Machine learning-based prediction of tear osmolarity for contact lens practice.

To investigate the effect of ptosis surgery on dry eye disease as measured by dry eye parameters and meibomian gland function. This prospective, case series study included patients with involutional ptosis with no prior history of dry eye disease who were scheduled for a levator aponeurosis advancement procedure. Dry eye evaluation included the ocular surface disease index (OSDI) questionnaire as well as objective measurements, which included meibomian gland loss measured by meibography, meibomian gland disease grading, tear breakup time (TBUT), corneal and conjunctival fluorescein staining, tear meniscus height, and Schirmer testing. All dry eye measurements were recorded preoperatively and repeated 21-28 days postoperatively. A total of 30 eyes were included with a mean age of 65.6 ± 11.9 years. There was a significant improvement in margin reflex distance1 (MRD1) postoperatively ( p < 0.001) and a significant decrease in upper lid margin thickening ( p = 0.022). There were no significant differences between the pre- and postoperative measurements in meibomian gland loss, TBUT, corneal and conjunctival fluorescein staining, tear meniscus height, and the Schirmer test. OSDI was increased nonsignificantly postoperatively (16.094 vs. 24.296, respectively, p = 0.107). The levator aponeurosis advancement procedure does not affect the eyelid meibomian glands, nor does it cause an increase in dry eye signs and symptoms, according to the measured parameters.

BackgroundThe aim of this study was to explore the differences in terms of tear film and meibomian glands (MGs) between young Asian soft contact lens (CL) wearers and non-wearers.MethodsA prospective, cross-sectional observational study was conducted using 148 subjects (63 non-wearers, and 85 soft CL wearers who had been wearing CLs for more than 1 year) recruited from a clinic in Tianjin, China. All subjects first responded to an Ocular Surface Disease Index (OSDI) questionnaire and then underwent a standardized dry eye examination, which included measuring tear meniscus height (TMH), non-invasive tear breakup time (NIBUT), and corneal fluorescein staining (CFS). The MGs were evaluated via ImageJ, distorted MG count and the MG dropout were recorded.ResultsCompared to the control group (non-wearers), the CL group recorded higher OSDI and CFS scores, lower TMH and NITBUT values, a larger distorted MG count, and larger MG dropout (all P < 0.05). Pearson correlation analysis found a correlation between MG dropout and the duration of CL use (r = 0.440, P < 0.001), OSDI (r = 0.298, P = 0.006), and CFS scores (r = 0.442, P < 0.001).ConclusionCL wearers showed higher MG dropout and reduced TMH and NITBUT, which likely contributes to severe CL-related dry eye symptoms. CL use may lead to a higher MG dropout rate, and the extent of the MG dropout presumably influences the tear film status in CL wearers.

Dry eye disease (DED) is most commonly caused by evaporative subtypes and mainly induced by meibomian gland dysfunction (MGD). Intense pulsed light (IPL) combined with meibomian gland expression (MGX) is a noninvasive treatment for improvement of ocular discomfort symptoms and MGD. In this prospective study between November 2020 and May 2022, the patients with MGD and abnormal meibomian expressibility that met the criteria of both ocular surface disease index (OSDI) ≥ 13 scores and standardized patient evaluation of eye dryness (SPEED) ≥ 8 scores were enrolled in Kaohsiung Veteran General Hospital. Three separate treatment sessions of IPL therapy combined with MGX were administered to the lower lids, with an interval of 28 days. Further tear film assessment included lipid layer thickness (LLT), tear meniscus height (TMH), noninvasive tear break-up time (NIBUT), and meibomian gland loss (MGL) either before or after first and third IPL therapy combined with MGX. In addition, lissamine green staining and pain scores were also recorded. We totally enrolled 37 patients of 74 eyes. Men accounted for 18.92% (7/37). The mean age was 54.51 ± 11.72 years. The mean OSDI scores were 58.12 ± 22, while the SPEED scores were 17.03 ± 5.98. The mean Schirmer’s test was 3.66 ± 2.43 mm. After three sessions of IPL treatment with MGX, the OSDI, SPEED, LLT, TMH, MGL, MGXS, and pain scores were significantly improved. For the MGX scores (MGXS) ≤ 20 group, lissamine green scores showed nearly significant improvements. For the MGXS > 20 group, TMH revealed statistical improvement. Noninvasive IPL therapy with MGX statistically improved not only dry eye symptoms, but also tear film assessments, including LLT, TMH, and MGL.

Allergic rhinitis (AR) is a common chronic inflammatory condition of the upper respiratory tract that can significantly diminish quality of life. AR contributes to dry eye disease (DED) and meibomian gland alterations due to ocular surface inflammation triggered by repeated exposure to environmental allergens. This study aims to evaluate DED and meibomian gland loss (MGL) in patients with AR. A comparative cross-sectional study was conducted involving 79 patients with AR at Hospital Universiti Sains Malaysia. The subjects underwent a detailed evaluation of dry eye parameters using noninvasive ocular surface analyzer including assessment of noninvasive tear breakup time (NIBUT), lipid layer thickness (LLT), and tear meniscus height (TMH). MGL was assessed by meibography. The results were compared with those of a control group of 81 age-matched healthy individuals without AR. Patients with AR showed statistically significantly lower NIBUT, LLT, and TMH values compared to the control group (P < 0.001). Meibomian gland analysis revealed a statistically significant MGL in patients with AR compared to controls. A significant negative correlation was observed between MGL and TMH and NIBUT (P < 0.001). Patients with AR are at an increased risk of DED with a notable change in dry eye parameters and MGL. These findings underscore the importance of early detection and management of DED in patients with AR to prevent further ocular surface damage and improve their quality of life.

BackgroundThe purpose of this investigation was to evaluate the morphology and physiological function of the meibomian glands between type 2 diabetics with dry eye disease (DED) and control subjects. Doing so will help to better reveal the pathologic mechanisms of meibomian gland dysfunction (MGD) and DED in type 2 diabetes mellitus (T2DM).MethodsNinety subjects were divided into the following four groups: DM-DED group: T2DM patients with DED (n = 30); DM control group: DM patients without DED (n = 18); DED group: DED patients without DM (n = 26); and normal control group: normal subjects (n = 16). All participants administered the ocular surface disease index (OSDI) questionnaire, tear meniscus height (TMH), noninvasive Keratograph tear film break-up time (NIKBUT), Schirmer I test (SIT), corneal fluorescein staining (CFS), eyelid margin abnormality examinations, meibum quality and meibomian gland (MG) dropout evaluations. ResultsThe percentage of MG dropout in the upper and lower lids was significantly higher in the DM-DED group than the DED group (P < 0.05 or P < 0.01). However, there was no significant difference in other MG parameters between these two groups. Oppositely, Significant difference was observed in all of MG parameters except MG dropout in the lower lids comparing DM group with normal controls (P < 0.05 or P < 0.01). While the SIT values decreased in the DM-DED group compared to the DED group (P < 0.05), no significant differences were found in the values of other tear parameters. ConclusionsThe higher prevalence and increased severity of MGD was found in patients with both T2DM and DED compared to those only with DED. Trial registrationChinese Clinical Trial Registry ChiCTR1800019939, date of registration December 9, 2018, prospectively registered.

PurposeTo assess the ocular surface and meibomian gland (MG) of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and to explore the effects of surgery for OSAHS on the ocular surface and MG.MethodsBased on the apnea hypopnea index (AHI), 21 patients with mild OSAHS (Group A, 5/h ≤ AHI < 15/h), 20 patients with moderate OSAHS (Group B, 15/h ≤ AHI < 30/h), 62 patients with severe OSAHS (Group C, AHI ≥ 30/h) were examined. The ocular surface and MG were evaluated using Keratograph 5M. In addition, detailed Ophthalmic examination including visual acuity, refraction, slit-lamp examination of the anterior segment, corneal fluorescein staining (CFS), ocular surface disease index (OSDI) scoring, Schirmer I test (SIT) and serum lipid measurement was performed. For OSAHS patients with dry eye syndrome (DES) who underwent uvulopalatopharyngoplasty for improving AHI, the conditions of the ocular surface and MG were compared before surgery and 3 months after surgery. Only the data of the right eyes were analyzed.ResultsThere were no significantly different in the OSDI score, tear meniscus height (TMH), or loss ratio of the lower eyelid (LRLE) among these groups. The first non-invasive tear film breakup time (fNIBUT), average non-invasive tear film breakup time (avNIBUT), bulbar redness index (BRI), lipid layer grading (LLG), CFS, plugged orifices and distortion in MG, the loss ratio of upper eyelid (LRUE), and the incidence of DES, floppy eyelid syndrome (FES) and meibomian gland dysfunction (MGD) showed significant differences between Groups A and C (p = 0.015, p = 0.018, p < 0.001, p = 0.022, p = 0.036, p = 0.007, p = 0.019, p = 0.017, p = 0.045, p = 0.013, and p = 0.029, respectively). The SIT in the Group A was significantly higher than in Group B (p = 0.025) and in Group C (p < 0.001). In the correlation analyses, the fNIBUT, avNIBUT, SIT and LLG had negative correlations with the AHI (p = 0.013, p = 0.010, p = 0.003, p < 0.001, and p = 0.006, respectively). The BRI, CFS and LRUE were positively correlated with the AHI (p = 0.006, p = 0.007, and p = 0.046, respectively). Three months after surgery, there were no significant differences in the ocular surface or MG.ConclusionPatients with severe OSAHS have poor stability of tear film and are prone to lipid-deficient dry eye as a result of the loss of meibomian gland. By improving the AHI, the ocular surface damage of OSAHS patients cannot be reversed in a short time.

IntroductionTo analyze outcomes on objective ocular surface parameters and subjective symptoms of serial weekly sessions using the Activa mask in patients with meibomian gland dysfunction (MGD).MethodsThis is a prospective study including patients with symptomatic MGD who were treated with four weekly sessions using the Activa mask (SBM Sistemi, Turin, Italy). Noninvasive ocular surface examination was carried out before (T0) and 2 weeks after the last mask session (T1) using Idra (SBM Sistemi, Turin, Italy) for the measurement of: (1) noninvasive break-up time (NIBUT); (2) lipid layer thickness (LLT); (3) tear meniscus height (TMH); (4) meibomian gland loss (MGL) of upper and lower eyelids. The I-Pen tear osmolarity system (I-Med Pharma Inc, Dollard-des Ormeaux, Quebec, Canada) was used to measure tear osmolarity values. Ocular discomfort symptoms were ascertained by means of the ocular surface disease index (OSDI) questionnaire.ResultsAll 25 patients (11 males, 14 females; mean age 57.1 ± 11.9 years) regularly completed the cycle of four mask sessions. No patients used prohibited medications, and no device-related adverse events were noted. At T1, mean values of NIBUT and LLT increased significantly compared to T0 (respectively from 6.0 ± 1.4 to 6.6 ± 1.2 s, P = 0.043, and from 53.2 ± 17.4 to 65.3 ± 16.3 nm, P < 0.001), while mean values of MGL and tear osmolarity decreased significantly (respectively from 17.1 ± 9.3 to 15.1 ± 8.0%, P = 0.014, and from 307.3 ± 12.2 to 301.5 ± 6.8 mOsm/l, P = 0.005). In parallel, OSDI score reduced significantly from 62.4 ± 11.7 at T0 to 34.5 ± 11.2 at T1 (P < 0.001).ConclusionWeekly serial sessions using the Activa mask significantly improved objective parameters of the ocular surface as well as subjective ocular discomfort symptoms in patients with recalcitrant MGD. As a further benefit from the treatment, patients were able to avoid the use of concomitant medications, apart from tear substitutes, throughout the study.

The aim of this study was to examine the relationship among oral contraceptive pill (OCP) use, contact lens wear, and dry eye signs and symptoms in healthy young women. Fifty-two women using OCPs and 45 women not using any form of hormonal contraception were enrolled. Medical, menstrual, and contact lens histories were obtained and dry eye symptoms assessed using the Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE) questionnaires. Tear osmolarity testing was performed using the TearLab Osmolarity System. The mean age of all subjects was 26.0 ± 3.7 years. There were no significant differences in any of the measurements between the follicular and luteal phases. Although SANDE scores were significantly higher in subjects with OCP and recent contact lens use (P < 0.01), there were no significant differences in OSDI and tear osmolarity among the same subject groups. Subjects who reported both OCP and recent contact lens use had significantly higher OSDI and SANDE scores (P = 0.015 and P < 0.001, respectively). There were no differences between the phases of the menstrual cycle. Tear osmolarity was not affected by OCP or contact lens use in young women. However, the combination of OCP use and contact lens wear may increase the severity of dry eye symptoms.

To determine the effects of clinical variables, including age, sex, history of refractive or cataract surgery, contact lens use, and ocular surface and meibomian gland parameters on the lipid layer thickness (LLT) in normal subjects and patients with dry eye syndrome (DES). A total of 64 normal subjects and 326 patients with DES were enrolled, and they underwent measurements of LLT with a LipiView interferometer and tear meniscus height using optical coherence tomography, tear film break-up time (TBUT) determination, ocular surface staining, Schirmer's test, examination of the lid margins and meibomian glands, and assessment using the Ocular Surface Disease Index (OSDI). In normal subjects, the median (range) LLT was 67 (33-100) nm, and age was the only factor that was significantly associated with LLT (β = 0.678, P = 0.028). In patients with DES, the median (range) LLT was 84 (20-100) nm, and 79.0% of the participants fulfilled the diagnostic criteria for meibomian gland dysfunction (MGD). In a multivariate analysis, increased age and female sex were significantly related to increased LLT (β = 0.282, P = 0.005 and β = 11.493, P < 0.001), and hypersecretory MGD and lid margin inflammation were independently associated with increased LLT (β = 11.299, P = 0.001 and β = 12.747, P = 0.001). Lipid layer thickness measurements using a new interferometer are significantly affected by demographic factors such as age, sex, ocular surgical history, and MGD type. Therefore, all of these factors must be considered in the diagnosis of ocular surface diseases.

To compare dry eye disease (DED) following PRK and T-PRK surgeries using a combined approach of subjective and objective measures, focusing on clinically meaningful outcomes and adjusted statistical modeling. In this prospective observational study, 89 eyes of patients aged over 20 years were enrolled and grouped into PRK (43 eyes) and T-PRK (46 eyes). The primary outcome was change in ocular surface diseases index (OSDI) score at 6 months. Secondary outcomes included non-invasive tear breakup time (NITBUT) and meibomian gland expressibility. Exploratory parameters such as tear meniscus height (TMH), redness score, strip meniscometry (SM Tube), meibomian gland dropout, and meibum quality were also assessed. Statistical models were adjusted for baseline age differences, and corrections for multiple comparisons were applied. The mean age of the patients was 34.16 ± 7.23 in the PRK and 28.72 ± 6.26 in the T-PRK group (P < 0.001). The two groups were not significantly different for gender (P = 0.367). After statistical adjustment, only the change in OSDI and NITBUT at 1-month remained significant between groups (adjusted P = 0.038 and P < 0.05, respectively). Effect sizes were small to moderate, and none of the differences exceeded minimal clinically important thresholds. Exploratory analyses revealed no significant between-groups differences. Age was identified as an independent predictor of OSDI change. In short-term follow-up, both procedures induced some degree of DED. However, T-PRK was associated with slightly fewer signs and symptoms of dry eye disease, but the differences were not clinically significant.

PurposeThe purpose of this study was to investigate the impact of Helicobacter pylori (H. pylori) infection on ocular surface homeostasis, including dry eye symptoms, ocular microbiota alterations, and related immune responses.MethodsThirty-one H. pylori-positive (Hp_pos) and 30 H.pylori-negative (Hp_neg) subjects underwent dry eye assessments, including the Schirmer I test, noninvasive keratography first and average breakup times (NIKf-BUTs and NIKav-BUTs), tear meniscus height, meibomian gland loss, and the Ocular Surface Disease Index (OSDI). Sterile swabs were used to collect samples from each eye of subjects for 16S rRNA sequencing. Additionally, a murine H.pylori infection model was established to evaluate dry eye phenotypes and immune responses in the lacrimal gland.ResultsCompared with Hp_neg subjects, Hp_pos subjects showed significantly reduced Schirmer I test results, NIKf-BUT, and NIKav-BUT, along with higher OSDI scores (all P < 0.05), whereas tear meniscus height and meibomian gland loss did not differ between the two groups. The ocular surface microbiota of Hp_pos subjects exhibited altered alpha and beta diversity, with 10 enriched genera (dominated by Veillonella and Capnocytophaga), which were characteristically associated with dry eye manifestations. In the murine model, infected mice at 6 weeks post-infection displayed aqueous tear deficiency, corneal epithelial barrier impairment, lacrimal gland infiltration of CD4+ and CD45+ T lymphocytes, and upregulated proinflammatory cytokines (IFN-γ, IL-17A, IL-4, TGF-β, TNFα, IL-6, and IL-1β). However, no significant differences were observed at 2 or 4 weeks post-infection.ConclusionsThe H.pylori infection disrupts tear secretion and ocular surface microbiota, potentially via inducing T lymphocyte infiltration and lacrimal gland inflammation, contributing to dry eye pathogenesis.

This study aimed to analyze ocular sur-face parameters and evaluate meibomian gland dys-function using meibography in newly diagnosed patients with atopic dermatitis compared with healthy controls. This cross-sectional clinical study included 51 newly diagnosed patients with atopic dermatitis and 45 ageand sex-matched healthy controls. Disease severity was assessed using the Eczema Area Severity Index. The Ocular Surface Disease Index questionnaire, Schirmer test, tear meniscus height, noninvasive tear break-up time, conjunctival redness grading, and meibography staging were performed. Meibomian gland dropout was graded for each eyelid from 0 (no loss) to 3 (loss of >2/3 of the total gland area). Schirmer test values, tear meniscus height, and noninvasive tear break-up time were significantly lower in the atopic dermatitis group than in the control group (p<0.001, p<0.001, and p<0.001, respectively). In contrast, Ocular Surface Disease Index scores, conjunctival redness grades, and total meiboscores were significantly higher in the atopic dermatitis group than in the control group (p<0.001, p<0.001, and p<0.001, respectively). Moreover, in the atopic dermatitis group, a significant positive correlation was observed between the Eczema Area Severity Index score and total meiboscore (rₛ=0.390, p=0.005), while a significant negative correlation was found between the Eczema Area Severity Index score and Schirmer test results (rₛ=-0.301, p=0.032). Newly diagnosed patients with atopic dermatitis exhibit significant alterations in tear film parameters and meibomian gland morphology compared with healthy individuals. These patients should be monitored for early development of dry eye disease and meibomian gland dysfunction to prevent associated complications.

Contact Lens Wear Is Associated with Decrease of Meibomian Glands

Background Dry eye is among the most prevalent complications following refractive surgery, significantly impacting the training and daily lives of recruits. While recent years we have witnessed some advancements in understanding the occurrence and progression of dry eye, the specific effects of refractive surgery on this condition remain unclear. This study aims to investigate the impact of refractive surgery on dry eye among 300 army recruits. Methods A series of examinations specific to dry eye were conducted on the subjects using the OSDI questionnaire and the ocular surface comprehensive analyzer. The correlation between refractive surgery and dry eye was analyzed in conjunction with dry eye symptoms and related data. Additionally, optical coherence tomography (OCT) was employed to observe fundus changes in dry eye patients, comparing those with low to moderate myopia against patients with high myopia prior to surgery. The morphology of the meibomian glands in the upper eyelid was assessed using the Keratograph 5M ocular surface analyzer, where the area of meibomian gland loss was calculated and scored, facilitating an exploration of the relationship between meibomian gland loss and dry eye. Furthermore, the dry eye detection rates of Non-Invasive Break-Up Time (NIBUT), Lipid Layer Thickness Measurement (LTMH), and basal Schirmer secretion (SIT) were calculated, and the diagnostic differences among these three methods for dry eye were analyzed. Results According to the OSDI questionnaire, 117 (39%) patients opted for SMILE, 60 (20%) for F-LASIK, and 123 (41%) for LASIK. Among the recruits, 78 (26%) were diagnosed with dry eye following refractive surgery. Single factor and multiple logistic regression analyses indicated that LASIK may serve as an independent risk factor for the development of dry eye after refractive surgery. Furthermore, the incidence of leopard-pattern fundus was significantly higher in recruits with high myopia compared to those with low to moderate myopia. Keratograph5M assessments revealed that 52.6% of patients exhibited no meibomian gland loss; 45.5% had meibomian gland loss of less than 1/3; 1.9% experienced meibomian gland loss ranging from 1/3 to 2/3; and no patients had meibomian gland loss exceeding 2/3. These results suggest that there is no direct relationship between dry eye and meibomian gland loss following refractive surgery. Additionally, the dry eye detection rate using non-invasive tear break-up time (NIBUT) was 92.6%, while the detection rate for LTMH dry eye was 91.0%. The basal Schirmer test (SIT) yielded a dry eye detection rate of 78.2%, indicating that non-invasive tear assessment methods have a higher detection rate for dry eye. Conclusions The incidence of dry eye among recruits following excimer laser corneal refractive surgery is significantly higher than that observed with other surgical methods, suggesting that it may represent an independent risk factor for dry eye post-refractive surgery. Consequently, we do not recommend the use of laser in situ keratomileusis for refractive surgery.

Dry eye is among the most prevalent complications following refractive surgery, significantly impacting the training and daily lives of recruits. While recent years we have witnessed some advancements in understanding the occurrence and progression of dry eye, the specific effects of refractive surgery on this condition remain unclear. This study aims to investigate the impact of refractive surgery on dry eye among 300 army recruits. A series of examinations specific to dry eye were conducted on the subjects using the OSDI questionnaire and the ocular surface comprehensive analyzer. The correlation between refractive surgery and dry eye was analyzed in conjunction with dry eye symptoms and related data. Additionally, optical coherence tomography (OCT) was employed to observe fundus changes in dry eye patients, comparing those with low to moderate myopia against patients with high myopia prior to surgery. The morphology of the meibomian glands in the upper eyelid was assessed using the Keratograph 5M ocular surface analyzer, where the area of meibomian gland loss was calculated and scored, facilitating an exploration of the relationship between meibomian gland loss and dry eye. Furthermore, the dry eye detection rates of Non-Invasive Break-Up Time (NIBUT), Lipid Layer Thickness Measurement (LTMH), and basal Schirmer secretion (SIT) were calculated, and the diagnostic differences among these three methods for dry eye were analyzed. According to the OSDI questionnaire, 117 (39%) patients opted for SMILE, 60 (20%) for F-LASIK, and 123 (41%) for LASIK. Among the recruits, 78 (26%) were diagnosed with dry eye following refractive surgery. Single factor and multiple logistic regression analyses indicated that LASIK may serve as an independent risk factor for the development of dry eye after refractive surgery. Furthermore, the incidence of leopard-pattern fundus was significantly higher in recruits with high myopia compared to those with low to moderate myopia. Keratograph5M assessments revealed that 52.6% of patients exhibited no meibomian gland loss; 45.5% had meibomian gland loss of less than 1/3; 1.9% experienced meibomian gland loss ranging from 1/3 to 2/3; and no patients had meibomian gland loss exceeding 2/3. These results suggest that there is no direct relationship between dry eye and meibomian gland loss following refractive surgery. Additionally, the dry eye detection rate using non-invasive tear break-up time (NIBUT) was 92.6%, while the detection rate for LTMH dry eye was 91.0%. The basal Schirmer test (SIT) yielded a dry eye detection rate of 78.2%, indicating that non-invasive tear assessment methods have a higher detection rate for dry eye. The incidence of dry eye among recruits following excimer laser corneal refractive surgery is significantly higher than that observed with other surgical methods, suggesting that it may represent an independent risk factor for dry eye post-refractive surgery. Consequently, we do not recommend the use of laser in situ keratomileusis for refractive surgery.