Changes in conjunctival cytology and tear function tests with radioiodine treatment for hyperthyroidism

Purpose To characterize dry eye disease after severe unilateral infectious (non‐viral) keratitis. Methods Tear break‐up time (BUT), Schirmer I test, Ocular surface disease index (OSDI) and Tear film osmolarity by means of Tearlab* (Tearlab, San Diego, CA, USA) were collected in patients admitted for severe unilateral non‐viral infectious keratitis in Ophthalmology departments of Strasbourg and Paris‐Bicetre university hospitals (France) between January and May 2010. All of these data were collected in both eyes (infected eye and non‐infected controlateral eye as a control) at least 3 month after the beginning corneal infection and 1 month after the end of topical treatment. Severity of infection was defined as a large (> 2 mm) and/or a deep corneal infiltrates (> 50% thickness). Results 21 patients (9 men, 12 women) were followed during the study. Mean age was 37 year‐old (range 19‐64). Bacteria, fungi and acanthamoeba were involved as pathogenic agents in 16, 3 and 2 cases respectively. The mean score of OSDI was 5.94+/‐3.83 in infected eyes and 2.17+/‐2.28 in control (non‐infected) eyes (p=0.0017). Tear osmolarity as 290.67+/‐7.56 mOsm/L in infected eyes as compared to 300.71+/‐6.40 in control eyes whereas tear BUT and Schirmer test were also significantly decreased in infected eye (p<0.001 p=0.0023 and 0.0011 respectively). Conclusion Secondary dry eye disease is a common finding after severe corneal infection. However, decreased tear film osmolarity has been observed in all patients. These results are in contradiction with increased tear osmolarity reported in primary mild to moderate dry eye disease. Prolonged inflammation and subsequent destruction of resident cells of the conjunctiva and lacrimal glands could be hypothetized.

Purpose This study aimed to assess the efficacy of a platelet-rich plasma (PRP) injection into the lacrimal gland in severe dry eye and to compare it with preservative-free artificial tears. Patients and methods This study included a total of 74 eyes of 40 patients divided into two groups. The intervention group received three PRP injections transcutaneously in the region of the lacrimal gland. The control group was treated with preservative-free artificial tears. Results The intervention group showed improvement in all measured parameters, except the Meibomian gland score, with a statistically significant improvement in the Ocular Surface Disease Index (OSDI) score (P<0.001) and the Schirmer test (P=0.011) and less significant improvement in the ocular surface staining score (P=0.076) and tear breakup time (TBUT) (P=0.09). Compared with the control group, the PRP intervention group showed a statistically significant improvement in the OSDI score (P<0.001), the Schirmer test (P=0.005) and the ocular surface staining score (P=0.013) and less significant improvement in TBUT (P=0.2). Conclusion The use of PRP injections is safe and effective, with improvement in the OSDI, Schirmer test, and ocular surface staining and less improvement in TBUT, but it is not effective in improving Meibomian gland function.

ABSTRACTPurpose: To evaluate corneal parameters of patients with ankylosing spondylitis (AS) by Scheimpflug imaging and also to clarify the associations between disease severity and clinical status of AS and corneal parameters. Methods: Fifty-seven patients with AS and 57 healthy subjects were included in this cross-sectional study. All participants underwent a detailed ophthalmological evaluation. Corneal parameters were measured by Pentacam. In addition, Schirmer test, tear break-up time (TBUT), corneal fluorescein staining, and Ocular Surface Disease Index (OSDI) scores were evaluated. Duration of disease and scores of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Quality of Life scale (ASQoL) of the patients were recorded. The laboratory evaluation consisted of human leukocyte antigen (HLA)-B27, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Results: Corneal parameters were significantly different between patients with AS and healthy controls. The mean central corneal thickness (538 ± 26 µm versus 569 ± 27 µm, p < 0.001) and the mean corneal volume (59.8 ± 3.33 mm3 versus 62.3 ± 3.40 mm3, p < 0.001) were reduced significantly in AS patients compared to those in healthy controls. The values of TBUT and Schirmer test scores were significantly lower in AS patients than in controls. Also, corneal fluorescein staining and OSDI scores were higher in AS patients than in controls. Factors related to the corneal parameters were dry eye tests (TBUT, Schirmer test, corneal fluorescein staining), OSDI score, and CRP (p < 0.05 for all). Conclusion: The AS patients have thinner corneas compared to control subjects, which may be affected by tear disfunction and inflammatory processes.

Purpose: To explore the correlations between tear osmolarity, as measured using I-PEN&lt;sup&gt;®&lt;/sup&gt; (I-MED Pharma, Inc., Dollard-des-Ormeaux, QC, Canada), and various dry eye indicators, including the Schirmer test, tear break-up time (TBUT), Oxford scale, and Ocular Surface Disease Index (OSDI), in patients with obstructive meibomian gland dysfunction (MGD).Methods: The medical records of 44 cases of obstructive MGD were reviewed. Tear osmolarity was obtained using I-PEN&lt;sup&gt;®&lt;/sup&gt; (I-MED Pharma, Inc.). The TBUT, Schirmer test, Oxford scale, OSDI, and MGD grade were used to assess the cases, and their correlations with tear osmolarity were analyzed.Results: Spearman and Pearson correlation analyses showed a significant correlation between tear osmolarity and MGD grade (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and OSDI (&lt;i&gt;p&lt;/i&gt; = 0.005). However, the results of the TBUT, Schirmer test, and Oxford scale were not significantly related to tear osmolarity. The patients were divided according to MGD severity into those with MGD grades ≤ 2 and those with MGD grades ≥ 3. Tear osmolarity (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and OSDI (&lt;i&gt;p&lt;/i&gt; = 0.014) showed significant differences between the two groups.Conclusions: In patients with obstructive MGD, tear osmolarity, assessed using I-PEN&lt;sup&gt;®&lt;/sup&gt; (I-MED Pharma, Inc.), is significantly correlated with MGD grade and OSDI.

Purpose: To investigate the clinical efficacy of rebamipide eyedrops in patients with meibomian gland dysfunction (MGD) associated with Sjögren’s syndrome.Methods: The study included 50 patients with Sjögren’s syndrome accompanied by MGD treated with 0.05% (w/v) cyclosporine and 0.15% (w/v) sodium hyaluronate eyedrops. They were divided into two groups: 25 who added rebamipide eyedrops to their existing treatments and a control group of 25 whose treatments did not change. We evaluated the tear breakup time, the Schirmer test and conjunctival staining scores, meibomian gland quality and function, and eyelid margin irregularity before prescribing rebamipide eyedrops and 1 and 3 months after prescription. Additionally, before eyedrops use and 3 months later, meibographic scores were assessed via imaging of the meibomian gland and ocular surface disease index values also were assessed.Results: The rebamipide group exhibited significant improvements in the tear breakup time, conjunctival staining score, and ocular surface disease index compared to before treatment (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05). However, the Schirmer test result, meibomian gland quality and function, and eyelid margin irregularity did not differ between either groups before or after treatment. After 3 months of eyedrop use, the rebamipide group exhibited a significantly higher tear breakup time (&lt;i&gt;p&lt;/i&gt; &lt; 0.01) and Schirmer test score (&lt;i&gt;p&lt;/i&gt; &lt; 0.01) than the control group (&lt;i&gt;p&lt;/i&gt; = 0.01), and significantly lower ocular surface disease index and conjunctival staining scores (&lt;i&gt;p&lt;/i&gt; &lt; 0.01).Conclusions: Addition of rebamipide eyedrops to the conventional treatment of patients with Sjögren’s syndrome accompanied by MGD effectively improves dry eye symptoms and the ocular surface parameters.

To evaluate the clinical efficacy of topical 0.05% cyclosporine nano-emulsion in the treatment of dry eye syndrome (DES) with meibomian gland dysfunction (MGD). This prospective study included 64 patients with DES and MGD who were randomly assigned to three groups: Group 1 (n=24, conventional cyclosporine), Group 2 (n=21, nano-emulsion cyclosporine), and Group 3 (n=19, control). Lid margin telangiectasia (LMT), meibomian gland secretion (MGS), conjunctival injection (CI), corneal staining (CS), tear break-up time (TBUT), Schirmer test I (STI), Ocular Surface Disease Index (OSDI), and lipid layer thickness (LLT) was evaluated at 4, 8, and 12wk of treatment. In Group 3 (control), LMT, CS, and CI improved after 8wk, MGS, TBUT after 12wk of treatment. In Group 1 (conventional cyclosporine), LMT, MGS, and TBUT improved significantly after 4wk, whereas CS, CI, STI, and LLT improved significantly after 8wk, and OSDI at 12wk. In Group 2 (nano-cyclosporine), LMT, MGS, CS, CI, TBUT, and OSDI significantly improved after 4wk, and STI after 8wk. Especially, LLT was significantly higher than other groups after 4wk. Cyclosporine and nano-cyclosporine shows significant improvement in DES with MGD than the control group. In contrast, the nano-cyclosporine group shows more statistically improved CI and CS at 4wk, especially LLT at 4, 8, and 12wk compared to the conventional cyclosporine group.

Purpose of study: To investigate the effects of cigarette smoking on meibomian gland and tear function test. Methods: It was a hospital-based cross-sectional study, which enrolled examined 30 subjects with a smoking history of at least 1 year (study group) alongside 25 healthy non-smokers (control group). Each participant’s symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire. A comprehensive ophthalmological evaluation followed, which included the non-invasive tear breakup time (NITBUT) and Schirmer test (with anesthesia). Additionally, we conducted a detailed analysis of the meibomian glands in both the upper and lower eyelids using meibography, employing the advanced Sirius anterior segment analysis system. Results: Participants in the study group averaged a smoking history of 6.94 ± 6.73 pack years. The mean OSDI score was 36.45 ± 10.60 in the study group, compared to 31.41 ± 8.12 in the control group (P = 0.05). For the NITBUT and Schirmer test, the study group recorded values of 9.54 ± 5.89 seconds and 14.77 ± 9.39 mm, respectively, while the control group showed 9.95 ± 6.15 seconds and 19.08 ± 7.08 mm (P = 0.85 and P = 0.03, respectively). Upper lid meibography revealed a 55.40 ± 10.10% gland loss in the study group, significantly higher than the 46.33 ± 14.70% observed in the control group (P = 0.01). However, no statistically significant difference was found in lower lid meibomian gland loss between the groups, with the study group at 54.08 ± 9.71% and the control group at 51.41 ± 17.24% (P = 0.49). Conclusion: Smoking results in meibomian gland damage which may be a risk factor for dry eye. In cases of ocular surface disorders related to chronic smoking, meibomian gland damage should be taken into consideration.

Lacrimal Gland in Sjögren's Syndrome

To evaluate the clinical efficacy of 3% diquafosol sodium ophthalmic solution for dry eye, and to analyze the concentration of tear proteins and mucin-like substances after the treatment. Fifty eyes of 25 patients with dry eye syndrome were prospectively enrolled. The patients were treated with diquafosol solution at a dose of 1 drop in each eye 6 times daily for 4 weeks. The parameters of clinical efficacy were tear osmolarity, tear breakup time (BUT), fluorescein staining scores for the cornea and conjunctiva, Schirmer test values, and subjective symptoms evaluated using the ocular surface disease index (OSDI). Tears collected with Schirmer test strips were analyzed by high-performance liquid chromatography, and the concentrations of the total protein and the 4 major tear proteins, namely, secretory IgA, lactoferrin, lipocalin-1, lysozyme, and N-acetyl-neuraminic acid (Neu5Ac), were measured. Neu5Ac is a major sialic acid, a marker of secretory mucins. The BUT, keratoconjunctival staining scores, and Schirmer test values were improved with statistical significance after the treatment with diquafosol solution, while changes in the other parameters, including tear osmolarity, corneal staining scores, and OSDI scores were not significant. The Neu5Ac concentration was significantly increased, which was not accompanied by changes in tear proteins. Topical application of diquafosol significantly improved the clinical parameters of the BUT, keratoconjunctival staining scores, and Schirmer test values and was accompanied by increased sialic acid content in the tears of patients with dry eye.

BackgroundThe characteristics of the meibomian gland and tear film in patients with type 2 diabetes (T2D) with different glycemic control levels and diabetic durations remain largely unexplored. This study aimed to identify the association of dry eye and meibomian gland dysfunction (MGD) in T2D.Materials and MethodsNinety-nine patients with type 2 diabetes mellitus (DM group), 33 dry eye patients without diabetes mellitus (DE group), and 40 normal subjects (NC group) were recruited for this study. Participants were evaluated with an Ocular Surface Disease Index (OSDI) questionnaire, tear film breakup time (BUT), the Schirmer I test (SIT), corneal fluorescein staining (FL), lipid layer thickness (LLT), and MGD parameters. Glycosylated hemoglobin (HbA1c) and duration of diabetes were recorded.ResultsThe SIT value in the DM group was higher than that of the DE group (p < 0.05). The BUT and LLT were lower, and MGD parameters were higher in the DM group than those of the DE and NC groups (p < 0.05). In the DM group, 47 patients were diagnosed with dry eye (DM + DE group), whereas 40 patients without dry eye were categorized as the DM − DE group. The SIT, BUT, and LLT values in the DM − DE group were higher (p < 0.01), and MGD parameters were lower (p < 0.01) in the DM − DE group than those of the DM + DE group. The MGD parameters were higher in the DM − DE group than those in the NC group (p < 0.05). The HbA1c levels were correlated with OSDI, BUT, LLT, FL, and MGD parameters (p < 0.001) in the DM group. However, in patients with low HbA1c, normal SIT value, and low OSDI, the MGD parameters were higher than those in the NC group (p < 0.05). The duration of diabetes positively correlated with MGD parameters (p < 0.001).ConclusionAsymptomatic MGD may be an early sign of dry eye and ocular discomfort in T2D. The MGD parameters were associated with the HbA1c level and diabetic duration.

Objective To evaluate the effect of suspension of the prolapsed lacrimal glands via keyhole of lacrimal fossa.Methods Twenty four patients (48 eyes) with prolapsed lacrimal glands were studied for retrospective analysis.The operation was done via double eyelid incision approach.Two keyholes were performed behind superolateral orbital rim.The lacrimal glands were suspended into the lacrimal fossa through the 2 keyholes with 3-0 suture.The appearance of the patients and CT features were analyzed after operation.The Schirmer's test and break up time (BUT) test were done before and after operation in all the patients.The postoperative follow up periods ranged from 6 to 24 months (mean=12 months).Results The lacrimal glands of 24 patients (48 eyes) were repositioned perfectly.No recurrence occurred during the follow up periods.The striking bulkincss of temporal upper eyelid disappeared,upper eyelid arc was moderate,and the appearance was satisfying.The results of Schirmer's test and BUT test were normal after operation.No one suffered the dry eye syndrome and foreign body sensation after operation.Conclusions Suspension the lacrimal glands into lacrimal fossa through the pores of superolateral orbital rim is a good method to treat lacrimal glands prolapse,it can achieve functional and cosmetically acceptable results,and may have wide application prospects in future. Key words: Lacrimal gland prolapse; Keyhole; Lacrimal gland reposition

To evaluate the impact of corneal and conjunctival tumors on the ocular surface and quality of life of patients before and after surgical treatment. This prospective study conducted a preoperative and 30- and 90-day postoperative assessment of patients diagnosed with conjunctival and corneal tumors. Demographic data were collected preoperatively. The 12-Item Short-Form Health Survey (SF-12) and Ocular Surface Disease Index (OSDI) questionnaires were applied to assess patients' quality of life and perception of their vision-related functions. The tear breakup time and Schirmer tests were performed for ocular surface evaluation. The tumor extensions were measured using ImageJ image analysis software. Twenty-three patients were enrolled. The mean age at examination was 52.8 ± 17.3 years (range: 27-9 years). The most common tumor type was squamous cell carcinoma (61.5%). The patients' visual acuity improved significantly at 1 month and 3 months (p=0.018 and p=0.036, respectively). No significant differences were found between tear breakup time and Schirmer tests preoperatively and at 3 months postoperatively (p=0.150 and p=0.490, respectively). The SF-12 scores demonstrated significant differences between the preoperative and 30- and 90-day postoperative mental components (p=0.008 and p=0.026, respectively). Tumor extension was 868.7 ± 344.9 pixels (range, 224.6-1481.6 pixels) and were significantly correlated with the preoperative (p=0.011), 30-day postoperative (p=0.017), and 90-day postoperative (p=0.012) SF-12 mental components, as well as the emotional component at the 30th postoperative day (p=0.016). Patients with corneal and conjunctival tumors improved their ocular symptoms, visual acuity, and the emotional component of their quality of life after surgical excision of the tumor.

The aim of this study was to evaluate the goblet cell density (GCD) of conjunctiva in medically-controlled glaucoma using laser scanning confocal microscopy (LSCM). Fifty-five glaucomatous patients were enrolled and divided into two groups: Group 1 (27 eyes), controlled with one medication; and group 2 (28 eyes), controlled with two medications. Seventeen patients with dry eye disease (DED) and 17 healthy individuals served as controls. Patients completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent determination of tear film break-up time (BUT), corneal staining, and Schirmer test I. For the GCD assessment, 12 high-quality images were acquired from the upper conjunctival epithelium (superior nasal, superior central, and superior temporal sectors). Overall, GCD was significantly reduced in both glaucoma groups and those with DED compared to healthy controls (p<0.001), with values markedly lower in group 2 compared to group 1 (p<0.05). GCD was not significantly different between those with DED and group 2. A significant negative correlation was found of GCD with OSDI and with BUT (p<0.001; R=-0.795 and R=-0.756, respectively). Glaucoma therapy leads to a marked reduction of GCs, especially in the associative regimens. Given the negative correlation with tear film function tests, GCD reduction may play a pivotal role in the pathophysiology of the glaucoma-related disease of the ocular surface.

To compare high or low concentration of hyaluronic acid eye drops (HY) for dry eye syndromes (DES). Randomized controlled trials (RCTs) comparing various concentrations of HY were searched in PubMed, Embase, Web of Science, Cochrane, SinoMed, CNKI, Wanfang Database, CQVIP, and Chinese journals databases between inception and July 2023. Pooled standardized mean differences (SMD) or weighted mean difference (WMD) with 95% confidence intervals (CI) from RCTs evaluating Schirmer's I test (SIT), corneal fluorescein staining score (CFS), tear breakup time (TBUT), DES score (DESS), and Ocular Surface Disease Index (OSDI) were calculated. Sensitivity analysis, Egger's test and Meta-regression analysis were performed for all indicators. We conducted a Meta-analysis of 10 RCTs that met the inclusion criteria, involving 1796 cases. High-concentrations group significantly improved the outcome of CFS according to random effects modelling (SMD, -3.37; 95%CI, -5.25 to -1.48; P=0.0005). The rest of the results were not statistically significant, including indicators such as SIT, TBUT, DESS and OSDI. For dry eyes with positive corneal staining, a high concentration of HY is recommended, whereas in other cases, a high concentration of HY does not offer a more pronounced advantage over a low concentration of HY in the treatment of dry eyes.

Graves' ophthalmopathy is associated with a reduced blinking frequency, eyelid retraction, proptosis, incomplete eyelid closure. Smoking significantly increases the incidence and severity of GO in patients with Graves' disease Objective: To assess the influence of smoking on the development of dry eyes in patients with Graves' ophthalmopathy (GO) and to determine the properties of tear secretion and ocular surface in these patients. Methods: A cross-sectional study was conducted at the outpatient department of the Eye Diseases Clinic of the Lithuanian University of Health Sciences. The study included 52 patients with a mean age of 47.3 (17.4–69.6) years. The study included 25 smokers and 27 non-smokers with Graves' ophthalmopathy (a total of 52 patients). Their mean age was 47.3 (17.4–69.6) years. Patients underwent ophthalmological examination, ocular surface disease index (OSDI) assessment, Schirmer test without local anesthesia (&lt;5 mm was abnormal), slit-lamp biomicroscopy (tear break-up time (TBUT) under blue light illumination). Statistical analysis was performed using SPSS for Windows software (SPSS Inc., Chicago, IL, USA). Statistical significance was determined at p &lt; 0.05. Results: The mean OSDI score in smoking GO patients was significantly higher (28.79 ± 15.29) compared to non-smoking patients (10.58 ± 7.41), (p &lt; 0.05). The mean Schirmer test value in smoking GO patients was significantly lower (4.21 ± 3.07 mm) compared to non-smoking patients (11.74 ± 6.24 mm). The difference was statistically significant (p &lt; 0.04), indicating insufficient tear production. The mean tear film break-up time (TBUT) was lower in smoking GO patients (7.04 ± 2.25 s) compared with non-smoking patients (10.93 ± 3.12 s), ( p &lt; 0.04), indicating an unstable tear film. Conclusion: The study found statistically significantly increased OSDI scores, shorter Schirmer scale and tear film breakup time measurements in smokers with GO. These data may indicate a predisposition to dry eye syndrome in smokers.