Association between tear film break up time and blink interval in visual display terminal users

AIM：To investigate the association between tear film break up time（TBUT）and blinking interval in visual display terminal（VDT）users.METHODS：Nine hundred and thirty VDT users underwent dry eye testing,and functional visual acuity（FVA）test.The blinking interval during FVA was compared with TBUT.Subjects with longer blinking interval than TBUT were considered as unstable tear film.Logistic regression analysis revealed the risk factors for unstable tear group.RESULTS：Among 930 workers,858 subjects（92.3%）participated in this study.Almost 80% of the subjects were categorized into the unstable tear group.Unstable tear group has significantly lower Schirmer values and TBUT（17.5±11.6 vs 21.1±11.5 mm,3.7±2.6 vs 5.7±2.7s,both P〈0.001）.There were no significant differences in epithelial staining or severity of symptoms.Logistic regression showed that over 40y was a risk for being unstable tear group[odds ratio（OR）=1.53;95%confidence interval（CI）=1.06-2.20].Contact lens use was protective factor for being in the unstable tear group（OR=0.37;95%CI=0.26-0.53）.CONCLUSION：Subjects with shorter TBUT than blinking interval are prevalent among VDT users.Subjects over the age of 40 shows an increased risk for unstable tear film.

Ocular surface microbiota in patients with varying degrees of dry eye severity

AIM:To elucidate the profiles of commensal bacteria on the ocular surfaces of patients with varying severity of dry eye(DE).METHODS:The single-center,prospective,case-control,observational study categorized all participants into three distinct groups:1)control group(n=61),2)mild DE group(n=56),and 3)moderate-to-severe DE group(n=82).Schirmer’s tear secretion strips were used,and the bacterial microbiota was analyzed using 16S ribosomal ribonucleic acid gene sequencing.RESULTS:The three groups had significant differences in alpha diversity:the control group had the highest richness(Chao1,Faith’s phylogenetic diversity),the mild DE group showed the highest diversity(Shannon,Simpson),and the moderate-to-severe DE group had the lowest of the above-mentioned indices.DE severity was positively correlated with a reduction in beta diversity of the microbial community,with the moderate-to-severe DE group exhibiting the lowest beta diversity.Linear discriminant analysis effect size presented distinct dominant taxa that significantly differed between each.Furthermore,the exacerbation of DE corresponded with the enrichment of certain pathogenic bacteria,as determined by random forest analysis.CONCLUSION:As DE severity worsens,microbial community diversity tends to decrease.DE development corresponds with changes in microbial constituents,primarily characterized by reduced microbial diversity and a more homogenous species composition.

Prevalence of Dry Eye and Its Association with Various Risk Factors in Rural Setup of Western Uttar Pradesh in a Tertiary Care Hospital

Purpose: To study the prevalence of dry eye in a hospital based population of rural setup and to evaluate its association with various risk factors. Material and Methods: In this cross sectional study, patients above 20 years of age were screened randomly for dry eye. An 8 points questionnaires, slit lamp examination of meibomian glands, tear film breakup time, fluorescein staining of cornea, schirmer test were used to diagnose dry eye. The diagnosis was made when three of the five parameters were positive. The role of various occupations as well as role of different exposure factors like sunlight, excessive wind, smoking, drugs, and air pollution as dry eye risk factors was accessed. Result: Out of 445, 45.39% patients had dry eye. Dry eye prevalence was higher in those above 70 years of age (74%). It was higher in male population (51.82%) compare to female population (37.37%), nearly equal in rural (46.04%) and urban population (44.31%) and highest among factory workers (90%). Correlation of dry eye with drugs (P = 0.0002), sunlight/high temperature (P = 0.0003) and smoking (P = 0.03) were significant. Conclusion: This is a hospital based study which provides prevalence of dry eye in rural region of western Uttar Pradesh. It is more common in old age male population and significantly higher in factory workers. Out of different modifiable risk factors most important are drugs, sunlight/high temperature and smoking.

Validity of subjective assessment as screening tool for dry eye disease and its association with clinical tests

AIM: To determine the role of subjective assessment using Mc Monnies dry eye questionnaire in diagnosing dry eye disease and its association with clinical tests.METHODS: There were 500 patients screened for dry eye using Mc Monnies dry eye questionnaire between May to October 2013 at the outpatient Department of Ophthalmology of a medical college hospital. All 500 patients were subjected to clinical tests. Dry eye was defined as having one or more symptoms often or all the time. Positive signs were if one or both eyes revealed tear film breakup time(TBUT) of ≤10s, a Schirmer test score of ≤10 mm, a Rose Bengal staining score of ≥1, a Lissamine green staining score of ≥1 or existence of meibomian gland disease(≥grade 1). Statistical analysis was performed to describe the distribution of symptoms and signs, to assess the correlations between Mc Monnies score(MS) and variable clinical signs of dry eye, and to explore the association between dry eye symptoms and variable clinical signs. Analysis was performed using software package Epi info. A Probability(P) value using Chi-square test of 【0.005 was taken as significant.· RESULTS: Dry eye prevalence with symptoms(questionnaire), Schirmer test, TBUT, Rose Bengal staining and Lissamine green staining was 25.6%,15.20%, 20.80%, 23.60%, and 22.60% respectively. Among those with severe symptoms(MS】20), 75.86% had a low TBUT(【10s), 58.62% had a low Schirmer’s I test(≤10 mm),86.20% had Rose Bengal staining score of ≥1, 79.31%had Lissamine green staining score of ≥1. We found statistically significant associations between positive Schirmer test and arthritis(P 【0.002), dryness elsewhere(P 【0.001), contact lens use(P 【 0.002), systemic medication(P 【0.0001), sleeping with eyes partly open(P 【0.002), history of dry eyes treatment(P 【0.0001),environmental factors(P 【0.001), swimming(P 【0.001).· CONCLUSION: Subjective assessment plays an important role in diagnosing dry eye disease. There is strong correlation between MS and Schirmer test, TBUT,Rose Bengal staining and Lissamine green staining in normal as well as marginal and pathological dry eye.

The Anatomical Dry Eye <br/>—A Different Form of Ocular Surface Disease Deserves Focus

Introduction: Dry eye disease is currently considered mainly tear film related ocular surface condition. This concept does, however, not respect ocular surface topography. The micro-anatomy of the corneal changes may lead to enhanced demands on the tear film and lead to significant complaints. However, they often remain undetected and hence untreated. It is suggested that the pathophysiology for an entire subgroup of dry eye disease patients is primarily of surface morphological nature. Methods: The tear film break up was observed and used to identify anatomical alterations in eyes of patients with dry eye complaints. The localization and pattern of TFBUT using fluorescein was compared between eye with normal surfaces and surface alterations. Results: Premature tear film rupture was localized at constantly same areas and did match changes on the ocular epitheliopathy in patients with diseases such as microcystic epithliopathy, MFD, and after excimer laser treatment. Disusssion: Whereas in normal surfaces TFBUT does occur within the floating tear film, the anatomical dry eye identifies itself with constant location of tear film break up and a constant spreading pattern. In contrast to the classic, tear film caused dry eye, the anatomical dry eye is accessible to treatment. This should catch our attention and intent to identify it. It is the ease of possible treatment that should make these ocular surface alterations prime target of dry eye disease diagnostic. It is hence suggested to introduce the anatomical dry eye as a subgroup in the large group of dry eye and ocular surface disease.

Comparison of the Clinical Efficacy of Four Different Liposomal Sprays for the Treatment of Dry Eye

Purpose: To compare the clinical efficacy of four different liposomal sprays for dry eye treatment. Methods: Prospective randomized consecutive intraindividual comparison enrolling 166 patients (age, 18 - 93 years). Patients were randomly assigned to one of 4 groups, receiving one spray in their right eye and another one in their left eye: Ocuvers Hyaluron (OH) (87 eyes) and Ocuvers Lipostamin (OL) (80 eyes) (Innomedis AG), and Tears Again (TA) (80 eyes) and Tears Again Sensitive (TAS) (85 eyes) (Optima Pharmaceutical). Symptomatology was evaluated with the OSDI (Ocular Surface Disease Index) questionnaire. Subjective comfort, tear break up time (TBUT), redness, tear meniscus, application comfort and smell were evaluated during a 30-minute follow-up. Results: Smell for TA and TAS was significantly fattier compared to OH and OL (p Conclusions: The four evaluated liposome sprays may be useful for dry eye treatment, with higher subjective comfort and less dry eye signs using the Ocuvers sprays. The use of OL may be a better treatment option for severe dry eye.

Assessment of tear film parameters post-treatment with commercial eyelid cleaning wipes:a pilot study

AIM:To investigate the short-term effects of commercially available eyelid-cleaning wipes on film parameters.METHODS:This study enrolled 48 healthy participants aged 20-35y(both males and females).Clinical assessment included the Ocular Surface Disease Index(OSDI)questionnaire,non-invasive tear break-up time(NITBUT),tear meniscus height(TMH),and lipid layer pattern(LLP).Based on these initial results,participants were categorized as either non-dry eye or dry eye.Participants in each group were randomly allocated to either Blephaclean■or Systane■treatments.Changes in NITBUT,TMH,and LLP levels before and after lid wipe treatment were assessed.RESULTS:The dry eye group exhibited significantly higher OSDI scores and lower NITBUT and TMH levels than in the non-dry eye group(P<0.001).Following the application of eyelid wipes(Systane■wipes),dry eye subjects experienced a significant improvement in NITBUT levels(P=0.0014)compared to the non-dry eye individuals.Although the remaining participants showed a marginal increase in TMH and NITBUT levels,these changes did not achieve statistical significance(P>0.05).Similarly,the LLP levels were significantly improved with Systane■(P<0.001)post-treatment compared to individuals in the non-dry eye group.However,the dry eye subjects showed higher posttreatment LLP levels than the untreated group(P<0.02).CONCLUSION:The short-term effects of Systane®eyelid wipes on tear film parameters suggest their effectiveness in dry eye disease.Nonetheless,further exploration of their long-term impact is essential to justify their cost effectiveness and efficacy in treating both aqueous deficiency and evaporative dryness.

A randomized,fellow eye,comparison of keratometry,aberrometry,tear film,axial length and the anterior chamber depth after eye rubbing in non-keratoconic eyes

Background:To investigate the effect of eye rubbing on keratometry(K),aberrometry,tear film break-up-time(TFBUT)and anterior chamber depth(ACD).Methods:Volunteers without any corneal pathology or dry eyes were randomised to rubbing in one eye and the fellow-eye was control.Eye rubbing was performed for 2 min.Primary outcomes studied were anterior and posterior K changes.Secondary outcomes were changes in TFBUT,axial length(AL)&ACD,K changes in various zones,asphericity and aberrometry.Pre and post rubbing K,aberrometry,ACD and TFBUT were assessed in a predetermined sequence.The relationship of the above parameters to axial length(AL)was also assessed.Astigmatism was analysed using vector analysis.Results:Pre versus post rubbing,anterior flatter K further flattened(42.51±1.52 D vs.42.36±1.53 D,p=0.003)and the changes to J0 vector in central cornea(−0.16±0.26 D vs.-0.27±0.33 D,p=0.038)suggested change to against-the-rule(ATR)astigmatism.There was significant change in Z^(+2)_(2) polynomial following rubbing.We found a positive correlation between axial length and change in posterior K(r=0.335,p=0.020).The TFBUT reduced following eye rubbing(15.3 s vs.13.9 s,p=0.0001).There was a positive correlation between AL and increase in ACD post rubbing(r=0.300,p=0.038).There was a positive correlation between ACD and change in mean posterior K(r=0.305,p=0.035).Conclusions:In healthy eyes,following eye rubbing,there is a significant change in TFBUT and central anterior K changes towards ATR astigmatism.Longer eyes had more changes in posterior K and ACD.Whereas,eyes with deeper ACD showed more steepness of posterior K.