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PURPOSE: To use artificial intelligence to identify relationships between morphological characteristics of the Meibomian glands (MGs), subject factors, clinical outcomes, and subjective symptoms of dry eye. METHODS: A total of 562 infrared meibography images were collected from 363 subjects (170 contact lens wearers, 193 non-wearers). Subjects were 67.2 % female and were 54.8 % Caucasian. Subjects were 18 years of age or older. A deep learning model was trained to take meibography as input, segment the individual MG in the images, and learn their detailed morphological features. Morphological characteristics were then combined with clinical and symptom data in prediction models of MG function, tear film stability, ocular surface health, and subjective discomfort and dryness. The models were analyzed to identify the most heavily weighted features used by the algorithm for predictions. RESULTS: MG morphological characteristics were heavily weighted predictors for eyelid notching and vascularization, MG expressate quality and quantity, tear film stability, corneal staining, and comfort and dryness ratings, with accuracies ranging from 65 % to 99 %. Number of visible MG, along with other clinical parameters, were able to predict MG dysfunction, aqueous deficiency and blepharitis with accuracies ranging from 74 % to 85 %. CONCLUSIONS: Machine learning-derived MG morphological characteristics were found to be important in predicting multiple signs, symptoms, and diagnoses related to MG dysfunction and dry eye. This deep learning method illustrates the rich clinical information that detailed morphological analysis of the MGs can provide, and shows promise in advancing our understanding of the role of MG morphology in ocular surface health.

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

Perfluorohexyloctane ophthalmic solution (Miebo) and water-free cyclosporine ophthalmic solution 0.1% (Vevye) are recently approved treatments for dry eye disease (DED). Perfluorohexyloctane (PFHO) uses a novel approach to treat evaporative DED, whereas water-free cyclosporine (CsA 0.1%) is formulated to increase ocular delivery of its active ingredient to improve tear production. The two medications utilize the distinctive properties of two different semifluorinated alkanes (SFAs) to elicit their therapeutic effects. PFHO consists of 100% active ingredient and forms a monolayer on the surface of the tear film to inhibit evaporation. CsA 0.1% utilizes a vehicle consisting of perfluorobutylpentane (PFBP) and ethanol to facilitate delivery of cyclosporine to ocular tissues. The structure of these SFAs determines their differing behaviors and functions. The longer chain length of PFHO results in a slower evaporation rate and facilitates formation of a stable monolayer on the ocular surface. In vitro, PFHO demonstrated a substantially lower evaporation rate versus PFBP or human meibum, as well as a significantly longer ocular surface residence time. Ex vivo, PFHO demonstrated a longer ocular surface residence time than PFBP. The shorter chain length of PFBP enables it to better solubilize cyclosporine and improve drug delivery to ocular tissues. Although both of these ophthalmic drops utilize SFAs, their differences—in physicochemical properties and the mechanisms by which they are understood to intervene in the DED cycle—are important considerations in treatment selection for patients with DED. [ABSTRACT FROM AUTHOR]

Introduction: Meibomian Gland Dysfunction (MGD) represents the most common cause of dry eye disease (DED). Traditional treatments mainly rely on heating and liquifying the meibum to favor its expression. However, recent knowledge advances have led to the development of novel therapies specifically designed for patients with MGD. Areas covered: Literature search was conducted on current and novel treatments for MGD. Conventional treatment strategies, non-pharmacological approved device-based therapies, approved dry eye therapies and both recently approved and emerging pharmacological treatments specifically designed to address MGD are discussed. Expert opinion: The better understanding of MGD and DED pathophysiology has allowed to develop drugs able to target the primary mechanisms of the disease. Miebo has been the first FDA approved drug for patients with DED associated with MGD and its ability to reduce the tear film layer evaporation rate and the minimal impact on the quality of vision are important innovations. Great expectations also accompany the phase 3 study of AZR-MD-001, understood to be a keratolytic and lipogenic agent able to improve meibum quantity and quality. The chance to specifically target MGD represents an important step forward and will allow more tailored treatment for each type of ocular surface disease. [ABSTRACT FROM AUTHOR]

The aim was to compare the outcomes acquired from the OSA-Vet® device with conventional quantitative and qualitative tear tests and between groups within each test, in brachycephalic dogs both healthy and those diagnosed with keratoconjunctivitis sicca. The dogs were divided into four groups: healthy dogs (HD), with mild KCS (MIKCS); moderate KCS (MOKCS); severe KCS (SKCS). All patients underwent ocular surface diagnostic examination in the following order, with a 10-minute interval between tests: non-invasive tear film breakup time (TBUTNI - OSA-Vet®), tear meniscus height (TMH-OSA-Vet®), meniscometry (I-Tear® test), Schirmer Tear Test-1 (STT-1), and tear film breakup time (TBUT). Kruskal-Wallis H tests were performed to establish the difference between the groups and Spearman´s correlation coefficient test to assess the correlation between tests. And an analysis of variance (ANOVA) followed by Tukey-Kramer post-hoc test was performed for TMH. Results with (p <.05) were considered statistically significant. The correlation of conventional tests in relation to those obtained by OSA-Vet® proved to be low, except between TBUTNI (OSA-Vet®) and TBUT in MOKCS, with a strong correlation (r =.925). In the comparison between TBUTNI (OSA-Vet®) and TBUT in MIKCS the correlation was moderate (r =.547) as well as STT-1 and I-Tear® test in MOKCS (r =.416). In the comparison between groups, the main result observed was a significant difference between all the KCS groups and HD, in the TBUT and TBUTNI (OSA-Vet®) test. The OSA-Vet® and conventional tests are useful for evaluating the ocular surface of brachycephalic dogs. However, the OSA-Vet® does not correlate well with conventional standardized tests. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Reliable assessment is critical for diagnosing and managing meibomian gland dysfunction. Multi‐functional diagnostic devices, such as meibographers, streamline clinical workflows by integrating multiple ocular assessments. Ensuring reproducibility across examiners is vital for accurate diagnosis and monitoring of treatment. This prospective study determined the inter‐examiner reproducibility (IER), inter‐rater reproducibility (IRR) and within‐subject variability (WSV) of the Huvitz HRK‐9000A meibographer.Meibomian glands (MGs) of both eyelids of healthy participants were captured during the same session by Examiner 1 (E1) and Examiner 2 (E2) in a counter‐balanced design. The images were rated offline by E1, E2 and an Independent rater (R1). The inter‐examiner reproducibility (IER between E1 vs. E2) and inter‐rater reproducibility (IRR between E1 vs. R1 and E2 vs. R1) were determined based on non‐parametric Bland–Altman plots, intraclass correlation coefficients (ICCs) and weighted Kappa (κ) values. Within‐subject variability (WSV) was determined using ICCs.Mean MG loss of the upper (E1: 1.0 ± 0.8 vs. R1: 0.9 ± 0.8, E2: 1.2 ± 0.8 vs. R1: 0.9 ± 0.7) and lower eyelids (E1: 1.9 ± 0.9 vs. R1: 2.1 ± 1.1, E2: 1.5 ± 1.0 vs. R1: 1.8 ± 1.0) of 35 participants (mean age 22 ± 3 years, range 19–30) was significantly correlated (p < 0.001) for all pairs of examiners (E1–E2, E1–R1 and E2–R1), but was significantly different for the upper eyelids of E2 vs. E1 (p < 0.002) and E2 vs. R1 (p < 0.003). Median differences between pairs of raters for both eyelids were close to zero, with >74% of comparisons falling within the interquartile range, except for the upper eyelids of E2 vs. E1 and E2 vs. R1 (63% and 66%, respectively). IRR demonstrated moderate agreement (0.43–0.57) with good reliability (ICC range 0.76–0.86) for the upper eyelids and good agreement (0.60–0.65) with good reliability (ICC range 0.85–0.88) for the lower eyelids. The WSV was excellent (ICCs for repeated measurements > 0.90).The HRK‐9000A meibographer demonstrated excellent reliability, with good inter‐examiner and inter‐rater reproducibility. It is suitable for meibographic assessment, follow‐up or treatment. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate changes in corneal topography and aberrometry in patients with acquired blepharoptosis after levator resection surgery. This prospective, interventional study evaluated 30 eyelids of 19 patients who underwent levator resection surgery for acquired blepharoptosis with fair and good levator function (LF). Patients underwent corneal topography before and 3 months after surgery. Results: Eleven patients had bilateral, and 8 patients had unilateral surgery. There were significant decreases in steep keratometry (K2) (preoperative: 46.21±5.02, postoperative: 44.58±2.11, P=0.046) and corneal astigmatism (preoperative: 2.98±0.61, postoperative: 1.59±1.50, P=0.034). There were no statistically significant differences between the preoperative and postoperative values of flat keratometry (K1) (P=0.585), mean keratometry (Kmean) (P=0.122), axis of corneal astigmatism (P=0.548), central corneal thickness (P=0.350), anterior chamber depth (P=0.747) and anterior chamber volume (P=0.679). The root mean square (RMS)-higher order aberrations (HOA) (P<0.001), RMS-Coma (Z₃¹) (P<0.001), and RMS-Trefoil (Z₃³) (P=0.005) decreased significantly. Preoperative and postoperative values of the seconder astigmatism (P=0.345), RMS-spherical aberration (Z₄⁰) (P=0.255), and RMS-Quadrafoil (Z₄⁴) values were found similar. Conclusions: Levator resection for acquired blepharoptosis can improve the topography and aberrometry measurements of the cornea 3 months after surgery. [ABSTRACT FROM AUTHOR]

Terahertz (THz) waves reside in the electromagnetic spectrum between the microwave and infrared bands. In recent decades, THz technology has demonstrated its potential for biomedical applications. With the highly unique characteristics of THz waves, such as the high sensitivity to water and optimal spatial resolution coupled with the characteristics of the human cornea, such as its high water content, THz technology has been explored as a potential modality to assess corneas and corneal diseases. This systematic review provides an overview of the characteristics of THz waves, the safety profile of THz technology in the field of ophthalmology, and its clinical applications, including the objective evaluation of the corneal hydration, tear film, dry eye disease, corneal endothelium, corneal elasticity, and scarring. The paper also presents our viewpoint on the present challenges and future directions of THz technology prior to its broader integration into clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To study tear film parameters and Meibomian glands in pediatric patients with vernal keratoconjunctivitis (VKC). Methods: Forty-four eyes of 22 patients with VKC and 44 eyes of 22 age-matched controls were studied in a hospital-based cross-sectional study. Each subject underwent a complete ophthalmological examination including slit-lamp biomicroscopy, non-invasive break-up time (NIBUT), fluorescein break-up time (FBUT), corneal fluorescein staining, and Schirmer's test. Non-contact meibography was performed using a Sirius topographer. Results: All patients had VKC grades between 1 and 3 (Bonini scale). The mean NIBUT for cases was 8.83 ± 4.02 s and in controls, it was 15 ± 2.8 s (P value < 0.001). The mean FBUT for cases was 9.41 ± 3.45 s and in controls, it was 16.7 ± 2.5 s (P value < 0.001). Schirmer's values were 32 ± 3.1 mm in cases and 21.4 ± 4.1 mm in controls, which were significantly higher (P value < 0.001). Also, 22.72% of the cases had corneal fluorescein staining in the form of superficial punctuate keratitis, whereas none of the control groups showed corneal staining. The examination of Meibomian glands using non-contact meibography showed a mean Meibomian gland dropout in the upper lid to be 29.7 ± 14.4% in VKC cases and 10.5 ± 3.2% in controls (P value < 0.001). Meibography of the lower lid showed 25.9 ± 10.2% dropout in cases and 20.5 ± 6.1% in controls (P value = 0.004). Conclusion: Tear film parameters were significantly deranged in children with VKC in the active stage as compared to age-matched controls. Children with VKC also had a higher Meibomian gland dropout. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to illustrate a novel method for improving presbyopia by drinking cassiae tea. Materials and Methods: A total of 425 eyes from 425 participants (aged 52.5 ± 9.5 years) were recruited and divided into several experimental groups over a 6-month period. Participants consumed cassiae tea daily (10 g of cassiae semen brewed in 500 cc of water). Meanwhile, control group participants consumed 500 cc of plain water along with 1000 mg of vitamin C each day. Experiments 1 and 2: Participants with severe dry eye and intraocular pressure (IOP) > 30 mmHg were enrolled, and outcomes were assessed for these conditions, respectively. Experiments 3, 4, and 7: These experiments evaluated pupil size, near vision, and serum superoxide dismutase (SOD) levels in two groups of volunteers. Experiment 5: Different quantities of cassiae tea were prescribed to various groups, and near vision was measured. Experiment 6: Three questionnaires assessed presbyopic symptoms after cassiae tea consumption. Experiment 8: The antioxidant activity of cassiae tea compared with other bioactive compounds and Chinese herbs was evaluated using the DPPH test. Results: By the fourth month of the study, participants experienced increased tear volume and reduced IOP. Pupil size constricted, near vision improved, and serum SOD levels increased. Furthermore, greater consumption of cassiae tea was correlated with better near vision. The antioxidant activity of cassiae tea was found to surpass that of anthocyanins, wolfberry, and vitamin C. Conclusions: Drinking cassiae tea improves dry eye symptoms, reduces IOP, regulates pupil size, and enhances near vision due to its excellent antioxidant and pharmacological properties. These benefits may particularly aid individuals with presbyopia and those engaged in near-distance activities, such as smartphone use. [ABSTRACT FROM AUTHOR]

The surface of the eye is constantly exposed to the external environment and is affected by atmospheric conditions and air pollution, and dry eye is a typical ocular surface disease. The aim of this study is to determine whether there are seasonal differences in the number of dry eye operations in Japan and to investigate whether meteorological conditions and air pollutants are related to. The operations were examined using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) database from fiscal years 2019 to 2021. Temperature, atmospheric pressure, relative humidity, volume humidity, wind speed, sulfur dioxide (SO₂), nitrogen oxides X (NOX), photochemical oxidants (OX), carbon monoxide (CO) and particulate matter 2.5 (PM2.5) were considered. The number of dry eye operations was significantly higher in winter than in summer. (p = 0.0023) No significant differences were found among the other seasons. Volume humidity and temperature were strongly negative correlated, NOX and atmospheric pressure were strongly positive correlated. [ABSTRACT FROM AUTHOR]

Introduction: Wearing a face mask is a regular practice in health care workers, however it has increased during and after COVID 19 era. Mask associated dry eye has also increased in prevalence. This paper aims to compare ocular and periocular discomfort among healthcare workers using different types of face masks, including N95 respirators and surgical masks. METHODS: A cross-section observational survey was conducted to compare surgical and N95 mask in terms of dry eye induced in Health care workers. A questionnaire was prepared for the participants regarding general information about the participants; the effects of masks that they use in terms of quality of vision, pain/discomfort, quality of communication with patients and comorbidities. OSDI questionnaire was also provided. Results: Out of 110 participants (males =47, females= 63), average age was 36.67years. 72.73% of the participants were using N95 mask as they were the recommended masks to be used during COVID patient care. Average quality of vision in all the participants was 1.74 out of 5 (max) with no significant difference between N95 and Triple-layered surgical masks (p=0.62). Average discomfort / pain in all the participants was 2.25 out of 5 (max) with no significant difference between N95 and Triple-layered surgical masks (p=0.67). 4% reported foreign body sensation in eyes and 13-26% reported skin rashes around eyes. 79% participants using the masks complained of air leak towards the eyes while using the mask. Conclusion: Both N95 and Triple-layered surgical mask were associated with mild dry eyes, without a significant difference between the two. [ABSTRACT FROM AUTHOR]

Sjogren's disease, well-described in people, is rarely identified in veterinary species. In people, Sjogren's disease is one of the most common systemic autoimmune disorders with an incidence of 0.5% in the female population. The hallmark histopathologic finding of primary Sjogren's disease is lymphomononuclear cell infiltrates aggregating as periductal infiltrate in salivary glands. Sjogren's-like disease has been reported in a domestic shorthair cat and golden retriever dog. However, both lacked positive antinuclear antibody (ANA) titers and the dog showed no clinical evidence of dry eye disease. The following case report describes the clinical and immunohistochemical findings suggestive of Sjogren's disease in a 3-year-old spayed female German shepherd cross that was presented for medically refractory absolute dry eye, xerostomia confirmed with oral atropine response tests, and bilateral mandibular salivary gland enlargement. Routine topical lacrostimulants, anti-inflammatories, heterologous serum, ocular lubrication, and oral pilocarpine failed to improve clinical signs or tear production. The ANA titer at 1:160 was interpreted as positive, while the complete blood count and serum biochemistry panels were unremarkable. Head and neck ultrasound revealed bilateral moderately enlarged mandibular salivary glands with a hypoechoic, mottled echotexture consistent with sialoadenitis and regional lymphadenomegaly; thoracic radiography and abdominal ultrasonography were normal. In vivo confocal microscopy and spectral-domain optical coherence tomography of the cornea confirmed lipid keratopathy presumably secondary to corneal desiccation and steroid administration. Salivary gland histopathological and immunohistochemical analyses supported an immune-mediated etiology. Approximately 60% of the salivary section contained inflammatory cells replacing the glandular structures with a focus score of 12. Immunohistochemical markers CD3, CD204, CD79a, and CD20 were evaluated. The inflammatory infiltrate was a mixture of T-cells and macrophages with rare individual immunoreactive B-cells. CD3 and CD4+ T-cells were confirmed using immunohistochemistry and quantitative PCR, respectively. Clinical signs including ocular discharge and mandibular salivary gland enlargement markedly improved following oral immunomodulatory therapy with prednisone (1 mg/kg/d, tapered over 2 months) and long-term leflunomide (2 mg/kg/d). Ocular discomfort improved dramatically decreasing the need for topical lubricants; however, tear production failed to improve likely due to extensive lacrimal gland atrophy. The aim of this report is to increase awareness of Sjogren's disease in dogs and interpret the pathology involved. [ABSTRACT FROM AUTHOR]

Objectives Animals Procedures Results Conclusions Keratoconjunctivitis sicca (KCS) is characterized by decreased aqueous tear film components, leading to ocular surface damage. Diagnosis involves clinical examination, Schirmer Tear Test (STT1), and Tear Film Break‐Up Time (TFBUT) measurement. This retrospective study aimed to assess dry eye syndrome in intact, purebred, Aksaray Malakli breed dogs, and investigate potential associations with hereditary ocular diseases due to inbreeding for phenotype preservation.Fifty healthy, purebred, intact Aksaray Malakli dogs of varying ages and sexes, all exhibiting conjunctival hyperemia and mucoid ocular discharge. Dogs with chronic diseases, systemic medication, or ongoing ophthalmic treatment were excluded.Demographic data, ophthalmic examination results, and ocular anomalies were recorded. STT1 and TFBUT assessments were performed to measure tear production and film stability. STT1 values were scored from 1 (normal) to 4 (severe dry eye), and TFBUT ≥20 s was considered normal. Statistical analyses were used to evaluate correlations and differences.The correlation between age and STT1 values (r = −.182, p = .206) was not statistically significant. Mean STT1 was higher in females than males, though not significantly (p = .849). Dogs without third eyelid gland prolapse had significantly higher STT1 and TFBUT measurements compared to those with prolapse (p = .027). No significant sex difference was found in the frequency of third eyelid prolapse (p = .289). A significant positive correlation was observed between STT1 and TFBUT (r = .924; p < .001).Aksaray Malakli dogs, particularly those with third eyelid gland prolapse, are predisposed to mild to moderate KCS. These findings suggest the need for further clinical and genetic investigations to better understand and manage dry eye syndrome in this breed. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to systematically review the evidence from randomized controlled trials that evaluate the efficacy and safety of perfluorohexyloctane in the treatment of dry eye disease. Methods: Literature search was conducted on PubMed and Scopus in April 2024 with the search strategy (“perfluorohexyloctane” or “NOV03” or “semifluorinated alkane”) and “dry eye.” Extension and paired-eyes study were excluded. The risk of bias was assessed using the Cochrane risk-of-bias tool. Forest plots and a summary of findings were prepared for total corneal fluorescein staining (tCFS), tear film break-up time (TFBUT), eye dryness score (EDS), and Ocular Surface Disease Index (OSDI). Results: The pooled standardized mean difference (SMD) for tCFS after 8 weeks of treatment was −0.53 (95% CI: −0.68 to −0.38; p < 0.001), indicating a significant improvement in patients treated with perfluorohexyloctane. The between-study heterogeneity was moderately high (I2 = 52.0%). No significant differences in TFBUT were observed (SMD = 0.05; 95% CI: −0.16 to 0.25; p = 0.654). Regarding symptoms, patients treated with NOV03 had significantly lower EDS compared to controls (SMD = −0.49; 95% CI: −0.66 to −0.32; p < 0.001), with moderately high heterogeneity (I2 = 71.1%). Conversely, the pooled SMD of OSDI was −0.13 (95% CI: −0.43 to 0.17; p = 0.412), indicating no significant difference. Conclusion: Perfluorohexyloctane is an effective and safe alternative for the treatment of evaporative dry eye disease due to MGD that can significantly reduce tCFS and eye dryness symptoms. More well-designed non-sponsored randomized clinical trials are required to investigate the impact on other ocular surface parameters. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the role of Interleukin-37 (IL-37) in mouse models of dry eye. Methods: Two murine models of dry eye were employed in this investigation. The evaluation of the anti-inflammatory impact of IL-37 (200 μl, 10 μg/ml) on dry eye mice involved intraperitoneal injections administered once daily for 7 days. Additionally, intraperitoneal injection of VO-Ohpic trihydrate (VO, 0.25 mg/kg) in dry eye mice was performed to investigate the role of PTEN in the IL-37 anti-inflammatory signaling pathway. Tear production was assessed using phenol red cotton thread, while corneal damage was examined through sodium fluorescein staining using a slit lamp. Histological alterations in the lacrimal gland were observed through H&E staining. PAS staining was used to assess conjunctival goblet cells. The levels of NFκB-P65, p-NFκB-P65, IL-1β, IL-6, TNF-α, CD3, AQP5, α-SMA and PTEN proteins were determined via Western blotting or immunofluorescence. Results: Following IL-37 treatment, both dry eye models exhibited reduced corneal fluorescence staining scores and enhanced tear production. In lacrimal gland, the expression of p-NFκB-P65, IL-1β, IL-6, CD3 and TNF-α was diminished, while PTEN, AQP5, α-SMA expression increased after IL-37 treatment in both dry eye mice. However, the intraperitoneal injection of VO significantly attenuated the anti-inflammatory effect of IL-37 on dry eye mice. Conclusion: IL-37 emerges as an anti-inflammatory mediator within the lacrimal gland of dry eye mice, exerting its effects through the IL-37-PTEN-NFκB signaling pathway. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to determine the frequency of neurotrophic keratopathy (NK) among patients presenting for cataract surgery consultation in a suburban US practice. Methods: Patients presenting for cataract consultation were evaluated with corneal staining without anesthetic. Those with grade 1 or greater corneal stain and a tear breakup time (TBUT) of ≤ 10 underwent corneal sensitivity testing with a Cochet Bonnet esthesiometer. The study also evaluated patient SPEED score symptoms, corrected distance visual acuity (CDVA), corneal higher-order aberrations (HOAs), and conjunctival hyperemia. Results: Among the 31 patients enrolled, mean corneal esthesiometry was 40 ± 9.5 mm (range 13 to 55). Esthesiometry of ≤ 40 mm, indicating neurotrophic keratopathy, was detected in 18 (58%, 95% CI 39– 75%) patients. Corneal higher-order aberrations were significantly worse at 0.83 ± 0.22 μ in the group with NK vs 0.67 ± 0.16 among patients without NK (P < 0.028). A nonsignificant correlation was found between reduced corneal sensitivity and reduced symptoms. Older patients had slightly reduced sensation, but this trend was not statistically significant. No trend was seen between reduced sensation and either CDVA or corneal staining. Conclusion: More than half of patients presenting for cataract evaluation with dry eye had stage 1 neurotrophic keratopathy. These patients had significantly worse higher-order aberrations than patients with normal sensitivity. Among patients with NK, symptoms were milder and age was higher, but neither trend was statistically significant. No trend was observed between corneal sensation and either corneal staining or CDVA. Plain Language Summary: We performed this study to determine how common reduced corneal sensation is among patients who present for cataract surgery evaluation when they also have signs of dry eye. Fifty-eight percent of patients met criteria for Stage 1 reduced sensation, and they also had significantly more corneal irregularity than those without reduced sensation. Further study is needed to determine whether patients with reduced sensation should be treated differently from other dry eye patients when preparing their eyes for preoperative biometry. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of rebamipide ophthalmic suspension on optical quality and efficacy of patients with dry eye under different conditions. Methods: A comprehensive search across five databases (PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, and Wan Fang) was conducted for studies published through May 13, 2024, focusing on rebamipide for dry eye treatment. Results: A total of 11 studies including 334 patients with dry eye were included. Tear breakup time (TBUT) values of patients with dry eye increased significantly after 2 weeks (standardized mean difference [SMD] =1.07, 95% confidence interval [CI] = [0.05, 2.09]), 4 weeks (SMD = 1.26, 95% CI = [0.77, 1.75]), and 12 weeks (SMD = 1.04, 95% CI = [0.37, 1.71]) of rebamipide treatment. Subgroup analysis revealed that patients with dry eye wearing soft contact lens (SCL) exhibited higher TBUT values after 4 weeks of rebamipide treatment compared with those who received rebamipide alone. In addition, rebamipide significantly improved fluorescein staining score of patients with dry eye after 4 weeks of treatment (SMD = −0.34, 95% CI = [−0.63, −0.06]). However, 4 weeks of rebamipide treatment showed no significant effect on Schirmer I test values (SMD = −0.04, 95%, CI = [−0.43, 0.35]) and higher-order aberrations (SMD = −0.73, 95% CI = [−1.77, 0.30]). Conclusions: These results indicate a significant improvement in the efficacy of rebamipide treatment for patients with dry eye, particularly for those wearing SCL. The effect of rebamipide on visual quality was found to correlate with the underlying dry eye status. [ABSTRACT FROM AUTHOR]

Purpose: It is well-known that patients' perceptions of their disease can impact management strategies and disease outcomes. Limited knowledge exists on such perceptions in dry eye disease (DED) and the role of language in these perceptions. Herein, we compared the perceptions about DED between Spanish- and English-speaking patients. Methods: This cross-sectional study included 146 patients with DED who underwent ophthalmic evaluation and completed questionnaires assessing their perceptions of DED on a 10-point scale during their routine appointments. Perceptions included opinions on the level of satisfaction with understanding of DED, ease of following doctor's advice, effectiveness of treatment, satisfaction with DED care, and outlook on DED. Perceptions were categorized as low (scores 0–2), moderate (scores 3–7), and high (scores 8–10). The percentage of patients with high perception scores were then compared between Spanish- and English-speaking patients. Results: There were 48 Spanish speakers and 98 English speakers. Overall, high scores of DED perceptions were identified in 47.9% for satisfaction with the level of understanding of DED, 72.6% for ease of following doctor's advice, 52.1% for helpfulness of DED treatment, 64.4% for satisfaction with DED care, and 52.1% for optimistic outlook on DED. High scores for satisfaction with the level of understanding of DED were significantly lower in Spanish speakers (27.1%) than English speakers (58.2%, p <.001). No significant differences were observed in other perceptions between Spanish- and English-speaking participants. Conclusions: Spanish-speaking subjects reported lower satisfaction with their understanding of DED than English speakers. Clinicians should provide health services and educational materials in the patient's preferred language to minimize barriers to understanding their disease. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy of 0.05% cyclosporine A (CsA) eye drops (II) and 3% Diquafosol ophthalmic solution (DQS) in the treatment of dry eye (DE) after cataract surgery (CS). Methods: Clinical data of 123 patients with DE after CS treated at the Fourth Hospital of Hebei Medical University from June 2022 to August 2023 were retrospectively analyzed. Patients were divided into three groups based on the treatment: Conventional group (tobramycin & dexamethasone eye drops combined with pranoprofen eye drops, n=41), DQS group (3% DQS based on the conventional treatment, n=42), and CsA group (0.05% CsA eye drops(II) based on the conventional treatment, n=40). The therapeutic effects; Schirmer I test (SIt), tear film breakup time (TBUT), levels of serum inflammatory factors, and tear cytokine levels before and after treatment were compared between the groups. Results: Chief complaint score, conjunctival congestion score, corneal fluorescein staining score, and ocular surface disease index score of the DQS group and the CsA groups were significantly lower than those of the conventional group (P<0.05). After treatment, the improvement in SIt, TBUT, serum inflammatory factors, and tear cytokine levels in the DQS group and the CsA group was significantly better than that in the conventional group (P<0.05). However, these indexes were comparable in the DQS and the CsA group (P>0.05). Conclusions: Compared to the conventional treatment alone, the addition of 3% DQS or 0.05% CsA eye drops (II) to the conventional treatment both are effective and might more effectively alleviate DE in patients undergoing CS. [ABSTRACT FROM AUTHOR]

Purpose: Run-Mu-Ling granules (RMLG), a traditional Chinese medicinal formula, are used to treat dry eye (DE); however, the underlying mechanism remains poorly understood. This study aimed to elucidate the potential molecular mechanisms by which RMLG alleviates ocular surface inflammation in DE. Methods: We established an in-vivo DE rat model and in-vitro human corneal epithelial cell line (HCEC) injury models. Corneal damage severity was evaluated using various tests, including corneal fluorescein staining, tear break-up time, and phenol red tear test. Hematoxylin and eosin staining was used to examine histopathological changes in corneal tissues. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling detected corneal cell damage in rats. Transmission electron microscopy was used to observe the microstructures of corneal tissue. Immunofluorescence and Western blotting analyses were used to assess NLRP3, GSDMD, ASC, caspase-1, IL-18, IL-1β, and TNF-α expression levels in corneal tissues and HCEC. Cell viability was determined using CCK-8 and colony formation assays, and pyroptosis was examined using Annexin V-PI staining. Results: RMLG significantly improved tear film stability, promoted tear secretion, attenuated corneal tissue damage, enhanced HCEC activity, and suppressed pyroptosis. It also inhibited the activation of the NLRP3/GSDMD signaling pathway in corneal tissues and HCEC, reducing the release of downstream pro-inflammatory cytokines. Conclusion: This study suggests that NLRP3/GSDMD-mediated pyroptosis plays a crucial role in the pathogenesis of DE and that inhibition of this pathway is a key mechanism by which RMLG alleviates ocular surface inflammation in DE. These findings suggest that RMLG could be a promising therapeutic option for DE, offering new insights into its molecular action and potential clinical application. [ABSTRACT FROM AUTHOR]

With the development of science and technology, electronic devices have become an inevitable part of our daily life and work. There has been an increase of interest in the use of various video display terminals(VDT). The ocular surface is the first barrier of the visual system to resist the damage of the external environment. In recent years, the number of patients with dry eye has consistently increased with the excessive use of VDT. Blue light produced by VDT, with wavelengths ranging from 400 to 500 nm, has a high energy in visible light. Therefore, blue light may also be an important risk factor for dry eye. In particular, the outbreak of COVID-19 has left people worldwide suffering from increased blue light, which promotes further research into dry eye caused by blue light emitted from VDT. In this review, we summarize the recent studies on the role of blue light produced by VDT in dry eye to provide reference for future related research.

AIM: To assess the stability of the tear film and the characteristics of corneal nerves in patients with Parkinson's disease(PD).METHODS: This cross-sectional observational study included 72 PD patients and 50 healthy controls. Disease severity was determined using the Hoehn-Yahr(H-Y)scale, dividing patients into mild and moderate PD groups. Dry eye symptoms were evaluated via the ocular surface disease index(OSDI)questionnaire, while tear secretion was quantified using the Schirmer I test. Ocular surface damage was assessed through staining scores, and comprehensive ocular examinations were performed utilizing the LipiView ocular surface interferometer and an ocular surface analyzer. Corneal nerve parameters were examined using corneal confocal microscopy in conjunction with automated analysis software ACCMetrics, with correlations drawn between these parameters, PD course, and severity.RESULTS: PD patients exhibited significantly elevated OSDI scores, indicative of more pronounced dry eye symptoms compared to the control group(F=70.290, P

Introduction: Tobacco smoking is the primary avoidable cause of mortality, resulting in the deaths of seven million people worldwide annually. Tobacco smoke is a well-documented ocular irritant that exacerbates Dry Eye Disease (DED) and its associated symptoms. Aim: To compare tear film and corneal surface parameters in chronic smokers and non smokers. Materials and Methods: This cross-sectional study was conducted among chronic smokers and non smokers presenting at a tertiary eye care centre in Northern India. A total of 80 subjects were included in the study and divided into two groups of 40 subjects each, comprising group A (chronic smokers) and group B (non smokers). All participants underwent a series of measurements: Schirmer I test, Tear Breakup Time (TBUT), Central Corneal Thickness (CCT) and endothelial cell count using specular microscopy. Results: The mean age of smokers was 50.15±6.89 years, whereas the mean age of non smokers was 49.25±6.39 years, with a significant male preponderance. The dry eye parameters, such as the Schirmer I test and TBUT, were significantly lower in smokers compared to non smokers, with a statistically significant difference (p-value

Andrea Bedei,1 Pedro Rocha Cabrera,2 Luis Oliveira,3 Laura Castellini,1 Giulia De Grazia,4 Stefano Remiddi4 1Ophthalmology Department Casa di Cura San Camillo, Forte dei Marmi, Italy; 2Ophthalmology Department Hospital San Juan de Dios Tenerife, Santa Cruz de Tenerife, Spain; 3Ophthalmology Department Hospital Santo Antonio, Porto, Portugal; 4Department of Research and Development, MD Italy, Albano Laziale, ItalyCorrespondence: Stefano Remiddi, MD Italy srl, Department of Research and Development, Via Cancelliera, 12, Albano Laziale, Rome, 00041, Italy, Email stefano.remiddi@md-italy.itPurpose: To assess the efficacy, adherence, and tolerability of a new artificial tear based on arabinogalactan, hyaluronic acid, and trehalose in a population with dry eye disease (DED).Methods: A retrospective, real-world, post-marketing study identified 96 adult patients (aged 18– 80 years) with signs and symptoms of dry eye. These patients received fixed combination therapy with eye drops containing arabinogalactan, hyaluronic acid, and trehalose at various dosing schedules. The data for this study were collected from April 2022 to June 2023. Patients underwent evaluation at baseline (T0) and after a follow-up period of two–three months (T1) using a patient-reported questionnaire.Results: In 96 adult patients (71 women and 25 men) with dry eye due to various conditions, the results indicated a 98% positive response to therapy. This response included improvements in vision (13%), comfort (39%), redness (13%), itching (16%), photophobia (4%), and tearing (14%). Additionally, 61% of the patients experienced 1– 2 hours of comfort following instillation.Conclusion: This real-life post-marketing study demonstrated clinical improvement of signs and symptoms in patients with dry eye disease using a new artificial tear medical device based on arabinogalactan, hyaluronic acid, and trehalose.Keywords: dry eye, real-world study, arabinogalactan, hyaluronic acid, trehalose, post-marketing study

AIM: To investigate the effect of intense pulsed light(IPL)combined with Yuyin Runmu formula fumigation and meibomian gland massage on the treatment of patients with meibomian gland dysfunction(MGD)-related dry eye.METHODS: Prospectively selected 198 cases(396 eyes)of MGD-related dry eye patients admitted to our hospital from November 2021 to November 2023, and they were randomly divided into 99 cases(198 eyes)in control group treated with fumigation of Yuyin Runmu formula and meibomian gland massage, and 99 cases(198 eyes)in observation group treated with combined IPL on the basis of the control group. The efficacy of the two groups was compared, as well as the changes in the levels of ocular indexes [tear film break-up time(BUT), Schirmer I test(SⅠt)], visual quality [objective scattering index(OSI), Strehl ratio(SR), and modulation transfer function(MTF)], lipid layer thickness(LLT)of the tear film, and changes in tear fluid levels of inflammatory factors [tumour necrosis factor-α(TNF-α)and transforming growth factor-beta 1(TGF-β1)].RESULTS: All the patients completely received the treatment and follow-up. The levels of BUT, SⅠt, SR, MTF, and LLT increased and the levels of OSI, TNF-α, and TGF-β1 decreased in the two groups at 2 mo after treatment(all P

AIM:To analyze differential proteins associated with the pathogenesis of dry eye(DE)using bioinformatics methods, in order to reveal their potential molecular mechanisms.METHODS: Articles published in PubMed and EMBASE databases from the inception of the database to August 31, 2023, that used proteomic methods to detect protein expression in clinical samples of dry eye were searched. Differential proteins were selected and further analyzed using the STRING database and Cytoscape software for hub gene screening and module analysis. Protein-protein interaction(PPI)analysis, gene ontology(GO)functional annotation, and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis were performed.RESULTS: A total of 21 articles were included, identifying 74 differentially expressed proteins. The most frequently occurring differential proteins were calgranulin A(SA1008), lipocalin-1(LCN1), lysozyme C(LYZ), mammaglobin-B(SCGB2A1), proline-rich protein 4(PRR4), transferrin(TF), and calgranulinB(S100A9). The top 10 hub genes were serum albumin(ALB), tumor necrosis factor(TNF), interleukin 6(IL6), IL1B, IL8, matrix metalloproteinase 9(MMP9), alpha-1-antitrypsin(SERPINA1), IL10, complement component 3(C3), and lactotransferrin(LTF). Module analysis suggested MMP9 and PRR4 as seed genes. KEGG analysis showed that differential proteins were mainly enriched in the IL17 signaling pathway(61.9%).CONCLUSION: The results reveal potential molecular targets and pathways for DE and confirm the association between the pathogenesis of DE and inflammation. Further in-depth research is needed to confirm the significance of these biomarkers in clinical practice.