Impact of soft contact lenses on lid- parallel conjunctival folds.

PURPOSE: Lid-parallel conjunctival folds (LIPCOF) are related to dry eye symptoms and appear to be related to mechanical forces in blinks. The primary aim of this longitudinal, parallel group study was to investigate impact of contact lens wear (CLW) on LIPCOF and secondly the impact of contact lens wear on lid-wiper epitheliopathy (LWE) and dry eye symptoms. METHODS: After a 2-week wash-out phase with a hydrogen peroxide care regimen, 30 experienced contact lens wearers (female: 25, male: 5; median age: 34.5 years) with at least LIPCOF Sum grade 1 (nasal + temporal LIPCOF, either eye) were randomised into three groups: one which discontinued CLW (SPEC), one which were refitted with senofilcon A two-weekly replacement daily wear silicone hydrogel (OAS) and one which continued to wear their habitual lenses (HCL). LIPCOF Sum and LWE were evaluated at the enrolment visit and over a period of 12 weeks. LIPCOF were classified by fold number using a four-grade scale. LWE was classified using a five-point scale after staining with lissamine green and fluorescein. Symptoms were evaluated with the Ocular Surface Disease Index (OSDI). RESULTS: On enrolment, there were no differences between groups for LIPCOF Sum (median 2.0), LWE (1.0) and OSDI scores (12.5) (Kruskal-Wallis, p > 0.718). Median changes at 12-weeks follow-up compared to the enrolment visit were (HCL-group: 0.5, 0.0, 0.0; OAS-group: -1.0, -0.5, -10.42; SPEC-group: -0.5, -0.5, -5.21; LIPCOF, LWE and OSDI, respectively). LIPCOF (Friedman-Test, p = 0.178), LWE (p = 0.791) and OSDI (p = 0.874) were unaltered over the period of observation in the HCL group. LWE (p = 0.120) was unaltered in OAS group but LIPCOF (p = 0.001) and OSDI (p = 0.003) significantly improved. In the SPEC group LIPCOF (p = 0.031), LWE (p = 0.002) and OSDI (ANOVA repeated measurements, p = 0.034) changed significantly. CONCLUSIONS: Refitting experienced CLW with senofilcon A daily wear, 2-week reusable contact lenses, or ceasing lens wear, improved LIPCOF, LWE and dryness symptoms.

Investigating the Short-term Effect of Eyelid Massage on Corneal Topography.

PURPOSE: The aim of this study was to evaluate the short-term effect of eyelid massage, after the use of warm compresses, on corneal topography. METHODS: Corneal topography was evaluated on 20 subjects (mean age, 47.0 [SD ±17.3] years) using the Oculus Keratograph (Oculus, Wetzlar, Germany). Corneal eccentricity (Epsilon) was compared between topography measurements before eyelid warming (using warm compresses) (T1), after eyelid warming (T2), directly after eyelid massage (T3), and 30 minutes after eyelid massage (T4). Differences in corneal eccentricity between the enrolment measurement (T1) and consecutive measurements (T1-4) were analyzed. The contralateral eye-treated by warm compresses, but not by eyelid massage-was the control. Visual acuity (decimal), bulbar conjunctival hyperemia, and corneal staining (Cornea and Contact Lens Research Unit grading scale) were evaluated at T1 and T4 to assess clinical safety. RESULTS: No significant differences were found between consecutive eccentricity measurements overall and with the central radii (repeated-measures analysis of variance, P > .238 (massaged eyelid: Epsilon T1: 0.48 [95% confidence interval, ±0.07], T2: 0.49 [±0.05], T3: 0.49 [±0.06], T4: 0.48 [±0.06]; horizontal radii T1: 7.76 [±0.13] mm, T2: 7.74 [±0.13] mm, T3: 7.75 [±0.13] mm, T4: 7.76 [±0.13] mm; vertical radii T1: 7.56 [±0.12] mm, T2: 7.55 [±0.10] mm, T3: 7.54 [±0.10] mm, T4: 7.58 [±0.11] mm). Decimal visual acuity significantly improved at the end of the study (massaged eyelid: T1: 1.1 [±0.1]; T4: 1.3 [±0.1]; P < .032). No significant differences were detected between the consecutive evaluation of corneal staining (Wilcoxon test; P > .285). Redness was not significantly different between time points (repeated-measures analysis of variance; P = .187) in the colateral eyes. Hyperemia was significantly reduced in the massaged eyes (T1: 2.0 grade units [±0.3]; T4: 1.9 [±0.3]; P = .021). CONCLUSIONS: Eyelid warming followed by eyelid massage appears to be a safe procedure, without any clinically relevant short-term effects on the cornea.

A new model of central lid margin apposition and tear film mixing in spontaneous blinking.

PURPOSE: To investigate tear film spreading and central lid position in spontaneous blinks and to propose a model of the central lid position of the closed eye in such blinks. METHOD: In vivo: lid margin position and geometry of 15 subjects (9 female; median age=45 years) were evaluated by high-speed video and slit-lamp microscope video in consecutive spontaneous blinks. Upper lid (UL) tear meniscus (TM) depth was observed in the open and almost closed eye. Eyelid geometry, position and UL TM depth were analysed by Image-J Software. Lid margin thicknesses were measured with a Scheimpflug camera. In vitro: tear film spreading and lipid layer formation were simulated on a lubricated glass plate and videoed by high-speed camera (JVC, GZ-GX1BE, Japan). RESULTS: In vivo: the median central lid margin thickness was not significantly (p=0.258) different between UL (1.8mm) and LL (1.7mm) in the opened eye. During blinking, UL remained perpendicular to the corneal surface, while LL tilted in and thinned. A scaled model diagram was created and revealed an over-blink of the UL over the LL (>0.7mm) and a height offset of the posterior lid margin of >0.7mm. In vitro: the LL TM fused with the UL TM even before full lid touch due to capillary bridge building. CONCLUSIONS: The central UL overlaps the central LL during spontaneous blinking. This provides the appearance of complete closure. The space that results from the lack of lid margin apposition influences the fusion of the upper and lower TM and ultimately tear film mixing.

The relation between blinking and conjunctival folds and dry eye symptoms.

PURPOSE: To investigate the relationship between blink action, dry eye symptoms, and lid-parallel conjunctival folds (LIPCOF). METHODS: In 30 subjects (14 were women; mean [standard deviation {SD}] age, 42.4 [±12.3] years), spontaneous blinks were recorded from a temporal-inferior view (high-speed video), and the blink extent (incomplete [IC], almost complete [AC], and complete [CC]) was evaluated. Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI), and nasal and temporal LIPCOF grades were noted. Correlations between groups were calculated with Pearson correlation (or Spearman rank in nonparametric data), and differences between groups were calculated with an unpaired t-test (or U-test Mann-Whitney in nonparametric data). RESULTS: Blink rate was significantly higher in females (22.0% [±16.8]) than in males (8.6% [±7.2]; unpaired t-test: p = 0.007). The percentage of AC of all blinks (AC%) was significantly correlated to LIPCOF sum (nasal + temporal) and OSDI scores (r > 0.570, p < 0.001). The percentage of IC was significantly correlated to LIPCOF sum (r = -0.541, p < 0.001) but not to OSDI. CONCLUSIONS: The frequency and type of blinking may have an effect on dry eye symptoms and LIPCOF severity since almost all complete blinks were significantly related to both factors.

A new perspective on spontaneous blinks.

PURPOSE: To investigate whether the central portions of the upper and lower eyelid margins make complete contact during spontaneous blinks. DESIGN: A prospective case series of subjects located in Weinheim, Germany. PARTICIPANTS: Data were analyzed from 30 subjects (14 women; mean age, 42.4 ± 12.3 years). METHODS: A small drop of lissamine green (LG; 0.15 µl) was placed on the keratinized portion of the central lower lid. Spontaneous blinks were recorded by video from a frontal view and simultaneously from a temporal-inferior view (high-speed video). Blinks were analyzed as being complete or incomplete, and the number of blinks necessary to remove the LG was counted. The upper eyelid was observed to grade the extent of misalignment of the lids in the z-axis. This so-called overblinking of the lids was classified using a 5-grade scale (0 = aligned; 1 = less than one-third overblink; 2 = more than one-third to two-thirds overblink; 3 = more than two-thirds to three-thirds overblink; and 4 = more than three-thirds overblink). Correlations were calculated by Pearson correlation (or Spearman rank in nonparametric data), and differences between groups were calculated by unpaired t test (or Mann-Whitney U test in nonparametric data). MAIN OUTCOME MEASURES: Contact between lids in spontaneous blinks and lid alignment. RESULTS: Mean blink rate was 14.9 ± 14.1 blinks/minute, and 58.8 ± 22.6% of blinks were incomplete. Blink rate was significantly higher in women than in men (P = 0.007, unpaired t test; female, 22.0 ± 16.8 blinks/minute; male, 8.6 ± 7.2 blinks/minute). Incomplete blinking occurred significantly less often in women (51.2 ± 18.5%) than in men (67.4 ± 24.5%; P = 0.029) but was not related to age (Pearson r = 0.108; P = 0.285). Lissamine green stayed unaltered in spontaneous blinks and, on average, 1.5 ± 0.8 forced blinks were needed to remove the LG. Mean grade of upper lid overblink was 3.0 ± 0.9. Lid overblink was correlated significantly with age (r = 0.456; P = 0.006). CONCLUSIONS: Central lid margins do not touch in spontaneous blinks because the lids are not aligned. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Effect of three different liposomal eye sprays on ocular comfort and tear film.

PURPOSE: To evaluate the effect of three different liposomal eye sprays on ocular comfort and tear film stability. METHODS: OptrexActiMist (AM, Optima-Pharma, Germany) was applied onto one, randomly selected eye of 80 subjects (female=49; mean age=49 years±18.6 SD) in a multi-centred, double-masked study. DryEyesMist (DEM, Boots) or TearMist (TM, Tesco) was applied onto the contralateral eye in randomized order. Over-all symptoms were investigated using the Ocular Surface Disease Index (OSDI). Ocular comfort (visual-analogue scale 0-100 [100=perfect]) and non-invasive tear film stability (NIBUT) of each eye was evaluated before application (randomized order) and were again measured 10 min after application. Effects of products on ocular comfort and NIBUT were calculated as "factor" (=after-treatment/before-treatment). Differences between measurements were analysed by ANOVA repeated measurements and differences between groups by the dependent t-test (or the non-parametric equivalent). RESULTS: OSDI-scores (mean=8.1±9.0 SD), comfort (65±24) and NIBUT (12 s±12.3) were statistically similar between centres (p>0.400). Comfort and NIBUT were not different (p>0.14) between product groups before application. Comfort and NIBUT improved significantly after application of AM (p<0.001) but worsened with the comparing products (p<0.058). Comfort improved by a mean factor of 1.5 (±0.82 SD) after application of AM but decreased after application of the comparing products (DEM: 0.9±0.33; TM: 0.9±0.34). Both factors were significantly better in AM (p<0.027). CONCLUSION: The original liposomal eye-spray 'OptrexActiMist' significantly improved ocular comfort and tear film stability while 'TearMist' or 'DryEyesMist' worsened both criteria. The latter two products may not be clinically effective in the treatment of dry eye.

A comparison of an eyelid-warming device to traditional compress therapy.

PURPOSE: To assess the warming and humidifying effect and ocular safety of the Blephasteam® eyelid-warming device vs. warm and moist compresses in healthy volunteers. METHODS: Twenty subjects (8 females, 12 males; mean age 39.2 years) were included in the study. Temperature and relative humidity were measured over a period of 10 min at the lower eyelid margin of one randomly selected eye during application of the Blephasteam device and, 1 h later, during application of warm compresses (in a randomized order). Ocular signs and visual acuity were assessed before and after each application. RESULTS: The mean duration of warming (temperature ≥38°C) was significantly longer with Blephasteam than with compresses (7.5 vs. 1.0 min; p < 0.01). There was no significant difference between treatments in the duration of 100% relative humidity. Compared with pretreatment values, visual acuity significantly improved after Blephasteam treatment (p < 0.05) but significantly decreased after treatment with compresses (p < 0.05). Limbal redness, eyelid redness, and corneal staining scores all improved significantly after Blephasteam treatment (p < 0.05 for all). Ocular signs did not change after compress treatment except conjunctival redness, which was significantly increased (p = 0.01 vs. pretreatment). CONCLUSIONS: The Blephasteam eyelid-warming device appeared to provide more effective warming than warm and moist compresses in a group of healthy volunteers. Visual acuity, limbal redness, and eyelid redness were improved after Blephasteam use but not after treatment with compresses.

Relation between upper and lower lids' meibomian gland morphology, tear film, and dry eye.

PURPOSE: To analyze relations between upper lid (UL) and lower lid (LL) meibomian gland (MG) morphology and tear film and the MG criteria ability to predict dry eye. METHODS: MG, lipid layer, and non-invasive break-up time (NIBUT) were evaluated of the OD of 20 randomly selected subjects (female = 10; median age = 44.5 years, interquartiles = 39.5 to 55 years). Subjects were grouped into nine Ocular Surface Disease Index (OSDI)- and 11 OSDI+ by the OSDI. Non-contact infrared meibography and image analysis were performed to evaluate MG loss, MG thickness, and MG bent angle. RESULTS: MG loss (Pearson correlation; r = 0.647, p = 0.003) and MG bent angle (r = 0.489, p = 0.027) were significantly correlated between lids, but MG thickness was not (r = -0.059, p = 0.413). MG loss was significantly (t-test; p = 0.048) less in the UL (median = 26.9%; LL = 32.3%), thicker in the LL (p < 0.001) and were more bent in the LL (p = 0.001). MG loss was significantly correlated to lipid-layer thickness (r < -0.597, p < 0.003) and NIBUT (r < -0.453, p < 0.030), whereas MG thickness and bent angle of the UL only were related to NIBUT (r < -0.563, p < 0.018). Combining MG loss of both lids (linear regression analysis) resulted in the best predictive ability of OSDI± (area under the receiver operative characteristic curve = 0.929, p = 0.001). CONCLUSIONS: MG scores between lids were significantly different but correlated. MG loss was significantly correlated to tear film characteristics including lipid layer thickness and stability. MG thickness and bent angle of the UL were related to NIBUT. The combination of both lids' MG loss showed best predictive ability of dry eye.