Assessment of Tear Film Anomalies in Childhood Obesity

Purpose To determine if childhood obesity has an effect on the ocular surface and tear film of children who are afflicted. Methods Patients who had childhood obesity, 85 eyes, and patients who were healthy, 75 eyes, were enrolled in this prospective and comparative study. The tear film breakup time (TF-BUT), tear meniscus area and height (TMA and TMH) values, Schirmer test scores, and ocular surface disease index (OSDI) scores were obtained for all participants. Results The TMH, TMA, TF-BUT, and Schirmer test results were statistically significantly lower in the obesity group (p < 0.001 for all). The children with obesity and insulin resistance had lower TMH, TMA, TF-BUT, and Schirmer test results when compared to the children without insulin resistance (p < 0.05 for all). The body mass index was found to be correlated with the TMH, TMA, TF-BUT, and Schirmer test results (p < 0.001 for all). Conclusion Children with obesity had lower TMA, TMH, TF-BUT, and Schirmer test results than healthy subjects. When insulin resistance was added to obesity, these values were even lower.

Evaluation of Tear Production as Measured by Schirmer Test I in Dogs after Acepromazine and Acepromazine–Methadone Premedication

The purpose of the current study was to investigate the effects of two commonly used sedation protocols in dogs, acepromazine (ACP) and acepromazine–methadone (ACP–MET) combination, on tear production measured by the Schirmer Tear Test (STT) 1. We hypothesized that both sedation protocols cause a reduction in canine tear production for a variable time. Fifteen client-owned dogs were recruited for the study. Each dog was subjected to sedation twice, 2–3 weeks apart, and they were randomly allocated to one of two groups receiving ACP (0.015 mg kg−1) or ACP–MET (0.010 mg kg−1 and 0.2 mg kg−1) intramuscularly. In both eyes, tear production was measured 15 min before sedation (T0) and 20 min (T20 m), 40 min (T40 m), 1 h (T1), 2 h (T2), 4 h (T4) and 8 h (T8), after drug administration. Two-way repeated measures ANOVA, followed by the Bonferroni post hoc test (p < 0.05), showed a significant effect of time (p < 0.0001) and treatment (p < 0.0001). A significant decrease in tear production at T20 m, T40 m, T1 and T2 compared to T0 was observed in the ACP experimental protocol, while in the ACP + MET protocol, this reduction persisted until T8. Comparing the two experimental protocols, no statistically significant differences were observed at T0 or T20 m, and STT 1 values were statistically lower in the ACP + MET than the ACP protocol at the other data points. In the ACP + MET group, at T40 m, 100% of dogs showed STT 1 readings lower than 15 mm/min. This finding is clinically relevant as it can predispose dogs to corneal injuries. The major reduction in tear production due to the ACP + MET protocol proves the need for adequate corneal hydration, particularly to discourage its use in animals with altered tear production. The data obtained provide important information helping clinicians to better manage the drug’s effects on tear production.

Rear 4-minute Schirmer Test, A Modified Indicator of Schirmer Test in Diagnosing Dry Eye

This study was desgined to find a reliable and convenient indicator (a modified Schirmer test) to improve the accuracy of assessing tear secretion and diagnosing dry eye. This is a prospective continuous study on 180 volunteers. Schirmer test I without anesthesia was performed once on both eyes to determine the value of normal Schirmer test. The values of tear secretion were recorded in each minute. Examined individuals also underwent other examinations: the standard patient evaluation of eye dryness (SPEED), the Ocular Surface Disease Index (OSDI), fluorescein stain, tear film breakup time (BUT), and Meibomian gland (MG)grading. The participants were divided into two groups: dry eye (DE) groupand non-dry eye (ND) group. The mean age was 39.41±14.05 years in DE group and 37.62±13.17 in ND group. The value of 2-minute Schirmer test, rear 3-minute Schirmer test, rear 4-minute Schirmer test and 5-minute Schirmer test was 5.36±4.63, 5.57±2.11, 7.21±4.13 and 10.93±6.30 respectively in DE group. And these indicators was 8.25±6.80, 2.73±2.31, 7.36±3.42, 11.84±6.16 in ND group. The rear 4-minute ST has significant correlation with OSDI and SPEED in DE group (r =-0.242/-0.183) and in ND gruop(r =-0.316 /-0.373). Meanwhile, rear 4-minute ST had stronger connection with fBUT(r =0.159) and MG (r =-0.162) in DE gruop. And rear 4-minute ST also had higher accuracy in diagnosing severe dry eye and borderline dry eye.The rear 4-minute Schirmer test may be a supplement indicator in assessing tear secretion and diagnosing dry eye.

Alteration of corneal biomechanical properties in patients with dry eye disease

Purpose To evaluate the association between symptoms and signs of dry eye diseases (DED) with corneal biomechanical parameters. Methods This cross-sectional study enrolled 81 participants without history of ocular hypertension, glaucoma, keratoconus, corneal edema, contact lens use, diabetes, and ocular surgery. All participants were evaluated for symptoms and signs of DED using OSDI questionnaire, tear film break-up time (TBUT), conjunctival and corneal staining (NEI grading) and Schirmer test. Corneal biomechanical parameters were obtained using Corvis ST. Mixed-effects linear regression analysis was used to determine the association between symptoms and signs of DED with corneal biomechanical parameters. Difference in corneal biomechanical parameter between participants with low (Schirmer value ≤10 mm; LT group) and normal (Schirmer value >10mm; NT group) tear production was analyzed using ANCOVA test. Results The median OSDI scores, TBUT, conjunctival and corneal staining scores as well as Schirmer test were 13±16.5 (range; 0–77), 5.3±4.2 seconds (range; 1.3–11), 0±1 (range; 0–4), 0±2 (ranges; 0–9) and 16±14 mm (range; 0–45) respectively. Regression analysis adjusted with participants’ refraction, intraocular pressure, and central corneal thickness showed that OSDI had a negative association with highest concavity radius (P = 0.02). The association between DED signs and corneal biomechanical parameters were found between conjunctival staining scores with second applanation velocity (A2V, P = 0.04), corneal staining scores with second applanation length (A2L, P = 0.01), Schirmer test with first applanation time (A1T, P = 0.04) and first applanation velocity (P = 0.01). In subgroup analysis, there was no difference in corneal biomechanical parameters between participants with low and normal tear production (P>0.05). The associations were found between OSDI with time to highest concavity (P<0.01) and highest displacement of corneal apex (HC-DA, P = 0.04), conjunctival staining scores with A2L (P = 0.01) and A2V (P<0.01) in LT group, and Schirmer test with A1T (P = 0.02) and HC-DA (P = 0.03), corneal staining scores with A2L (P<0.01) in NT group. Conclusions According to in vivo observation with Corvis ST, patients with DED showed more compliant corneas. The increase in dry eye severity was associated with the worsening of corneal biomechanics in both patients with low and normal tear production.

Ocular Surface Failure in Urban Syndrome

Background: Nowadays, the continuous increase in air pollution has significantly changed air quality, leading to the onset of the so-called urban syndrome (US), an allergic-like conjunctivitis triggered by pollutants. These patients are characterized by persistent dysregulation of ocular surface para-inflammation, causing chronic low-grade inflammation and ocular discomfort, with significant consequences for occupational health and job productivity prospects. This study aims to investigate the effects of topical glycerophosphoinositol (GPI) eye drops on the signs and symptoms of US. Methods: A multicenter prospective open interventional study was performed. Patients affected by US, enrolled from occupational medicine clinics, were treated with eye drops containing 0.001% GPI in 0.2% HA vehicle three times a day. Ocular surface disease index (OSDI), tear break-up time (T-BUT), Schirmer test, Oxford score, hyperemia and ocular surface symptoms were recorded at patient enrolment (T0), after 1 week (T1) and after 1 month (T2) of treatment. Results: A total of 113 consecutive patients (226 eyes) were included. OSDI score displayed a significant improvement after one week (T0: 39.9 ± 19, T1: 20.8 ± 17.9, T2: 18.4 ± 15.6, p < 0.0001); T-BUT (T0: 5.2 ± 2, T1: 7.7 ± 2.2, T2: 9.7 ± 1.8, p < 0.0001) and Schirmer Test (T0: 6.6 ± 2.4, T1: 9.7 ± 2.7, T2: 12.6 ± 2.6, p < 0.0001) progressively improved from T0 to T2. Conclusions: trice-daily topic instillation of 0.001% GPI in 0.02% HA vehicle resulted an effective and well tolerated treatment in US patients.

COMPUTER VISION SYNDROME: REVIEW AND METHODS FOR ASSESSMENT

Computer vision syndrome (CVS) is a combination of eye and vision problems associated with the use of digital devices. CVS affects the eyesight, visual comfort and occupational productivity of workers due to the different symptoms computer users and staff experience: ocular discomfort, headache, dry eye, blurred vision etc. Aim of the study: To assess the symptoms of CVS in a software company in Varna by subjective and objective tests and prescribe measures for prevention. Materials and methods: 40 participants-31 men and 9 women were distributed with a valid questionnaire regarding common symptoms of CVS. The group was tested with the Schirmer test to measure the tear film quantity. Participants have passed a medical exam by an ophthalmologist before the study. Results: - 11 or 27,5% of the participants in the questionnaire have reached score ≥6 – have CVS - 10 or 25 % of the participants in the Schirmer test have reached results < 5mm. in the tear strip - The gender distribution shows 3 women (33.33%) and 8(25.8%) of men have CVS by questionnaire study and 3(33.33%) of women and 7(22.6%) of men based on Schirmer test have dry eye as asymptom of CVS. Conclusion: The results of the study predispose to further evaluation and tracking of the symptoms of CVS among this occupational group. All of the participants are aware of Ordinance № 7 related to health and safety work conditions with VDT’s and received information regarding the physiological work-rest regime. Occupational risk of CVS can be reduced with early diagnose, assessment and prevention of the symptoms.

Conjunctival Matrix Metalloproteinase-9 Clinical Assessment in Early Ocular Graft versus Host Disease

Purpose. Graft versus Host Disease (GVHD) typically affects the ocular surface, with a presentation resembling Dry Eye Disease (DED). Although the etiopathology is not completely known, the conjunctiva might be a key site of T-cell activation. The differential diagnosis might be tricky at early stages, because of the lack of dedicated clinical and laboratory tests. To meet these needs, we evaluated the suitability of ocular surface matrix metalloproteinase-9 (MMP-9) clinical test. Methods. Consecutive GVHD patients, referred to IRCCS San Raffaele Scientific Institute, were recruited. DED patients served as controls. MMP-9 was tested through InflammaDry immunoassay kit in both groups; Ocular Surface Disease Index (OSDI) questionnaire, tear osmolarity, fluorescein Tear Break-up Time (TBUT), corneal and conjunctival staining, and Schirmer test I were also collected. Parametric and nonparametric statistical tests were used to analyze the intergroup differences; Receiver Operating Characteristics (ROC) curve analysis was carried out to perform sensitivity and specificity evaluations. Results. Forty-five GVHD and 40 DED patients were included. MMP-9 expression was significantly higher in GVHD group than in DED (84.4% vs 33%, p ≤ 0.001 ). Corneal and conjunctival staining scores resulted worse in GVHD than in DED (0.95 ± 1.16 vs 0.40 ± 0.63, p = 0.02 ; 0.77 ± 0.42 vs 0.40 ± 0.49, p = 0.0005 , respectively). No significant differences regarded the other collected parameters. GVHD group was characterized by positive correlations between MMP-9 and conjunctival staining (rho = 0.55, p = 0.0002 ) and between MMP-9 and OSDI (rho = 0.3, p = 0.01 ); a faint inverse correlation was found between MMP-9 and Schirmer test (rho = −0.25, p = 0.04 ). Conclusion. MMP-9 has a role in physiologic cellular remodeling; when a proinflammatory stimulus occurs, MMP-9 molecules are overreleased in the extracellular matrix. The positive expression of MMP-9 in GVHD may be interpreted as the consequence of a T-cell aggression against self-antigens and may be considered a reliable biomarker to detect ocular surface inflammation in GVHD, even in early stages of the disease.

Toll-Like Receptors in InflammAging at Ocular Surface.

Purpose: To evaluate changes in Toll Like Receptors expression at the ocular surface of healthy control volunteers within age. Methods: 51 volunteers were enrolled in a pilot observational study. Clinical (OSDI questionnaire, Schirmer test and BUT) and Biomolecular (ICAM1, Goblet cells) biomarkers were assessed in all subjects. Temporal Conjunctival imprints were used for molecular analysis while nasal ones were harvested for epifluorescence microscopy. Results: Within the age in our sample OSDI score increases, T-BUT values decrease, and goblet cells showed a decreasing trend. Relative real time PCR detected up-regulation of TLR2 and down-regulation of TLR7, TLR8 and MyD88 transcripts. Immunofluorescence data corroborated the PCR results reporting increased TLR2 and decreased TLR7 and TLR8 expression in elder population. A direct correlation was showed between increasing ICAM and increasing TLR2 changes with age. Conclusion: Changes in TLR expression are associated with aging, suggesting physiological role of TLRs in modulating innate and adaptive ocular surface immunity. TLRs age related changes may participate to the failure of ocular surface homeostatic mechanisms with inflammAging.

Difference of Schirmer Test Results Before and After Using Smartphones with Various Screen Brightness Levels

Background : The use of smartphones and other digital devices such as laptops and tablets is familiar in Indonesian society. Excessive uses of the devices are associated with dry eye syndrome and tear film dysfunction. The intensity of blue light when penetrating the eye is believed to affect tear film stability. Thus it will encourage tear evaporation which proved by Schirmer test.Objective : To find out the difference of Schirmer test results before and after using a smartphone with various screen brightness levels.Methods : This study used pretest-posttest quasi-experimental study. The research subjects were students of the Faculty of Medicine, Diponegoro University (n = 30) who were selected by purposive sampling. In this study, the research subjects used smartphones for an hour with a predetermined screen brightness level, with the same room lighting. Before and after treatment the subject was measured the quantity of tears using the Schirmer test. Data were analyzed using the Wilcoxon test, Mann Whitney U test, and Kruskal Wallis test.Results : The average pretest result on low brightness was 25,60 ± 9,44 and the post-test result was 17,60 ± 8,45. The pre-test result on medium brightness was 27,90 ± 9,46 and the post-test result was 24,80 ± 10,46. The pre-test result on high brightness was 23,60 ± 6,80 and the post-test result was 19,10 ± 7,95. The Schirmer test results before and after using smartphones with low brightness showed a significant different (P<0.05) and there was no significant difference for the pre-post test using smartphones with medium and high brightness. Comparison of Schirmer test results on low, medium and high screen brightness did not show a significant difference.Conclusion : There is no significant difference between the Schirmer test results among low, medium and high screen brightness after one hour of smartphone usage.

Impression cytology and meibomian glands in conjunctivochalasis

Purpose: To evaluate the tear parameters, meibomian glands and lid margin and tarsal conjunctival impression cytology in patients with conjunctivochalasis (CCH). Methods: The study included 57 patients diagnosed with CCH and 35 healthy volunteers. Tear break-up time (TBUT) was measured and Schirmer test was performed. Meibomian gland morphologies, dropout rates, and meiboscores were evaluated using meibography. Finally, impression cytology samples were taken by pressing the impression filters on the lower lid margin and lower tarsal conjunctiva. The samples were evaluated according to the Nelson grading system. Results: Schirmer test was longer and TBUT was shorter in the study group ( p = 0.035 and p < 0.001, respectively). The median of meibomian gland dropout rate was 33.45% (Interquartile range [IQR]; 23.17%–49.75%) and 18.80% (IQR; 12.35%–26.50%) in the study and control groups, respectively ( p < 0.001). There was no significant difference in terms of lid-margin cytology between the two groups ( p = 0.481). In tarsal conjunctiva cytology, the median value of Nelson grade of the study group was 2 (IQR; 1–2) and that of the control group was 1 (IQR; 1–2) ( p = 0.040). When Nelson grade-2 and above was accepted as the pathological limit, it was found that 27.5% of the study group and 15.2% of the control group showed pathological findings ( p = 0.204). Conclusions: In patients with CCH, damage occurs in the tarsal conjunctiva with the effects of redundant conjunctival folds. In these patients, atrophy occurs in the meibomian glands and tear stability is impaired. Therefore, CCH should not be overlooked in clinical practice.