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AIM: To investigate the image features of dynamic changes of tear film break-up after corneal fluorescein staining(FL)combined with tear film lipid layer(TFLL)dynamic changes in patients with dry eye and its value of diagnosis in dry eye. METHODS: A prospective study. A total of 66 patients(132 eyes)with dry eye admitted to our hospital during September 2019 to December 2020 were divided area break-up group(17 cases, 28 eyes), circle break-up group(20 cases, 27 eyes), line break-up group(25 cases, 28 eyes), spot break-up group(21 cases, 24 eyes)and random break-up group(20 cases, 25 eyes)according to the different fluorescein tear film break-up patterns(BUPs). The image features of tear film break-up dynamic changes and the image features of TFLL dynamic changes were compared in each group, and the differences in the first non-invasive tear film break-up time(NIBUTf), average non-invasive tear film break-up time(NIBUTav), tear meniscus height(TMH)and fluorescein staining scores were compare,RESULTS:A statistically significant differences were observed in NIBUTf among the groups of patients(P<0.001). Except that there was no difference between spot break-up group and random break-up group(7.56±1.54s vs 8.02±1.86s, P=0.881), other groups had significant differences in pairwise comparisons(P<0.05). There were statistically differences among the groups for NIBUTav(P<0.001). Except that there was no difference between spot break-up group and random break-up group(9.54±2.12s vs 9.73±1.94s, P=0.997), other groups had significant differences in pairwise comparisons(P<0.05). There was statistically difference among the groups for TMH(P<0.001). Except that there was no difference between circle break-up group and line break-up group(0.16±0.03mm vs 0.17±0.03mm, P=0.986), there was no difference between spot break-up group and random break-up group(0.22±0.03mm vs 0.21±0.05mm, P=0.993), other groups had significant differences in pairwise comparisons(P<0.05). There were statistically significant differences among the groups for FL scores and TFLL grading(P<0.001).CONCLUSION:It is shown that different fluorescein BUPs intuitively reflects the tear film structure of the pathological changes according to evaluation and analysis of images feature of dynamic changes of FL tear film and TFLL combined with the results of static examination of tear film. It is helpful for clinicians to identify subtypes of dry eye, which has potential clinical value for the diagnosis and classification of dry eye.
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PURPOSE: To determine whether eyeliner tattoo affects the meibomian gland (MG) and ocular surface.METHODS: The medical charts of an eyeliner tattoo group (16 eyes of 8 patients) and a control group (16 eyes of 18 patients) were retrospectively reviewed. The ocular surface disease index questionnaire, ocular surface staining score, tear film break-up time (TBUT), upper eyelid abnormality, meibum expressibility and quality, and MG loss and tear film lipid layer thickness (LLT) which measured with LipiView® (TearScience, Morrisville, NC, USA) were compared. In the tattoo group, the correlation between the distance from the MG orifice to the tattoo pigment and other indices were analyzed.RESULTS: Compared to controls, the tattoo group had a significantly higher ocular surface disease index (p = 0.002), shorter TBUT (p < 0.001), higher vessel engorgement of the upper lid (p = 0.016), poorer meibum expressibility and quality (p = 0.006 and p < 0.001, respectively), higher MG loss (p < 0.001), and thinner LLT (p = 0.024). In the tattoo group, the closer the tattoo was to the MG orifice, the more the upper lid vessel was engorged and the more MG loss occurred (r(s) = −0.560, p = 0.024; r(s) = −0.563, p = 0.023, respectively), and a thinner LLT was observed (r(s) = 0.567, p = 0.022).CONCLUSIONS: Eyeliner tattoos may be related to changes in the lid margin, loss of the MG, and thinning of the LLT.
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Dry Eye Syndromes , Eyelids , Meibomian Glands , Retrospective Studies , TearsABSTRACT
Objective To explore the effect of glucocorticoid on ocular surface changes in the patients with thyroid-associated ophthalmopathy. Methods Sixty eyes of 30 patients with thyroid-associated ophthalmopathy were examined for the break-up time of tear film (BUT), blinks, incomplete blinks, tear film lipid layer thickness (LLT) and the fluidity of tear film lipid layer before and after glucocorticoid treatment. The differences of each detection index were compared and analyzed. Results The BUT of the patients with thyroid-associated ophthalmopathy was significantly longer after glucocorticoid treatment versus before glucocorticoid treatment (the medians were 5.0 s and 7.0 s, respectively; P0.01). The average, maximal and minimal values of LLT were significantly increased after glucocorticoid treatment than those before glucocorticoid treatment (average, maximal and minimal values of LLT before and after treatment were 59 nm and 64.5 nm, 73.5 nm and 78.8 nm, and 52.4 nm and 57.5 nm, respectively; all P0.01). There were no significant differences in the blinks, incomplete blinks or the fluidity of tear film lipid layer between before and after glucocorticoid treatment (all P0.05). Conclusion Glucocorticoid treatment can improve the lipid secretion of tear film, thus maintaining the stability of tear film.
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PURPOSE: We report the clinical manifestations of dry eye syndrome after cataract surgery involving meibomian gland structure, meibomian gland function, and tear lipid layer analysis. METHODS: The clinical manifestations of dry eye syndrome were retrospectively evaluated in 34 eyes of 31 patients who underwent cataract surgery from September to November 2017. The ocular surface disease index (OSDI), tear break-up time (tBUT), Oxford stain score, presence or absence of blepharitis, and meibomian gland expression were measured preoperatively and at 1 week, 1 month, and 2 months postoperatively. Lipid layer thickness (LLT), partial blinks, and meibomian gland images were measured using LipiView® (TearScience, Morrisville, NC, USA), an interferometric eye surface measuring device. RESULTS: The postoperative OSDI was significantly higher than preoperative OSDI (17.09 ± 1.81): 22.76 ± 1.99 at 1 week, 23.12 ± 1.91 at 1 month, and 22.68 ± 1.92 at 2 months (p < 0.05). The postoperative tBUT was significantly lower than preoperative tBUT (5.07 ± 0.39): 3.99 ± 0.31 at 1 week, 3.49 ± 0.27 at 1 month, and 4.72 ± 0.39 at 2 months (p < 0.05). The Oxford staining score increased after surgery, but the difference was not statistically significant. Postoperative meibomian gland expression was significantly lower preoperative values (4.9 ± 2.8): 4.4 ± 2.8 at 1 month, and 3.9 ± 2.8 at 2 months (p < 0.05). The LLT decreased at 1 month postoperatively and increased at 2 months postoperatively, but these differences were not statistically significant. CONCLUSIONS: Cataract surgery resulted in a short-term meibomian gland dysfunction, leading to deterioration of dry eye after cataract surgery. However, we could not confirm structural changes in the meibomian gland, so it will be necessary to observe the clinical features of dry eye syndrome over a longer period of time.
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Humans , Blepharitis , Cataract , Dry Eye Syndromes , Meibomian Glands , Retrospective Studies , TearsABSTRACT
· Meibomian gland dysfunction (MGD) is one of the common diseases in ophthalmology clinic.The diagnosis of MGD ought to be evaluated according to symptoms,signs and corresponding assistant examinations.Traditional examination methods,such as slit-lamp examination,break-up time of tear film,Schirmer tear test and so on,have definite value in the diagnosis of MGD.In 2017,the experts on the diagnosis and treatment of Meibomian gland dysfunction in our country have reached consensus that some novel clinical examination methods such as Meibomian gland loss rate and tear film lipid layer thickness are also worked as auxiliary diagnostic criteria for MGD.The combination of traditional methods and new detection techniques will lead to more comprehensive and accurate conclusions for the diagnosis of MGD.
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Objective To measure the tear film lipid layer thickness (LLT) in dry eye patients and investigate the correlations of LLT with ocular surface signs.Methods One hundred and thirty dry eye patients (130 eyes),including 64 meibomian gland dysfunction (MGD) patients and 66 non-MGD patients,were included in this study.LLT,break-up time (BUT),fluorescein staining (FL),Marx's line (ML) score and Schirmer I test were performed and examined.The distribution of LLT in different age groups and the correlations between LLT and other examinations were analyzed.Results There was significant difference in LLT among different age groups (P =0.007),while LLT was not significantly different between male and female in each age group (P ＞ 0.05).LLT was positively correlated with age (r =0.334,P ＜ 0.001) and was not correlated with sex (r =0.107,P =0.226).LLT was positively correlated with upper eyelid ML score (r =0.295,P =0.001) and lower eyelid ML score (r =0.233,P =0.008).There was no significant correlation of LLT with BUT,FL or Schirmer Ⅰ test (all P ＞0.05).In the MGD group,there were positive correlations of LLT with upper eyelid ML score and lower eyelid ML score (all r =0.306,P =0.014),and no correlation of LLT with other examinations (all P ＞ 0.05).In the non-MGD group,there was no correlation of LLT with other examinations (all P ＞ 0.05).In a multivariate linear regression analysis,age and upper eyelid ML score were significantly related to LLT (β =0.254,P =0.005 for age and β =0.207,P =0.022 for upper eyelid ML score) in all dry eye patients.Age was the only factor related to LLT (β =0.382,P =0.002) in the MGD group.Upper eyelid ML score and lower eyelid ML score were higher in the MGD group than the non-MGD subgroup (all P ＜ 0.001).Conclusion LLT is positively correlated with age and ML score in dry eye patients.The measurement of tear film LLT,as an auxiliary examination in the diagnosis of dry eye disease,should be analyzed with the influential factors including age.
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PURPOSE: The changes in tear film lipid layer thickness (LLT) after artificial tears application using LipiView®II interferometer were assessed. METHODS: We performed a prospective study of patients with dry eye disease. All subjects underwent measurement of tear film break-up time, Schirmer test, ocular surface staining, meibomian gland evaluation, and subjective score assessment using the Ocular Surface Disease Index. All subjects were randomly assigned to 1 of 3 groups using table of random numbers (group 1, sodium hyaluronate [HA] 0.1% eye drops without preservatives; group 2, HA 0.3% eye drops without preservatives and group 3, HA 0.1% with benzalkonium chloride 0.003%). LLT was measured before, immediately after and 1 hr, 3 hrs, and 6 hrs after artificial tears application. Additionally, the patients were divided into 2 subgroups depending on the presence of meibomian gland dysfunction (MGD) and further evaluated. RESULTS: Significant change in LLT was observed at 3 hrs after artificial tears instillation. LLT in groups 1 and 2 showed significant changes over time (p < 0.01 and p < 0.01, respectively). However, LLT in group 3 showed no change. LLT was unchanged in patients without MGD. Conversely, in MGD patients, a significant difference in LLT between groups 1 and 2 was observed immediately after and 1 hr and 3 hrs after instillation of artificial tears (p = 0.04, p < 0.01 and p = 0.02, respectively) but not at 6 hrs. However, no significant difference in LLT between groups 1 and 3 was observed in MGD patients. CONCLUSIONS: LLT after instillation of artificial tears measured using LipiView®II interferometer was affected by artificial tear concentration and presence of preservatives. Additionally, the presence of MGD can impact the pattern of LLT changes induced by artificial tear instillation. Therefore, LLT measurements using LipiView®II interferometer require at least a 6-hrs interval after use of eye drops, especially for patients with MGD or using artificial tears with preservatives.
Subject(s)
Humans , Benzalkonium Compounds , Eye Diseases , Hyaluronic Acid , Lubricant Eye Drops , Meibomian Glands , Ophthalmic Solutions , Prospective Studies , TearsABSTRACT
The lipid layer plays a important role in tear film stability. And several studies have reported the differences of lipid layer pattern and tear film break up time between normal and dry eye. To determine the availability of Tearscope(Keeler, UK), we observed the characteristics of lipid layer and compared non-invasive break up time(NIBUT) to invasive break up time(IBUT) in dry eye symptom and non-dry eye symptom group. By questionnaire, we selected the dry eye symptom(94 eyes in 47 persons) and the non-dry eye symptom(112 eyes in 56 persons) group. We observed lipid layer pattern and color by Tearscope, and measured NIBUT of Tearscope and IBUT of fluorescein solution. In the lipid layer, the dry eye symptom group had brown-yellow(about 112 nm) and uneven pattern. But, the non-dry eye symptom group represented amorphous(about 94 nm) and even pattern. In NIBUT, the dry eye symptom group had 9.57+/-11.40sec and the non-dry eye symptom group represented 27.42+/-20.15sec. In IBUT, two groups had 6.38+/-4.45sec and and 13.02+/-8.41sec, respectively. In conclusion, Tearscope is available in diagnosis and treatment in dry eye and also in diagnosis of tear lipid layer disorder.