативный стресс, однако в лечении этого заболевания доминирует слезозаместительная терапия, тогда как стимуляторы выработки слезы и антигипоксанты применяются явно недостаточно. Цель работы — изучить влияние препарата, содержащего митохондриальный субстрат и кофакторы окисления, на продукцию и состав слёзной жидкости при синдроме «сухого глаза» профессиональной этиологии. Материал и методы. В исследовании участвовали 124 пациента (248 глаз) с синдромом сухого глаза профессионального генеза (сварщики и офисные работники). Пациентов разделили на 4 симметричные группы сравнения: две из которых получали препарат, содержащий янтарную кислоту, рибоксин, никотинамид, рибофлавин, две — плацебо. Препарат и плацебо принимали по 2 таблетки 2 раза в день в течение 25 дней три цикла с перерывом в 1 мес. Оценивали слезопродукцию (проба Ширмера), стабильность слезы (проба Норна) и её состав (по содержанию белка, глюкозы, холестерина, триглицеридов, железа и кальция) до и после каждого цикла, через 6 и 12 мес. после окончания лечения. Результаты. У сварщиков и офисных работников исходно была снижена слезопродукция и стабильность слёзной плёнки в 1,5—2,0 раза, уменьшено содержание белка, триглицеридов, холестерина, железа и кальция в 2—3 раза. По мере суммации фармакодинамических эффектов препарата в ходе лечения к окончанию 3-го цикла увеличились слёзопродукция и прочность слёзной плёнки, возросло содержание белка, глюкозы, триглицеридов, холестерина, железа и кальция в слёзной жидкости, причём у офисных работников позитивные сдвиги преобладали. Заключение. Митохондриальные субстраты и кофакторы корректируют слёзопродукцию, свойства и состав слёзной плёнки при синдроме «сухого глаза» профессионального генеза., Hypoxia and oxidative stress are especially distinguished among the links in the pathogenesis of the dry eye syndrome, however tear replacement therapy dominates in the treatment of this disease, while tear stimulants and antihypoxants are still not as popular. The aim of the study is to investigate the effect of a preparation containing mitochondrial substrate and oxidation cofactors on the production and composition of lacrimal fluid in occupational dry eye syndrome. Materials and Methods: 124 patients (office managers and welders) with occupational dry eye syndrome were randomized into 4 symmetric comparison groups. The patients in two of the groups received a medication containing succinic acid, riboxin, nicotinamide, and riboflavin; while the other two groups received placebo. The treatment regimen in all groups consisted of 3 cycles of 2 tablets 2 times per day for 25 days with 1 month break. Schirmer test was used to assess tear production, Norn's test — to control tear stability. Tear composition (proteins, glucose, cholesterine, triglycerides, iron, and calcium levels) was also checked. The tests and tear components assessment were undertaken before and after every cycle, as well as 6 and 12 months after the end of treatment. Results: initially, tear production and stability of the tear film were reduced by 1.5–2.0 times in both welders and office workers; the content of protein, triglycerides, cholesterol, iron, and calcium was reduced by 2–3 times. As the pharmacodynamic effects of the drug were summarized during treatment, tear production and tear film strength increased by the end of the 3rd cycle, the content of protein, glucose, triglycerides, cholesterol, iron, and calcium in the lacrimal fluid increased; positive changes prevailed among office workers. Conclusion: mitochondrial substrates and cofactors improve tear liquid production, properties and composition of the tear film in the case of occupational dry eye syndrome.

The establishment of parameters for tear production in different species is important for better understanding eye´s health and is one of the components of the ophthalmic semiological technique. Particularities derived from the anatomophysiology of non-domestic species induce the search for more reliable methodologies. The aim was to evaluate and compare tear production of white-eared opossum (Didelphis albiventris) and Brazilian common opossum (Didelphis aurita) by three different methods. Fifteen individuals of each species, juveniles, healthy, of both sexes, with 60 to 90 days of life, were physically restrained. Phenol red thread test (PRTT), endodontic absorbent paper point tear test (EAPPTT) and modified -Schirmer tear test (mSTT) were performed. PRTT was the most difficult to perform because of the wire malleability, while EAPPTT was more feasible for both species. The median ± semi-quartile range for PRTT were 19.79±2.61mm/15 “and 5.22±2.92mm/15”, for EAPPTT were 16.25±1.82mm/min and 10.9±3.04mm/min, and for STTm were 0±1.63mm/min and 0±1.63mm/min for white-eared opossum and Brazilian common opossum respectively. There was no difference between the right and left eye neither sex. A significant difference was obtained for the same test to different species. No significant correlation was found between the tests for both species. The description of tear production parameters for juvenile white-eared opossum and Brazilian common opossum may be used as a tool, which will allow the early diagnosis of ocular diseases. RESUMO: O estabelecimento do parâmetro de produção lacrimal nas diferentes espécies é importante para o entendimento da saúde do olho e é um dos componentes da semiotécnica oftálmica. Particularidades derivadas da anatomofisiologia das espécies não domésticas induzem a busca de metodologias que sejam mais fidedignas aos parâmetros. Objetivou-se com este estudo avaliar e comparar a produção lacrimal de gambás-de-orelha-branca (Didelphis albiventris) e gambás-de-orelha-preta (Didelphis aurita) por três diferentes métodos. Quinze indivíduos de cada espécie, juvenis, hígidos, de ambos os sexos, com 60 a 90 dias de vida, foram contidos fisicamente para realização do teste lacrimal do vermelho de fenol (TLVF), da ponta de papel absorvente estéril e do teste lacrimal de Schirmer modificado (TLSm). O TLVF foi o mais difícil de ser executado devido à maleabilidade do fio, enquanto a TEPA se mostrou mais exequível para ambas as espécies. A mediana ± intervalo semi-interquartil para o TLVF foi de 19,79±2,61mm/15” e 5,22±2,92mm/15”, para a TEPA foram de 16,25±1,82mm/min e 10,93±3,04mm/min, e para o TLSm foram de 0±1,63mm/min e 0±1,63mm/min, para gambás-de-orelha-branca e gambás-de-orelha-preta, respectivamente. Não houve diferença entre o olho direito e esquerdo e nem quanto ao sexo. Obteve-se diferença significativa para um mesmo teste entre as espécies. Não foi encontrada correlação significativa entre os testes para ambas as espécies. A quantificação da porção aquosa da lágrima poderá auxiliar no diagnóstico precoce de doenças oculares nas espécies estudadas.

Dry eye syndrome (DES, also referred to as keratoconjunctivitis sicca, or KCS) is very common, affecting between 5% and 30% of the population. Symptoms range from occasional irritation to debilitating pain and visual compromise. Numerous studies have found that DES significantly affects patient’s quality of life. In 2015 alone, the sale of dry eye medications and devices accounted for $3.2 billion, and this is expected to grow to $4.5 billion by 2020. While it is easy to identify the symptoms associated with dry eye (foreign body sensation, grittiness, epiphora, burning, etc.), it is much more challenging to define the syndrome itself. “Dry eye” is a multifactorial and complicated condition, dependent on tear production and evaporation, inflammation of the ocular surface, and patient symptomatology.

Background Past studies have shown that 5-mm Schirmer tear tests (STTs) are difficult to interpret in guinea pigs. Modified 2.5-mm STT strips are more adequate for measuring the small volume of tear production in these animals. The aim of this study was to establish reference values for the modified 2.5-mm STT strips. Methods Modified STT measurements were performed in random order in both eyes of 50 guinea pig patients. The wetting of the strip was noted at 30 seconds and at 1 minute. Results The mean±sd STT values for both eyes were 7.58±3.19 mm at 30 seconds and 10.42±3.92 mm at 60 seconds. The median was 8 mm at 30 seconds and 10 mm at 60 seconds for both eyes. Animals under one year of age had lower STT values. STT values at 30 and 60 seconds can both be used. Both eyes should be measured when possible. Conclusion The authors recommend values above 8 mm at 30 seconds and 10 mm at 60 seconds to be considered normal when using a 2.5-mm STT strip. There are ambiguous areas at 5–8 mm and 6–10 mm. If in these ranges the results should be combined with clinical signs and judgement.

Objectives To evaluate the combined effect of intramuscular acepromazine and methadone on tear production in dogs undergoing general anaesthesia for elective, non-ocular procedures. Design Prospective, non-randomised, pre-post treatment study. Setting Patients were recruited from a referral practice in the United Kingdom. Methods Thirty client-owned dogs were enrolled in this study and received a combined intramuscular premedication of methadone (0.3 mg/kg) and acepromazine (0.02 mg/kg) prior to general anaesthesia for elective, non-ocular procedures. Full ophthalmic examination was performed and tear production was quantified using the Schirmer tear test-1 (STT-1). On the day of general anaesthesia, an STT-1 was performed before (STT-1a) and after (STT-1b) intramuscular premedication with methadone/acepromazine. Results Using a general linear model, a significant effect on STT-1 results was found for premedication with methadone/acepromazine (P = 0.013), but not eye laterality (P = 0.527). Following premedication, there was a significant reduction observed in the mean STT-1 readings of left and right eyes between STT-1a (20.4 ± 2.8 mm/min) and STT-1b (16.9 ± 4.1 mm/min; P < 0.001). Significantly more dogs had an STT-1 reading less than 15 mm/min in one or both eyes after premedication (30%; 9/30 dogs) compared with before premedication (6.7%; 2/30 dogs; P = 0.042). Conclusions An intramuscular premedication of methadone and acepromazine results in a decrease in tear production in dogs prior to elective general anaesthesia. This may contribute to the risk of ocular morbidities, such as corneal ulceration, particularly in patients with lower baseline tear production.

This study was performed to evaluate the effect of topical 1% cyclopentolate hydrochloride on tear production (STT), intraocular pressure (IOP), and vertical pupil diameter (VPD) in healthy Turkman horses. Forty eyes of 20 clinically normal horses were used for this study, which were randomly assigned to two groups. Before instillation of 1% cyclopentolate, the baseline STT, IOP, and VPD of each group were recorded. Then, one drop of cyclopentolate was instilled randomly into one eye of each animal, and the contralateral eye served as control. Measurements were repeated at 20 minutes, 60 minutes, 90 minutes, 120 minutes, 12 hours, and 24 hours, and every 24 hours up to 120 hours post drug instillation in all animals. There was no significant effect on STT over the time course measured in both the treated and untreated eyes of the treatment groups after unilateral instillation of 1% cyclopentolate when compared to baseline values. A significant increase in the IOP was observed after 20 minutes, which persisted for more than 90 minutes; then, the IOP insignificantly decreased below the baseline values after 120 minutes. Maximum VPD was recognized at 12 hours post instillation in treated eyes (15.8 ± 2.3 mm), which was significantly different in comparison to the baseline (P = .07). Cyclopentolate could be considered as a long term and potent cycloplegic drug in horses when taking into account the possible side effect of atropine.

OBJECTIVES The purpose of this study was to determine if a circadian rhythm exists in Schirmer's tear test (STT-1) values in a group of healthy adult cats. ANIMALS STUDIED Twenty adult neutered Domestic Short-haired cats (DSH) were used in the study. PROCEDURES Tear production was measured with the Schirmer tear test (STT-1) at 12 different time points over a 48-hour period. RESULTS A significant difference (approximately 4.3 mm/min) was noted between STT-1 values measured between 4 pm (lowest) and 12 am (highest) on both day 1 (P = 0.02) and day 2 (P = 0.01), and substantial variation in STT-1 values was observed at different times during the 48-hour period. CONCLUSIONS Significant variation in mean STT-1 values demonstrates that there is a circadian rhythm in tear production in cats and thus shows the importance of taking the time of day into account when measuring STT-1 in cats.

A high incidence, continuous growth rates as well as collected data on modifying influence of subclinical hypothyroidism (SH) on cardiovascular disease, necessitate the improvement of clinical diagnostic methods of hypothyroidism at the early stages. Thyroid hypofunction has been proved to be influential in the tear fluid secretion and dry eye syndrome development. However, there is insufficient evidence of tear production parameters use for hypothyroidism diagnosis at the preclinical stages in patients with cardiovascular disease. The aim of the work – to improve the diagnostics of SH in hypertensive patients by examining tear production parameters using the Schirmer test. Materials and methods. 102 patients with essential hypertension stage II were enrolled in the study after signing an informed consent. Depending on the thyroid stimulating hormone (TSH) level patients were divided into 2 groups - with normal (0.4–4.0 mU\ml) and moderately increased level of TSH (4.0–15.6 mU\ml with normal levels of thyroid hormones). The group of hypertensive patients without SH included 71 patients (83.1 % of women (59) and 16.9 % of men (12)), the group of hypertensive patients with concomitant SH consisted of 31 patients (90.32 % of women (28) and 9.68 % of male, (3)). Patient groups were matched for age (55.11 ± 8.67 years versus 58.09 ± 10.04 years; P = 0.131), gender (P = 0.363), height (P = 0.821), weight (P = 0.832), body surface area (P = 0.780), body mass index (P = 0.885). Apart from laboratory thyroid screening (TSH, Free T4), all patients underwent the Schirmer test according to the standard procedure. There were conducted ROC-analysis, univariate logistic regression analysis, Bland-Altman analysis; the Mann-Whitney U-test and χ2 were used. Results. The average levels of TSH in hypertensive patient groups with euthyroidism and SH were 1.98 ± 0.82 mU\ml and 7.12 ± 2.96 mU\ml (P = 0.0001), the Schirmer test mean values – 20.02 ± 8.8 mm and 8.45 ±7.66 mm (P = 0.0001), respectively. According to the ROC-analysis the critical value of Schirmer test was indicator of13 mm (sensitivity 93.7%, specificity 69.6 %, AUC 0.853; 95 % CI 0.703–0.945; P = 0.0001). Univariate logistic regression analysis has shown that in patients with hypertensive disease the Schirmer test values ≤13 mm increased odds ratio for SH by 21.44 times (95 % CI 3.76–312.72, P = 0.0017). Results of Bland-Altman analysis have demonstrated high consistency of the data obtained by different methods of SH diagnosis. Conclusions. In hypertensive patients with concomitant SH a decrease in tear production according to the Schirmer test has been detected. The Schirmer test value of less than13 mm per 5 minutes should be considered as a criterion for SH diagnosis in hypertensive patients. Application of Bland-Altman method in comparing two methods of diagnosis allows using the Schirmer test for screening (prior to TSH levels determination) in patients with hypothyroidism as an additional factor of cardiovascular risk in patients with arterial hypertension.

Purpose: To determine if the Schirmer I test (without anesthesia) cut-off value is a predictor of dry eye severity in a large Norwegian cohort of dry eye disease (DED) patients, which are grouped into six levels of tear production. Methods: Patients (n = 1090) with DED of different etiologies received an extensive dry eye work-up: osmolarity (Osm), tear meniscus height (TMH), tear film break-up time (TFBUT), ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test (ST), meibum expressibility (ME), and meibum quality (MQ). Classification of dry eye severity level (DESL) and diagnosis of meibomian gland dysfunction (MGD) were also included. The cohort was divided into six groups: below and above cut-off values of 5 (groups 1 and 2), 10 (groups 3 and 4), and 15 mm (groups 5 and 6) of ST. Mann-Whitney test and Chi-Square test were used for group comparison of parameters (p ≤ 0.05). Results: The groups 1, 3, and 5 had values indicating more severe DED than the groups 2, 4, 6 with significant difference in DESL, Osm, TFBUT, OPI, OSS, and TMH. Regardless of the choice of cut-off values, there was no statistically significant difference in ME, MQ, and MGD between groups below and above selected cut-off value. When gender difference was considered in each group, significant difference was only observed for DESL (groups 2, 4, and 5), TFBUT (groups 2, 4, and 5), OPI (groups 2 and 6), and ME (group1). Conclusions: Schirmer I is a robust discriminator for DESL, Osm, TFBUT, OPI, OSS, and TMH, but not for ME, MQ, and MGD. Patients with lower tear production levels presented with more severe DED at all three defined cut-off values. Interestingly, the differences in the mean values of DESL were minimal although statistically significant. Thus, the clinical value of different Schirmer levels appears to be limited. KEYWORDS: Dry eye disease, Schirmer I test, tear production levels, clinical tests, large population of patients

WOS: 000442755200003, The current study was undertaken to establish reference values of intraocular pressure in clinically normal Turkish Shepherd Dogs with the rebound tonometer (TonoVet (R)) and the applanation tonometer (Tono-Pen Vet (R)). Twenty-eight dogs (14 male and 14 female, aged 9 months-9 years, 56 eyes) were used in this study. All animals were healthy and showed no abnormalities in ophthalmic examinations, which consisted of the Schirmer tear test, slit lamp bio-microscopy, and fluorescein staining. The animals were restrained manually without using systemic anesthetics or tranquilizers. IOP was measured in both eyes with a TonoVet (R) and a Tono-Pen Vet (R). In normal dogs, the mean IOP values for all eyes were 17.63 +/- 3.34 mmHg according to the TonoVet (R) and 14.95 +/- 2.92 mmHg according to the Tono-Pen Vet (R). There was no effect of sex, age, or eye side (right vs. left) on the results obtained with either the TonoVet (R) or the Tono-Pen Vet (R). The mean IOP obtained with the rebound tonometer was 2-3 mmHg higher than that measured with the applanation tonometer. The reference data obtained in the present study may assist in diagnostic testing for ophthalmic diseases in Turkish Shepherd Dogs and may promote further studies in this area.

Purpose: The aim of this paper was to investigate the degree of inflammation and dry-eye disease (DED) in recurrent pterygium. Methods: Fifty-five patients with a history of pterygium excision were divided into 3 groups – Group 1: no recurrence after the first excision; Group 2: recurrence after the first excision; Group 3: no recurrence after the second excision. Dry-eye symptoms and tear production were elicited for each patient. Results: A high prevalence of DED was observed in patients with primary and recurrent pterygium based on self-reported dry-eye symptoms (63.6%) and an abnormal Schirmer test result (78.1%). There was a statistically significant difference (p = 0.025) in the Schirmer test values between patients with (5.6 mm) and without (11.4 mm) recurrence after surgery for primary pterygium. Patients who were cured after a second excision had an improved Schirmer test value (9.5 mm), although this was not significant. Conclusion: Pterygium recurrence is associated with a greater severity of dry eye, possibly by perpetuating ocular surface inflammation in the postoperative period.

In 1980, botulinum toxin type A (BTX-A) was introduced for the treatment of strabismus and benign essential blepharospasm. Since then, a number of additional indications have been introduced, which continue to expand, providing less invasive solutions in managing different ophthalmic conditions.Successful trials of BTX-A injection into the lacrimal gland have been reported for the treatment of epiphora caused by primary lacrimal gland hyperlacrimation, functional tearing, gustatory tearing, and lacrimal outflow obstruction. This is achieved through blockage of the cholinergic receptors by BTX-A at the glandular level. Interestingly, BTX-A has also been found to be useful in treating patients with dry eyes by compromising the tear drainage from the eye through injection of BTX-A in the medial part of the lower eyelid. BTX-A may help provide effective relief for patients who have two different ophthalmic comorbidities such as benign essential blepharospasm and dry eye.Better understanding of the mechanism of BTX-A action in the treatment of the growing applications in ophthalmology helps provide relatively noninvasive solutions for patients. Full awareness of possible side effects of BTX-A and the optimal way to manage them is vital for the success of this treatment option.

Dry eye disease is a disorder of the tear film. In this study, the effect of Viola odorata L. oily extract was examined for the treatment of patients suffering from dry eye disease.A randomised, double-blind, placebo-controlled study was designed. During the trial, Schirmer's test, tear breakup time, Oxford staining and the Ocular Surface Disease Index were assessed. Overall, 105 patients with dry eye symptoms between the ages of 18 and 60 years were allocated to the violet-almond oil, almond oil and placebo (1% w/v hydroxypropyl methylcellulose solution) groups. The treatment and placebo were administered intranasally, two drops three times a day for one month. The patients were followed up for four weeks. A total of 91 patients (32, 29 and 30 in the violet-almond oil, almond oil and placebo groups, respectively) completed the study.At baseline, there was no difference between the three groups in terms of demographic data and the measurement parameters. After the intervention, the results revealed that the Schirmer's score without local anaesthesia and the tear breakup time results significantly improved in the violet-almond oil group. One-way ANOVA indicated a significant improvement in the Schirmer's score, tear breakup time and Ocular Surface Disease Index of the treatment group, as compared with the other groups (p 0.05). However, the obtained results did not present any significant mean difference between and within the groups of the Oxford staining grade (p 0.05).This trial showed that the intranasally administered V. odorata L. oily extract enhances tear production and improves tear film stability.

Background Dry eye disease (DED) is a prevalent complication of diabetes and presents as reduced tear production and/or increased corneal surface sensitivity often with secondary ocular surface changes. This study examined the safety and efficacy of a proprietary new eye drop formulation for topical treatment of DED. Methods Type 1 diabetes (T1D) was established in male Sprague-Dawley rats to study the efficacy and safety of the investigational compound that contained 20 μg/ml of naltrexone (NTX). Tear production was measured by the Schirmer’s 1 test, and ocular surface sensitivity was measured using an aesthesiometer. Diabetic rats received twice daily applications of a single drop (~ 0.02 ml) of the proprietary formulation (NTX-001) or vehicle onto one eye. For comparison, some diabetic rats received eye drops containing NTX in sterile Vigamox®. Safety was monitored by assessment of ocular histopathology in naïve male rats and naïve male rabbits receiving twice daily treatment of two drops for 30 days. Results Dry eye in T1D rats was reversed within hours of a single treatment of NTX-001, and over a period of 10 days NTX-001 restored corneal sensitivity and reversed dry eye relative to values measured in diabetic rats receiving vehicle. In comparison to NTX dissolved in Vigamox®, the proprietary NTX-001 was more effective at reversing dry eye. Safety studies in naïve rats and rabbits revealed no visible ocular pathology after 30 days of treatment. Conclusions An investigational new eye drop containing 20 μg/ml NTX effectively reversed tear film deficits and restored corneal surface sensitivity in diabetic animals without causing toxic side effects.

Conducted a comparative analysis of functional changes in tear production in patients with dry eye syndrome and endocrine ophthalmopathy in the conditions of the long-term acting of preservative free medications based on natural substances. A total of 30 people, aged 35 to 53 years old with clinical manifestations of DES on the background of EO were divided on two groups. In I group eye drops of ectoine and in II - artificial tears were administered. The examination included general and specific methods. The term of follow up - 30 days. It was found that long-term use of preservative free eye drops based on ectoine leads to more expressive positive changes in the condition of the anterior surface of the eye and the secretion and quality of the tear.

Author(s): Li, Songhao; Kim, Young Hyun; Li, Wing; Lin, Meng C; Radke, Clayton J | Abstract: SIGNIFICANCE:A simple methodology is presented to quantify basal tear production with a modified Schirmer-tear test. PURPOSE:We introduce a simple clinical procedure to measure quantitative basal tear-production flowrates, QL, from a modified Schirmer-tear test (STT). METHODS:Eight healthy subjects aged at least 18 years underwent modified STTs on both eyes for two visits each. Schirmer strips were sheathed with transparent tape before insertion. Topical anesthetic minimized reflex tearing. Wetting lengths were measured every 30 s for 5 min; QL was calculated from the linear slope of wetting length versus time. Determination of QL requires mass-balance equations on the tear prism and Schirmer strip with strip imbibition kinetics obeying Darcy and Young-Laplace laws. RESULTS:Basal tear production rates varied from essentially 0 to about 2 μl/min. With some exceptions, right and left eyes showed similar tear production rates. CONCLUSIONS:By following the modified STT, QL is established with minimal additional effort over a standard Schirmer test. We predict and observe four different subtypes of imbibition kinetics depending on how short or long the time is for first appearance of the wetting front and on how fast or slow is tear production. For slow lacrimal production rates, the standard 5-min wetting length does not correlate with basal tear production.

Keratoconjunctivitis sicca (KCS) is a relatively common condition affecting dogs worldwide.1-3 KCS is characterised by a deficiency in the production of the aqueous portion of the tear film, leading to conjunctival hyperaemia, bacterial overgrowth, ocular discharge, corneal vascularisation, corneal pigmentation, ocular pain and loss of vision.4-6 The primary cause of KCS is immune-mediated, but many other causes have also been reported, including congenital, metabolic, infectious, drug-induced, neurogenic, radiation, iatrogenic and idiopathic.7 The diagnosis of KCS is based on the presence of consistent clinical signs and measurement of decreased aqueous tear production using the Schirmer tear test (STT).8 It is largely accepted that an STT value greater than 15 mm/minute is considered normal for dogs, 11 to 14 mm/minute indicates subclinical KCS, 6 to 10 mm/minute indicates mild KCS and 5 mm/minute or less indicates severe KCS. However, several authors have criticised the STT’s variable sensitivity and reproducibility for diagnosing mild KCS.9,10 Due to the variability of STT measurements, a definitive diagnosis for mild cases of KCS may be difficult with the STT alone. As such, there is currently much interest in alternative measures for the diagnosis of KCS. A small number of previous studies …

Objectives The purpose of this study was to establish a reference value of tear production and intraocular pressure in clinically normal ducks and geese. Animal Studied The study population consisted of forty-eight ducks (24 males and 24 females) and fifty-two geese (26 males and 26 females). Procedures Birds were gently physically restrained in dorsoventral position without any pressure to the head and neck. Tear secretion and intraocular pressure were measured using 5-mm-wide Schirmer tear test strips and TonoVet® rebound tonometer, respectively. Results Overall mean ± 2SD STT and IOP values of all eyes were 6.2 ± 2.2 mm/min and 10.2 ± 2.2 mmHg, respectively, for the ducks; 5.5 ± 2.6 mm/min and 9.1 ± 2.0 mmHg, respectively, for the geese. There was no statistically significant difference in IOP between left eye and right eye or between males and females in ducks (P = 0.56, P = 0.63) and geese (P = 0.23, P = 0.22). Analysis of variance revealed that there were no significant differences in the STT and IOP between the breeds in ducks (P = 0.49, P = 0.68) and geese (P = 0.14, P = 0.26). Conclusions Results of this study may be beneficial for the diagnosis and therapeutic monitoring of ducks and geese affected with Keratoconjunctivitis sicca, glaucoma, and uveitis.

The aim of this study was to determine whether long-term wear of a fluid-filled scleral lens alters basal tear production, corneal sensation, corneal nerve density, and corneal nerve morphology in 2 disease categories.Patients recruited from the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment program at the Weill Cornell Medical College were categorized into 2 groups: distorted corneas (DC) or ocular surface disease (OSD). We measured tear production, central corneal sensation, subbasal nerve density and tortuosity, and stromal nerve thickness before and after long-term wear of the prosthetic device used in PROSE treatment, defined as at least 60 days of wear for a minimum of 8 hours a day.Twenty patients were included in the study. After long-term wear of the prosthetic device, tear production decreased in patients with DC (21.2 ± 8.5 to 10.4 ± 4.6 mm; P0.0001) but did not change in patients with OSD (7.5 ± 5.2 to 8.7 ± 7.2 mm; P = 0.71). Corneal sensation increased in the DC group (45.6 ± 9.2 to 55.0 ± 5.6 mm; P0.05). There was no significant change in sensation in patients with OSD (45.0 ± 8.7 to 49.1 ± 14.8 mm; P = 0.37). Subbasal nerve density, subbasal nerve tortuosity, and stromal nerve thickness remained unchanged in both DC and OSD groups after long-term wear (P0.05).Patients with DC had significantly reduced basal tear production and increased corneal sensation after long-term wear of the scleral lens, but patients with OSD did not show any changes in tear production or corneal sensation.

We report a rare case of a 4-year-old girl with involuntary watering of eyes and facial redness during painless voiding since early infancy. Here, we describe her response to urotherapy with improvement of involuntary tearing during micturition, which although neither life threatening nor debilitating, may be quite bothersome for children and their parents, leading to anxiety, emotional burden, or embarrassment. We hypothesize that the lacrimal glands and the bladder and bowel have common central nervous system pathways and that bladder retraining and bowel management might be a potential treatment for this rare condition.

Purpose To design a proof-of-concept study to assess the effect of lacrimal nerve stimulation (LNS) with an implantable pulse generator (IPG) to increase aqueous tear production. Methods Experimental animal study design of 6 Dutch Belted rabbits. Ultra high-resolution optical coherence tomography (UHR-OCT) quantified tear production by measuring the baseline tear volume of each rabbit's OD and OS. A neurostimulator was implanted adjacent to the right lacrimal nerve. After 2 minutes of LNS (100 μs, 1.6 mA, 20 Hz, 5-8 V), the tear volumes were measured with UHR-OCT. The change in tear volume was quantified and compared with the nonstimulated OS. Three rabbits underwent chronic LNS (100 μs, 1.6 mA, 10 Hz, 2 V) and their lacrimal glands were harvested for histopathologic analysis. Results The UHR-OCT imaging of the OD tear volume showed a 441% average increase in tear production after LNS as a percent of baseline. After stimulation, OD had statistically significant greater increase in tear volumes than OS (p = 0.028, Wilcoxon test). Poststimulation OD tear volumes were significantly greater compared with baseline (p = 0.028, Wilcoxon test). Histopathologic examination of the lacrimal glands showed no discernible tissue damage from chronic neurostimulation. In addition, there were no gross adverse effects on the general well-being of the animals due to chronic stimulation. Conclusions LNS with an IPG appears to increase aqueous tear production. Chronic LNS showed no histopathologic lacrimal gland damage. This study suggests that LNS is a promising new treatment strategy to increase aqueous tear production.

Purpose The aim of this study was to assess time-course changes of the ocular surface after simultaneous phacoemulsification and limbal relaxing incisions (LRIs) in the early postoperative period. Patients and methods We prospectively examined 35 eyes of 22 consecutive patients who underwent simultaneous cataract surgery with LRIs both preoperatively and postoperatively (1 week, 1 month, and 3 months). Ocular surface quality was assessed in terms of corneal sensitivity, tear break-up time (BUT), and tear production, both preoperatively and postoperatively. Corneal sensitivity was measured using the Cochet–Bonnet corneal aesthesiometer, and tear volume was determined using Schirmer’s I test. Results Corneal sensitivity was 58.5±3.9 mm preoperatively and was 58.3±2.7, 58.9±2.5, and 59.8±0.6 mm at 1 week, 1 month, and 3 months postoperatively, respectively [analysis of variance (ANOVA), P=0.13]. The BUT was 9.7±5.6 s preoperatively and was 5.6±3.1, 5.9±4.7, and 4.5±2.6 s at 1 week, 1 month, and 3 months, postoperatively, respectively (ANOVA, P=0.002). Tear volume was 15.2±8.8 mm preoperatively and was 12.2±6.9, 12.5±7.3, and 11.8±8.0 mm at 1 week, 1 month, and 3 months postoperatively, respectively (ANOVA, P=0.26). Conclusion Simultaneous phacoemulsification with LRIs induced a significant decrease in BUT postoperatively without significantly affecting tear volume or corneal sensitivity.

Author(s): Kim, Young Hyun; Graham, Andrew D; Li, Wing; Radke, Clayton J; Lin, Meng C | Abstract: PurposeTo assess and compare the wetting kinetics of sheathed and unsheathed Schirmer's tear test (STT) strips, and to determine the repeatability of 5-minute wetted length (WL) and basal tear production rate (BTPR).MethodsSeventeen subjects underwent two sheathed and unsheathed STTs each for both eyes on four visits on separate days. After administration of topical anesthetic, WLs were measured every 30 seconds for 5 minutes, and BTPRs were calculated for sheathed strips. Limits of agreement (LoA), difference-versus-mean plots (DVM), and the coefficient of repeatability (CR) assessed WL and BTPR repeatabilities. Variance estimates were used to calculate sample sizes for future study.ResultsFor the unsheathed STT, the mean (SD) difference in WLs between visits was 0.74 (5.05) mm, LoA were [-9.17, 10.64], and CR was 9.17 mm; for the sheathed STT, the mean (SD) intervisit difference was 0.16 (5.94) mm, LoA were [-11.49, 11.8], and CR was 10.53 mm. Eight of 48 sheathed STTs and 20 of 44 unsheathed STTs showed constant WL for the final 90 seconds of the test. The mean (SD) difference between repeated visits for BTPR was approximately 0.0 μL/min, LoA were [-1.82, 1.82], and CR was 1.91 μL/min.ConclusionsRepeatability of sheathed and unsheathed 5-minute WL and BTPR is inadequate for measuring within-subject changes, but is sufficient for group studies with moderate sample sizes. Constant WL for the final 90 seconds with the eight sheathed STT measurements suggests varying BTPR, whereas constant WL with the unsheathed STT can be explained by balancing evaporation and BTPR.Translational relevanceRepeatability of the modified STT is evaluated clinically to establish quantitative BTPRs rather than inference from a strip WL.

Objective To evaluate the effects of long-term computer use on tear production and evaporation. Methods In this study, 30 eyes of 30 people using computer for 8 hours a day were taken as the study group. In the control group, 30 eyes of 30 healthy individuals who did not spend 1 hour using computer on a daily basis were evaluated. The cases were examined at 8 am and 5 pm. The Schirmer test, tear break-up time (TBUT), and ocular surface disease index (OSDI) were evaluated. Results There was no significant difference between the groups in terms of age and gender. The Schirmer test results, which measure the parameters of tear production, were 16.80±2.04 and 15.50±2.06 mm (p>0.05) in the study group, and 17.28±1.52 and 17.16±2.53 in the control group. The TBUT measurements were 9.15±2.93 and 6.80±1.11 sec in the study group. It was observed that the evening TBUT decreased (p 0.05) in the control group. The OSDI scores were 26.7±3.36 and 28.3±1.19 in the study group, and 25.0±4.48 and 27.3±2.27 in the control group. Conclusion As a result, it was found that a long-term computer use did not change the Schirmer test results significantly, but there were statistically significant changes in the tear break-up time (TBUT) results of the evaporative type eye dryness. According the our study results, long-term computer usage may cause an evaporative-type dry eye disease.

Purpose: To survey ophthalmologists regarding their current therapy preferences and desires for future treatment to help guide providers in choosing treatments and pharmaceutical startups in developing future therapies. Methods: A prospective survey developed internally and sent twice to ophthalmologists. Results: There were 76 responses. Approximately 30% of respondents stated they examined a few cases of DED patients a day and 20% noted DED was a majority of their practice. Almost all physicians recommended tear replacement drops (95%) for their patients while 80% prescribed cyclosporine. Importantly, 40% started prescribing lifitegrast and the same percent prescribe tetracycline. When asked what new mechanisms of action physicians preferred, about 70% indicated improved tear film stability, while 50% desired greater lacrimal gland tear production. Further, 70% of physicians noted they would prescribe a product that increased tear film stability as first line. With two anti-inflammatory DED products currently available 55% of participants noted a third product should have a different mechanism of action while 25% desired better anti-inflammatory activity. In evaluating the available DED medications specifically, participants believed cyclosporine and lifitegrast had similar moderate levels of efficacy; with lifitegrast being slightly better tolerated than cyclosporine. Conclusions: The survey showed that DED patients are an important part of the ophthalmic practice. Multiple different therapeutic techniques are used and there is desire for new products that especially would treat tear film stability and corneal surface disease.

Dry eye syndrome (DES) or keratoconjunctivitis sicca (KCS) is a common disorder of the tear film caused by decreased tear production or increased evaporation and manifests with a wide variety of signs and symptoms. The present review from interpretation of the literature gives detailed information on the prevalence, definition, causes, diagnostic tests, and medical management of dry eye disease. A number of systems contribute to the physiological integrity of the ocular surface and disruption of system may or may not produce symptoms. Therefore accurate diagnosis of dry eyes with no or minimal disruption of physiological function is necessary. The paper also discusses different colloidal drug delivery systems and current challenges in the development of topical ophthalmic drug delivery systems for treatment of KCS. Due to the wide prevalence and number of factors involved, newer, more sensitive diagnostic techniques and novel therapeutic agents have been developed to provide ocular delivery systems with high therapeutic efficacy. The aim of this review is to provide awareness among the patients, health care professionals, and researchers about diagnosis and treatment of KCS and recent developments and future challenges in management of dry eye disease.

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.

ZusammenfassungGegenstand und Ziel: Eine Allgemeinanästhesie geht bekanntermaßen mit einer Verminderung der Tränenproduktion einher und auch nach Narkoseende werden nicht sofort wieder physiologische Werte erreicht. Folglich muss während dieser Zeit eine ausreichende Befeuchtung des Auges zum Schutz der Hornhaut gewährleistet werden. Hierzu stehen unterschiedliche Methoden zur Verfügung, wie das Zukleben der Augenlider oder die Applikation von Augensalben, -gelen oder -tropfen. Humanmedizinische Studien belegen, dass die verschiedenen Formulierungen in unterschiedlicher Ausprägung zu Irritationen am Auge führen können. Ziel dieser Studie war, die Tränenproduktionsmenge nach Allgemeinanästhesie bei der Katze und auftretende Augenirritationen hinsichtlich ihrer Pathogenese zu untersuchen. Material und Methoden: Bei 41 Katzen erfolgte nach Allgemeinanästhesie eine Messung der Tränenproduktion und die Augen wurden auf Irritationsanzeichen untersucht. Es kamen zwei unterschiedliche Narkoseprotokolle zur Anwendung und zum Schutz der Hornhaut wurde bei Narkoseeinleitung jeweils in das rechte Auge eine Augensalbe und in das linke Auge ein Augengel appliziert. Ergebnisse: Die Tränenproduktion war auf dem rechten Auge bis 6 Stunden und auf dem linken Auge bis 18 Stunden nach der Narkose signifikant reduziert. Bei 92,7% (n = 38) der Katzen bestand 2 Stunden nach Narkoseende ein Blepharospasmus am rechten Auge, während bei sämtlichen Tieren am linken Auge eine physiologische Lidöffnung vorlag. Schlussfolgerungen: Alle Katzen zeigten, unabhängig von verschiedenen Narkoseparametern, postanästhetisch eine signifikant verringerte Tränenproduktion. Sowohl das Augengel als auch die Augensalbe schützten die Hornhaut ausreichend. Bei gleicher Effektivität sollte jedoch dem Augengel der Vorzug gewährt werden, da davon auszugehen ist, dass die Augensalbe bei der Katze wie auch beim Menschen ein deutliches Fremdkörpergefühl im Auge verursacht.

The production of emotional tears appears to be uniquely present in Homo Sapiens. Despite the ubiquity of this human behavior, research is only just beginning to uncover the neurobiological underpinnings of human emotional crying. In this paper, we review the current state of the literature investigating the neurobiological aspects of this uniquely human behavior, including neuroanatomical, neurochemical, and psychophysiological findings. To set the context for this review, we first provide a brief overview of the evolutionary background and functions of tearful crying. Despite an accumulating understanding of the neurobiology of human emotional crying, the primary sources of information are currently from animal studies and observations in neurological patients suffering from pathological crying. Currently, most of the research on the neurobiology of crying in humans has focused on autonomic physiological processes underlying tearful crying, which may yield essential clues regarding the neural substrates of the production of crying behavior and its effects on the crier. Further challenges in elucidating the neurobiology of crying involve the complexity of crying behavior, which includes vocalizations, tear production, the involvement of facial musculature, subjective emotional experience, emotion regulatory behaviors, and social behaviors. Future research is needed to comprehensively characterize the neurobiology of this intriguing and complex human behavior.

The aim of this study is to determine the amount of tear secretion in sheep with infectious keratoconjunctivitis and healthy ones in the Siirt region by Schirmer tear test and phenol red thread tear test. A total of 47 Romanov sheep, consisting of sheep with infectious keratoconjunctivitis (n = 6) and healthy sheep (n = 41), constituted the study material. Phenol red thread tear test followed by Schirmer tear test was performed on both eyes of the animals, properly taken at a control visit on their feet. The Schirmer tear test and phenol red thread tear test values were measured as 18.83 +/- 5.29 mm/min and 22.22 +/- 6.09 mm/s in the right eyes and 18.41 +/- 7.15 mm/min and 20.83 +/- 5.72 mm/s in the left eyes, respectively, in healthy animals. The Schirmer tear test and phenol red thread tear test values were measured as 17.33 +/- 4.27 mm/min and 18.83 +/- 4.36 mm/s in the right eyes and 17.33 +/- 7.55 mm/min and 20.17 +/- 4.58 mm/s in the left eyes, respectively, in animals with infectious keratoconjunctivitis. The phenol red thread tear test measurement averages were found to be significantly higher than the Schirmer tear test measurement averages (P > 0.05). The amount of normal tear secretion was determined in Romanov breed sheep by the phenol red thread tear test and Schirmer tear test and there was no statistically significant difference in animals with infectious keratoconjunctivitis (P > 0.05). Siirt Üniversitesi Veteriner Fakültesi - 2016/02/14

The lacrimal gland is innervated by the cholinergic fibers of the seventh cranial nerve. Injection of botulinum toxin A (BTA) in the lacrimal gland is hypothesized to decrease the tear production by blocking presynaptic release of acetylcholine into neuromuscular end plates of cholinergic nerve fibers. Therefore, injection of BTA into the lacrimal gland can be an alternative treatment for epiphora due to severe gustatory hyperlacrimation, unsalvageable proximal lacrimal drainage system obstructions, and refractory functional epiphora. This chapter will discuss BTA properties, mechanism of action, and injection techniques into the lacrimal gland and complications.

Problems with indoor husbandry and immunological challenges are some of the stressors that broilers may face which can affect production. Infectious diseases can compound the effects of excessive concentrations of ammonia causing respiratory and ocular inflammation and increased lacrimal production in broiler chickens. The objectives of this investigation were to establish normal values of tear production in chicks and compare the practicality of the different methods. Palpebral fissure length (PFL) and tear production were evaluated in Cobb 500 chicks at 5 d old and then at 5 d of age by the following methods: modified Schirmer's test I (mSTT1), phenol red cotton thread tear test (PRCTTT), and standardized endodontic absorbent paper point test (EAPPTT). Ten chicks at the age of 5 and 42 d were evaluated for each method. In addition, at 42 d, when the palpebral fissure permitted, a regular-sized Schirmer tear test I (STT1) was performed in another group of 10 chickens. Overall, PFL and the secretion of the aqueous phase of the tear film increased with age. Mean mSTT1 results were 5.00 ± 1.83 mm and 10.45 ± 2.58 mm for 5- and 42-d-old chicks, respectively. Mean PRCTTT results were 12.37 ± 1.80 mm and 25.58 ± 4.8 mm for 5- and 42-d-old chicks, respectively. Mean EAPPTT results were 7.13 ± 0.72 mm and 12.03 ± 0.92 mm for 5- and 42-d-old chicks, respectively. Mean STT1 for 42-d-old chicks was 11.40 ± 2.60 mm. Results obtained with endodontic paper points showed the lowest coefficient of variation and investigators found the test easier to perform. These values reported for broilers at different ages may be applied in poultry ophthalmology to help the diagnosis of lacrimal production disorders and to detect early disease symptoms that could cause economic losses in poultry production.

The decision process of medical Ophthalmology vary in the degree to which a patient is fit with respect to various factors such as age, spectacle prescription, astigmatic, tear production rate, etc., In the past rough set theory has been used to study such decision processes. But no efficient procedures have been developed to deal with the complicating aspects of medical Ophthalmology. Therefore an attempt has been made to analyze the inconsistencies of the decision making process. In real life many types of contact lenses are in practice and there are several factors that influence the decision as to which type, if any, to suit. The decision support system adopted by an ophthalmologist is defined by the use of information entropy. Information entropy theory has been used in the method of analyzing the objects and attributes of the decision table for reducing its uncertainty. Then, the priorities of the attributes are determined. The results can address the ophthalmologists in their decision making process. Keywords— decision making; information entropy; uncertainty.

Purpose Contact lens discomfort remains poorly understood, not least due to lack of associations between clinical signs and symptoms. This study aimed to explore the relationships between osmolarity, comfort and lid wiper epitheliopathy in contact lens wear. Methods Twenty subjects participated in a randomized, cross-over study where comfilcon A and lotrafilcon A lenses were each worn for 10 days separated by a 7 days washout period. Tear and contact lens osmolarity, ocular symptoms including comfort, tear stability and production, and lid wiper epitheliopathy were measured. Results Comfort and tear stability decreased and upper lid wiper staining and foreign body sensation increased with lens wear. These were not affected by lens type. A reduction in tear production was seen after 10 days of comfilcon A lens wear. High proportions of lid wiper epitheliopathy were observed at the upper (range 65%–85%) and lower (range 90%–100%) lid margins. Tear and contact lens osmolarity were unaffected by lens wear or type. Contact lens osmolarity was associated with comfort (r = 0.45, p = 0.009). Tear osmolarity moderately correlated with tear stability (r = −0.53, p = 0.014) and tear production (r = −0.44, p = 0.012) but not with lid wiper staining. Conclusions A relationship between comfort and contact lens osmolarity and between tear osmolarity and tear stability and production were found, however, this study was unable to demonstrate an association between comfort and tear osmolarity or lid wiper epitheliopathy. Further studies using contact lenses with a wider range of comfort responses are warranted to investigate these associations further.