Corneal Nerve Abnormalities in Painful Dry Eye Disease Patients

This study aimed to compare the corneal nerve structural abnormalities detected using in vivo confocal microscopy (IVCM) in patients with neuropathic corneal pain (NCP) secondary to primary meibomian gland dysfunction (MGD) or autoimmune dry eye (AIDE). Methods: A two-stage retrospective nested case–control study was conducted. First, data from patients with either MGD or AIDE were assessed, selecting only cases with no corneal pain (VAS = 0) or severe pain (VAS ≥ 8). Ocular signs and symptoms of the 238 selected patients were compared between painful and painless cases. Next, painful patients with no corneal damage (Oxford score ≤ 1) were selected within each study group, defining the cases with NCP (i.e., “pain without stain”). IVCM images from all groups were compared with prospectively-recruited healthy controls, focusing on dendritiform cell density and nerve abnormalities (density, tortuosity, microneuromas). Results: AIDE patients had more ocular signs/symptoms than MGD patients. Compared with healthy controls, AIDE-related NCP patients showed increased nerve tortuosity and number of neuromas, whereas MGD-related NCP patients had reduced nerve density and increased number, perimeter, and area of microneuromas. Microneuromas were also observed in healthy controls. Furthermore, a higher number of microneuromas was found in MGD-related NCP compared to AIDE-related NCP or painless MGD. Conclusions: MGD-related NCP was associated with significantly more corneal nerve abnormalities than AIDE-related NCP or healthy controls. Although IVCM can be useful to detect NCP-related corneal nerve changes in such patients, the diagnosis of dry eye disease-related NCP will require an association of several IVCM-based criteria without relying solely on the presence of microneuromas.

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Corneal Nerve Regeneration after Self-Retained Cryopreserved Amniotic Membrane in Dry Eye Disease

Journal of Ophthalmology ◽

10.1155/2017/6404918 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 9

Author(s):

Thomas John ◽

Sean Tighe ◽

Hosam Sheha ◽

Pedram Hamrah ◽

Zeina M. Salem ◽

...

Keyword(s):

Nerve Regeneration ◽

Dry Eye ◽

Amniotic Membrane ◽

Signs And Symptoms ◽

Dry Eye Disease ◽

Eye Disease ◽

Study Group ◽

Corneal Sensitivity ◽

Corneal Nerve

Purpose. To evaluate the efficacy of self-retained cryopreserved amniotic membrane (CAM) in promoting corneal nerve regeneration and improving corneal sensitivity in dry eye disease (DED).Methods. In this prospective randomized clinical trial, subjects with DED were randomized to receive CAM (study group) or conventional maximum treatment (control). Changes in signs and symptoms, corneal sensitivity, topography, and in vivo confocal microscopy (IVCM) were evaluated at baseline, 1 month, and 3 months.Results. Twenty subjects (age 66.9 ± 8.9) were enrolled and 17 completed all follow-up visits. Signs and symptoms were significantly improved in the study group yet remained constant in the control. IVCM showed a significant increase in corneal nerve density in the study group (12,241 ± 5083 μm/mm2at baseline, 16,364 ± 3734 μm/mm2at 1 month, and 18,827 ± 5453 μm/mm2at 3 months,p=0.015) but was unchanged in the control. This improvement was accompanied with a significant increase in corneal sensitivity (3.25 ± 0.6 cm at baseline, 5.2 ± 0.5 cm at 1 month, and 5.6 ± 0.4 cm at 3 months,p<0.001) and corneal topography only in the study group.Conclusions. Self-retained CAM is a promising therapy for corneal nerve regeneration and accelerated recovery of the ocular surface health in patients with DED. The study is registered at clinicaltrials.gov with trial identifier:NCT02764814.

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Perfluorohexylcotane (NOV03) for the Treatment of Signs and Symptoms of Dry Eye Disease Associated With Meibomian Gland Dysfunction

Case Medical Research ◽

10.31525/ct1-nct04139798 ◽

2019 ◽

Author(s):

Keyword(s):

Dry Eye ◽

Signs And Symptoms ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Meibomian Gland Dysfunction ◽

Eye Disease

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Classifying signs and symptoms of dry eye disease according to underlying mechanism via the Delphi method: the DIDACTIC study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312581 ◽

2019 ◽

Vol 103 (10) ◽

pp. 1475-1480 ◽

Cited By ~ 1

Author(s):

Marc Labetoulle ◽

Tristan Bourcier ◽

Serge Doan

Keyword(s):

Dry Eye ◽

Signs And Symptoms ◽

Underlying Mechanism ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Eye Disease ◽

Eyelid Margin ◽

Mixed Treatment ◽

Evaporative Dry Eye ◽

Initial List

Background/aimsDry eye disease (DED) is categorised by pathophysiology as aqueous deficient dry eye (ADDE), evaporative dry eye (EDE) or mixed. Treatment should be tailored to DED pathophysiology, but this is challenging to determine. This Delphi consultation aimed to categorise and weight signs and symptoms to help identify the evaporative or aqueous deficient DED origin.MethodsA panel of French DED experts created an initial list of 77 DED signs and symptoms. In a Delphi consultation, experts categorised items by DED pathophysiology. Likert scoring was used to indicate whether items were strongly or moderately indicative of ADDE or EDE. Items could also be judged non-applicable to DED, with the opportunity to suggest alternative diagnoses.ResultsExperts attributed 19 items (of which 11 were strongly indicative) to a pathophysiology of EDE and 12 items (of which four were strongly indicative) to ADDE. Items scored strongly indicative with agreement >90% for EDE were previous chalazia, rosacea/rhinophyma, telangiectasias of eyelid margin and thick non-expressible meibomian gland secretions, and for ADDE were Sjögren syndrome or associated disease, and Schirmer <5 mm after 5 min (without anaesthesia). Seventeen items indicated neither pathophysiology and 18 items were found to be suggestive of alternative diagnoses.ConclusionsThis Delphi consultation categorised signs and symptoms, using an innovative weighting system to identify DED pathophysiology. An algorithm integrating the weighting of each sign and symptom of an individual patient would be valuable to help general ophthalmologists to classify the DED subtype and tailor treatment to DED underlying mechanism.

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The correction of conjunctivochalasis using high-frequency radiowave electrosurgery improves dry eye disease

Scientific Reports ◽

10.1038/s41598-021-82088-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yong Woo Ji ◽

Hyojin Seong ◽

Sujung Lee ◽

Mutlaq Hamad Alotaibi ◽

Tae-im Kim ◽

...

Keyword(s):

Dry Eye ◽

High Frequency ◽

Symptomatic Relief ◽

Tear Film ◽

Signs And Symptoms ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Eye Disease ◽

Film Stability ◽

Staining Score

AbstractWe aimed to determine the clinical impact of conjunctivochalasis (CCh) and its correction using high-frequency radiowave electrosurgery (HFR-ES), for signs and symptoms of dry eye disease (DED). Forty patients diagnosed with symptomatic CCh were prospectively enrolled. As a result, patients with CCh had moderate to severe DED and most of them exhibited meibomian gland dysfunction (MGD). Corneo-conjunctival fluorescein staining score (CFS) and all lid-parallel-conjunctival-folds scores (LIPCOFs) were positively correlated. Nasal LIPCOF significantly correlated with symptoms and tear volume. Central, temporal, and total LIPCOF significantly correlated with MG loss, MGD stage, and lipid layer thickness. Independent significant factors associated with total LIPCOF included CFS, tear break-up time, and MGD stage. One month following HFR-ES, CCh was completely resolved in all cases. Patient age and preoperative nasal LIPCOF were determinants of outcomes associated with postoperative improvements in symptoms. Ocular surface parameters significantly improved, but MGD-related signs did not. Collectively, CCh associated with MGD severity deteriorates not only tear film stability and reservoir capacity, leading to DED exacerbation. Therefore, CCh should be corrected in patients with DED and MGD. Younger patients with nasal CCh are likely to experience more symptomatic relief after HFR-ES. Particularly, management for MGD should be maintained after CCh correction.

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Prospective evaluation of intense pulsed light and meibomian gland expression efficacy on relieving signs and symptoms of dry eye disease due to meibomian gland dysfunction

Clinical Ophthalmology ◽

10.2147/opth.s130706 ◽

2017 ◽

Vol Volume 11 ◽

pp. 817-827 ◽

Cited By ~ 39

Author(s):

Steven J Dell ◽

Ronald N Gaster ◽

Sheila C Barbarino ◽

Derek Cunningham

Keyword(s):

Dry Eye ◽

Signs And Symptoms ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Intense Pulsed Light ◽

Meibomian Gland Dysfunction ◽

Eye Disease ◽

Prospective Evaluation ◽

Pulsed Light

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Meibomian gland dysfunction and keratopathy are associated with dry eye disease in aniridia

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310927 ◽

2018 ◽

Vol 103 (1) ◽

pp. 119-124 ◽

Cited By ~ 4

Author(s):

Erlend Christoffer Sommer Landsend ◽

Hilde Røgeberg Pedersen ◽

Øygunn Aass Utheim ◽

Jiaxin Xiao ◽

Muhammed Yasin Adil ◽

...

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Tear Film ◽

Vital Staining ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Eye Disease ◽

Control Group ◽

Healthy Controls ◽

Congenital Aniridia

AimsTo investigate the aetiology and characteristics of dry eye disease (DED) in a Nordic cohort of patients with congenital aniridia.MethodsThirty-four Norwegian and one Danish subject with congenital aniridia and 21 healthy controls were examined. All subjects underwent an extensive dry eye examination, including evaluation of meibomian glands (MGs) by meibography, measurement of tear production and tear film osmolarity and grading of vital staining of the ocular surface. Moreover, slit-lamp biomicroscopy was undertaken, including grading of aniridia-associated keratopathy (AAK).ResultsMean tear film osmolarity was significantly higher (314±11 mOsmol/L) in patients with aniridia compared with the healthy control group (303±11 mOsmol/L, p=0.002). Vital staining score was higher in the aniridia group (4.3±3.0) compared with healthy controls (2.4±1.6, p=0.02). The degree of staining correlated positively with the stage of AAK (r=0.44, p=0.008) and negatively with corneal sensitivity (r=−0.45, p=0.012). Number of expressible MGs was lower in aniridia subjects (2.9±1.6) than in controls (4.0±1.3, p=0.007). MG loss, staged from 0 to 3, was higher in the aniridia group than in the control group, both in upper eyelid (0.86±0.89 vs 0.10±0.31, p=0.001) and lower eyelid (0.94±0.73 vs 0.30±0.47, p=0.003). Computerised analyses showed thinning (p=0.004) and lower density (p<0.001) of the MGs compared with the healthy population.ConclusionsPatients with congenital aniridia demonstrate increased tear film osmolarity, ocular surface staining, loss of MGs and lower MG expressibility. We conclude that meibomian gland dysfunction and keratopathy are related to development of DED in aniridia.

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Dry eye disease among Glaucoma patients on topical hypotensive medications, in a tertiary hospital, Ethiopia

BMC Ophthalmology ◽

10.1186/s12886-021-01917-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Miraf Sahlu ◽

Abeba T. Giorgis

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Signs And Symptoms ◽

Dry Eye Disease ◽

Eye Disease ◽

Eye Drops ◽

Schirmer Test ◽

Ocular Surface Disease Index ◽

Cross Sectional ◽

Corneal Staining

Abstract Background Dry eye disease is a multifactorial disease; causing various ocular symptoms with potential damage to the ocular surface. Applying hypotensive eye drops are presumed to initiate or exacerbate existing dry eye disease. The purpose of this study was to determine the frequency of signs and symptoms and severity of dry eye disease among glaucoma patients on topical hypotensive medications and controls. Methods A cross-sectional comparative study, involving 320 glaucoma patients and controls. Ocular Surface Disease Index (OSDI) symptoms score and Schirmer, tear breakup time and corneal staining tests were used to assess dry eye disease. Data was analyzed using SPSS version 24 software; p-value less than 0.05 was considered as statistically significant. Results Among the 160 study glaucoma patients, the mean duration of topical hypotensive medication use was 5.2 ± 5.21 years (range, 4 months - 32 years). Mild to severe level of OSDI score was found in 122 (76%) glaucoma patients and in 137 (86%) controls (p = 0.033). Mild to sever abnormal clinical tests in the glaucoma patients and control, respectively, were 106 (66%) vs 80 (50%) corneal staining (p = 0.045), 79 (49%) vs 72 (45%) TBUT (p = 0.021), and 91 (57%) vs 83 (52%) Schirmer test (p = 0.242). Test results at the level of sever: 2 (1%) vs 0 (0%) corneal staining, 50 (31%) vs 39 (24%) TBUT and 65 (41%) vs 60 (38%) Schirmer test in the glaucoma patents and controls, respectively. Corneal staining and TBUT had correlation with the number of drugs (p = 0.004 and 0.031, respectively), and more relationship of the two tests with total number of drops applied per day (p = 0.01 and p < 0.001, respectively). Patients on pilocarpine and timolol had more corneal staining and lower TBUT [(p = 0.011 and p < 0.001) and (p = 0.04 and 0.012), respectively]. Conclusions The study has identified glaucoma patients to be more affected by dry eye disease than non-glaucoma patients, and presence of significantly lower TBUT and higher corneal staining in the glaucoma patients on multidrops and multidose per day. We recommend consideration of evaluation and management of DED for glaucoma patients on multidrops and multidose hypotensive medications.

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