The association of pre-photorefractive keratectomy Schirmer-1 test value with postoperative corneal epithelial thickness, ocular surface discomfort, and visual acuity

ABSTRACT Purpose: To investigate the association of pre--photorefractive keratectomy Schirmer-1 test value with post--photorefractive keratectomy central corneal epithelial thickness, ocular surface disease index score, and uncorrected distance visual acuity. Methods: Patients were categorized according to preoperative Schirmer-1 value: the normal Schirmer Group (n=54; Schirmer-1 test value, >10 mm) and the low Schirmer Group (n=52; Schirmer-1 test value, between 6 and 10 mm). We analyzed ablation depth, visual acuity, result of Schirmer-1 test (with anesthesia), tear film break-up time, ocular surface disease index score, central corneal epithelial thickness, and spherical equivalent refraction. Results: We found significant differences between the groups in Schirmer-1 test value, tear film break-up time, and ocular surface disease index score, both preoperatively and postoperatively (p<0.001). The preoperative central corneal epithelial thicknesses of the two groups were similar (p>0.05). After photorefractive keratectomy, the Schirmer-1 test value and spherical equivalent refraction decreased in both groups (p<0.05), and ocular surface disease index scores and central corneal epithelial thickness values increased in the low Schirmer Group (p<0.001) but not in the normal Schirmer Group (p>0.05). The postoperative central corneal epithelial thicknesses of the low Schirmer Group were significantly higher than those of the normal Schirmer Group (p<0.001). Postoperative uncorrected distance visual acuity did not differ significantly between the two groups (p>0.05). Conclusions: In patients with low Schirmer-1 test values before photorefractive keratectomy, the corneal epithelium thickened and ocular surface complaints increased during the postoperative period. However, changes in the corneal epithelium did not affect the postoperative uncorrected distance visual acuity. To reduce postoperative problems on the ocular surface in these patients, we recommend that dry eye be treated before photorefractive keratectomy.

Comparison of strip meniscometry and Schirmer tear test results and tear film breakup time between healthy dogs and dogs with dry eye disease / Comparação entre o teste de meniscometria em tira, o teste lacrimal de Schirmer e o tempo de ruptura do filme lacrimal em cães normais e com olho seco

ABSTRACT Purpose: To compare strip meniscometry and Schirmer tear test 1 results and tear film breakup time between dogs with normal eyes and dogs diagnosed with keratoconjunctivitis sicca. Methods: One-hundred fifty-six eyes of 78 dogs, 88 normal eyes, and 68 eyes diagnosed with keratoconjunctivitis sicca were included in the study. The tests were performed in the following sequence: Schirmer tear test 1 was used to allocate the dogs to the normal or keratoconjunctivitis sicca group, followed by the strip meniscometry test and tear film breakup time measurement. Results: The results (mean ± standard deviation) of the tests in the normal group were as follows: Schirmer tear test 1, 22.75 ± 3.88 mm/min; strip meniscometry test, 10.01 ± 2.35 mm/5 sec; and tear film breakup time, 25.82 ± 5.47 sec. In the keratoconjunctivitis sicca group, the results were as follows: Schirmer tear test 1, 6.10 ± 4.44 mm/min; strip meniscometry test, 3.03 ± 2.62 mm/5 sec; and tear film breakup time, 10.78 ± 4.23 sec. The Spearman correlation coefficient in the keratoconjunctivitis sicca group was very high, with a significant difference between the strip meniscometry test and Schirmer tear test 1 (r=0.848, p<0.001), and moderate and significant between the strip meniscometry test and tear film breakup time (r=0.773, p<0.001). The cutoff for the strip meniscometry test for keratoconjunctivitis sicca was 7.0 mm/5 sec. Keratoconjunctivitis sicca was suspected when the values were <10 mm/5 sec. Conclusions: This study provided strip meniscometry test values from dogs with normal eyes and eyes with keratoconjunctivitis sicca, with high sensitivity and specificity compared with those of the Schirmer tear test 1. In the future, the strip meniscometry test may be another important quantitative test and could complement the gold standard Schirmer tear test for the diagnosis of keratoconjunctivitis sicca in dogs, an excellent animal model for the study of the disease.

RESUMO Objetivo: Comparar o teste de meniscometria em tira com o teste lacrimal de Schirmer 1 e o tempo de ruptura do filme lacrimal, em cães com olhos normais e cães com diagnóstico de ceratoconjuntivite seca. Métodos: Cento e cinquenta e seis olhos de 78 cães, 88 olhos normais e 68 olhos com diagnóstico de ceratoconjuntivite seca. Os testes foram realizados na seguinte sequência: o teste lacrimal de Schirmer 1 foi utilizado para alocar os cães no grupo normal ou no grupo ceratoconjuntivite seca, seguido pelo teste de meniscometria em tira e tempo de ruptura do filme lacrimal. Resultados: As médias e desvios-padrão para os olhos normais foram: teste lacrimal de Schirmer 1 = 22,75 ± 3,88 mm / min; teste de meniscometria em tira = 10,01 ± 2,35 mm / 5 seg; tempo de ruptura do filme lacrimal = 25,82 ± 5,47 seg; e para os olhos do grupo ceratoconjuntivite seca foram: teste lacrimal de Schirmer 1 = 6,10 ± 4,44 mm / min; teste de meniscometria em tira = 3,03 ± 2,62 mm / 5 seg; tempo de ruptura do filme lacrimal = 10,78 ± 4,23 seg. O teste de correlação de Spearman no grupo ceratoconjuntivite seca foi muito alto, com diferença significativa entre teste de meniscometria em tira e teste lacrimal de Schirmer 1 (r=0,848, p<0,001), moderada e significativa entre teste de meniscometria em tira e tempo de ruptura do filme lacrimal (r=0,773, p<0,001). O cut-off para teste de meniscometria em tira para ceratoconjuntivite seca foi identificado em 7,0 mm / 5 seg, valores abaixo de 10 mm / 5 seg podem ser considerados suspeitos para KCS. Conclusões: Este estudo forneceu valores de teste de meniscometria em tira em olhos normais e com ceratoconjuntivite seca em cães, revelando alta sensibilidade e especificidade em comparação com o teste lacrimal de Schirmer 1. No futuro, o teste de meniscometria em tira pode ser outro teste quantitativo importante e pode complementar o teste lacrimal de Schirmer padrão ouro para o diagnóstico de ceratoconjuntivite seca em cães, um excelente modelo animal para o estudo de ceratoconjuntivite seca.

Comparing the efficacy of sodium hyaluronate eye drops and carboxymethylcellulose eye drops in treating mild to moderate dry eye disease

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.

Evaluation of the ocular surface in asymptomatic glaucoma patients on topical medications and following trabeculectomy - A cross-sectional study

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.

A simple technique of meibography for morphological and functional evaluation of meibomian glands in dry eye conditions

Purpose: Dry eye disease (DED) is because of a decrease in the tear film’s volume or a change in the composition of tears. Evaporative dry eye is the most common type, which is due to meibomian gland dysfunction (MGD). In this study, the morphology of meibomian glands was evaluated in all kinds of dry eyes to look for any loss of meibomian glands, assess the function of remaining glands, and investigate the relationship between anatomy, function, and severity of DED. Methods: A total of 300 patients were included in the study, with 150 eyes in the study group and 150 in the control group. Meibomian gland morphology was assessed by examining the tarsal plate after everting the eyelids. Tear film function was evaluated using tear film break?up time (TBUT) and Schirmer’s test (SCH I and II). Meibomian gland morphology was examined with a slit?lamp under magnification, a transilluminator using a small light emitting diode (LED) bulb, and non?contact meibography using an auto refracto?keratometer (ARK). Results: Females had a higher prevalence of dry eyes in our study. In all, 103 eyes (68.6%) in the study group had evaporative dry eye, making it the most prevalent type. Among the 150 controls, 104 controls with 69.3% had no dry eye symptoms, and in those with symptoms, the evaporative type was the most common, with a 28% prevalence. Conclusion: TBUT should be performed in all patients with detectable MG abnormality. Meibography has high specificity and sensitivity to diagnose MGD and in turn dry eyes and should be considered a routine screening modality.

Optimization and evaluation of tear protein elution from Schirmer’s strips in dry eye disease

Purpose: Extraction of tear protein from Schirmer’s strip is a prerequisite for the proper identification and screening of biomarkers in dry eye disease. The study compares different methods of extraction of tear proteins from the Schirmer’s strip. Methods: Reflex tear was collected from healthy controls (HC; n = 12), Stevens–Johnson syndrome (SJS; n = 3) and dry eye disease (DED; n = 3) patients using capillary tube. This tear was used to measure the volume absorbed by Schirmer’s strip per microliter. Different buffers (6) were used to compare the protein yield from the Schirmer’s strip in four different conditions. The tear proteins extracted using the highest protein yield buffer were analyzed by mass spectrometry. Results: A linear relationship between the tear volume and wetting length was observed (r = 0.0.997, n = 6). The highest yield was observed after incubation of the Schirmer’s strip in 100 mM ammonium bicarbonate (ABC) with 0.25% Nonidet P?40(NP?40) at 4°C for an hour (P < 0.00005). The in?solution digestion of tear eluted in the above condition 100 Mm ABC + 0.25% NP?40 with one?hour incubation yielded a total of 2119 proteins in HC, SJS, and DED. The unique protein observed in SJS and DED was 0.6% and 17.9%, respectively. The significantly expressed proteins are associated with innate immune response, proteolysis, wound healing, and defense response. Conclusion: A method for extraction of protein from Schirmer’s strip was optimized for increase in protein yield from the tear sample. SJS and DED tear samples have unique protein signature. The study will aid in better design of tear protein?based experimental study.

Occurrence of dry eye in mobile phone users

Background: Most Indians today own one or more mobile phones. The average time of phone usage per person per day is 4.8 h and the excess usage of mobile phone is an emerging cause of dry eye. Although some studies have established this relation, not many studies focus on South India. Our study aims to highlight the South Indian population. Aim and Objective: To study the prevalence of dry eye among medical students of 18–25 years. Materials and Methods: This is a cross-sectional study, whose participants are undergraduate medical students, both males and females, between 18 and 25 years. Schirmer’s test was done for each candidate after answering an Ocular Surface Disease Index questionnaire. Results: The most frequent symptom reported by the participants at the time of answering the questionnaire was soreness and irritation of the eye (8%). The most common long-term symptom reported was burning and watering of eyes of tolerable severity (27%). Some participants experienced uncomfortable and bothersome eye fatigue. Conclusion: Dry eye in the form of symptoms of both dryness of eye and reflex epiphora is present in the population under study. About 76% of the study population use their phones for over 3 hours a day. The soreness and irritation of eyes, watering and burning of eyes are attributed to the mobile phone usage for more than 6 hours per day.

Correlation and consistency of three methods for tear evaluation in the diagnosis of dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the correlation and consistency of three tear assessment methods in the diagnosis of dry eye, which include the Schirmer Ⅰ test(SⅠt), tear meniscus height(TMH)measurement and a new generation of tear detection technology-Strip meniscometry tube(SMTube).METHODS: A diagnostic test study. A total of 183 dry eye outpatients(183 right eyes)in the Dry Eye Center of Henan Eye Hospital were enrolled from May to June 2021. The SⅠt, TMH and SMTube were performed on all patients, and the correlation and consistency of the measurement results were analyzed.RESULTS:The ocular surface disease index(OSDI)of all included patients was 43.75(31.25, 58.33), noninvasive breakup time(NIBUT)was 7.26(4.97, 9.37)s, and the results of SⅠt, TMH and SMTube were 6(2, 12)mm/5min, 0.18(0.14, 0.22)mm and 5(3,8)mm/5s, respectively; The results of correlation analysis: TMH was positively correlated with SMTube(rs=0.751, P<0.001), however, SⅠt had no correlation with TMH(rs=0.139, P=0.060)and SMTube(rs=0.019, P=0.799). The results of consistency analysis: TMH showed good consistency with SMTube(Kappa=0.794, P=0.044), however, SⅠt showed poor consistency with TMH(Kappa=0.271, P=0.074)and SMTube(Kappa=0.193, P=0.070)respectively.CONCLUSION:SMTube is a new, simple and convenient tool for evaluating tear volume. It has a good correlation and consistency with TMH measurement results. Therefore, it can replace TMH measurement, but cannot replace SⅠt in clinical application.

Ocular manifestations in moderate-to-severe psoriasis in India: A prospective observational study

Purpose: Ocular manifestations in psoriasis are due to direct eye involvement with psoriatic plaques or psoriasis?related, immune?mediated inflammatory processes. The commonly reported pathologies are blepharitis, conjunctivitis, keratitis, dry eyes, and uveitis. Limited data is available on the ocular findings in psoriasis patients in India. In this study, we evaluated various ocular changes associated with moderate-to-severe psoriasis. Methods: In this prospective cohort study, treatment?naive psoriasis patients with Psoriasis Area Severity Index (PASI) score of more than 10 were included. The Ocular Surface Disease Index (OSDI) score, Schirmer’s score, tear film breakup time (TBUT), corneal and conjunctival staining score, and meibomian gland dysfunction score were noted. All these parameters were re?evaluated at 8 weeks of follow?up after systemic treatment. Results: Sixty-eight patients were enrolled in the study. The most common ocular pathologies observed in this study were tarsal hyperemia and anterior blepharitis in 128 (94.1%) and 64 (47%) eyes, respectively. Mild, moderate, and severe dry eyes were seen in 26 (19.1%), 14 (10.2%), and 34 (25%) eyes, respectively. Thirty?nine (57.3%) patients complained of significant difficulty watching television or digital screen. In 21 patients evaluated on follow?up at 8 weeks, cornea and conjunctiva’s ocular surface staining score increased and TBUT decreased significantly. Conclusion: The most common ocular pathologies observed in this study were anterior blepharitis and moderate dry eye, which significantly affected most patients’ daily routines. Screening patients with greater severity of psoriasis would help in early management of such problems.

Comparison of the OSDI Questionnaire, the Tear Film Break-up Time and Schirmer Tests for the Evaluation of Tear Film in Computer users and Contact Lenses without Dry Eye Symptoms

Aims: To compare the diagnostic values of the OSDI, the Schirmer’s and tear film breakup time test to check for dry eye in healthy adult students using computers and contact lenses.Methodology: Our sample consisted of hundred (100) eyes from fifty (50) healthy adults aged 18-24 years students at the University of West Attica (25 participants were contact lens wearers, while the remaining 25 were not). All participants were exposed to a computer screen or a mobile screen. Qualitative tear measurement was performed with Tear Break-Up Time Test (TBUT), quantitative measurement of tears with Schirmer Test and use of the Ocular Surface Disease Index (OSDI).Results: During the analysis of the results, it was found that OSDI was inversely proportional to the TBUT test and the Schirmer test. 60% did not have dry eye, 34% had a mild dry eye, 4% had moderate dry eye and 2% had severe dry eye. ? statistically significant relationship existed between OSDI and the other variables as well as the TBUT test with Schirmer test (p-value <0.05).Conclusion: The OSDI questionnaire, used in conjunction with the TBUT test, was easy to perform and could be helpful in supporting the diagnosis of dry eye syndrome.

A study of the association between Vitamin D deficiency and Dry Eye Syndrome (DES) in the Indian population

Purpose: A study of the association between vitamin D deficiency and dry eye syndrome (DES) in the Indian population. Methods: This was a cross?sectional, hospital?based observational study. Sixty patients diagnosed with vitamin D deficiency (<20 ng/dl) who met the inclusion criteria were sent to the Eye OPD from the Endocrinology OPD (case) were compared to 60 subjects with normal vitamin D levels (?20 ng/dl) who attended the Eye OPD (controls). The examination of the tear film was done using Whatman filter paper in Schirmer test I and Schirmer test I (with anesthesia). The tear film break?up time (TFBUT) was determined by slit?lamp examination using the fluorescein stain, and scoring using the ocular surface disease index (OSDI) was done. Results: A significant difference in the mean values of Schirmer I and Schirmer I test (with anesthesia) (P < 0.001) was seen between the case and control groups. A significant difference in the mean values of TFBUT (P < 0.001) and OSDI scores (P < 0.01) was also seen between the two groups. Conclusion: A positive association was found between vitamin D deficiency and dry eye on comparing the above parameters.

Effect of acupuncture on intraocular pressure and tear production in healthy horses / Efeito da acupuntura sobre a pressão intraocular e a produção lacrimal em equinos hígidos

ABSTRACT: Acupuncture is an ancient Chinese form of therapy that involves needle stimulation of specific points on the body for therapeutic and homeostatic effects. In ophthalmology, acupuncture helps as a conventional or adjuvant therapy for numerous eye disorders, including myopia, strabismus, dry eye, and cataracts. This study aimed to evaluate the effect of acupuncture on tear production (TP) and intraocular pressure (IOP) in horses. Ten healthy horses, females and males with ages varying between eight months and nine years, were used. Schirmer's I test and applanation tonometry were used to evaluate the basal TP and IOP of both eyes. The measurements were taken immediately before (T10) the insertion of the needles and 5 (T5), 15 (T15), 30 (T30) and 60 (T60) minutes and 24 (T24) hours after a 20-minute acupuncture session. Mean values of both eyes were analyzed over time. TP increased in 50% of the animals at T5, T15 and T24, in 30% at T30, and in 40% at T60, with an increase of up to 8.5 mm/min at T15 and T60. In addition, there was a significant difference between T24 and T30, with a 14.1% increase in TP at T24. Meanwhile, IOP decreased in 50% of the animals at T5 and T30, in 20% at T15, in 60% at T60, and in 70% at T24. Thus, we suggest that acupuncture is a technique that can benefit horses with diseases that alter these parameters, either alone or as an adjunct in conventional therapeutic protocols.

RESUMO: A acupuntura é uma terapia milenar de origem chinesa que funciona através da estimulação de pontos específicos do corpo com agulhas, visando efeitos terapêuticos e homeostáticos. Na área de oftalmologia a acupuntura tem auxiliado como terapia convencional ou adjuvante de inúmeras afecções oculares, incluindo miopia, estrabismo, olho seco, catarata, entre outras. Esse estudo teve como propósito avaliar o efeito da acupuntura no comportamento da produção lacrimal e da pressão intraocular em equinos. Utilizou-se 10 equinos hígidos, fêmeas e machos, com idades variando entre oito meses e nove anos. O teste lacrimal de Schirmer tipo I e da tonometria de aplanação foram utilizados para avaliar a produção basal de lágrima (PL) e a pressão intraocular (PIO) de ambos os olhos. As aferições foram realizadas imediatamente antes da inserção das agulhas (T0) e cinco (T5), 15 (T15), 30 (T30) e 60 (T60) minutos e 24 (T24) horas após sessão de acupuntura de 20 minutos. Os valores obtidos foram analisados quanto ao seu comportamento ao longo do tempo, utilizando-se a média dos dois olhos de cada animal. A PL aumentou em 50% dos animais em T5, T15 e T24, 30% dos animais em T30 e 40% dos animais em T60, com aumento de até 8,5 mm/min em T15 e T60. Além disso, observou-se diferença significativa entre o T24 e o T30 (p = 0,0128), com aumento de 14,1% na PL no T24. Com relação à PIO, notou-se que 50% dos animais sofreram redução na pressão em T5 e T30, 20% dos animais redução em T15, 60% dos animais em T60 e 70% dos animais apresentaram redução em T24. A estimulação dos acupontos relacionados ao sistema visual foi capaz de aumentar a produção lacrimal e diminuir a pressão intraocular em equinos sadios. Dessa maneira, sugere-se que a acupuntura é uma técnica que poderá trazer benefícios a cavalos portadores de doenças que cursam com a alteração desses parâmetros, tanto quando empregada isoladamente, como quando adjuvante a protocolos terapêuticos convencionais.

Clinical observation of Tiaoshen acpuncture for dry eye syndrome with yin deficiency of liver and kidney / 中国针灸

OBJECTIVE@#To compare the curative effect of Tiaoshen acupuncture combined with artificial tears and artificial tears alone for dry eye syndrome with yin deficiency of liver and kidney.@*METHODS@#A total of 70 patients of dry eye syndrome with yin deficiency of liver and kidney were randomized into an acupuncture combined with medication group (35 cases, 2 cases dropped off) and a medication group (35 cases, 3 cases dropped off). In the medication group, 0.1% sodium hyaluronate eye drop was applied, 3 times a day, 1 drop each time. On the basis of the treatment as the medication group, Tiaoshen acupuncture was applied at Shenting (GV 24), Shenmen (HT 7), Benshen (GB 13), Taixi (KI 3), Taichong (LR 3), Guangming (GB 37), Fengchi (GB 20), Tongziliao (GB 1), Yuyao (EX-HN 4) in the acupuncture combined with medication group, Tongziliao (GB 1) and Yuyao (EX-HN 4) were connect with electroacupuncture, the needles were retained for 30 min, once a day, 6 times a week. Both groups were treated for 2 weeks. Before and after treatment, the clinical symptom score, SchirmerⅠtest (SⅠT), break-up time (BUT), corneal fluorescein staining (FL) score and Hamilton anxiety scale (HAMA) score were observed in the two groups, and the clinical efficacy was compared in the two groups.@*RESULTS@#Compared before treatment, the clinical symptom scores, corneal FL and HAMA scores were decreased (P<0.05), the levels of SⅠT and BUT were increased after treatment in the two groups (P<0.05). After the treatment, the clinical symptom score, FL and HAMA scores in the acupuncture combined with medication group were lower than the medication group (P<0.05), the levels of SⅠT and BUT in the acupuncture combined with medication group were higher than the medication group (P<0.05). The total effective rate in the acupuncture combined with medication group was 90.9% (30/33), which was higher than 71.9% (23/32) in the medication group (P<0.05).@*CONCLUSION@#Tiaoshen acupuncture combined with artificial tears could promote the secretion of tears for patients of dry eye syndrome with yin deficiency of liver and kidney, repair corneal defect and prolong tear film break-up time, and alleviate anxiety state, its curative effect is better than simple artificial tears.

Oral mucosa transplantation may improve tear film osmolarity in dogs with keratoconjunctivitis sicca - a preliminary study / [Transplante da mucosa oral na melhoria da osmolaridade do filme lacrimal em cães com ceratoconjuntivite seca - estudo preliminar]

The objective of this study was to evaluate the use of cyclosporine 1% alone or associated with oral mucosa transplantation (OMT) in dogs with dry keratoconjunctivitis (KCS). Schirmer Tear Test (STT-1) and Tear Film Osmolarity (TFO) were measured in both eyes of 30 adult dogs (before and 45 days after treatment. The animals were divided into three groups (10 dogs for group): control (normal dogs), group I (GI, treated with 1% cyclosporine alone), and group II (GII, treated with 1% cyclosporine and OMT). All STT-1 and TFO values were subjected to the Shapiro-Wilk normality test, and all were normally distributed. STT-1 and TFO values before and after treatment were subjected to the T-Student Test. The STT­1 and TFO values of the right eye were subjected to Repeated Measures ANOVA followed by a Tukey Test for comparison between groups I and II. Means with a value of p≤0.05 were considered significant. There was a decreased osmolarity in both groups after treatment. Mean osmolarity in GII (322.60±16.56 mOsm/L) was significantly lower than GI (336.40±5.66 mOsm/L). The OMT associated with cyclosporine 1% improved the osmolarity of the tear film in dogs with KCS with a seeming synergism between the clinical and surgical treatments.(AU)

Avaliou-se o uso de ciclosporina 1% isolada ou associada ao transplante de mucosa oral (TMO) em cães com ceratoconjuntivite seca (CCS). O teste lacrimal de Schirmer (TLS-1) e a osmolaridade do filme lacrimal (OFL) foram medidos em ambos os olhos, em 30 cães adultos, antes e 45 dias após o tratamento. Os animais foram divididos em três grupos (10 cães por grupo): controle (cães saudáveis), grupo I (GI, tratados apenas com ciclosporina 1%) e grupo II (GII, tratados com 1% de ciclosporina associada ao TMO). Todos os valores do TLS-1 e da OFL foram submetidos ao teste de normalidade Shapiro-Wilk, e todos foram distribuídos normalmente. Os valores de TLS-1 e OFT antes e depois do tratamento foram submetidos ao teste T-Student. Os valores TLS-1 e OFT do olho direito foram submetidos à ANOVA de medidas repetidas, seguida por um teste de Tukey para comparação entre os grupos I e II. Valor de P≤0,05 foi considerado significativo. Houve uma diminuição da osmolaridade em ambos os grupos após o tratamento. A osmolaridade média no GII (322,60±16,56 mOsm/L) foi significativamente inferior à no GI (336,40±5,66 mOsm/L). O TMO associado à ciclosporina 1% melhorou a osmolaridade do filme lacrimal em cães com CCS, com uma sinergia aparente entre os tratamentos clínicos e cirúrgicos.(AU)

Effect of acupuncture on expression of transfer growth factor-β1 in lacrimal gland of rabbits with dry eye / 针刺研究

OBJECTIVE: To observe the effect of acupuncture on expression of transforming growth factor-β1(TGF-β1) in lacrimal gland of rabbits with dry eye, so as to explore its underlying mechanism in improving dry eye. METHODS: Healthy male New Zealand rabbits were randomly assigned to 5 groups (n=6 in each group), namely, blank group, model group, western medicine group, acupuncture group and sham acupuncture group. The dye eye rabbit model was estabilished by subcutaneous injection of Scopolamine Hydrobromide solution for 21 days. After modeling, rabbits in the western medicine group were treated with Flumirone eye drops in their eyes 3 times a day, one drop each time. Rabbits of the acupuncture group reveived electroacupuncture(4 Hz/20 Hz, 1 mA) at "Cuanzhu"(BL2) and "Tongziliao"(GB1) for 15 min, and received acupuncture at "Jingming"(BL1), "Taiyang" (EX-HN5) and "Sizhukong"(TE23) for 15 min, once a day. Rabbits of the sham acupuncture group received blunt acupuncture at the surface of the same acupoints once a day. All the treatments were conducted for 14 days. The changes of tear flow, tear film break-up time (BUT) and lacrimal gland morphology in each group were observed. The expression of TGF-β1 protein and mRNA in lacrimal gland were detected by Western blot and quantitative real-time fluorescence PCR respectively. RESULTS: Following modeling, except for the blank group, the tear flow and BUT in other 4 groups decreased significantly (P<0.01). Compared with their own pretreatment, the tear flow and BUT in western medicine group and acupuncture group increased after the treatment (P<0.05). Compared with the model group, the tear flow and BUT increased in the western medicine group and the acupuncture group(P<0.05). Atrophic lacrimal epithelial cells and the stroma of mucous membrane infiltrated by lymphocytes and plasma cells were found in rabbits of the model group and the sham acupuncture group. By contrast, in the western medicine group and the acupuncture group, the structure of lacrimal epithelial cells was basically normal, and the infiltration of lymphocytes and plasma cells were scattered in the stroma of mucous membrane. In comparison with the blank group, the expression of TGF-β1 protein and mRNA in lacrimal gland were significantly up-regulated in the model and sham acupuncture groups (P<0.01). Compared with the model group, the expression of TGF-β1 protein and mRNA were significantly down-regulated in the western medicine and acupuncture groups (P<0.01, P<0.05). CONCLUSION: Acupuncture intervention can increase tear flow and BUT in rabbits with dry eye, which may be related to the regulation of TGF-β1 expression in lacrimal gland.

Effect of needle-knife as adjunctive therapy on dry eye syndrome / 中国针灸

OBJECTIVE@#To observe the clinical effect of needle-knife at cervical spine area as adjunctive therapy on dry eye syndrome.@*METHODS@#A total of 84 patients with dry eye syndrome were randomized into 3 groups, named group A, group B and group C, 28 cases in each one (1 case dropped off in the group A, 2 cases dropped off in both group B and C). In the group A, needle-knife was applied at the margo inferior of external occipital protuberance, the range of 4 cm bilateral to external occipital protuberance, the spinous process of C, the range of 3 cm bilateral to 2 cm above C spinous process, the range of 2 cm bilateral to C, C, C spinous process for once a week; acupuncture was applied at Jingming (BL 1), Cuanzhu (BL 2), Zusanli (ST 36), Sanyinjiao (SP 6), Taixi (KI 3), Yanglao (SI 6), Ganshu (BL 18), Shenshu (BL 23), etc. for once a day, 6 times a week; sodium hyaluronate eye drop was given one drop once, 5-6 times a day. Treatment of acupuncture and sodium hyaluronate eye drop was given in the group B, sodium hyaluronate eye drop was given in the group C, the acupoints selection and the manipulation of acupuncture, the dosage of sodium hyaluronate eye drop were the same as the group A. One week was as one course and 3 courses were required in the 3 groups. SchirmerⅠtest (SⅠT), break-up time (BUT), scores of corneal fluorescein staining (CFS) and eye symptom before and after treatment were observed, the clinical effect was evaluated in the 3 groups.@*RESULTS@#SⅠT was increased, BUT was prolonged, scores of CFS and eye symptom were reduced after treatment in the group A and group B (<0.01); scores of CFS and eye symptom were reduced after treatment in the group C (<0.01). The variations of SⅠT, BUT and the scores of CFS and eye symptom in the group A were greater than those in the group B and the group C (<0.01); the variations of above indexes in the group B were greater than those in the group C (<0.05, <0.01). The total effective rate was 94.4% (51/54) in the group A, which was superior to 78.8% (41/52) in the group B and 48.1% (25/52) in the group C (<0.01), and the total effective rate in the group B was superior to the group C (<0.01).@*CONCLUSION@#Needle-knife at cervical spine area as adjunctive therapy can relieve the clinical symptoms and improve the function of lacrimal gland in patients with dry eye syndrome.

The clinical profile and prevalence of dry eye in tertiary care hospital- based population

Background: Dry eye is recognized as a growing public health problem and one of the most frequent reasons for visiting an ophthalmologist in middle and old age people. Objectives: To the best of our knowledge, very less study has been undertaken in central India on dry eye. The present study was designed to study clinical profile and to evaluate the true prevalence and risk factors of dry eye in central India. Materials and Methods: A total of 1562 participants aged 30 years or more visiting ophthalmology department in a tertiary care rural hospital enrolled in a study. Study duration was 18 months. The study design was a prospective, cross-sectional, and observational study. An ocular surface disease index (OSDI) questionnaire was administered to all participants and individuals with OSDI score greater than 12 were further evaluated with dry eye tests in sequence of tear break-up time, lissamine green staining, Schirmer-1 test, and slit-lamp examination for meibomian gland dysfunction. The participants with OSDI Score ≥13 were diagnosed to be having dry eye. The data were compiled and subjected to statistical analysis using SPSS v.17.0 software (SPSS Inc., Chicago, Illinois, USA). P < 0.05 was considered to be statistically significant. Results: Prevalence of dry eye in our study was 24.7%. Prevalence of lipid layer, aqueous layer, and mucin layer deficiency dry eye was 13.8%, 5.2%, and 7.8%, respectively. Increasing age, illiteracy, and menopause were the significant risk factors and female sex, urban habitat, and laborer and factory worker were insignificant risk factors for dry eye. Conclusion: Prevalence of dry eye in our study is higher than reported in literature in central India. Lipid anomaly dry eye was the most prevalent, followed by mucin layer deficiency and lastly aqueous tear deficiency.

Comparative Study of Dry Eye after Phacoemulsification and Manual SICS in Tertiary Centre of Jharkhand

Introduction: Cataract is the major cause of blindness inthe developing world. Study aimed at evaluation of tearfilm stability and tear secretion after phacoemulsificationcompared with MSICS.Material and methods: This prospective comparativerandomized study was performed in a tertiary centre ofJharkhand between June 2018 to March 2019. 187 patientswith senile cataract were included in this study. Group A had110 patients undergoing MSICS and group B 77 patientsundergoing phacoemulsification. Dry eye symptoms(DES)characterizedby redness, burning, stinging, foreign bodysensation, photophobia. Corneal fluorescein staining wasperformed. Basal Schirmer test was performed for assessmentof aqueous tear production. Patients were examined postoperatively on 1st week, 4th week and 3rd month.Results: Out of 187 patients 103(55.08%) were male and84(44.91%) were female. Grade of DES increased significantly1 week after each procedure compared to pre-operative dataand remained increased after 4 weeks of surgery. After 3months the symptoms decreased and returned to baseline data.Conclusion: MSICS is as effective as phacoemulsificationwith no difference between both techniques regarding tearfilm stability and tear secretion.

Comparative Study of Dry Eye after Phacoemulsification and Manual SICS in Tertiary Centre of Jharkhand

Introduction: Cataract is the major cause of blindness inthe developing world. Study aimed at evaluation of tearfilm stability and tear secretion after phacoemulsificationcompared with MSICS.Material and methods: This prospective comparativerandomized study was performed in a tertiary centre ofJharkhand between June 2018 to March 2019. 187 patientswith senile cataract were included in this study. Group A had110 patients undergoing MSICS and group B 77 patientsundergoing phacoemulsification. Dry eye symptoms(DES)characterizedby redness, burning, stinging, foreign bodysensation, photophobia. Corneal fluorescein staining wasperformed. Basal Schirmer test was performed for assessmentof aqueous tear production. Patients were examined postoperatively on 1st week, 4th week and 3rd month.Results: Out of 187 patients 103(55.08%) were male and84(44.91%) were female. Grade of DES increased significantly1 week after each procedure compared to pre-operative dataand remained increased after 4 weeks of surgery. After 3months the symptoms decreased and returned to baseline data.Conclusion: MSICS is as effective as phacoemulsificationwith no difference between both techniques regarding tearfilm stability and tear secretion.

A Clinical Study on Meibomian Gland Dysfunction and Dry Eye in Patients with Type 2 Diabetes Mellitus

Objective: The objective of the study was to find the occurrence of meibomian gland dysfunction (MGD) and dry eye disorder in patients with type 2 diabetes mellitus (DM) and to assess the profile of MGD in type 2 DM patients.Materials and Methods: An observational case-control study was conducted on 100 type 2 diabetes patients and 100 controls who are attending ophthalmology outpatient department with distinct complaints, for example, correction of refractive error. Age and gender matching was done. Tear film evaluation was done for both the groups, lid margin abnormalities were noted under slit lamp biomicroscope, fluorescein staining of ocular surface performed, and pre-corneal tear film was observed for debris. Schirmer’s test as well as tear breakup time test was performed.Results: Of 100 diabetic patients, dry eye disorder was found in 56 (56%) cases, among which 24 patients had MGD. Twenty-four of 56 that is 42% of dry eye is credited to MGD. Of 100 non-diabetics, 15% had dry eye disorder, among which 6 cases had MGD.Conclusions: Diabetes can cause changes in ocular surface with respect to both qualitative and quantitative parameters. Diabetic patients are more susceptible for dry eye disorders when compared to normal subjects. In diabetics, the frequency of MGD is considerably more when compared to nondiabetic group. As the duration of DM increases prevalence and severity of MGD also increases proportionately.