Pain, Prostheses, and Prophylaxis

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.

Objective: To investigate the distribution of tear film lipid layer thickness (LLT) and the relationship between symptoms and signs of dry eye and tear film LLT in the population of Taishitun Community in Beijing. Methods: A cross-sectional study. From May 2016 to August 2016, three streets of Taishitun Community were randomly selected as survey districts and 540 persons were taken as investigation subjects. Every participant completed 6 items of dry eye examinations as follows: questionnaire (Ocular Surface Disease Index, OSDI), measurement of tear film LLT, tear film break-up time (TBUT), corneal and conjunctival staining, SchirmerⅠtest and the infrared meibomian photography. According to their age, all participants were divided into four groups: junior group (<18 years old), youth group (18 to 40 years old), middle-aged group (41 to 59 years old) and the elderly group (over 60 years old). With the OSDI criteria, no dry eye symptom group (score, <12 points), mild to moderate dry eye symptom group (score, 12 to 32) and severe dry eye symptom group (score, 33-100) were included. With the statistical methods of variance analysis and multivariate Logistic regression analysis, distribution of the variables of LLT and the relationship between dry eye symptoms and LLT were studied. Results: A total of 473 residents finally participated in this study, and the response ratio was 87.6%. The values of LLT were normally distributed. The average LLT was (59.87±18.50) nm [(60.16±19.15) nm in males and (59.67±18.57) nm in females], and the comparison of LLT with different genders was not statistically significant (t=0.198, P=0.843). The tear film LLT of four different age groups had statistical significance (F=15.092, P<0.05), and increased with age [(56.10±18.33) nm in the junior group, (54.60±16.29) nm in the youth group, (60.61±19.18) nm in the middle-aged group and (73.25±14.58) nm in the elderly group]. The LLT was inversely proportional to the severity of dry eye symptoms. With a thinner LLT, the symptoms of the subjects turned severe. In the elderly with different degrees of symptoms, the LLT was significantly different (F=0.019, P<0.05), while in the youth and middle-aged groups with different degrees of symptoms, the LLT was not significantly different (F=0.096, P>0.05. F=0.538, P>0.05). In the OSDI symptom questionnaire, only blurred vision and decreased visual acuity were related to the tear film LLT (P<0.05). There was no significant correlation between the TBUT, SchirmerⅠtest result, meibomian gland loss rate and the tear film LLT (P>0.05). Conclusions: In Taishitun Community of Beijing, the values of tear film LLT had a normal distribution. The LLT was positively correlated with age, but inversely correlated with the severity of the symptoms of dry eye. There was no significant correlation between the LLT and the TBUT, SchirmerⅠtest result and meibomian gland loss rate.(Chin J Ophthalmol, 2017, 53: 495-501).

Tear osmolarity and subjective dry eye symptoms in migraine sufferers

Dry Eye Profiles in Patients with a Positive Elevated Surface Matrix Metalloproteinase 9 Point-of-Care Test Versus Negative Patients

ABSTRACTPurpose: Based on the relationship between keratoconus and dry eye, the aim of this study was to evaluate changes in signs and symptoms of dry eye in keratoconus patients before and after intrastromal corneal ring surgery.Methods: Fifteen keratoconus patients were enrolled in Fundación Jiménez-Díaz of Madrid and University Clinic of Optometry of the Universidad Complutense de Madrid (Madrid, Spain). Tear break up time (TBUT), Schirmer test without anesthesia, corneal staining, diadenosine tetraphosphate (Ap4A) concentration, and ocular surface disease index (OSDI) were evaluated. Impression cytology combined with laser confocal microscopy was performed to evaluate goblet cell density, mucin cloud height (MCH), and cell layer thickness (CLT). All measurements were performed before (pre) surgery, 1 month (post) and 6 months after surgery (post6m).Results: We found no statistical differences in time in Schirmer test, TBUT, and corneal staining. OSDI scores were 44.96 ± 8.65, 26.30 ± 6.79, and 19.31 ± 4.28 for (pre), (post), and (post6m) surgery, respectively (p < 0.001). Impression cytology showed a decrease in cell density at (post6m) compared with presurgery (47.36 ± 35.15 cells/mm2 and 84.88 ± 32.08 cells/mm2, respectively, p = 0.04). At post6m, the MCH increased compared with presurgery values (13.97 ± 4.26 µm and 6.77 ± 2.51 µm, respectively, p < 0.001). There was a statistically significant increase in CLT in time. Ap4A tear concentrations were lower post6m than presurgery (1.02 ± 0.65 and 2.56 ± 1.10 µM, respectively, p < 0.001). Conclusion: Intrastromal corneal ring surgery induces changes improving dry eye symptoms but no changes were found in signs of dry eye after surgery in keratoconus patients except for the MCH that increases drastically. More studies are needed to clarify the reason of its improvement.

To examine ocular symptoms and signs of veterans with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) diagnosis, ME/CFS symptoms, and controls. This was a prospective, cross-sectional study of 124 South Florida veterans in active duty during the Gulf War era. Participants were recruited at an ophthalmology clinic at the Miami Veterans Affairs Hospital and evaluated for a diagnosis of ME/CFS, or symptoms of ME/CFS (intermediate fatigue, IF) using the Canadian Consensus criteria. Ocular symptoms were assessed via standardised questionnaires and signs via comprehensive slit lamp examination. Inflammatory blood markers were analysed and compared across groups. Mean age was 55.1 ± 4.7 years, 88.7% identified as male, 58.1% as White, and 39.5% as Hispanic. Ocular symptoms were more severe in the ME/CFS (n = 32) and IF (n = 48) groups compared to controls (n = 44) across dry eye (DE; Ocular Surface Disease Index [OSDI]: 48.9 ± 22.3 vs. 38.8 ± 23.3 vs. 19.1 ± 17.8, p < 0.001; 5 item Dry Eye Questionnaire [DEQ-5]: 10.8 ± 3.9 vs. 10.0 ± 4.6 vs. 6.6 ± 4.2, p < 0.001) and pain-specific questionnaires (Numerical Rating Scale 1-10 [NRS] right now: 2.4 ± 2.8 vs. 2.4 ± 2.9 vs 0.9 ± 1.5; p = 0.007; Neuropathic Pain Symptom Inventory modified for the Eye [NPSI-E]: 23.0 ± 18.6 vs. 19.8 ± 19.1 vs. 6.5 ± 9.0, p < 0.001). Ocular surface parameters and blood markers of inflammation were generally similar across groups. Individuals with ME/CFS report increased ocular pain but similar DE signs, suggesting that mechanisms beyond the ocular surface contribute to symptoms.

Background/Objectives: Dry eye (DE) can cause persistent eye rubbing, contributing to keratoconus (KC) development and progression. Both keratoconus (KC) and dry eye (DE) significantly impact patients’ functional and emotional well-being, with KC patients exhibiting a higher prevalence of DE symptoms and signs. This study examined whether functional (KEPAQ-F) and emotional (KEPAQ-E) quality of life, assessed by the Keratoconus End-Points Assessment Questionnaire, differ when influenced by symptoms and clinical signs of general DE versus meibomian gland dysfunction (MGD) in KC patients. Methods: Volunteers with KC (ages 18–70) underwent DE and MGD assessments, completing OSDI, MGD (MGDQ), and KEPAQ questionnaires. Clinical measures included NITBUT, Schirmer, and meibography. Pearson correlations and path analysis assessed relationships between DE and MGD symptoms and KEPAQ-F/E. Results: Forty-five KC participants (mean age: 45 ± 13, range: 20–69 years, 25 males) were enrolled; 22 (49%) had DE, and 15 (33%) had MGD. Significant correlations were observed between KEPAQ-E (2.9 ± 3.0 Logit) and KEPAQ-F (1.7 ± 3.0 Logit) scores with OSDI (26.5 ± 26.7) and MGDQ (3.3 ± 2.2) scores, and all Belin outcome measures A-D for all participants. In participants with diagnosed dry eye, KEPAQ E and F were also significantly correlated with loss of meibomian glands in the lower eyelids (R = −0.44, p = 0.04). Path analysis showed both DE and MGD were negatively correlated with lower KEPAQ-E and KEPAQ-F scores, with DE symptoms more influential (p < 0.05). The model explained 42% of the KEPAQ-E variance and 41% of the KEPAQ-F variance. Conclusions: Emotional and functional quality of life in KC is significantly and negatively related to DE and MGD symptoms, with DE symptoms exhibiting a greater impact. Furthermore, greater loss of meibomian glands in the lower eyelids is significantly associated with reduced emotional and functional KEPAQ scores in DE patients. These results underscore the critical importance of evaluating DE in KC to improve patient-reported outcomes.

Context: Kanpur is a major leather processing center in India, where a large number of tanneries are situated. During tanning process, workers are constantly exposed to heat, leather dust produced in buffering operations and a wide range of chemicals. All these factors are known to cause dry eye. Being ophthalmologists of a tertiary health care center in Kanpur, we used to notice over a period of time that a considerable number of patients with dry eye symptoms, attending our out-patient department, were related to leather tanning industries. But, no published data is available on the prevalence of and risk factors for dry eye disorders among tannery worker. Objective: To estimate the prevalence of dry eye problem and its severity among the workers of leather tanneries in the industrial belt of Kanpur and to evaluate various risk factors related to it. Methods: In this cross-sectional case–control study, Ocular Surface Disease Index (OSDI) Questionnaire was presented to randomly selected tannery workers and control group. OSDI score was calculated based on subjects’ response, and was evaluated with OSDI chart to assess the magnitude of dry eye symptoms and to grade its severity. Results were analyzed statistically to evaluate the significance level. Results: A total of 800 workers were selected by simple random sampling, out of which 72 workers were excluded from the study. Thus the questionnaire was presented to a total of 728 workers, while control group included 260 individuals. All the workers as well as controls were male with age ranging from 20 to 59 years. The mean age for tannery workers was 34.05 ± 8.96 years and that for control group was 32.97 ± 10.59 years (p = 0.14). The tannery workers had mean duration of work at tanneries for 6.99 ± 4.86 years. The prevalence of dry eye symptoms among tannery workers was 33.79% (95% CI: 30.35–37.24), while that in control group was 15.77% (95% CI: 11.31–20.23) (p < 0.0001). Among symptomatic workers, 47.96% (95% CI: 41.68–54.26) workers had mild, 36.99% (95% CI: 30.91–43.07) workers had moderate and 15.04% (95% CI: 10.54–19.54) workers had severe dry eye symptoms. Severe symptoms were more prevalent among symptomatic workers of age ≥40 years in comparison to those <40 years (34.72% versus 6.90%, p < 0.0001). With increase in duration of work (1–5, 6–15 and 16–25 years), both prevalence and severity of dry eye symptoms increased significantly (p = 0.036 and <0.0001, respectively). Conclusion: Dry eye is a significantly prevalent occupational hazard among tannery workers, severity of which increases with the age and the duration of work in tannery. Chemical exposure in hot and dusty working environment of a tannery may have a causative role. Tannery workers should be motivated to use various preventive measures to reduce chemical and dust exposure such as wearing protective glasses, and their ocular health should be monitored periodically for adequate and timely treatment, if required.

Background: Dry eye disease is a multifactorial disorder of the ocular surface and is a common cause of postoperative discomfort following cataract surgery, especially in the elderly population. Symptoms such as foreign body sensation, grittiness, ocular fatigue, and visual disturbance significantly affect the quality of life and patient satisfaction after surgery. Cataract surgery, being the most frequently performed ophthalmic procedure, particularly for senile cataract, can exacerbate pre-existing or subclinical ocular surface disease due to surgical trauma, corneal nerve damage, and postoperative topical medications. Early identification and management of dry eye are therefore essential to improve postoperative outcomes. Methods: This prospective comparative study included 160 patients undergoing cataract surgery, divided equally into two groups: 80 patients underwent manual Small Incision Cataract Surgery (SICS) and 80 underwent phacoemulsification. Patients were evaluated preoperatively (1 day before surgery) and postoperatively at 7, 30, and 90 days. Dry eye was assessed using the Ocular Surface Disease Index (OSDI) questionnaire, Tear Break-Up Time (TBUT), and Schirmer’s test. The incidence and severity of dry eye and ocular surface damage were compared between the two surgical techniques. Results: A significant increase in dry eye signs and symptoms was observed during the first postoperative week in both groups, evidenced by increased OSDI scores and reduced TBUT and Schirmer’s values. OSDI and TBUT showed better correlation with dry eye severity compared to Schirmer’s test. By 30 and 90 days postoperatively, tear film parameters gradually improved and returned to near-normal levels. Phacoemulsification was associated with a significantly lower incidence and severity of postoperative dry eye compared to manual SICS. Conclusion: Dry eye disease is a common but transient postoperative complication following both manual SICS and phacoemulsification. Symptoms are more pronounced in the early postoperative period, likely due to frequent use of topical medications and ocular surface toxicity and resolve as medications are tapered. OSDI and TBUT are more reliable indicators of postoperative dry eye than Schirmer’s test. Early postoperative ocular surface evaluation and the use of tear substitutes can reduce epithelial damage and improve patient comfort. Phacoemulsification causes less ocular surface disturbance and offers better postoperative patient well-being.

The association between dry eye disease (DED) and psychiatric conditions is a highly researched topic. This work reviews the literature on this relationship, examining the prevalence and correlations of depression and anxiety with dry eye signs and symptoms. A comprehensive literature search of MEDLINE, EMBASE, PsycINFO, and gray literature was conducted, with keywords for dry eye and mood disorders, depression, anxiety, and suicide. Eligible studies underwent quality assessment using the Newcastle-Ottawa Scale. Meta-analysis was performed using STATA 15.0. Fixed- and random-effects models were computed based on the presence of heterogeneity. Thirty-two studies were included, with 31 reporting on depression and 19 on anxiety. Meta-analysis results found a depression prevalence of 40% (CI: [0.29, 0.52]) in DED patients, with 1.81 times higher odds of prevalence compared to controls (CI: [1.61, 2.02]). Prevalence of anxiety was 39% (CI: [0.15, 0.64]), with 2.32 times higher odds of prevalence compared to controls (CI: [1.67, 3.23]). Depression scores were significantly higher in patients with DED in all studies. Anxiety scores were significantly higher in DED patients in studies using all scales except the Hospital Anxiety and Depression Scale-Anxiety Subscale. DED symptom scores were significantly associated with depression (ES = 0.43; CI: [0.31, 0.55]) and anxiety (ES = 0.41; CI: [0.32, 0.50]) scores. In conclusion, depression and anxiety are more prevalent and severe in DED patients and are correlated with dry eye symptoms but not signs. These findings highlight the interrelationship between these disorders and have important implications for providing appropriate care to these patients.

Complementary/integrative healthcare utilization in US Gulf-War era veterans: Descriptive analyses based on deployment history, combat exposure, and Gulf War Illness

To study the relationship between eyelid laxity and ocular symptoms and signs of dry eye (DE). A total of 138 patients with normal external anatomy were prospectively recruited from a Veterans Administration hospital. Symptoms (via the Dry Eye Questionnaire 5 and Ocular Surface Disease Index) and signs of DE were assessed along with presence or absence of eyelid laxity. It was observed that 71% of participants (n = 98) had clinical evidence of eyelid laxity (upper and/or lower) compared with 29% (n = 40) with no eyelid laxity. Individuals with eyelid laxity were older (67 ± 10 vs. 55 ± 8 years without laxity, P < 0.005) and more frequently male (76% of males had laxity vs. 18% females, P < 0.005). Patients with eyelid laxity had increased symptoms and signs of DE compared with their counterparts without laxity including ocular pain described as grittiness (63% vs. 45%, P = 0.049), decreased tear break-up time (8.6 ± 3 vs. 10.3 ± 4 seconds, P = 0.02), increased corneal staining (2.5 ± 3 vs. 1 ± 2, P = 0.002), decreased Schirmer score (14±6 vs. 17±7 mm, P = 0.01), increased meibomian gland drop out (2 ± 1 vs. 0.8 ± 0.8, P < 0.005), increased eyelid vascularity (0.8 ± 0.8 vs. 0.2 ± 0.5, P < 0.005), and more abnormal meibum quality (2 ± 1.3 vs. 1.4 ± 1.2, P = 0.02). In a multivariable analysis considering both signs of DE and laxity, lower eyelid laxity remained significantly associated with ocular surface disease index scores, suggesting a direct effect of laxity on symptoms of DE. The presence of eyelid laxity associates with abnormal tear parameters compared with the absence of eyelid laxity. Based on these data, it is important for clinicians to test for eyelid laxity in patients with symptoms and/or signs of DE.

To determine the impact of dry eye on quality of life, depression, anxiety, and stress in a healthy youthful clinical sample. This was a clinic-based cross-sectional study. Subjects were patients visiting the University of Cape Coast Eye Clinic for comprehensive eye examination. The age range for recruitment into the study was 16 to 35 years. Eligible participants completed three questionnaires namely the Ocular Surface Disease Index (OSDI), short version of the depression, anxiety, and stress scale (DASS-21), dry eye quality of life score (DEQS) questionnaire. All eligible participants underwent clinical assessment including meibomian gland expressibility, corneal staining, tear breakup time, and Schirmer 1 test. The Spearman correlation coefficient was used to determine the relationship between variables. Univariate and multivariate analyses of variance were used to determine the impact of the OSDI score on DASS-21 subscales scores and the dry eye quality of life scores. All 211 subjects who met the inclusion criteria were included in the analysis. The mean age for the entire sample was 21.6±3.0 years with a range of (17-31) years. Spearman correlation coefficient showed a statistically significant association between OSDI scores and DEQSs (P<0.001), anxiety scores (P<0.001), depression scores (P<0.001), and stress scores (P<0.001). Spearman correlation coefficient showed no statistically significant association between clinical test results and quality of life scores (P>0.05), DASS-21 subscales scores (P>0.05), except anxiety subscale and meibomian gland expressibility score (P=0.026). There were no statistically significant association between clinical test results and OSDI scores (P>0.05) except for the tear breakup time (P=0.018). Using Pillai's trace in the multivariate analysis of variance (MANOVA), there was a significant effect of OSDI severity classification on depression, anxiety, and stress subscales scores of the DASS-21, V=0.37, F(3, 207)=9.67, P<0.001. Furthermore, separate univariate analyses of variances on the outcome variables revealed a significant effect of OSDI severity classification on depression F(3, 207)=35.24, P<0.001, anxiety F(3, 207)=25.27, P<0.001, and stress F(3, 207)=13.08, P<0.001. The MANOVA was followed up with a discriminant analysis, which revealed three discriminant functions. When subjects were classified according to the OSDI grading of severity, there were a statistically significant difference between all levels of severity dry eye symptoms for the DEQSs (F(3, 207) = 63.9.3 P<0.001, η=0.48). The study showed that the severity of dry eye symptoms impacted on psychosomatic symptoms and quality of life. The study also revealed that the severity of dry eye symptoms impacted more on the depressive symptoms compared with other psychosomatic symptoms in this youthful clinical sample.

To determine the prevalence of dry eye syndrome, analyze the relationship between dry eye symptoms and signs, and identify associated risk factors for dry eye syndrome in an elderly Tibetan population at high altitude. A population-based survey was conducted from October 2006 to December 2006. A stratified, clustered, random sampling procedure was used to select 2632 native Tibetan people >or=40 years of age. Symptoms of dry eye were assessed by using a 6-item validated questionnaire. Dry eye syndrome was diagnosed in those subjects having 1 or more symptoms often or all the time. Positive signs included a tear film breakup time of <or=10 seconds in 1 or both eyes, a Schirmer test score of <or=5 mm, or a fluorescein score of >or=1. Correlations between symptoms and signs were analyzed. Of a total of 2632 eligible subjects, 2229 (84.69%) were examined. The data of 1840 participants were analyzed. Of 1840 participants, 52.4% (95% confidence interval: 50.2-54.7) were symptomatic. The tear film breakup time of <or=10 seconds was seen in 35.3% (95% confidence interval: 33.1-37.5), a Schirmer test score of <or= 5 mm was seen in 24.7% (95% confidence interval: 22.8-26.7), and a fluorescein score of >or=1 was seen in 5.8% (95% confidence interval: 4.7-6.9). The correlations between dry eye symptoms and signs were statistically significant. Independent risk factors for dry eye syndrome were positive dry eye signs, increased age, low education level and socioeconomic status, and higher altitude. This study shows a high prevalence rate of dry eye syndrome in elderly Tibetans, representing an important health problem.

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.