A newly developed video-meibography system featuring a newly designed probe.

PURPOSE: To demonstrate the usefulness of a video-meibography system featuring our newly designed probe. METHODS: This study utilized a newly designed probe featuring an obliquely inclined, T-shaped head containing 16 windows in the portion of the probe applied for emitting infrared light. The transilluminated structure of the meibomian gland is conducted to a highly sensitive, infrared charge-coupled device video camera and recorded digitally. The utility of the new probe was compared with the intraocular illumination probe traditionally used for meibography, both being applied to the eyelids of ten healthy volunteers and ten patients with meibomian gland dysfunction. The results were then analyzed. RESULTS: The newly designed probe facilitated eyelid eversion and transilluminated the meibomian gland structure effectively. Moreover, subjects experienced no irritation and only limited invasiveness when the new probe was applied. CONCLUSIONS: Our meibography system featuring the newly designed probe provided greater ease of use, an improved visualization of the meibomian gland structure, and increased comfort for patients during the examination.

New instruments for dry eye diagnosis.

Several non-invasive techniques for dry eye diagnosis have been developed in the past decade. These include quantitative assessment of tear volume, tear film stability, tear dynamics, and integrity of ocular surface epithelium. A combination of meniscometry and interferometry is useful for proving focal dry eye, by confirming whether or not tears at the meniscus have an effect on the ocular surface. Interferometer is also useful to evaluate tear dynamics on soft contact lenses. Fluorophotometry is useful for assessing the severity of dry eye from the view point of corneal epithelial barrier function and measuring the tear turnover rate. Both video-meibography and meibometry are useful for screening meibomian gland dysfunction. The advances in these techniques accumulate knowledge regarding pathophysiology of dry eye and allow precise diagnosis of dry eye. More targeted treatment will become feasible based on the clearer pathophysiology.

Relationship between tear volume and tear meniscus curvature.

OBJECTIVE: To investigate the relationship between tear volume and tear meniscus curvature by means of the video meniscometer. METHODS: Eleven eyes of 11 patients with severe dry eye were studied (all female; mean +/- SD age, 66.2 +/- 7.7 years; 7 left eyes and 4 right eyes), each of whose puncta had been therapeutically occluded. Four instillations of balanced salt solution were given at intervals of 1 minute in each studied eye, with the concentration increasing in 5-microL steps from 5 to 20 microL. Before and after the instillation of balanced salt solution, tear meniscus changes were recorded by video meniscometer and radius of the meniscus was calculated from the printed images by means of the concave mirror formula. RESULTS: The mean radius of the meniscus increased linearly with increased drop volume (r(2) = 0.65, P<.001), with mean +/- SD radius values of 0.24 +/- 0.08 mm at baseline and 0.48 +/- 0.13, 0.62 +/- 0.13, 0.84 +/- 0.26, and 1.00 +/- 0.32 mm after separate instillations of 5, 10, 15, and 20 microL of balanced salt solution, respectively. For each subject, a significantly different slope defining the relationship between instilled volume and meniscus radius was seen (0.016-0.063 mm/ microL; mean +/- SD, 0.039 +/- 0.015 mm/ microL), which was thought to depend on the difference in capacity of the fluid reservoir over the ocular surface. CONCLUSIONS: This study confirmed that the volume of instilled eyedrops is linearly related to the resulting radius of the tear meniscus, suggesting that this radius is a useful measure in monitoring the tear volume. This is likely to have implications both for dry eye diagnosis and for confirming the efficacy of punctal occlusion in this condition.

Effect of environmental conditions on tear dynamics in soft contact lens wearers.

PURPOSE: Dry eye symptoms are often associated with soft contact lens (SCL) wear and may be affected by environmental conditions. This study was conducted to determine the effects of temperature and humidity on the tear film in SCL wearers. METHODS: All 11 enrolled subjects were males (mean age, 23.5 +/- 5.2 [SD] years), and all wore SCL daily. They were exposed in different sessions to four different conditions in an environmental chamber with the air temperature (AT) and relative humidity (RH) set at 5 degrees C/10% (AT/RH), 15 degrees C/20%, 25 degrees C/40%, or 35 degrees C/50%. Two different types of hydrogel SCL (SCL-a and SCL-b; water content 72.0% and 37.5%, respectively) were used. The meniscus tear volume was determined on a video meniscometer by measuring the tear meniscus radius (TMR) with and without SCL. The tear interference patterns on the contact lens (TIPCL) were classified into five grades (the higher the grade, the thinner the film). Using a video interferometer, the non-invasive tear film breakup time (NIBUT) was recorded with and without SCLs; ocular dryness was also scored with and without SCLs. RESULTS: Under the environmental conditions examined, there were no significant differences in the TMR without or with SCL, regardless of their type. As AT and RH decreased, there was a significant increase in the TIPCL grade (CL-a: P = 0.042; CL-b: P = 0.002), a significant decrease in NIBUT (CL-a: P = 0.004; CL-b: P = 0.001), and a significant increase in the dryness score (without SCL P = 0.023; with CL-a P = 0.009; with CL-b P = 0.003). The dryness scores were higher with CL-a than CL-b (P = 0.011 at 15 degrees C/20%). Under identical experimental conditions, we observed no significant change in NIBUT in the absence of an SCL. CONCLUSIONS: AT and RH apparently had no effect on the tear volume in the presence of SCLs. As AT and RH decreased, the tear film on the SCL became thinner, NIBUT became shorter, and dryness increased. Dryness was more pronounced in eyes with SCL of the higher water content.

[Evaluation of canalization of the canaliculus with digital photo system for treating dry eye].

PURPOSE: We developed a simple evaluation technique of canalization of canaliculus by observing sequential images of the meniscus height after instillation of fluorescein solution. SUBJECTS AND METHODS: We used nine eyes of eight patients [one male eye, eight eyes of seven females, age: 68.3 +/- 15.9 (mean +/- standard deviation)] whose punctal plugs were extruded due to granulation formation within the canaliculi. Fluorescein solution was instilled into the eyes, until the tear meniscus was of sufficient height. Then the tear meniscus at the center of the lower lid margin was photographed with a slit-lamp equipped with a digital camera every three minutes for 15 minutes. These sequential photographs were displayed on the screen of a personal computer and from these photographs, canalization of the canaliculus was evaluated. RESULTS: In six eyes of six subjects, the meniscus height was remarkably diminished with time and the meniscus showed significant decrease as late as 15 minutes. In three eyes of two subjects, no remarkable decrease was noted during the 15 minutes. CONCLUSION: This simple method can be usefully applied in a clinical situation, because canalization of the canaliculus is easily evaluated just looking at the sequential meniscus images on the computer display.

Dynamic changes in tear meniscus curvature at the rigid contact lens edge.

PURPOSE: To investigate dynamic changes in tear meniscus curvature at the edge of a rigid contact lens. METHODS: Four eyes of four men and seven eyes of seven women who were daily wearers of rigid contact lenses were enrolled in the study. A digital video-meniscometer was used to observe real-time changes in tear meniscus curvature. Quantitative measurements have not previously been made at these locations. RESULTS: The meniscus at the lens edge showed stereotypical changes with each blink. The meniscus radius is lowest at the end of the up-phase of the blink and then increases to a steady value 0.213 +/- 0.024 mm (mean +/- SD, n = 6) after about 1 second. CONCLUSIONS: The video-meniscometer permitted observation of real-time changes in meniscus curvature at the contact lens edge during the blink. The short radius at the end of the up-phase suggests that tears are drawn away from the lens during the upward movement of the lid and lens. The restoration of a longer radius of curvature in the period that follows is thought to be due to a flow of fluid into the meniscus from the neighboring tear film.

New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis.

PURPOSE: To introduce a new surgical procedure for treating superior limbic keratoconjunctivitis (SLK) and to suggest the association of SLK with conjunctivochalasis. DESIGN: Interventional case series. METHODS: Six eyes of five patients with long-standing severe ocular irritation unresponsive to treatment with topical steroid and artificial tears were operated on using our new procedure. This technique consists of four steps as follows: (1) Rose bengal (RB) staining is used to localize the abnormal conjunctival area; (2) an arc-like conjunctival incision is placed from the 2 to the 10 o'clock position adjacent and distal to the RB-stained area; (3) the conjunctiva is resected to form a crescent using the arc-like incision as the base; the size of the resection is determined by conjunctival redundancy after removal of the subconjunctival connective tissue; and (4) the crescent conjunctival opening is closed with interrupted sutures. In two eyes, the new surgical procedure was performed together with surgery for inferior bulbar conjunctivochalasis. RESULTS: In all operated eyes, RB staining had disappeared by the end of the second postoperative week; recovery from symptoms and loss of inflammation were recorded by 1 month after treatment. In the case with the longest follow-up (14 months), there was cytologic evidence of goblet cell recovery at 3 months after the operation. In another, there was normalization of the nucleo/cytoplasmic ratio of conjunctival cells without the appearance of goblet cells. CONCLUSIONS: Our treatment very effectively resolved symptoms associated with SLK, even in eyes unresponsive to conventional therapy with eye drops. Considering that we did not address the diseased part of the conjunctiva but rather the adjacent conjunctival redundancy, we propose that superior bulbar conjunctivochalasis is involved in the pathogenesis of SLK.