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Introduction: Graves' Orbitopathy (GO) is an autoimmune disorder characterized by inflammation of orbital tissues, leading to various ocular manifestations, including ocular surface disease. This cross-sectional study aimed to assess the presence of ocular surface disease using the Ocular Surface Disease Index (OSDI) in patients with Graves' disease (GD) and moderate-to-severe active GO compared to those with GD and mild non-active GO. Additionally, we aimed to investigate the correlation between ocular surface disease and the eye features of GO. Methods: Consecutive GD patients with GO referred to the Ophthalmology and Endocrinology Units of the University Hospital of Pisa between June 2022 and February 2023 were enrolled. OSDI scores were obtained from 79 GD patients, categorized into moderate-to-severe active GO and mild non-active GO groups. Results: OSDI scores were significantly higher in patients with moderate-to-severe active GO compared to those with mild non-active GO (P=0.0006). A cutoff value of 33 for positive tests revealed a higher frequency of pathological OSDI in moderate-to-severe active GO patients compared to mild non-active GO patients (P=0.0221; OR 3.673, CI 1.277-9.531). Within the moderate-to-severe active GO group, a significant positive correlation was found between OSDI and Clinical Activity Score (CAS) (R= 0.3867, 95% CI from 0.1403 to 0.5880; P=0.0030). Using a cutoff value of 55 (the 75th percentile of the study population), patients with CAS ≥ 3 had a significantly higher proportion of pathological OSDI compared to those with CAS <3 (P=0.0039; OR 4.075, CI 1.619-10.39). Proptosis values ≥ 22 mm and the presence of lagophthalmos were identified as significant risk factors for ocular surface disease development (P=0.0406 and P=0.0493, respectively). Discussion: Our study highlights a significantly higher prevalence of ocular surface disease, as measured by OSDI, in patients with moderate-to-severe active GO compared to those with mild non-active disease. The degree of GO activity positively correlates with ocular surface involvement, and proptosis and lagophthalmos increase the risk of its occurrence. These findings emphasise the importance of assessing and managing ocular surface health in GO patients. Early identification and appropriate treatment of ocular surface disease need to be pursued to improve patient management. [ABSTRACT FROM AUTHOR]

Background: Dry eye is a condition of the tear film and ocular surface that causes discomfort, visual disturbance, and tear film instability. The subjective symptoms in dry eye disease (DED) are often nonspecific. More or less common are conjunctival redness and damage to the ocular surface with punctate epithelial erosions. Rheumatoid arthritis (RA) is a systemic autoimmune disease with approximately 25% of patients having ocular manifestations. Methodology: A prospective observational study was carried out in the ophthalmology outpatient department of a tertiary care center. There were 200 RA patients enrolled. Dry eye workup was done using various tests and the Ocular Surface Disease Index questionnaire. RA patients were divided on the basis of duration of illness into two groups. The results of dry eye tests were compared between these two groups. Results: Out of 200 RA patients, 89% were females. The overall prevalence of dry eye was 52.5% according to Schirmer's test without anesthesia. There were 112 patients who were suffering from RA for <5 years and another group of 88 patients who were suffering for ≥5 years. Schirmer's test and corneal fluorescein staining suggested that the patients with longer duration of RA are more prone to DED. Conclusion: The prevalence of dry eyes in patients with RA is high. Chronic ocular surface changes were observed with the longer duration of RA disease activity which affects the quality of life in such patients. [ABSTRACT FROM AUTHOR]

Introduction: Dry eye disease (DED) is a frequently observed condition characterized by ocular discomfort and visual disturbance. It is highly prevalent and impairs patients' quality of life (QoL). This study assessed the benefit of a preservative-free bioprotectant eye drop formulation containing sodium hyaluronate and trehalose (SH-trehalose) with regards to DED, as well as patient satisfaction, through a large-scale real-life survey. Methods: In a multi-center, international, prospective observational study, subjects with DED received SH-trehalose for 84 days. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire-5 items (DEQ-5), and patient satisfaction were assessed at baseline, day 28, and day 84, and clinical evaluations included ocular surface staining, Schirmer test, tear film break-up time (TBUT), and conjunctival hyperemia at baseline and day 84. Results: A total of 312 patients were evaluated, of whom 82.4% were women. The mean age was 57.9 ± 15.2 years. The mean OSDI score at baseline was 41.7 ± 20.6. After 84 days, the mean OSDI score was 27.3 ± 19.8 (p < 0.001). The percentage of patients with a severe OSDI score decreased from 60.3 to 34.5%. The DEQ-5 score significantly (p < 0.001) improved after 28 and 84 days, as did patient satisfaction. Ocular surface staining, Schirmer test, TBUT, and conjunctival hyperemia scores improved significantly (all p < 0.001) for both eyes with SH-trehalose between baseline and day 84. Tolerance of SH-trehalose was good. Conclusions: SH-trehalose significantly improved the clinical signs and symptoms of DED after 84 days. Moreover, it significantly increased patient satisfaction and was well tolerated. Trial Registration: NCT04803240. [ABSTRACT FROM AUTHOR]

Ethnopharmacological Relevance: Sjögren's syndrome (SJS) and dry eye syndrome (DES) are characterized by ocular dryness from inadequate tear production or excessive evaporation. To evaluate the effectiveness of TBDESJS (Chun‐Yu‐Ching‐Hua‐Yin, CYCHY), a TCM tea bag, in treating SJS and DES patients compared with healthy controls (NHC). Materials and Methods: This phase II pilot study included 100 participants (60 SJS, 30 DES, 10 NHC) across 8 weeks, assessing changes in Schirmer's test, OSDI, ESSPRI, PSQI, FIRST, and artificial tear usage, using repeated measurement ANOVA and Tukey's honestly significant difference (HSD) for analysis. Results: Total 97 subjects completed the trial, for the left eye (OS) of Schirmer's test, significant improvements at 4, and 8 weeks were observed in SJS (0.13 ± 0.43–5.77 ± 2.87, and 7.60 ± 4.84 mm) and DES (0.21 ± 0.41–6.21 ± 2.97, and 7.86 ± 3.47 mm) (all p <.001). For the right eye (OD), significant improvements were observed in SJS (0.13 ± 0.39–6.77 ± 4.53, and 8.79 ± 5.92 mm) and DES (0.34 ± 0.55–6.59 ± 2.50, and 8.24 ± 3.42 mm) (all p <.001). Secondary outcomes showed reduced the dryness of ESSPRI scores in SJS (6.37 ± 1.97–5.57 ± 1.79, p <.001) and DES (6.10 ± 1.97–5.28 ± 2.23, p <.05). PSQI global scores improved significantly in all groups at 8 weeks (p <.05). Artificial tear usage decreased in SJS (4.93 ± 2.45–1.00 ± 0.82 times/day), DES (4.47 ± 1.99–0.66 ± 0.67 times/day) (all p <.001). No serious adverse events in this study. Conclusion: TBDESJS significantly improved tear production, ocular dryness, and sleep quality, indicating potential neural regulation, anti‐inflammatory and immunomodulatory benefits. These findings advocate for TBDESJS (Chun‐Yu‐Ching‐Hua‐Yin, CYCHY)'s comprehensive therapeutic value in SJS and DES treatment, emphasizing the need for further research to understand long‐term effects and mechanisms. [ABSTRACT FROM AUTHOR]

Background: The evaluation of dry eye disease (DED) and the ocular surface can be approached from patient-centered questionnaires, clinical scales using the slit-lamp microscope, and more recently innovative ophthalmological devices that allow for noninvasive tests. The OCULUS Keratograph 5M (K5M) is a device that allows for noninvasive measurement of ocular surface parameters. Materials and Methods: The present article is a retrospective and observational study detailing the correlation of the OCULUS K5M surface parameters and the Ocular Surface Disease Index (OSDI) score. Patients of any gender and age attending a cornea and refractive surgery practice in an academic center underwent a full ophthalmological examination and tear meniscus height, tear breakup time, bulbar redness, meibography, and OSDI score measurement through the K5M. Results: One hundred and sixty-four eyes of 82 patients were included. The sample showed a female preponderance (78%) and a mean age of 49.45 years. When comparing the OSDI score with ocular surface parameters, a weak negative correlation was found with the tear meniscus height (Pearson coefficient: [ -0.229, P = 0.003]). There were no other statistically significant correlations between the K5M and the OSDI score. In addition, the meibomian gland dropout was significantly associated with increasing age, whereas conjunctivochalasis was associated with the female gender, increasing age and increasing OSDI score. Conclusions: The subjective symptoms of DED measured with OSDI score correlate only with tear meniscus height measured by the K5M in a Hispanic population. The detection of symptomatic DED patients through the K5M is incomplete in this population. [ABSTRACT FROM AUTHOR]

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Background: Allergic conjunctivitis (AC) is a prevalent ocular condition triggered by environmental allergens, causing significant discomfort and reduced quality of life. Dry Eye Disease (DED), marked by ocular discomfort and visual disturbances, frequently overlaps with AC symptoms. This study examines the prevalence of DED in AC patients and explores the relationship between different AC types and DED severity. Method: A cross-sectional, observational study was conducted from June to September 2023 in the Department of Ophthalmology at a tertiary center in North India. A total of 264 AC patients aged 18 years and older with itchy eyes were included. Patients with contact lens use, recent ocular surgery, trauma, corneal pathology, or certain systemic diseases were excluded. DED was assessed using the Ocular Surface Disease Index (OSDI), Schirmer's test, and Tear Film Break-Up Time (TFBUT). Results: DED was found in 70% of AC patients, with 20% mild, 19% moderate, and 32% severe cases. Females were more affected (64%). VKC patients showed higher tear production and better TFBUT scores. PAC patients had the most severe DED. Conclusion: DED is common in AC patients, with PAC associated with more severe DED, while VKC shows milder symptoms. Tailored treatment approaches are needed for managing AC and DED. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the changes in corneal biomechanical properties and tear film layer analysis after upper eyelid blepharoplasty surgery. Method: Sixty eyes of 30 patients were included in our prospective study. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc) and Goldmann intraocular pressure (IOPg) measurements were taken with the Ocular Response Analyzer (ORA) device at the preoperative, postoperative 1st and 3rd months. The ocular surface was evaluated with tear breakup time (TBUT) and Ocular Surface Disease Index (OSDI) scores. Lid crease (LC), margin-to-reflex distance 1 (MRD1), and palpebral fissure height (PFH) were evaluated at each visit. Results: In the ORA analysis, in the 1st month CH value was found to be significantly lower than the preoperative value (preoperative 13.39 ± 6.08 mmHg; 1st month 10.74 ± 1.94 mmHg, p = 0.011). In addition, there was a statistically significant decrease in the 3rd month value compared to the preoperative values (10.46 ± 1.69 mmHg, p = 0.021). However CRF decreased postoperatively, no statistical difference was detected (preop 12.59 ± 3.84; 1st month 11.94 ± 3.04; 3rd month 9.78 ± 1.74; p = 0.149). While there was a decrease in IOPcc and IOPg in the postoperative period, no statistical difference was detected (respectively p = 0.96, p = 0.71). In the postoperative 1st month, TBUT increased significantly (p = 0.024). When those with a TBUT value below 10 were considered dry eye, significant decrease was observed in the percentage of dry eye in the first postoperative month (p = 0.027). Although the dry eye percentage decreased in the 3rd month compared to the preoperative percentage, no statistical difference was detected (p = 0.125). There was a significant decrease in the number of those with an OSDI score above 13 in the first month (p = 0.004). Conclusion: In our study, a decrease in ORA values was observed after blepharoplasty, with only CH being statistically significant. Reducing the load on the cornea after surgery may change the corneal biomechanics. These changes should be taken into consideration after eyelid surgery, especially in patients who may require glaucoma follow-ups. [ABSTRACT FROM AUTHOR]

To assess the effect of subconjunctival injection of anti-VEGF bevacizumab in the management of dry eye disease in a tertiary care hospital. In this quasi-experimental trial 150 eyes of 75 patients were selected using non-probability consecutive sampling technique. Detailed clinical examination was performed, the ocular surface disease index (OSDI) questionnaire score, tear film break-up time (TBUT) and Schirmer test 2 were measured and compared pre and post injection. Six patients were excluded and sixty-six patients were included having the mean age was 65.3 (SD=±10.2) years, 50% were aged 66-83 years old, 65.2% were female. Pre injection OSDI score was 30.3 (SD=±2.79), whereas post injection it was 20.2 (SD=±3.01). Pre injection TBUT was 3.0 (SD=±0.30), whereas post injection it was 5.17 (SD=±0.40). Pre injection Schirmer 2 test was 7.97 (SD=±0.51), whereas post injection it was 10.5 (SD=±0.50). Ten patients suffered mild subconjunctival hemorrhage which resolved spontaneously. Three patients were lost to follow up. Subconjunctival injection of anti-VEGF agent bevacizumab can offer a modern and safe solution in patients suffering from dry eye disease nevertheless more trials with large number of patients and longer follow up durations are required for widespread adaptation. [ABSTRACT FROM AUTHOR]

IntroductionGraves' Orbitopathy (GO) is an autoimmune disorder characterized by inflammation of orbital tissues, leading to various ocular manifestations, including ocular surface disease. This cross-sectional study aimed to assess the presence of ocular surface disease using the Ocular Surface Disease Index (OSDI) in patients with Graves' disease (GD) and moderate-to-severe active GO compared to those with GD and mild non-active GO. Additionally, we aimed to investigate the correlation between ocular surface disease and the eye features of GO.MethodsConsecutive GD patients with GO referred to the Ophthalmology and Endocrinology Units of the University Hospital of Pisa between June 2022 and February 2023 were enrolled. OSDI scores were obtained from 79 GD patients, categorized into moderate-to-severe active GO and mild non-active GO groups.ResultsOSDI scores were significantly higher in patients with moderate-to-severe active GO compared to those with mild non-active GO (P=0.0006). A cutoff value of 33 for positive tests revealed a higher frequency of pathological OSDI in moderate-to-severe active GO patients compared to mild non-active GO patients (P=0.0221; OR 3.673, CI 1.277-9.531). Within the moderate-to-severe active GO group, a significant positive correlation was found between OSDI and Clinical Activity Score (CAS) (R= 0.3867, 95% CI from 0.1403 to 0.5880; P=0.0030). Using a cutoff value of 55 (the 75th percentile of the study population), patients with CAS ≥ 3 had a significantly higher proportion of pathological OSDI compared to those with CAS

Dry eye syndrome (DES) is a tear film disorder caused by increased tear evaporation or decreased production. The heavy workload on the eye and the increased usage of digital screens may decrease blink frequency, leading to an increased evaporation rate and an upsurge in the incidence and severity of DES. This study aims to assess the severity of DES symptoms and the risk factors among university students. A cross-sectional study was conducted at Umm AlQura University to evaluate the severity of DES among students and explore its potential association with digital screen use. Validated questionnaires were used to assess the severity of DES and digital screen usage. The study included 457 participants, of which 13% had symptoms suggestive of severe DES. Furthermore, multiple risk factors had a significant association with the severity of DES, including gender, use of monitor filters, monitor and room brightness, and smoking habits. DES symptoms were prevalent among university students, particularly female students. Although there was no significant association with the duration of screen usage and collage distribution. Other factors however, such as the usage of screen monitors and the brightness of both the monitor and the room, were significantly associated with the severity of DES symptoms. [ABSTRACT FROM AUTHOR]

Background Dry eye syndrome (DES) is a common condition characterized by insufficient tear production or excessive tear evaporation, leading to discomfort, visual disturbances, and potential damage to the ocular surface. Carboxy methyl cellulose (CMC) is frequently used in artificial tears for its viscosity and lubricating properties. The addition of glycerin and balanced electrolytes to CMC formulations may enhance moisture retention and support ocular surface health, potentially offering superior relief from DES symptoms. Materials and Methods This study is a randomized, double-blind, controlled trial comparing the efficacy of CMC with glycerin and balanced electrolytes (Group A) versus plain CMC (Group B) in maintaining ocular moisture and alleviating DES symptoms. A total of 100 participants, aged 18-65, were randomized into two groups. The primary outcome was the improvement in Ocular Surface Disease Index (OSDI) scores over eight weeks. Secondary outcomes included changes in tear break-up time (TBUT), Schirmer test results, and patient-reported comfort and satisfaction. Adverse events were also monitored. Results Group A showed significant improvement in TBUT, with mean times increasing from 6±2 seconds at baseline to 11±3 seconds at Week 12, compared to 8±2 seconds in Group B. Schirmer test results indicated greater tear production in Group A, with mean values rising from 7±3 mm at baseline to 12±4 mm at Week 12, versus 9±3 mm in Group B. OSDI scores improved significantly more in Group A, with a mean reduction of 20 points, compared to 12 points in Group B. Participant comfort and satisfaction were higher in Group A throughout the study. Adverse events were similar in both groups, with slightly fewer reported in Group A. Conclusion CMC with glycerin and balanced electrolytes is more effective than plain CMC in improving tear stability, tear production, and patient comfort in DES management, with a comparable safety profile. These findings support the use of additional excipients in enhancing the therapeutic efficacy of artificial tears. [ABSTRACT FROM AUTHOR]

Background and Objectives: Dry Eye Disease (DED) is a chronic condition characterised by tear film instability and ocular surface disruption, significantly impacting patients' quality of life. This study aimed to provide top-level clinical evidence for the long-term efficacy of dehydrated amniotic membrane (dAM, Omnigen®) delivered via a specialised bandage contact lens (sBCL, OmniLenz) for managing moderate-to-severe DED. Materials and Methods: This randomised controlled trial (NCT04553432) involved 93 participants with moderate-to-severe DED, randomised to receive a 1-week bilateral treatment of either dAM (17 mm diameter with 6 mm central 'window') applied under a sBCL or sBCL alone. Participants were assessed at baseline and followed up at 1, 3, and 6 months post-treatment. Outcomes included changes in symptomatology, tear film and ocular surface measurements, and in vivo confocal microscopy imaging of corneal nerve parameters and corneal dendritic cell (CDC) counts. Results: The dAM-sBCL group demonstrated a 65% reduction in OSDI scores at 6 months (p < 0.001), with 88% of participants showing improvement at 1 month. Corneal staining was significantly reduced in both groups. dAM-sBCL provided significant improvements in corneal nerve parameters at 1 month, with sustained positive trends at 3 months. Additionally, dAM-sBCL significantly reduced mature CDC counts, suggesting an anti-inflammatory effect. Conclusions: Treatment with dAM-sBCL for just 1 week significantly and rapidly improved dry eye symptoms as well as ocular surface signs for at least 3 months. It also enhanced corneal nerve health while reducing activated/mature corneal inflammatory cell numbers, presenting a safe and promising new treatment for moderate-to-severe DED. [ABSTRACT FROM AUTHOR]

Background: Allergic conjunctivitis (AC) is a prevalent ocular condition triggered by environmental allergens, causing significant discomfort and reduced quality of life. Dry Eye Disease (DED), marked by ocular discomfort and visual disturbances, frequently overlaps with AC symptoms. This study examines the prevalence of DED in AC patients and explores the relationship between different AC types and DED severity. Method: A cross-sectional, observational study was conducted from June to September 2023 in the Department of Ophthalmology at a tertiary center in North India. A total of 264 AC patients aged 18 years and older with itchy eyes were included. Patients with contact lens use, recent ocular surgery, trauma, corneal pathology, or certain systemic diseases were excluded. DED was assessed using the Ocular Surface Disease Index (OSDI), Schirmer’s test, and Tear Film Break-Up Time (TFBUT). Results: DED was found in 70% of AC patients, with 20% mild, 19% moderate, and 32% severe cases. Females were more affected (64%). VKC patients showed higher tear production and better TFBUT scores. PAC patients had the most severe DED. Conclusion: DED is common in AC patients, with PAC associated with more severe DED, while VKC shows milder symptoms. Tailored treatment approaches are needed for managing AC and DED.

Aim: To compare the performance of the Dry Eye Questionnaire (DEQ-5) questionnaire with the Ocular Surface Disease Index (OSDI) questionnaire and check its application in large screening camps or nonclinic-based settings. Study Designs: Cross-sectional observation study. Purpose: To evaluate the DEQ 5 questionnaire by comparing its performance to that of OSDI in assessing dry eye. Materials and Methods: A cross-sectional study comparing the performance of two questionnaires was conducted. Demographic information was collected. The Cronbach’s alpha reliability and correlation were determined using the Pearson correlation coefficient. Results: The reliability of both the DEQ 5 and OSDI was 0.52 and 0.78, respectively. There was a statistically significant correlation between both questionnaires. (r = 0.6, P < 0.050). Conclusion: DEQ-5 questionnaire can serve as a useful tool for evaluating and monitoring in various dry eye settings in comparison to OSDI.

Per Jensen,1 Christian Nilsen,1 Morten Gundersen,1 Kjell Gunnar Gundersen,1 Rick Potvin,2 Parisa Gazerani,3 Xiangjun Chen,4– 6 Tor P Utheim,3– 8 Øygunn A Utheim4,7,8 1Ifocus Eye Clinic, Haugesund, Norway; 2Science in Vision, Frisco, TX, USA; 3Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; 4Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; 5Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; 6Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway; 7Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; 8The Norwegian Dry Eye Clinic, Oslo, NorwayCorrespondence: Per Jensen, Ifocus Eye Clinic, Sørhauggata 111, Haugesund, 5527, Norway, Tel +47 906 13 685, Email per@ifocus.noPurpose: To compare the effect of treatment with preservative-free dexamethasone, NSAIDs and trehalose/hyaluronic acid eye drops with the preservative benzalkonium chloride containing dexamethasone and NSAIDs after cataract surgery in dry versus non-dry eyes.Patients and Methods: In this prospective randomized intervention study, dry eye tests were performed before and 6 weeks after cataract surgery. Patients were considered as having dry eye, SDE (sign of dry eye), if at least one of the following dry eye tests were abnormal; corneal fluorescein staining (CFS), non-invasive keratograph breakup time (NIKBUT) or tear osmolarity. Patients with SDE were randomly assigned to one of two groups. Group 1 patients were treated with dexamethasone and bromfenac eye drops with the preservative benzalkonium chloride (BAC). Group 2 patients were treated with preservative-free dexamethasone and preservative-free diclofenac, as well as a preservative-free lubricant with trehalose and hyaluronic acid both before and after surgery. Patients with normal tear film status acted as the control group (group 3) and received same treatment as group 1.Results: A total of 215 patients were enrolled six weeks after surgery, the number of patients with SDE decreased significantly in groups 1 and 2 (p < 0.001). Subjective symptoms and objective measures including osmolarity, NIKBUT, CFS, and tear film thickness (TFT) improved after surgery, tear production remained unchanged, while corneal sensitivity and meibomian gland dysfunction (MGD) parameters worsened. In the control group with normal tear-film status, SDE increased significantly after the surgery (p < 0.001). There were no statistically significant differences in tear film parameters between the three groups after surgery.Conclusion: After cataract surgery, patients with mild to moderate dry eyes may experience improved tear film status and reduced symptoms. However, we found no additional beneficial effect on dry eye parameters with treatment with preservative-free dexamethasone, NSAIDs, and lubricants compared to preservative-containing eye drops.Keywords: sign of dry eye, cataract surgery, osmolarity, corneal fluorescein staining, non-invasive keratograph tear break-up time, ocular surface disease index, meibomian gland dysfunction

AIM: To investigate the preoperative ocular symptoms and the characteristics of asymptomatic ocular surface abnormalities in hospitalized patients with primary pterygium.METHODS: Cross-sectional study. Hospitalized patients diagnosed with primary pterygium and scheduled to receive pterygium excision surgery at the Xiamen Eye Center of Xiamen University from August 2022 to October 2022 were enrolled. Ocular surface disease index questionnaire(OSDI), six examinations including non-invasive tear film break-up time, Schirmer I test, tear meniscus height, lid margin abnormality, meibomian gland dropout and tear film lipid layer thickness, and anterior segment optical coherence tomography(AS-OCT)were performed and statistically analyzed.RESULTS: A total of 178 cases(178 eyes), with a mean age of 54.39±10.75 years old, were recruited, including 75 males(42.1%)and 103 females(57.9%). The average values of ocular surface parameters in these patients included OSDI: 11.47±9.69, tear film break-up time: 7.10±3.86 s; tear meniscus height: 0.16±0.07 mm, Schirmer I test values: 14.39±7.29 mm/5 min, and pterygium thickness: 504.74±175.87 μm. Totally 161 eyes(90.4%)presented with abnormal lid margin, 44 eyes(24.7%)presented with meibomian gland dropout score ≥4, 52 eyes(29.2%)presented with low lipid layer thickness. In the 6 objective examinations, abnormalities in at least 4 of these tests were found in 85.4% of eyes. Pterygium morphology was classified into four grades: 10 eyes(5.6%)of grade Ⅰ, 93 eyes(52.2%)of grade Ⅱ, 60 eyes(33.7%)of grade Ⅲ, and 15 eyes(8.4%)of grade Ⅳ. In patients with a higher grade of pterygium, the tear film break-up time was lower, and the proportion of abnormal lid margin was also significantly higher(P

Glaucoma is a chronic neurodegenerative disease that eventually leads to irreversible blindness. The main risk factor for the development and progression of glaucoma is elevated IOP. In cases where the use of prostaglandin analogues is limited, brimonidine is the most rational choice as initial therapy. It is the only molecule that both reduces aqueous humor production and enhances uveoscleral outflow. The use of several hypotensive drugs for a long time can lead to pronounced changes in the tissues of the anterior segment of the eye. In this case, there are complaints characteristic of the dry eye syndrome. The aggravation of this condition can affect the adherence of patients to treatment and worsen the course of the disease. Therefore, it is important to prescribe hypotensive drugs that have a sufficient hypotensive effect with a good safety profile. Purpose. To evaluate the efficacy and safety of Brimonidine SZ in combination therapy for glaucoma after changing the hypotensive regimen. Patients and methods. The study was conducted in a group of 50 patients (50 eyes) with initial or advanced drug-compensated primary open-angle glaucoma (mean age 64.8 years), among them there were 27 (54 %) women and 23 (46 %) men. In patients included in the study, brimonidine 0.15 % or 0.2 % was replaced with Brimonidine SZ as part of combination hypotensive therapy. To analyze the results obtained, data on corneal-compensated IOP, the degree of corneal staining with fluorescein, assessments of conjunctival hyperemia, indicators of the OSDI questionnaire and the level of adherence to treatment at the initial visit, as well as 1 and 3 months after changing the hypotensive regimen, were compared. Results. There were no statistically significant differences in the level of IOP at different times after changing the hypotensive regimen. Objective indicators of the state of the tissues of the anterior surface of the eye did not change. According to the results of the evaluation of the main signs of dry eye syndrome (OSDI) and the degree of adherence of patients to treatment, no significant changes were found either. Conclusion. Brimonidine SZ has a similar hypotensive efficacy with brimonidine 0.15 % and 0.2 % as part of combination hypotensive therapy. The safety profile of Brimonidine SZ is comparable to analogues, which allows us to consider this drug as a possible alternative when choosing hypotensive therapy.

Abstract Purpose: To determine the long-term effects of night shift work on dry eye in hospital nurses. Methods: Each participant was evaluated four times, including at the beginning of the day shift (8 am), at the end of the day shift (2 pm), at the beginning of the night shift (8 pm), and at the end of the night shift (8 am), using the tear break-up time (TBUT) test and ocular surface disease index (OSDI) questionnaire. Results: The results showed significant differences in the TBUT and OSDI between the end of the day shift (2 pm) (10.26, 16.61) and the end of the night shift (8 am) (6.89, 38.59) relative to each other and relative to the beginning of the day and night shifts. As for the correlation between TBUT and OSDI, a significant correlation was found at all measurement times (correlation coefficient: - 0.478, - 0.707, - 0.556, and - 0.365, respectively) (p < 0.05). Conclusion: The results showed that the severity of dry eye increased after the night shift with variation over a 24-hr period. Moreover, a significant correlation was observed between TBUT and OSDI results at the beginning and at the end of the day and night shifts.

Patricia del Carmen Muñoz-Villegas,1,2 Alejandra Sánchez-Ríos,1 Oscar Olvera-Montaño1 1Regional Medical Affairs Department, Laboratorios Sophia, S.A. de C.V, Zapopan, Jalisco, Mexico; 2Centro de Investigación en Matemáticas A.C. (CIMAT), Unidad Aguascalientes, Aguascalientes, MexicoCorrespondence: Patricia del Carmen Muñoz-Villegas, Regional Medical Affairs Department, Laboratorios Sophia, S.A. de C.V, Paseo del Norte 5255, Guadalajara Technology Park, Zapopan, Jalisco, 45010, Mexico, Tel +52 (33) 3301 4200, Email patricia.munoz@sophia.com.mxPurpose: A randomized clinical trial was run to evaluate the effectiveness of a preservative-free 0.4% sodium hyaluronate eye drop (LOF) in different dosage schemes to alleviate signs and symptoms of dry eye disease (DED).Methods: A total of 116 subjects with mild-to-moderate DED were included, and 111 completed the study (from which 67.6% were female and 65.3% were users of oral contraceptives). Patients were randomly assigned to instill a drop of LOF either 2 (BID), 4 (QID) or 6 (6TD) times a day (at least 3 hours apart) for 30 days. The clinical parameters and symptom endpoints were Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), ocular surface staining, and conjunctival hyperemia. Other parameters evaluated were chemosis, best corrected visual acuity, and the incidence of adverse events (AE).Results: There was a significant reduction in OSDI scores by day 30 in all groups. The recovery of the OSDI score back to normal values was observed in 51.4% of patients treated (50%, 48.6%, and 55.6% in BID, QID, and 6TD, respectively, p = 0.822). Similar improvement was observed for TBUT, 50.5% of patients increased this variable to > 10 seconds (39.5%, 51.4%, and 61.1%, p = 0.175), and for ocular surface staining, ≥ 72% showed Grade 0. There were no significant differences among posology groups regarding ocular surface staining, conjunctival hyperemia, or any safety parameters. No overall improvement in OSDI and TBUT to normal values was noted for 31 patients (21 were female and 71.4% users of contraceptive drugs).Conclusion: The ophthalmic use of preservative free LOF, 2, 4 or 6 times a day, may alleviate clinical parameters and symptoms in 50% of patients with mild-to-moderate DED after a one-month treatment. This improvement seemed to be less ubiquitous in patients within reproductive age and using oral contraceptives.Trial Registration: This trial is registered at clinicaltrials.gov (NCT0704531).Keywords: contraceptives, dry eye disease, ocular surface disease index, sodium hyaluronate, tear break-up time

Objectives:To evaluate sarcoidosis-induced tear film changes using subjective and objective diagnostic tests, particularly conjunctival impression cytology (IC), and to compare the results with healthy individuals.Materials and Methods:This study evaluated clinical data collected between January 2019 and January 2021 from 57 right eyes of 57 sarcoidosis patients without ocular involvement (Group 1) and 33 right eyes of 33 healthy individuals with similar demographic characteristics (Group 2). The Schirmer I test, tear break-up time (TBUT), fluorescein staining, and conjunctival IC were all performed as part of the conjunctival and corneal examinations following a thorough ophthalmological examination. The Ocular Surface Disease Index (OSDI) was used to assess subjective ocular symptoms.Results:The mean ages in Groups 1 and 2 were 49.26±3.18 and 51.91±2.89 years, respectively (p=0.720). The mean Schirmer I test, TBUT, and OSDI scores differed significantly (p

Aim: Upper eyelid blepharoplasty (ULB) is a prevalent aesthetic and functional surgery. This study aims to compare the post-operative dry eye syndrome (DES) symptoms and related diagnostic tests between the patients who underwent ULB with or without fat excision. Materials and Methods: A total of 44 patients (22 with fat excision, 22 without) were evaluated preoperatively and post-operatively in the 1st and 6th months for DES parameters (Schirmer I, tear break-up time, and corneal staining score) and Ocular Surface Disease Index (OSDI) score. Results: Patients undergoing ULB regardless of fat excision demonstrated favorable outcomes in both objective DES tests and subjective DES scale in the postoperative 6th month. There was no significant difference between the two surgical groups in terms of DES parameters in both the 1st and 6th months. Conclusion: ULB appears to ameliorate both objective and subjective manifestations of DES. The inclusion of fat excision during the procedure does not seem to exert a significant effect on these outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Dry eye is a significant eye health issue. In dry eyes, the tear film is weakened, mostly due to low tear film quality and the quantity of secretion. This low quality of tear secretion can lead to the rapid breakup of tears. In recent times, particularly since the COVID-19 pandemic, the prevalence of dry eye has increased. Relevant studies found that the prevalence of dry eye is higher in females than males. This research work is based only on symptoms of dry eye disease in Malaysia to determine its prevalence among students at the UCSI University KL campus because of the increase in reported cases of dry eyes especially post Movement Control Order (MCO). Methods: A total of 199 students, ranging in age 17 to 30, were included in this research. This is a cross-sectional study that was conducted on participants who fulfilled the inclusion criteria. Demographic questionnaires and Ocular Surface Disease Index (OSDI) results were collected. Results: On the UCSI KL Campus, students who suffer from dry eye are 82% of the population. The Pearson Chi-Square test showed a significant difference between gender and dry eye, X2 (1, N= 199) = 8.64, p < 0.0033. Female students are more likely to develop dry eye than male students. Conclusion: The prevalence of dry eyes among UCSI students is high. This could be attributable to prolonged or improper mask-wearing. It is suggested that researchers and health policymakers should take heed to these emerging risk factors related to wearing of mask. [ABSTRACT FROM AUTHOR]

AIM: To explore the relationship between ocular and systemic conditions and the impact of ocular complications on the quality of life (QOL) in patients after allogeneic hematopoietic stem cell transplantation (ALLO-HSCT). METHODS: Forty-four patients with severe hematopoietic disease were enrolled after ALLO-HSCT at our center from July 2018 to October 2020. They completed two questionnaires: the Ocular Surface Disease Index (OSDI) and the quality-of-life scale for Chinese patients with visual impairment (SQOL-DV1). Ocular conditions and systemic conditions were also assessed. RESULTS: Eye damage was correlated with total bilirubin (P=0.005), and gamma-glutamyl transferase (GGT) (P=0.021). There was no significant correlation between the overall QOL score and OSDI (P=0.8226) or SQOL-DV1 (P=0.9526) scores. The OSDI and the overall QOL score were not correlated with ocular conditions, including best-corrected visual acuity (BCVA), intraocular pressure, Schirmer tear test II, sodium fluorescein staining, tear film breakup time, and tear meniscus height. SQOL-DV1 was correlated with BCVA (P=0.0007), sodium fluorescein staining (P=0.007), and tear film breakup time (P=0.0146). CONCLUSION: In some patients, early ocular symptoms are not evident after ALLO-HSCT, while ocular surface complications can be observed after a comprehensive ophthalmological examination. Especially for those with elevated total bilirubin or GGT, regular ophthalmic follow-up visits are essential to diagnose and treat ocular graft versus host disease (oGVHD), especially for patients with elevated total bilirubin or GGT.

Background and Objectives: Dry Eye Disease (DED) is a chronic condition characterised by tear film instability and ocular surface disruption, significantly impacting patients’ quality of life. This study aimed to provide top-level clinical evidence for the long-term efficacy of dehydrated amniotic membrane (dAM, Omnigen®) delivered via a specialised bandage contact lens (sBCL, OmniLenz) for managing moderate-to-severe DED. Materials and Methods: This randomised controlled trial (NCT04553432) involved 93 participants with moderate-to-severe DED, randomised to receive a 1-week bilateral treatment of either dAM (17 mm diameter with 6 mm central ‘window’) applied under a sBCL or sBCL alone. Participants were assessed at baseline and followed up at 1, 3, and 6 months post-treatment. Outcomes included changes in symptomatology, tear film and ocular surface measurements, and in vivo confocal microscopy imaging of corneal nerve parameters and corneal dendritic cell (CDC) counts. Results: The dAM-sBCL group demonstrated a 65% reduction in OSDI scores at 6 months (p < 0.001), with 88% of participants showing improvement at 1 month. Corneal staining was significantly reduced in both groups. dAM-sBCL provided significant improvements in corneal nerve parameters at 1 month, with sustained positive trends at 3 months. Additionally, dAM-sBCL significantly reduced mature CDC counts, suggesting an anti-inflammatory effect. Conclusions: Treatment with dAM-sBCL for just 1 week significantly and rapidly improved dry eye symptoms as well as ocular surface signs for at least 3 months. It also enhanced corneal nerve health while reducing activated/mature corneal inflammatory cell numbers, presenting a safe and promising new treatment for moderate-to-severe DED.

Purpose: A randomized clinical trial was run to evaluate the effectiveness of a preservative-free 0.4% sodium hyaluronate eye drop (LOF) in different dosage schemes to alleviate signs and symptoms of dry eye disease (DED).Methods: A total of 116 subjects with mild-to-moderate DED were included, and 111 completed the study (from which 67.6% were female and 65.3% were users of oral contraceptives). Patients were randomly assigned to instill a drop of LOF either 2 (BID), 4 (QID) or 6 (6TD) times a day (at least 3 hours apart) for 30 days. The clinical parameters and symptom endpoints were Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), ocular surface staining, and conjunctival hyperemia. Other parameters evaluated were chemosis, best corrected visual acuity, and the incidence of adverse events (AE).Results: There was a significant reduction in OSDI scores by day 30 in all groups. The recovery of the OSDI score back to normal values was observed in 51.4% of patients treated (50%, 48.6%, and 55.6% in BID, QID, and 6TD, respectively, p = 0.822). Similar improvement was observed for TBUT, 50.5% of patients increased this variable to > 10 seconds (39.5%, 51.4%, and 61.1%, p = 0.175), and for ocular surface staining, ≥ 72% showed Grade 0. There were no significant differences among posology groups regarding ocular surface staining, conjunctival hyperemia, or any safety parameters. No overall improvement in OSDI and TBUT to normal values was noted for 31 patients (21 were female and 71.4% users of contraceptive drugs).Conclusion: The ophthalmic use of preservative free LOF, 2, 4 or 6 times a day, may alleviate clinical parameters and symptoms in 50% of patients with mild-to-moderate DED after a one-month treatment. This improvement seemed to be less ubiquitous in patients within reproductive age and using oral contraceptives.Trial Registration: This trial is registered at clinicaltrials.gov (NCT0704531). [ABSTRACT FROM AUTHOR]

Purpose: To propose additional items for established dry eye disease (DED) instruments that cover blepharitis-specific signs and symptoms and to determine the association between the clinical findings and subjective complaints. Methods: Thirty-one patients with blepharitis and DED were prospectively included in the pretest period for selecting suitable questions. In the main phase of the study, the selected questions were then tested on 68 patients with blepharitis and DED and 20 controls without blepharitis or DED. Pearson's coefficient of correlation was calculated between the blepharitis-specific questions, tear break-up time (TBUT), the Schirmer test score, and the ocular surface disease index (OSDI) score; and the similarity between the blepharitis-specific questions, OSDI questions, and objective parameters for DED was assessed via hierarchical clustering. Furthermore, the discriminatory power of the blepharitis-specific questions was investigated with the receiver operating characteristic (ROC) curve. Results: The additional question about heavy eyelids revealed a significant correlation with the OSDI score (r = 0.45, p < 0.001) and Schirmer score (r = − 0.32, p = 0.006). Cluster analysis demonstrated the similarity between the question about heavy eyelids and TBUT. In addition, the OSDI questionnaire had the highest discriminatory power in ROC analysis, and the OSDI score significantly correlated with the specific questions about eyelids sticking together (r = 0.47, p < 0.0001) and watery or teary eyes (r = 0.34, p = 0.003). Conclusions: The blepharitis-specific additional questions were closely associated with objective parameters for DED. The question about heavy eyelids might be well suited for recording the symptoms of hyposecretory and hyperevaporative dry eye with blepharitis. [ABSTRACT FROM AUTHOR]

Purpose: To determine the long-term effects of night shift work on dry eye in hospital nurses. Methods: Each participant was evaluated four times, including at the beginning of the day shift (8 am), at the end of the day shift (2 pm), at the beginning of the night shift (8 pm), and at the end of the night shift (8 am), using the tear break-up time (TBUT) test and ocular surface disease index (OSDI) questionnaire. Results: The results showed significant differences in the TBUT and OSDI between the end of the day shift (2 pm) (10.26, 16.61) and the end of the night shift (8 am) (6.89, 38.59) relative to each other and relative to the beginning of the day and night shifts. As for the correlation between TBUT and OSDI, a significant correlation was found at all measurement times (correlation coefficient: -0.478, -0.707, -0.556, and -0.365, respectively) (p <0.05). Conclusion: The results showed that the severity of dry eye increased after the night shift with variation over a 24-hr period. Moreover, a significant correlation was observed between TBUT and OSDI results at the beginning and at the end of the day and night shifts. [ABSTRACT FROM AUTHOR]

aimi,5 Yahya Al-Najmi61Ophthalmology Department, King Faisal Medical Complex, Taif, Saudi Arabia; 2Ophthalmology Department, Alhada Military Hospital, Taif, Saudi Arabia; 3Ophthalmology Department, Jeddah Eye Hospital, Jeddah, Saudi Arabia; 4Ophthalmology Department, Asir Central hospital, Abha, Saudi Arabia; 5Ophthalmology Department, College of Medicine, Majmaah University, Majmaah, Saudi Arabia; 6Ophthalmology Department, Saggaf Eye Center, Jeddah, Saudi ArabiaCorrespondence: Yahya Al-Najmi, Ophthalmology Department, Saggaf Eye Center, Abdullah Salman St., Al Faiha'a Dist., P.O. Box: 31903, Jeddah, 21418, Saudi Arabia, Tel +966 564844281, Email [email protected] Purpose: To estimate the prevalence and determinants of Ocular Surface Disease Index (OSDI) score based dry eye disease (DED) among the adult urban population of four cities located at high altitudes in Southwest Saudi Arabia.Methods: This cross-sectional survey was held in 2023. OSDI questionnaire was used to collect the responses of the adult participants. The score was further graded into none, mild, moderate, and severe DED to estimate age-sex-adjusted DED prevalence. The OSDI score was correlated to demographic (age group, gender, education, occupation, city) and risk factors like smoking and co-morbidities.Results: Of the 401 adults, 388 (response rate of 97.8%) participated. The age-sex-adjusted prevalence of mild, moderate, and severe DED was 21.7%, 13.1%, and 32%, respectively. The median ODSI score was 22.9 [Interquartile range (IQR) 10.4; 47.9)]. The score was significantly higher in females (Mann–Whitney U-test P = 0.038), residents of Taif city (KW P = 0.05), those with primary/middle school education (Kruskal–Wallis P = 0.004), comorbidities like hypertension, asthma (KW P < 0.001) and risk factors like past refractive surgeries, arthritis (KW P = 0.013). Education status (P < 0.001) [B = − 9.0 95%] and presence of comorbidity (P = 0.022), [B = − 0.823] were significant predictors of DED.Conclusion: The prevalence of DED and severe grade was high. The level of education and presence of comorbidities significantly influenced DED in the adult urban Saudi population of cities at high altitudes. [ABSTRACT FROM AUTHOR]

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Introduction: The aim of the study was to determine the effect of oral isotretinoin therapy on the functional and morphological condition of the anterior segment of the eye, with particular emphasis on the meibomian glands. Methods: Twenty-four patients (48 eyes) with a diagnosis of acne vulgaris were involved in the survey. All patients underwent a thorough ophthalmological examination at three time points: before therapy, 3 months after the start of therapy, and 1 month after the completion of isotretinoin therapy. The physical examination included the following elements: blink rate, analysis of the lid margin abnormality score (LAS), tear film break-up time (TFBUT) and Schirmer's test, meibomian gland loss (MGL), and the evaluation of the meibum quality score (MQS) and meibum expressibility score (MES). Additionally, the total score of an ocular surface disease index (OSDI) questionnaire was analysed. Results: In comparison with pretreatment values, significant increases in OSDI during and after the treatment (p = 0.003 and p = 0.004, respectively) were observed. Substantial deterioration during the treatment was observed for MGL (p < 0.0001), MQS (p < 0.001) and LAS (p < 0.0001), while an improvement in those parameters after isotretinoin cessation was observed (p = 0.006, p = 0.02 and p = 0.0003, respectively). The frequency of using artificial eye drops was positively associated with MGL during (Spearman's rank correlation coefficient (Rs) = + 0.31; p = 0.03) and after the cessation of the therapy (Rs = + 0.28; p = 0.04). Meibomian gland atrophy correlated significantly with MQS during (Rs = + 0.29; p = 0.04) and after treatment (Rs = + 0.38; p = 0.008). The decrease in TFBUT values correlated with increased LAS (Rs = − 0.31; p = 0.03) during the course of isotretinoin usage. We found no changes in Schirmer's test or blink rates. Conclusion: Isotretinoin therapy leads to increased ocular complaints related to lipid tear film component dysfunction. This is due to reversible changes in meibomian gland morphology and function observed during drug usage. [ABSTRACT FROM AUTHOR]

Purpose: Aim of this study was to compare the efficacy of sodium hyaluronate (SH) and carboxymethyl cellulose (CMC) eye drops in treating mild to moderate dry eye disease in terms of relief of symptoms, mean change in tear film breakup time, Schirmer's test, and impression cytology of conjunctiva from baseline. Methods: An observational study was carried out during a 2-year period in our tertiary referral hospital. The study consisted of 60 patients randomly allotted to two groups to receive SH and CMC eye drops for an 8-week period. Ocular surface disease index, tear film breakup time, and Schirmer's test were performed at baseline visit and 4 and 8 weeks of treatment, and impression cytology of conjunctiva was performed at baseline and 8 weeks. Results: Significant improvement in patient symptoms, tear film breakup time, and Schirmer's test from baseline was seen in both SH and CMC groups at 8 weeks posttreatment, whereas impression cytology of conjunctiva in both groups did not show significant improvement at 8 weeks of treatment. Data analysis using unpaired t-test showed comparable results. Conclusion: Both CMC and SH demonstrated equal efficacy in treating mild to moderate dry eye disease.

Purpose: This present prospective, cross-sectional study aims to comprehensively evaluate the ocular surface in asymptomatic patients with diffuse blebs after trabeculectomy versus chronic anti-glaucoma medication use and compare it with the age-matched normal population. Methods: Objective clinical evaluation was done by tear film break-up time (TBUT) and Schirmer's test (ST) in the three groups–trabeculectomy >6 months with a diffuse bleb (Wurzburg bleb classification score ≧10), chronic anti-glaucoma medication (AGM >6 months) group, and normal population. In all groups, tear film osmolarity was checked with the TearLab® device (TearLab Corp., CA, USA), and subjective evaluation was performed by administering Ocular Surface Disease Index (OSDI) questionnaire. Patients already on chronic lubricants or any other drug for the treatment of dry eyes (viz. steroids, cyclosporin) or having symptoms suggestive of an abnormal ocular surface, who had undergone refractive or intraocular surgery, and contact lens users were excluded. Results: In total, 104 subjects/eyes were recruited over 6 weeks. Thirty-six eyes recruited in the trab group were compared with 33 eyes studied in the AGM group, and both these groups were compared to 35 normal eyes. When compared to normals, TBUT and ST were significantly lower (P = 0.003 and 0.014) and osmolarity and OSDI were statistically significantly higher (P = 0.007 and 0.003) in the AGM group, whereas only TBUT was statistically significantly different (P = 0.009) when the trab group was compared to normals. Also, when the trab group was compared to the AGM group, ST was found to be higher (P = 0.003) and osmolarity was lower (P = 0.034). Conclusion: To conclude, ocular surface is affected even in asymptomatic patients on AGM but near normalcy is possible following trabeculectomy when blebs are diffuse.

Background Dry eye disease (DED) is a common ophthalmic disorder which affects 5–50% of the global population. Aim The aim of this study was to compare the effects of topical application of cyclosporine A (CsA) to prednisolone in patients with DED. Patients and methods The study included 40 patients diagnosed with DED. They were randomly divided into two groups: group A patients received treatment with topical 0.05% CsA twice a day, and group B patients received treatment with topical 1% prednisolone four times a day for 1 month. All patients were examined at three visits: before treatment, after 2 weeks, and 1 month after the intervention to show the effect of the two drugs on the tear break-up time (TBUT), Schirmer’s score, ocular surface disease index (OSDI), and surface stain, in addition to assessment of the patient’s DED-related symptoms. Results In the prednisolone group, the pretreatment Schirmer’s test results were 3.05±1.57 and 2.35±1.57 mm for the right (OD) and left eyes (OS), respectively. It improved to 5.65±2.30 and 5.85±2.43 mm, respectively 2 weeks after discontinuation of treatment (posttreatment). Similarly, the pretreatment values for the CsA group were 1.35±1.57 and 2.0±1.52 mm and became 5.65±2.30 and 5.85±2.434 mm, respectively after treatment. There was a statistically significant difference between the two groups regarding the pretreatment (P=0.001) and posttreatment (P=0.026) Schirmer’s test results. In the prednisolone group, the pretreatment TBUT was 4.20±1.61 and 3.85±1.09 s and improved to 6.60±1.31 and 6.85±1.42 s, respectively after treatment. Similarly, in the CsA group the pretreatment values were 2.65±1.81 and 3.30±1.38 s and became 8.65±1.69 and 9.30±1.42 s, respectively, posttreatment. In addition, there was a statistically significant difference between the studied groups regarding the pretreatment (P=0.007) and posttreatment TBUT (P0.05). The surface stain improved in both groups after treatment, with the prednisolone group showing the greatest improvement at 2 weeks (P=0.002). However, there was no statistically significant difference between the two groups at 1 month (P>0.05). Conclusion Both topical CsA and prednisolone demonstrated effectiveness in treating moderate to severe DED cases and were comparable. Prednisolone showed a greater improvement in OSDI (that assesses the DED-related symptoms) and surface stain, while CsA was associated with more improvement in Schirmer’s test and TBUT.

Jennifer B Nadelmann,1,2 Vatinee Y Bunya,1 Gui-Shuang Ying,3 Peiying Hua,3 Mina Massaro-Giordano1 1Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2Department of Ophthalmology, Weill Cornell Medicine, New York, NY, USA; 3Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USACorrespondence: Mina Massaro-Giordano, Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Tel +1-215-662-8100, Email mina@pennmedicine.upenn.eduPurpose: Platelet rich plasma (PRP) is an autologous preparation that concentrates platelets in a small volume of plasma. The purpose of this study was to determine if PRP eye drops improved the symptoms and signs of ocular surface disease.Patients and Methods: A retrospective case series was conducted of patients who were prescribed PRP eye drops. Subjects were excluded if they did not have follow-up, underwent intraocular surgery prior to follow-up, received nerve growth factor treatments, or did not have a baseline examination with photography. Symptoms were assessed using the Ocular Surface Disease Index (OSDI). Patients also underwent a slit lamp exam, ocular surface staining with fluorescein and lissamine green, and Schirmer testing.Results: The charts of 47 patients treated with PRP drops for ocular surface disease were reviewed. Sixty-four eyes of 32 patients were included in the study who had photographs of lissamine green staining taken at baseline and at follow-up. Thirteen patients (28%) had ocular graft-versus-host disease, 16 patients (34%) had Sjögren’s syndrome, and 4 patients (8.5%) had rheumatoid arthritis. There was a statistically significant decrease in OSDI score from baseline to follow-up (39.5 vs 30.8 points, p = 0.02). Among the 64 eyes included, 9 (14%) had an improvement in conjunctival lissamine green staining, while 6 (9%) had an increase in staining at follow-up. Among the 20 eyes with Schirmer testing, there was a borderline significant increase in score from baseline to follow-up (5.9 vs 9.7, p = 0.06). Among the 44 eyes that had corneal fluorescein staining (CFS) reported, 8 (18.2%) had decreased staining and 2 (4.5%) had increased staining at follow-up.Conclusion: Treatment with PRP drops was associated with a significant improvement in symptoms in patients with ocular surface disease. Future larger prospective studies are needed to further evaluate the efficacy of PRP drops for treating ocular surface disease.Keywords: ocular surface disease, cornea, lissamine green, Ocular Surface Disease Index, platelet-rich plasma

AIM: To evaluate the quantitative and qualitative results of the noninvasive tear film break-up time (NI-BUT) test and investigate the predictive ability of the new NI-BUT parameter in discriminating between normal Ocular Surface Disease Index (OSDI; scores ≤12) and abnormal OSDI (scores ≥13). METHODS: A total of 341 eyes of 341 volunteers who applied for routine eye outpatient control were included in the prospective study. All participants' noninvasive first tear film break-up time (NIF-BUT), noninvasive average tear film break-up time (NIAvg-BUT) and average value of the first three break-up time (A3F-BUT) were analyzed. A3F-BUT, the new NI-BUT parameter, is calculated by adding the NIF-BUT value to the 2nd break-up time value that has a difference of at most 1 second from the NIF-BUT value and to the 3rd break-up time and then dividing the respective sum by 3. Receiver operating characteristic (ROC) curve and forward logistic regression analyses were performed to determine the parameter that had the best predictive ability between the OSDI groups. RESULTS: The NI-BUT values of 255 eyes of 255 volunteers included in the study were analyzed statistically. The mean NIF-BUT, NIAvg-BUT, and A3F-BUT values were calculated as 5.3±3.0, 8±3.1, and 5.8±3.0 seconds, respectively. All three parameters were found to be significantly lower in the abnormal OSDI group (P=0.014, 0.034, and 0.011, respectively). The area under the curve (AUC) of the A3F-BUT to predict abnormal OSDI was AUC=0.625 (0.529-0.720), P=0.011 and NIF-BUT was AUC=0.599 (0.502-0.696), P=0.043. The A3F-BUT parameter and NIF-BUT parameters were found to be significantly efficient in discriminating abnormal OSDI. CONCLUSION: The new parameter for the NI-BUT test has more predictive ability in the discrimination of OSDI groups.

Objectives:To evaluate the corneal subbasal nerve morphology, corneal sensitivity, and anterior segment alterations in short-term silicone hydrogel contact lens (SiHCL) users by confocal microscopy.Materials and Methods:The study included 25 right eyes of 25 male volunteers aged 25-30 years who had never used SiHCLs before. ocular surface disease index (OSDI), tear break-up time, Schirmer test, tear meniscus area, strip meniscometry tube, corneal sensitivity, and corneal subbasal nerve morphology were evaluated before and after 1 month of CL use.Results:OSDI was 10.6±1.1 before CL use and 17.2±1.2 after 1 month of CL use (p0.05). Tear film break-up time was 7.1±0.4 s before and 6.2±0.3 s after CL use (p>0.05). The tear meniscus area was 0.026±0.002 mm2 before and 0.024±0.001 mm2 after 1 month of CL use (p>0.05). Stripmeniscometry tube results were 5.4±0.9 mm before and 4.9±0.8 mm after 1 month of CL use (p>0.05). Corneal sensitivity values were 3.2±0.4 mm before and 2.95±0.3 mm after 1 month of CL use (p>0.05). Dendritic cell density evaluated by confocal microscopy was 14.84±3.1 cells/mm2 before and 32.57±4.2 cells/mm2 after 1 month of CL use (p0.05). Subbasal nerve density was measured as 4726±310 pixels/frame before and 4570±272 pixels/frame after 1 month of CL use (p>0.05).Conclusion:After a month of SiHCL use, no significant changes were observed in tear secretion, corneal sensitivity, tear meniscus volume, subbasal corneal nerve density, reflectivity, or tortuosity, while a significant increase was found in OSDI and dendritic cell density.

Bruno Barbosa Ribeiro,1 Ana Marta,1,2 João Ponces Ramalhão,1 João Heitor Marques,1 Irene Barbosa1,2 1Centro Hospitalar Universitário do Porto’s Department of Ophthalmology (CHUPorto), Oporto, Portugal; 2Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, PortugalCorrespondence: Ana Marta, Centro Hospitalar Universitário do Porto’s Department of Ophthalmology, Largo do Prof. Abel Salazar, Oporto, 4099-001, Portugal, Tel +351 222077500, Email analuisamarta2@gmail.comPurpose: To review the indications and efficacy of Intense Pulsed Light (IPL) application in the treatment of Meibomian Gland Dysfunction (MGD). Its main purpose is to describe its physiology, efficacy, indications, and adverse effects.Patients and Methods: A two database (PubMed, EMBASE) search was performed from July 2017 to July 2022 using the MeSH terms (“Intense Pulsed Light” AND (“Meibomian Gland Dysfunction” OR “Dry Eye”). We included randomized studies and systematic reviews with meta-analysis. Exclusion criteria were non-randomized trials, studies enrolling non-MGD dry eye disease, and other works older than 5 years.Results: Current literature shows that IPL is an effective and safe treatment modality for severe dry eye. Available evidence shows improvement of symptoms and objective indicators, such as noninvasive breakup time, thickness of lipid layer, and Schirmer test. However, our review concluded that the beneficial effects of IPL may lose some efficacy at 6-months after the initial session, and subsequent sessions may be required. Thus, IPL treatment should not be considered as first-line therapy for MGD but instead as an adjuvant option to the standard of care. The optimal treatment modality remains unknown and should be tailored according to each patient’s phenotype, clinician’s experience, and available technology. There is evidence that IPL treatment may down-regulate pro-inflammatory markers (such as interleukin (IL) 6, IL17a, IL-1) and Prostaglandin E2 (PGE2).Conclusion: MGD is a multifactorial disease and IPL treatment seems a promising treatment modality. Despite this, more evidence is needed to study its benefits – since this is an emerging technology, it is expected an increase in comparative studies in the following years, with longer follow-up periods, which may enable more precise conclusions about this treatment modality.Keywords: dry eye disease, meibomian gland dysfunction, intense pulsed light, low-level light therapy, near-infrared light therapy, ocular surface disease index

Wissam Ghach,1,2 May M Bakkar,3 Mona Aridi,4 Ithar Beshtawi,5 Rita Doughaily,2 Noha Al-Fayoumi6 1Faculty of Communication, Arts and Sciences, Canadian University Dubai (CUD), Dubai, United Arab Emirates; 2School of Health Sciences, Modern University for Business and Science (MUBS), Damour, Lebanon; 3Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan; 4School of Computer and Applied Sciences, Modern University for Business and Science (MUBS), Damour, Lebanon; 5Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; 6Ibn Al-Nafees Hospital, Damascus, SyriaCorrespondence: Wissam Ghach, School of Health Sciences, Modern University for Business and Science (MUBS), Damour, Lebanon, Tel +9615601801, Fax +9615601667, Email wghash@mubs.edu.lb Mona Aridi, School of Computer and Applied Sciences, Modern Universityfor Business and Science (MUBS), Damour, Lebanon, Tel +9615601801, Fax +9615601667, Email maridi@mubs.edu.lbPurpose: To estimate the prevalence of symptomatic dry eye disease (DED) in four Middle Eastern Countries and investigate the association between behavioral-based risk factors and severity of DED.Patients and Methods: Population-based cross-sectional study of 1463 participants from 4 Mediterranean countries (Lebanon, Syria, Jordan, and Palestine). The Arabic version of the Ocular Surface Disease Index (ARB-OSDI) questionnaire was used to estimate the prevalence and severity of symptomatic DED using an online format survey. The survey also included demographic questions and possible behavioral risk factors (tobacco and cosmetic use). One-Way ANOVA and multivariate regression analyses were used to investigate the association between OSDI mean scores and behavioral-based risk factors.Results: The prevalence of symptomatic DED (OSDI score ≥ 13) among the overall population (332 males and 1132 females) reached 70.2%. Tobacco and cosmetic users reported a higher significant prevalence and severity of symptomatic DED than non-users (p < 0.0001). Smoking habits (eg, smoking cigarettes or Ajami, smoking in closed areas, and daily smoking) were more likely to report symptomatic DED. Bad hygiene process during the use of any cosmetic product was behind the high prevalence and severity of symptomatic DED among the females of the study population.Conclusion: Symptomatic DED is substantial in Middle Eastern countries. It is statistically associated with cosmetic and tobacco use.Keywords: eye dryness, Ocular Surface Disease Index, smoking, cosmetic use, middle east

Objectives: To evaluate sarcoidosis-induced tear film changes using subjective and objective diagnostic tests, particularly conjunctival impression cytology (IC), and to compare the results with healthy individuals. Materials and Methods: This study evaluated clinical data collected between January 2019 and January 2021 from 57 right eyes of 57 sarcoidosis patients without ocular involvement (Group 1) and 33 right eyes of 33 healthy individuals with similar demographic characteristics (Group 2). The Schirmer I test, tear break-up time (TBUT), fluorescein staining, and conjunctival IC were all performed as part of the conjunctival and corneal examinations following a thorough ophthalmological examination. The Ocular Surface Disease Index (OSDI) was used to assess subjective ocular symptoms. Results: The mean ages in Groups 1 and 2 were 49.26±3.18 and 51.91±2.89 years, respectively (p=0.720). The mean Schirmer I test, TBUT, and OSDI scores differed significantly (p<0.05 for all), with Group 1 having a significantly higher percentage of dry eyes than Group 2. Group 1 had significantly higher Nelson's grading system grades than Group 2 based on conjunctival IC analysis (p=0.001). There were no significant differences in visual acuity (p=0.17) or intraocular pressure (p=0.14) between groups. Conclusion: Sarcoidosis patients had significantly higher Nelson grades in conjunctival IC, as well as significantly higher percentages of dry eye as determined by the Schirmer I test, TBUT, and OSDI. Reduced tear quantity and quality may destabilize the tear film layer, resulting in a variety of ocular symptoms. [ABSTRACT FROM AUTHOR]

Background: Intense pulsed light therapy (IPL) is a recently developed way of treating dry eye disease (DED). During the last decade, there was a multiplication of trials studying IPL efficacy. The goal of this review is to summarize the most important and significant results of these trials estimating effect sizes. Methods: The PubMed and sciencedirect databases were searched using a PICO model-based approach. Randomized controlled trials including at least 20 patients with DED and no other eye condition, with a control group and break-up time or symptom scores data available for extraction were included in this review. Statistical analysis evaluated the tear break-up time (TBUT), non-invasive break-up time (NIBUT), ocular surface disease index (OSDI), and standard patient evaluation of eye dryness (SPEED). Three comparisons were carried on for each outcome: longest follow-up values vs. baseline in the treatment group, longest follow-up values in the treatment group vs. control group, and changes from baseline in the treatment group vs. control group. A subgroup analysis was carried on. Results: Eleven randomized controlled trials, published between 2015 and 2021 were included in this systematic review with 759 patients in total. The longest follow-up values vs. baseline in the treatment group analyses were significantly in favor of IPL for all the parameters studied for instance: NIBUT (effect size (ES), 2.02; 95% confidence interval (CI), (1.43; 2.62)), TBUT (ES, 1.83; 95% CI, (0.96; 2.69)), OSDI (ES, −1.38; 95% CI, (−2.12; −0.64)) and SPEED (ES, −1.15; 95% CI, (−1.72; −0.57)). The longest follow-up values in the treatment group vs. control group analyses, and, the change from baseline in the treatment group vs. control group analyses, were both significantly in favor of IPL for NIBUT, TBUT, and SPEED but not for OSDI. Conclusions: IPL seems to have a positive effect on tear stability evaluated by the break-up times. However, the effect on DED symptoms is less clear. Some confounding factors such as the age and the IPL device used influence the results indicating that the ideal settings still need to be found and personalized for the patient. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of e-cigarettes on tear film by comparing the tear film parameters of smokers and non-smokers using Keratograph and SM Tube. Study Design: Cross sectional study. Place and Duration of Study: Qasim University, from Saudi Arabia. Methods: A total of 60 males of age group 20 – 38 years were divided into three groups (Twenty non-smokers, 20 tobacco smokers and 20 vapor users). After consent, dry eye symptoms questionnaire was given to the participants. Four different test parameters through the Keratograph (5M JENVIS). Tear meniscus height, non-invasive tear break-up time, ocular redness and lipid layer thickness were measured. The new strip menis cometry tube (SM Tube) was used to test tear production. Data were analyzed using Statistical Package for Social Sciences (SPSS) with p value of less than 0.05 considered as significant. Results: The average tear breakup time was significantly decreased in both smokers and vapors group (10.15 ± 1.92 and 10.25 ± 2.65 respectively) than in nonsmokers (13.35 ± 2.36). There was also statistically significant difference in tear meniscus height, redness and lipid layer thickness between e-smokers and non-smokers (p > 0.05). The difference in these parameters was statistically non-significant between smokers and e-cigarette users. Conclusion: E-cigarettes cause low tear breakup time, less tear volume and other dry eye parameters, which leads to dry eye. There is a need for strict checks and balances on E-cigarette consumption for controlling cases of vision impairments related with e-cigarettes. [ABSTRACT FROM AUTHOR]

Background: We investigated the safety and efficacy of short-term treatment with topical low-dose hydrocortisone sodium phosphate 0.335% (PFH) in patients with moderate to severe primary Sjögren syndrome (SS)-related dry eye disease (DED). Methods: A retrospective single-centre interventional study. All patients received PFH for 6 days with a pulsed posology: three times daily for 2 days, twice daily for 2 days, and once daily for 2 days. This scheme was repeated for 3 consecutive months and then alternated for 3 months. Data were collected at baseline, 3 months, and 6 months of follow-up. Results: A total of 40 SS patients were enrolled. Conjunctival hyperaemia and corneal-conjunctival stain significantly improved (p < 0.001). Ocular Surface Disease Index score reduced significantly between baseline and 3 months and between baseline and 6 months (p < 0.001). The tear film osmolarity lowered significantly in each eye from baseline to 3 months and from baseline to 6 months (p = 0.002 and p = 0.037, respectively). Comparing results at 3 and 6 months, the Ocular Surface Disease Index score (p = 1.000), the frequency of lacrimal substitutes installation (p = 0.632), and tear film osmolarity (right eye p = 0.518, left eye p = 1.000) did not change significantly. Intraocular pressure did not change during the study period. Conclusion: PFH eye drops with a pulsed posology improve signs and symptoms, not affecting the intraocular pressure in SS-related DED. Therefore, this pulsed treatment is safe and efficacious. [ABSTRACT FROM AUTHOR]

Purpose: This present prospective, cross-sectional study aims to comprehensively evaluate the ocular surface in asymptomatic patients with diffuse blebs after trabeculectomy versus chronic anti‑glaucoma medication use and compare it with the age‑matched normal population. Methods: Objective clinical evaluation was done by tear film break‑up time (TBUT) and Schirmer’s test (ST) in the three groups– trabeculectomy >6 months with a diffuse bleb (Wurzburg bleb classification score ≧10), chronic anti‑glaucoma medication (AGM >6 months) group, and normal population. In all groups, tear film osmolarity was checked with the TearLab® device (TearLab Corp., CA, USA), and subjective evaluation was performed by administering Ocular Surface Disease Index (OSDI) questionnaire. Patients already on chronic lubricants or any other drug for the treatment of dry eyes (viz. steroids, cyclosporin) or having symptoms suggestive of an abnormal ocular surface, who had undergone refractive or intraocular surgery, and contact lens users were excluded. Results: In total, 104 subjects/eyes were recruited over 6 weeks. Thirty‑six eyes recruited in the trab group were compared with 33 eyes studied in the AGM group, and both these groups were compared to 35 normal eyes. When compared to normals, TBUT and ST were significantly lower (P = 0.003 and 0.014) and osmolarity and OSDI were statistically significantly higher (P = 0.007 and 0.003) in the AGM group, whereas only TBUT was statistically significantly different (P = 0.009) when the trab group was compared to normals. Also, when the trab group was compared to the AGM group, ST was found to be higher (P = 0.003) and osmolarity was lower (P = 0.034). Conclusion: To conclude, ocular surface is affected even in asymptomatic patients on AGM but near normalcy is possible following trabeculectomy when blebs are diffuse. [ABSTRACT FROM AUTHOR]

Purpose: Aim of this study was to compare the efficacy of sodium hyaluronate (SH) and carboxymethyl cellulose (CMC) eye drops in treating mild to moderate dry eye disease in terms of relief of symptoms, mean change in tear film breakup time, Schirmer’s test, and impression cytology of conjunctiva from baseline. Methods: An observational study was carried out during a 2‑year period in our tertiary referral hospital. The study consisted of 60 patients randomly allotted to two groups to receive SH and CMC eye drops for an 8‑week period. Ocular surface disease index, tear film breakup time, and Schirmer’s test were performed at baseline visit and 4 and 8 weeks of treatment, and impression cytology of conjunctiva was performed at baseline and 8 weeks. Results: Significant improvement in patient symptoms, tear film breakup time, and Schirmer’s test from baseline was seen in both SH and CMC groups at 8 weeks posttreatment, whereas impression cytology of conjunctiva in both groups did not show significant improvement at 8 weeks of treatment. Data analysis using unpaired t‑test showed comparable results. Conclusion: Both CMC and SH demonstrated equal efficacy in treating mild to moderate dry eye disease. [ABSTRACT FROM AUTHOR]

Background: To examine firefighters (FFs) exposed to high levels of fire smoke and, as a result, to uncover risk factors for a dry eye disorder (DED) compared to age-and gender-matched healthy individuals. Methods: In this cross-sectional study, 51 FFs from the Afyonkarahisar Municipality Fire Department were chosen randomly (Group 1). A control group (Group 2) included 51 healthy relatives of patients who had routine ocular examinations. The Ocular Surface Disease Index (OSDI) questionnaire was administered after all participants thoroughly explained the study's objectives and procedures. Then, an ocular exam was performed on-site using a portable hand biomicroscope. DED was defined as a non-anesthetic Schirmer test result of <10 mm and a tear film break-up time (TBUT) of <5 seconds. Results: Groups 1 and 2 had mean ages of 44.82±7.29 and 44.73±7.41 years, respectively (p=0.946). The median work duration in Group 1 was 14 years (min-max: 1-27 years). The TBUT test revealed a significantly increased DED prevalence in Group 1 than in Group 2 (p=0.046). Despite the non-significant difference (p=0.276), the Schirmer test revealed that Group 1 had a higher DED prevalence than Group 2. The OSDI score showed that Group 1 had more mild, moderate, and severe DED than Group 2 (p=0.359). In addition, longer work duration was associated with a higher DED prevalence (p=0.179). Conclusions: Given the high prevalence of fire smoke-induced DED in FFs, preventive measures such as regular ocular exams, recommending personal protective equipment usage, and health education programs can assist in avoiding complications and reducing the burden of ocular diseases. [ABSTRACT FROM AUTHOR]

Objective: The aim of this prospective study is to comparatively assess the tear film, meibomian gland (MG), cornea and anterior chamber parameters and also subjective ocular complaints in patients with polycystic ovary syndrome (PCOS) and healthy control subjects. Materials and methods: We included 53 eyes of the 53 patients diagnosed with PCOS and 57 eyes of the 57 healthy control subjects (who are non-pregnant, none of the following clinical findings of male pattern hair loss, hirsutism or acne and with regular menstrual cycles, who have no laboratory findings in her medical history that indicate hyperandrogenism, and who have ovaries that appear to be normal ultrasonographically. All subjects were referred to the masked ophthalmologist by the obstetrician and gynecologist. Participants underwent evaluation of the non-invasive tear film break-up time test (NI-BUT); loss of MGs by non-contact meibography, evaluation of cornea and anterior chamber parameters, and evaluation of subjective ocular complaints using the ocular surface disease index (OSDI). Results: The mean age of PCOS group and controls was 25.08 ± 4.88 and 25.44 ± 5.00 years, respectively. There was no statistically significant difference between the PCOS and control groups in terms of age (p = 0.732). Mean non-invasive first tear film breakup times (NIF-BUT) values of PCOS group and controls were 6.15 ± 4.99 and 10.48 ± 5.81 s, and mean non-invasive average tear film breakup times (NIAvg–BUT) values of PCOS group and controls were 8.48 ± 4.27 and 11.94 ± 4.64 s, respectively; both cases refer to a significant difference between the groups (p = 0.000). In PCOS group, loss of MG in the upper lids was 40.21%, in the lower lids was 53.45%; on the other hand, in control group 15.76% and 21.47%, respectively; both cases refer to a significant difference between the groups (p = 0.000). The number of patients with abnormal OSDI scores (scores ≥ 13 points) was significantly higher in PCOS group (54.7%) than in controls (19.3%) (p = 0.000). Anterior chamber volume (ACV) measured by the topography device in PCOS group was significantly lower (156.5 and 167.4) (p = 0.024). Conclusion: Findings of this study indicated that tear film stability impaired in patients with PCOS and that this impairment was accompanied by the loss of MG, which play a key role in tear film stability. [ABSTRACT FROM AUTHOR]

Objective: To determine the management of primary Pterygium with intralesional Bevacizumab (AVASTIN) Injection. Study Design: Quasi-Experimental Study Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Oct 2019 to Mar 2020. Methodology: Sixty patients of Primary Pterygium with Grades 1, 2, and 3 were included. Pre-Intralesional injection evaluation includes the Ocular surface disease Index (OSDI), grading of Pterygium and ophthalmic examination, refraction, slit lamp bimicroscopy, fundoscopy, tonometry, and corneal topography. After four weeks of intralesional injection, reassessment was done. Results: A total of 60 participants with the mean age of the participants was 44.06±14.83 years were included in the study. In 26(43.3%) patients, grittiness, epiphora, redness, and photophobia were reported, and 16(26.6%) patients reported blurring of vision that improved in 100% of patients after intralesional injections. There was statistical significance (p-value ≤0.05) in means of K1, Sim K astigmatism, Surface asymmetry index, Surface Regularity Index, Grade of Pterygium, and Ocular surface disease index before and after the intralesional injection of Bevacizumab. However, no significant difference was recorded in Uncorrected Visual Acuity, Best Corrected Visual Acuity, and K2 parameters in pre and post-injection states (p-value ≥0.05). Only 7(11.6%) patients reported subconjunctival haemorrhage after the procedure. Conclusions: Treatment of Primary Pterygium with intralesional Bevacizumab injection successfully improves symptoms, Ocular Surface Disease Index, and reduces corneal astigmatism with minimum complications. [ABSTRACT FROM AUTHOR]

Rakan Jaser Alsahly,1 Abdulrahman Abbas Aldawsari,1 Nawaf Fahad Alzaidy,1 Faisal Ali Al Jabr,2 Mamdouh Mohammed Alotaibi,1 Elsadig Yousef Mohammed3 1College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia; 2College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia; 3Department of Community Medicine and Public Health, College of Medicine, Majmaah University, Al Majmaah, Saudi ArabiaCorrespondence: Rakan Jaser Alsahly, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia, Tel +966 566023995, Email RakanJaser1@gmail.comPurpose: To evaluate the association between dry eye disease (DED) symptoms and daily beverage intake among adults in Saudi Arabia.Patients and Methods: In this cross-sectional, questionnaire-based study, we distributed an online questionnaire to men and women older than 18 years living in Saudi Arabia. The questionnaire consisted of items related to the sociodemographic characteristics of the participants and two validated indices: the Ocular Surface Disease Index (OSDI) and the brief 15-item Beverage Intake Questionnaire (BEVQ-15). Participants were excluded if they were aged less than 18 years; wore contact lenses; had existing eye disease (excluding refractive errors), history of eye surgery (including corrective eye surgeries), or autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome); or were currently taking specific medications including antidepressants, antihistamines, and diuretics.Results: After applying the study exclusion criteria, a total of 615 participants were included in the statistical analysis. The majority of participants were 18– 34 years old (450, 73.2%), and men (381, 62%) exceeded women (234, 38%) by approximately 1.5-fold. OSDI scores showed that 344 participants (55.9%) had DED symptoms, 145 (23.6%) had mild dry eyes; and 106 (17.2%) and 93 (15.1%) had moderate and severe dry eyes, respectively. There was a significant association between sex and DED symptoms (p = 0.012); the frequency of DED symptoms in women exceeded that in men. However, no significant differences were observed with other demographic data such as age and location of residence. Although beverage intake was moderately correlated to OSDI score (R = 0.27), we found no significant association between beverage intake and DED symptoms.Conclusion: This is the first study to highlight the association between DED symptoms and daily beverage intake. We found a significant association between DED symptoms and female sex. However, no significant association was found between DED symptoms and other demographic characteristics or beverage intake.Keywords: Ocular Surface Disease Index, Beverage Intake Questionnaire, adult, ophthalmology, cross-sectional study