Correlation of lipid layer thickness measurements with fluorescein tear film break-up time and Schirmer's test.

PURPOSE: This study correlates measurement of lipid layer thickness (LLT) with two frequently used dry eye tests, fluorescein break-up time (FBUT) and Schirmer's test with anaesthesia (STA). METHODS: Subjects (n = 44 eyes) with symptoms of dry eye and positive results for dry eye with either FBUT or STA or both were selected. Quantification of LLT was performed by the observation of colour interference patterns in zones of specular reflection using a custom-designed instrument. RESULTS: All correlations among pairs of tests were strong and exhibited a significance of P < 0.000: STA with FBUT, Pearson's correlation 0.653; STA with LLT, 0.764; FBUT with LLT, 0.751. When LLT was high, ie > or = 120 nm, which occurred in 14 eyes, STA was also elevated in those eyes and FBUT was high in 13 of the 14 eyes. When LLT was low, ie < or = 60, which occurred in 22 eyes, STA was below normal in 14 of the 22 eyes, and FBUT was below normal in 15 of the 22 eyes. These clinical observations paralleled the statistical findings computed from the entire data set. CONCLUSIONS: The correlations demonstrated in this study support the premise (1) that measurement of LLT is a reliable test for the diagnosis of dry eye, and (2) that aqueous deficiency and lipid deficiency, as they apply to dry eye disorders, are not mutually exclusive.

Comparison of fluorescein break-up time measurement reproducibility using standard fluorescein strips versus the Dry Eye Test (DET) method.

PURPOSE: To compare the repeatability of fluorescein break-up time (FBUT) measurements determined with either a standard fluorescein strip or the Dry Eye Test (DET) modified fluorescein strip methods. METHODS: This was a prospective, randomized contralateral study of 100 patients, in which FBUT measurements were determined with a standard FUL-GLO fluorescein strip (Akorn, Inc., Buffalo Grove, IL, U.S.A.) in one eye and a DET strip (Akorn, Inc., Buffalo Grove, IL, U.S.A.) for the contralateral eye. Three consecutive measurements were made immediately after fluorescein instillation. The second eye was evaluated 1 minute after completion of the first eye. Data from patients with FBUT values less than 20 seconds were included in the data analysis, because measurements greater than 20 seconds are not diagnostically significant. RESULTS: Seventy-five patients met enrollment and FBUT measurement criteria. For three consecutive FBUT measurements, the DET values were within 3 seconds for 72 of the 75 patients (96%). Eighty percent of patients reported no sensation with the DET strip, 20% reported mild sensation, and no patient reported moderate sensation. With FUL-GLO strips, measurements were within 3 seconds for 53 of the 75 patients (71%) (p <0.005). The standard fluorescein strip method elicited reports of no sensation from 31% of patients, mild sensation from 60%, and moderate sensation from 9% (p <0.001). CONCLUSIONS: The DET strip provides a significant reduction in sensation upon application, improved single measurement reliability, and enhanced measurement precision, compared with a conventional fluorescein strip.

Comparison of the clinical efficacy and comfort of olopatadine hydrochloride 0.1% ophthalmic solution and nedocromil sodium 2% ophthalmic solution in the human conjunctival allergen challenge model.

BACKGROUND: Mast cell stabilizers, such as the ocular antiallergic agent nedocromil sodium 2% ophthalmic solution, are not rapid acting and often require a loading period of > or =2 weeks for maximal efficacy. Olopatadine hydrochloride 0.1% ophthalmic solution is a member of a new class of topical antiallergic agents that have combined antihistaminic and mast cell-stabilizing properties. OBJECTIVE: The purpose of this study was to compare the clinical efficacy and comfort of olopatadine with those of nedocromil in the conjunctival allergen challenge model. METHODS: This was a single-center, 3-visit, randomized, double-masked, contralaterally controlled study. Seventy-five subjects with a history of allergic conjunctivitis were screened, and the 52 who responded to conjunctival allergen challenge at visits I and 2 were randomized by eye to receive olopatadine, nedocromil, or placebo (a "natural tears" lubricant eye drop). Because nedocromil may require a 2-week loading period for maximal efficacy, the eyes assigned to that agent received nedocromil for 14 days (between visits 2 and 3), whereas the eyes assigned to olopatadine or placebo received placebo during this period. Throughout the loading phase, subjects instilled 1 drop of the assigned masked medication in each eye twice daily. At the assessment visit (visit 3), subjects received I drop of masked olopatadine, nedocromil, or placebo in each eye and were asked to rate the comfort of each drop on a scale from 0 to 8. Fifteen minutes after instillation of medication, subjects were challenged with the allergen concentration that had elicited a positive conjunctival allergic response at the previous visits. Subjects then scored their itching on a scale from 0 to 4 at 3, 5, and 10 minutes after challenge. Mean itching scores for all eyes were compared by treatment. Paired t tests were performed on the mean itching and ocular comfort scores at each time point. At the end of the study, subjects were asked which treatment they preferred in terms of comfort and efficacy. RESULTS: Forty-nine subjects completed the study. Forty eyes received olopatadine, 36 received nedocromil, and 22 received placebo. Olopatadine was clinically and statistically superior to nedocromil at reducing itching in the conjunctival allergen challenge model (mean unit difference: -1.60 at 3 minutes, -1.68 at 5 minutes, -1.19 at 10 minutes; P < 0.001). One drop of olopatadine was more efficacious than 29 drops of nedocromil. Olopatadine-treated eyes were rated as being significantly more comfortable than nedocromil-treated eyes (0.73 vs 1.55; P = 0.034). Of the 14 subjects treated with olopatadine and nedocromil who stated a preference, 10 (71%) were more satisfied with olopatadine than with nedocromil. CONCLUSION: In the conjunctival allergen challenge model, olopatadine was more efficacious and comfortable than nedocromil in reducing the itching associated with allergic conjunctivitis.

Effects of eyelid scrubbing on the lid margin.

PURPOSE: To compare the effects of eyelid scrubbing with an eyelid cleansing solution (ECS) to eyelid scrubbing with ECS and the addition of antibacterial or anti-inflammatory pharmaceuticals on the clinical appearance, microbial status, tissue histology, and the inflammatory cell profile of the normal eyelid margin. METHODS: Eyelid scrubbing was performed twice daily using ECS; ECS with the antibacterial sulfacetamide (ECS+); and ECS with sulfacetamide and prednisolone acetate (ECS++) over a 21 day period on three groups of 16 rabbits with clinically normal eyelids. RESULTS: Significant hyperemia of the margin occurred in all three groups over the 3 week period; however, the degree of hyperemia was less with ECS+ (P<0.05) and ECS++ (P<0.05). Chemosis, tearing, mucus discharge, and the microbial status were not significantly different than controls. There were no marked histologic differences in the tissues, except for increased red blood cell packing in the small vessels near the lid margins in scrubbed eyelids, consistent with hyperemia. The inflammatory cell profile showed minimal changes that were not statistically significant in any of the three groups, except that >50% of mast cells showed evidence of degranulation. CONCLUSIONS: Use of ECS with an antibiotic, or an antibiotic and steroid solution, resulted in less inflammation than scrubbing with ECS alone.

Epidermal and dermal phospholipids of the human eyelid: a 31P nuclear magnetic resonance spectroscopy study.

The phospholipids of the skin are difficult to quantify because they represent only a small fraction of the skin tissue. In this study, 31P nuclear magnetic resonance, which permits precise profiling of these phospholipids, was used to compare the phospholipids of upper eyelid epidermal and dermal lipid extracts (n = 13 profiles). Phospholipid profiles included alkylacylphosphatidylcholine (AAPC), dihydrosphingomyelin (DHSM), diphosphatidylglycerol (cardiolipin), ethanolamine plasmalogen (EPLAS), lysophosphatidylcholine, phosphatidic acid, phosphatidylcholine (PC), phosphatidylethanolamine, phosphatidylinositol, phosphatidylserine, sphingomyelin, and uncharacterized phospholipids (U1 and U2, particularly enriched in the epidermis). The computed phospholipid metabolic index (n = 86 indexes) findings can be summarized as follows: a lower content of the en-ol and ether phospholipids in the epidermis relative to the dermis, internal compensation among the component phospholipids so as to maintain the choline functional group ratio, and a greater concentration of hydroxyl-containing functional groups in the epidermis. A membrane index (fmem) value of -0.37 for the epidermis deviated considerably from the value of -0.06 characteristic of living membranes and the dermis. The production of the reduced phosphatides, EPLAS and AAPC, indicates the use of alternative pathways between the two tissues. Relative to the dermis, increased PC in the epidermis coupled with decreased DHSM, EPLAS, and AAPC are factors enabling the epidermis of eyelid tissue to be an effective water barrier.

Histopathology of the ocular surface after eye rubbing.

PURPOSE: This study demonstrates the effects of eye rubbing on ocular surface tissue. METHODS: Rabbits (3-4 kg; n = 24) were killed at 0, 4-h, 8-h, and 12-h intervals after a 5-min period of eye rubbing. Ocular surface tissues were studied by light and scanning electron microscopy. Contralateral eyes served as controls. Eye rubbing was accomplished by using digital pressure over the closed eyelid with a force sufficient to appreciate by palpation the orbital rim. Biomicroscopic examination revealed marked vascular injection of the conjunctiva. Ocular surface tissues studied included the lid margins, the upper and lower tarsal conjunctivae, the bulbar conjunctiva, and the cornea. RESULTS: Changes in the ocular surface included dramatic alteration in the upper tarsal conjunctiva when compared with controls. The cornea and bulbar and lower tarsal conjunctiva were not altered when compared with control tissues, except for some increase in exfoliating cells in the cornea. The surface epithelial cells of the upper tarsal conjunctiva had a spheroidal structure and were markedly elevated, the microprojections were altered, and there was evidence of increased cellular exfoliation. These changes were most pronounced at the 0 and 4-h time points, less noticeable at 8 h, and no appreciable changes were observed when compared with control tissues at 12 h. CONCLUSION: This study demonstrates that eye rubbing causes surface alterations in the stratified cuboidal to columnar epithelial surface of the upper tarsal conjunctiva while sparing the stratified squamous epithelial surface of the distal lid margins and cornea.

Ex vivo phosphorus magnetic resonance spectroscopy on eye bank corneas and corneal metabolic health.

BACKGROUND: Since a potential exists for untoward effects on the cornea from the high magnetic fields and radio-frequency energies, and the further manipulation required for phosphorus-31 magnetic resonance spectroscopy (31P-MRS), we determined the effects of this technology on tissues using paired human corneas (n = 4) meeting criteria acceptable for transplantation. METHODS: Slit-lamp biomicroscopy, pachometry, specular microscopy, and redux fluorophotometry were performed on all corneas. One cornea of each pair was examined (< 30 min) by 31P-MRS. Following 31P-MRS, slit-lamp biomicroscopy, pachometry, and redox fluorophotometry were again performed. RESULTS: Data tabulated included the 31P energy modulus (1.37 +/- 0.28), the ATP/Pi (2.92 +/- 0.59) and SP/Pi (0.76 +/- 0.04) ratios, and the intracorneal pH (7.24 +/- 0.09). CONCLUSION: Since there were no significant differences in slit-lamp biomicroscopy, endothelial density and morphometry, cell counts, and pachometric and redox fluorophotometric measurements between corneas of each pair before and after 31P-MRS analysis, it was concluded that there was no detectable metabolic damage secondary to such analysis. This study suggests that MRS analysis of human eye-bank tissues does not damage the cornea metabolically and may provide a practical evaluation of the health of the cornea at the biochemical level.

Meibomian gland phospholipids.

The content of the meibomian gland lipid exprimate is known, but little is known about the phospholipids that comprise the glandular cells. The purpose of the present study is to identify and quantitate the phospholipid complement of the meibomian gland cells that produce the lipid secretion of meibomian oil and which is vital to tear film stability. Eyelids (n = 50) were excised from rabbits, and after surgical removal of surrounding tissues, the tarsal plates with and without expressing meibomian oil were extracted and phospholipids of the plates quantified by 31P nuclear magnetic resonance (NMR). Seventeen phospholipids were quantified from tarsal plates expressed of oil and tarsal plates containing meibomian oil: alkylacylphosphatidylcholine (AAPC), dihydrosphingomyelin (DHSM), dimethylphosphatidylethanolamine, diphosphatidylglycerol (cardiolipin), ethanolamine plasmalogen (EPLAS), lysoethanolamine plasmalogen, lysophosphatidylcholine, lysophosphatidylethanolamine, lysophosphatidylserine, phosphatidic acid, phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylglycerol, phosphatidylinositol, phosphatidylserine, sphingomyelin (SM), sphingosylphosphorylcholine. The six zwitterionic and neutral phospholipids, DHSM, EPLAS, PE, SM, AAPC, and PC together comprise 79.5% of the total meibomian gland phospholipid profile (in meibomian oil this value is 84.2%). The zwitterionic and neutral phospholipids dominate meibomian gland phospholipid profiles. Since the meibomian gland cells undergo holocrine secretion and form the meibomian glad secretion, such a composition is consistent with the hypothesis that a chemically stable lamellar surfactant layer phospholipids bind non-polar meibomian oil to the aqueous layer of the tear film.

Effect of periocular humidity on the tear film lipid layer.

The purpose of this study was to determine the relationship between the tear film and humidity by examining whether alterations in periocular humidity influence the thickness of the tear film lipid layer. Thirteen dry eye subjects presenting with a baseline lipid layer thickness of < or = 60 nm were fitted with modified swim goggles in which the right eye (OD) was exposed to conditions of high humidity and the left eye (OS) remained exposed to ambient room conditions. The lipid layer was monitored over a 60-min time course with goggles on and for an additional 60 min following goggle removal. The OD lipid layer increased significantly in thickness within 5 min of exposure to conditions of high humidity (p < 0.0001), reaching a maximum increase of 66.4 nm after 15 min of goggle wear (p < 0.0001). This maximum increase to a lipid layer thickness of 120.5 nm was maintained at the 30- and 60-min goggle time points. No significant change was detected OS. Following goggle removal, OD values declined but remained significantly elevated over the OS lipid layer thickness throughout the 60-min postgoggle period. Moderate to total relief of dry eye symptoms was reported during goggle wear and generally persisted at a reduced level for 1-3 h following goggle removal. Increased periocular humidity results in an increase in tear film lipid layer thickness, possibly by providing an environment that is more conducive to the spreading of meibomian lipid and its incorporation into the tear film.

Tear film lipid layer formation: implications for contact lens wear.

An overview of the relation between lipid layer formation and contact lens wear is provided, with particular emphasis on factors that influence the delivery and spreading of lipid on the tear film. The disruption of the lipid layer by a contact lens is discussed, as well as factors that may enhance the stability of the prelens tear film lipid layer.

Phospholipids in meibomian gland secretion.

The bulk of the lipid layer overlying the aqueous portion of the precorneal tear film is composed of polar and nonpolar components. The nonpolar lipids have been the subject of numerous studies; however, the polar lipids have remained relatively uncharacterized. The polar lipids are thought to contain surfactant phospholipids that are critical to the spreading of a lipid film over the aqueous layer, by providing an interface between this layer and the nonpolar lipids. The purpose of the present study is to identify and quantitate the phospholipid complement of meibomian gland secretion which provides the tear film with phospholipids. Meibomian gland secretion was collected from rabbits and phospholipids identified and quantitated by 31P nuclear magnetic resonance spectroscopy. Ten phospholipids were detected from meibomian gland secretion: diphosphatidylglycerol, dihydrosphingomyelin, ethanolamine plasmalogen, phosphatidylethanolamine (PE), phosphatidylserine, sphingomyelin, lysophosphatidylcholine, phosphatidylinositol, alkylacylphosphatidylcholine, and phosphatidylcholine (PC). The two major phospholipids were PC and PE, together comprising nearly 60% of the total phospholipid profile. The nature and relative concentrations of the meibomian gland secretion phospholipids are congruous with a surfactant role at the aqueous-lipid interface and, considering the physical chemistry of the tear film, suggest that the phospholipids should be organized in a very flat or planar configuration.

Interspecies comparisons of lens phospholipids.

The purpose of this study was to compare and contrast quantitative crystalline lens phospholipid profiles among human, pig, rabbit, rat mouse, dog, lamb, guinea pig, beef, calf, chinook salmon, and golden roach. Lenses were extracted using chloroform-methanol. The extracts were prepared for phospholipid 31P NMR quantitative analysis using an NMR analytical reagent specifically designed for this purpose. Lens phospholipid profiles vary among vertebrate species. Thirteen different phospholipids [phosphatidylglycerol, lysophosphatidylethanolamine, phosphatidic acid, diphosphatidylglycerol, the ethanolamine plasmalogen (EPLAS), phosphatidylethanolamine (PE), phosphatidylserine (PS), sphingomyelin (SM), lysophosphatidylcholine, phosphatidylcholine (PC), including four uncharacterized (unknown) phospholipids at 1.31 ppm (human), 1.20 ppm (human, rabbit, dog, lamb, beef, calf), 0.13 ppm (all except rat), and -0.17 ppm (rat, beef) were detected. EPLAS, PE, PS, SM, and PC are the major lens phospholipids in all species except the human, where the major phospholipid is the unknown at 0.13 ppm. The lens content of this major unknown in mole percentage of the total detected phospholipid profile is: human 43.7; pig 6.7; rabbit, 6.1; rat (not detected); mouse, 3.2; dog, 5.0; guinea pig, 2.0; lamb, 7.0; beef, 7.7; calf, 5.6; chinook salmon, 6.7; and golden roach, 1.6. Large qualitative and quantitative differences were observed among lens species, indicating the necessity for prudent selection of appropriate animal models. The most striking finding is that no other species except the human species exhibits such a profound amount of the unknown phospholipid at 0.13 ppm. In the human lens, this phospholipid is the major phospholipid.

Distribution of membrane phospholipids in the rabbit neural retina, optic nerve head and optic nerve.

Since diseases of the neural retina and optic nerve can result in alteration of biological membranes, this study determines similarities and differences in the membrane phospholipid content of the neural retina, optic nerve head, and optic nerve to serve as baseline data. Neural retina, optic nerve head, and optic nerve were dissected, isolated as 5 sets from 20 rabbits and frozen in liquid N2. Separate pooled-tissue extracts were prepared for each set of tissues and phosphorus-31 nuclear magnetic resonance (31P NMR) analyses performed. Ten phospholipids were quantified (respective neural retina, optic nerve head, and optic nerve mole % are given for the 5 major phospholipids detected): phosphatidylcholine (PC), 44.61, 27.67, 26.40; PC plasmalogen or alkylacyl PC (CPLIP); phosphatidylinositol (PI); sphingomyelin (SM); phosphatidylserine (PS), 12.63, 14.77, 15.09; phosphatidylethanolamine (PE), 21.21, 9.59, 8.69; PE plasmalogen (EPLAS), 11.07, 30.96, 33.93; an unidentified (unknown) phospholipid (U) at the chemical-shift value of 0.13 ppm; diphosphatidylglycerol (DPG); and phosphatidic acid (PA), 0.46, 2.92, 1.57. Significant differences between the various tissues were determined by the one-way analysis of variance, using a Scheffé range value of P < 0.05. The neural retina in all phospholipids detected except for the uncharacterized (unknown) phospholipid was significantly different from the optic nerve head tissue. The optic nerve head was significantly different from the optic nerve in PC, CPLIP, PE, EPLAS, U, DPG, and PA. The data provide a baseline for studies on pathologically changed neural retina, optic nerve head, and optic nerve.

The effects of age on phosphatic metabolites of the human cornea.

Phosphatic metabolites from human corneas, pooled into 7 decades ranging from ages < 1 year through 79 years, were quantitated using phosphorus-31 magnetic resonance (31P MR) spectroscopy. Relative concentrations of phosphorus-containing compounds measured included the low-energy metabolites [phosphomonoesters (PME), inorganic orthophosphate (Pi), phosphodiesters (glycerol 3-phosphorylethanolamine and glycerol 3-phosphorylcholine)] and the high-energy metabolites [phosphocreatine (PCr), adenosine triphosphate (ATP), adenosine diphosphate (ADP), nucleosidediphosphosugars and the dinucleotides]. Significant linear changes attributable to age occur in the relative mole percentage decrease of phosphate concentrations of human corneal PME, PCr and ATP, and in the increase of Pi. Age-attributable rates of decrease in PME at -0.162 MPP/YR (mole percent phosphorus per year), PCr at -0.015 MPP/YR and ATP at -0.487 MPP/YR combined, approximate the rate of increase in Pi determined to be +0.729 MPP/YR. Of the indices computed from the human corneal spectral data, the ratios of ATP/Pi and PME/Pi and the tissue energy modulus were all found to decrease significantly with age. These changes in corneal phosphatic metabolites are indicative of an overall decline in high-energy metabolism with age.

Distribution of membrane phospholipids in the rabbit uvea.

BACKGROUND AND AIMS: Since the uveal tract becomes involved in inflammatory disorders, which are known to affect lipid metabolism, we studied normal membrane phospholipids (PLs) in order to (1) determine baseline PL profiles of the iris, ciliary body, and choroid, and (2) compare and contrast PL profiles of the uveal tissues. METHODS: Iris, ciliary body and choroid tissues were isolated from rabbit eyes (n = 30) and extracted with chloroform-methanol using a modified Folch procedure. Quantitative tissue PL profiles were obtained using 31P nuclear magnetic resonance. RESULTS: Fourteen PLs were detected and quantitated in all three uveal tissues among which was one unidentified PL at -0.17 ppm. The five major PLs in the iris, ciliary body and choroid, respectively, have the following PL composition (mole percent of total phosphorus): ethanolamine plasmalogen 14.58, 15.07, 16.52; phosphatidylethanolamine 13.10, 12.40, 9.23; phosphatidylserine 11.24, 10.27, 12.13; sphingomyelin (SM) 11.10, 11.97, 18.21; and phosphatidylcholine (PC) 36.61, 36.70, 29.88. Additionally, lysophosphatidic acid, phosphatidic acid, lysophosphatidylcholine, phosphatidylinositol, and PC plasmalogen or alkacyl PC were detected in all tissues. Sphingosylphosphorylcholine also was detected in the ciliary body and choroid. Lysophosphatidylethanolamine was detected in the choroid. In addition, 42 PL metabolic indexes were calculated from these data, which permitted pathway-specific lipid analyses. CONCLUSION: This study establishes baseline PL profiles of the uveal tract tissues and will permit comparisons with tissues from eyes with inflammatory disorders. The PL concentrations in conjunction with the indexes demonstrate that overall the choroid has membranes that are less permeable to ion translocation than either the iris or the ciliary body, although there are compensatory concentration changes between the SM and PC components among these three tissues.

Distribution of membrane phospholipids in the crystalline lens.

PURPOSE: To determine the phospholipid content of specific anatomic regions within the crystalline lens. METHODS: Phospholipid extracts of tissues dissected from 5 sets of 10 rabbit lenses were analyzed by 31P nuclear magnetic resonance spectroscopy. Twenty-nine pathway-specific metabolic indexes were calculated from groups of phospholipids and ratios of phospholipids. RESULTS: Phospholipid levels (mole percent) were determined from the capsule with attached epithelium, the cortex, and the nucleus. Eleven phospholipids were detected with significant regional differences in the lens phospholipid profiles. The levels of phosphatidylcholine (PC), PC plasmalogen-alkylacyl PC, phosphatidylinositol (PI), phosphatidylethanolamine (PE), and diphosphatidylglycerol (DPG), and of the lyso derivatives (lyso PC and lyso PE) were greater in the capsule plus epithelium than in the cortex or the nucleus. Levels of sphingomyelin, phosphatidylserine, and PE plasmalogen (EPLAS) were less in the capsule plus epithelium than in the cortex or the nucleus. PC, PC plasmalogen-alkylacyl PC, EPLAS, and lyso PE had nearly equal amounts in the cortex and the nucleus. PI, lyso PC, and DPG could not be detected in the nucleus. DPG was only detected in the capsule plus epithelium. An unidentified phospholipid at 0.13 ppm was approximately equal in the cortex and the nucleus, but it could not be detected in the capsule plus epithelium. CONCLUSIONS: These differences demonstrate a significant heterogeneity among these anatomic regions of the lens, and differences in the nucleus relative to other regions studied are consistent with those in membranes that less readily undergo transitions from the relatively impermeable lamellar phase to the more permeable hexagonal HII phase.