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Purpose: to evaluate the ocular surface changes (OSC) in seasonal and chronic allergic blepharoconjunctivitis (ABC) under dry eye (DE) conditions and to consider therapeutic possibilities.Materials and methods. 60 patients with seasonal ABC and mild DE syndrome (group 1) and 50 patients with chronic ABC and moderate DE syndrome (group 2) were tested for lipid deficiency (LD; negative lipid-interference test), aqua-deficiency (AD; inferior tear meniscus height < 250 fim), and mucose deficiency (Bijsterveld`s xerosis index > 3 scores; XI, scores), Ocular surface disease index (OSDI), tear film break-up time (TBUT, seconds), meibomian gland dysfunction (MGD) according to Korb, taking into account the proportion of MGD (%) and its severity (MGDS, scores), and the “lid-wiper” symptom (LWS, scores) Statistics: M ± s; Mann — Whitney U-test; differences were statistically significant at p < 0.05.Results. LD was diagnosed in 65% of the 1st group patients (OSDI 32.3 ± 4.2, TBUT 6.5 ± 0.6, TMH 363.4 ± 43.96, XI 2.1 ± 0.4, MGDproportion — 41.02 %, LWS 1.1 ± 0.2). LD and MD were detected in 35 % of 1st group patients (OSDI 41.3 ± 5.7, TBUT 5.7 ± 0.5, TMH 332.9 ± 29.9, XI 4.2 ± 0.7, MGD proportion — 61.9 %, LWS 1.24 ± 0.4). The differences in OSDI, TBUT and XI values between DE patients with LD and DE patients with LD and MD were statistically significant. LD and AD were diagnosed in 48 % of 2nd group (OSDI 48.5 ± 6.4, TBUT 5.5 ± 0.6, TMH 192.3 ± 20.8, XI 2.5 ± 0.5, MGDS 1.8 ± 0.4, LWS 1.9 ± 0.3). LD, AD and MD were detected in 52 % of the 2nd group patients (OSDI 57.5 ± 5.8, TBUT 4.6 ± 0.6, TMH 177.7 ± 16.9, XI 5.5 ± 0.6, MGD-S 2.2 ± 0.4, LWS 2.3 ± 0.4). The differences in OSDI, TBUT and XI values between DE patients with LD-AD combination and DE patients with LD-AD-MD were statistically significant.Conclusion. OSC included lipid deficiency (65 %) and lipid-mucose deficiency (35 %) in S-ABC patients; OSC were represented by lipid-aqua-deficiency (48 %) and lipid-aqua-mucose-deficiency (52 %) in C-ABC patients. In our opinion, the diagnostics of these clinical variants of OSP diagnosis, opens up opportunities for differentiated tear replacement therapy. MGD was diagnosed in one half of S-ABC patients and in all C-ABC patients, which we believe determines another possible therapy direction — eyelid therapeutic hygiene aimed at MGD relieving and lipid deficiency compensation.

Purpose: to evaluate the effectiveness of a fixed combination of 0.24 % hyaluronic acid, carbomer, glycerol and a lipid component in the hyposecretory dry eye treatment. Patients and methods. We examined 35 hyposecretory moderate dry eye (DE) patients in conditions of lipidaquas-mucin deficiency and meibomian gland dysfunction (MGD). All patients included in the study received instillations of a fixed combination of 0.24 % hyaluronic acid (in the form of sodium hyaluronate), carbomer, glycerol and a lipid component (in the form of medium chain triglycerides) — Artelak Night (3 times a day, 2 months). The main criterion for the effectiveness of therapy was the tear film brake up time (TBUT, Norn’s test, s). In addition, the dynamics of the following indicators were taken into account: OSDI (scores), “lid-wiper’ symptom (LWS, scores), lower tear meniscus height (LTMH, μm; OCT, OptoVue), Bijsterveld`s xerosis index (XI, scores; lyssamine green stained). Control points: at inclusion in the study; examination after 1 and 2 months of therapy. Statistics: calculation of the mean and its standard deviation (M ± s); assessment of the reliability of differences in indicators characterizing the state of the ocular surface before and after therapy (Wilcoxon t-test). Results. The patients showed a statistically significant increase in TBUT at the second and third control points, which indicated the effectiveness of DE therapy. The increase in TBUT was accompanied by a significant decrease in the severity of DE subjective symptoms at the same control points (OSDI). On the background of therapy, a trend towards a decrease in LWS was recorded, which was statistically insignificant. Apparently, a significant increase in TBUT and a decrease in OSDI were associated with a significant increase in LTMH at the third control point (decrease in the severity of aqua-deficiency) and a significant decrease in XI at the second and third control points (decrease in the severity of mucose-deficiency). Conclusion. A fixed combination of 0.24 % hyaluronic acid, carbomer, glycerol and a lipid component proved to be effective in the treatment of hyposecretory moderate DE in conditions of lipid-water-mucin deficiency, which was accompanied by a significant increase in TBUT and LTMH, as well as a decrease in OSDI and XI.