A clinical study of correlation between pterygium and dry eye

To study the clinical correlation between pterygium and dry eye and to evaluate the status of tear film in patients with pterygium.100 eyes with pterygium were compared with 100 control eyes without pterygium. Patients between 20–70 years were included in the study. Detailed history was taken and Schirmer’s test and TBUT were performed on all to evaluate the status of dry eye. Schirmer’s test ˂10 mm and TBUT ˂10 seconds was considered abnormal. Maximum number (52) of patients affected with dry eye in both the groups were in the age group 31-40 years which statistically showed age as a significant factor of association for both pterygium and dry eye (P<0.01). Schirmer’s test was slightly reduced in patients with pterygium(18.73±5.69 mm). TBUT was significantly reduced in the case group (12.26±2.24sec). TBUT decreased maximally in 51-60 yrs age group (13.00±2.77sec) with pterygium showing a tear film unstability. On comparison of pterygia and controls with normal and abnormal tear film, Odd’s Ratio was 1.14 showing risk of dry eye in pterygia patients to be 1.14 times higher than controls. A close relationship exists between ocular irritation symptoms and functional evidence of tear instability. Schirmer’s test and TBUT should routinely be used in the outpatient department to diagnose dry eye in patients with pterygium and these patients should be promptly treated to prevent any sight threatening complications.

Evaluation of Tear Film Urea Level as a Diagnostic Marker of Dry Eye Disease: A Pilot Study

Introduction Urea secreted in the sweat is important for skin moisture. Similarly, ocular surface moisture is maintained by the conjunctiva. Based on this, the level of urea in tear film can be used as a potential diagnostic test for dry eye disease (DED). One of the standard tests for DED is Schirmer's test (ST). The aim of this study was to compare tear film urea to values of ST. Methods Fifty patients symptomatic for DED having ST ≤ 10 mm/5 min were enrolled in the study. Fifty age- and sex-matched asymptomatic subjects with ST > 10 mm/5 min were taken as controls. All patients were subjected to an estimation of tear film urea, collected using micropipettes, and analyzed by an Erba Chem 5 semi-autoanalyzer. Based on the ST reading as per the Dry Eye Workshop 2007 (DEWS) classification, dry eye was classified as dry eye (≤ 10 mm/5 min), severe dry eye (≤ 5 mm/5 min), and very severe dry eye (≤ 2 mm/5 min). Tear film urea values were compared with ST values that were considered standard. Statistical analysis was done using Medcalc version 19.7. A p-value ≤ 0.05 was considered significant. Results The mean tear film urea levels in cases were (26.78 ± 5.70 mg/dL) significantly lower compared with controls (41.72 ± 6.86 mg/dL). The area under the receiver characteristic operator curve (AUC) for tear film urea in diagnosing DED was 0.936 (p < 0.0001) with a cutoff of ≤ 37.2 mg/dL, yielding a sensitivity of 96% and a specificity of 76%. For diagnosing severe DED, the AUC for tear film urea was 0.824 (p < 0.0001) with a cutoff value of ≤ 23.4 mg/dL, yielding a sensitivity of 60.8% and a specificity of 92.59%. For diagnosis of very severe DED, the AUC for tear film urea was 0.972 (p < 0.0001) with a cutoff value of ≤ 19.8 mg/dL, yielding a sensitivity of 100% and a specificity of 93.62%. On comparing ST values to tear film urea, the regression coefficient was 0.85 (p < 0.0001), suggesting a linear relationship between ST and tear film urea. Conclusion The study demonstrates that tear film urea can be a potential diagnostic marker for DED. The study also indicates that tear film urea level is linearly related to Schirmer's test values and provides an approximate diagnostic cutoff level for the design of future large-scale studies.

ASSESSMENT OF PREVALENCE OF DIGITAL EYE STRAIN AMONG DIGITAL SCREEN USERS IN SETTING OF COVID-19 PANDEMIC.

AIMS AND OBJECTIVES: To assess the impact of the increased digital device usage and its ocular surface health implications along with circadian rhythm abnormalities related to digital eye strain during COVID-19 pandemic. METHODS: A validated questionnaire was provided to all the participants and various symptoms people experienced were analyzed. Dry eye tests were performed in all the study subjects. RESULTS: A total of 256 participants were included of which 88.3% of subjects reported an increase in their screen time since the onset of pandemic. The average increase in digital device usage was calculated at about 4.4 ± 1.9 h per day. The total usage per day was found to be7.85 ± 3.63 hours. Sleep disturbances have been reported by 59.8% of participants. Typically, 93% of respondents had experienced at least one symptom related to digital device usage, and 66.4% said that the frequency and intensity of these symptoms increased since the pandemic started. Dry eye diagnosed clinically by Schirmer's test was present in 18.8 % of participants. CONCLUSION: The study highlights the increase in usage of digital devices after the onset of the COVID-19 pandemic leading to increase in digital eye strain across all age groups.

A comparative assessment of dry eye disease among outdoor street sweepers and indoor office cleaners

Background Occupational predisposition to dry eye disease is known. Simultaneous exposure to multiple factors may pose more risk. Street sweepers are exposed to sunlight in addition to dust which all sweepers are exposed to. Tropical climate predisposes to significant exposure to sunlight. Combined exposure to dust and sunlight may lead to a synergy of factors. This study aims to assess the prevalence of dry eye disease (DED) amongst Street sweepers and Office cleaners in Calabar metropolis. Methods A cross-sectional study was conducted among street sweepers and office cleaners. A systematic random sampling and multi-stage sampling method were used to select street sweepers (n = 115) and office cleaners (n = 115) respectively for the study. A pretested semi-structured interviewer-administered questionnaire was used to obtain information after which the respondents had an ophthalmic examination. An assessment of DED was done with Ocular Surface Disease Index (OSDI) questionnaire, Schirmer’s test, and tear break up time (TBUT). OSDI scores of 33 and above; Schirmer’s test readings of < 10 mm wetting in 5 min and a TBUT of less than 10s in either eye were considered as positive dry eye disease. Results The majority of respondents were females 215(93.5%) compared to males 15 (6.5%). The overall mean age of respondents was 40.96 ± 9.8 years. The average OSDI score, Schirmer’s test as well as TBUT among participants was 26.4 ± 16.0, 16.44 ± 9.52 mm, and 12.38 ± 4.53 s respectively. The prevalence of DED among Street sweepers was 35.7% compared to 20% among office cleaners using the OSDI questionnaire (p = 0.352). The prevalence of DED among street sweepers was 32.2% compared to 30.4% among Office cleaners using the Schirmer’s test. (p = 0.73) The TBUT reported a prevalence of 38.3% of DED among Street sweepers compared to 32.2% in office cleaners. (p = 0.48) Overall; the prevalence of dry eye disease among Street sweepers and office cleaners using OSDI score, Schirmers test, as well as TBUT were not statistically significant (> 0.05) Street Sweepers had higher odds of developing dry eye disease compared to office cleaners (OR = 2.085; C.I. =1.106–3.929; p = 0.02). Negative correlation coefficient was observed between TBUT and OSDI (rs = − 0.102; p = 0.125). This was not statistically significant. Conclusion Street sweepers had a higher prevalence of dry eye disease compared to office cleaners due to a higher risk of increased exposure to environmental factors such as dust, smoke, and sunlight. This effect is possibly due to a synergy of factors. Studies on dose-response are warranted.

Assessment of Dry Eye Syndrome among Computer Programmers in Computer Training Institutes in Benin City

Purpose: The purpose of this study was to evaluate dry eye syndrome among computer programmers in computer training institutes in Benin City.Methods: This cross-sectional study was carried out using 250 participants of 18 years and above who were computer instructors and students of various computer training institutes in Benin City. Sociodemographic data and relevant ocular history were obtained from the participants. External and Internal examinations of the eyes were carried out to check for the presence of any ocular abnormalities. Dryeye disease was assessed subjectively with the Ocular Surface Disease Index (OSDI) questionnaire and objectively by performing Schirmer’s test and Tear Break-up Time (TBUT). Participants with an OSDI score of ≥35 and who had < 10mm to Schirmer’s I test or < 10secs in Tear break-up Time (TBUT) test were considered to have dry eye.Results: The mean age of the participants was 25.32 ± 7.38 years and 68% were males. The prevalence of dry eye among the computer programmers was found to be 30.8%. Mean TBUT and Mean Schirmer’s Test value for those with dry eye was 10.21s±3.44s and 12.46 ± 7.27mm respectively. This study showed that age (p=0.213), gender (p=0.243) and duration of time spent on computer display units (p=0.124) were not statistically significant determinants of dry eye among the computer programmers.Conclusion: Computer programmers are predisposed to developing dry eye diseases. It is therefore imperative for them to go for regular eye examination to prevent ocular surface disorders and therefore maintain comfortable vision. Keywords: Dry Eye, Schirmer Test, Tear Break-up Time, Ocular Surface Disease Index, Computer Programmer.

Evaluation of dry eye subtypes and characteristics using conventional assessments and dynamic tear interferometry

Background/aimsTo evaluate subtypes and characteristics of dry eye (DE) using conventional tests and dynamic tear interferometry, and to investigate determinants of disease severity in each DE subtype.Methods309 patients diagnosed with DE and 69 healthy controls were prospectively enrolled. All eyes were evaluated using Ocular Surface Disease Index (OSDI), Schirmer’s test I (ST1) and Meibomian gland dysfunction (MGD) grade were analysed. The tear interferometric pattern and lipid layer thickness were determined using DR-1α and LipiView II, respectively.ResultsDynamic interferometric analysis revealed 56.6% of patients with DE exhibited Jupiter patterns, indicative of aqueous-deficiency, while 43.4% exhibited crystal patterns, indicative of lipid deficiency. These findings were in accordance with classification based on ST1 scores and MGD grade. Conventional assessment indicated 286 patients exhibited evidence of evaporative DE (EDE) due to MGD, while only 11 exhibited signs of pure aqueous-deficient DE (pure ADDE, only ST1 ≤5 mm). Interestingly, of 286 patients with EDE, 144 were categorised into the mixed-ADDE/EDE group, in which ST1 was identified as a strong negative determinant of OSDI. In contrast, 72.2% of patients with mixed-ADDE/EDE exhibited Jupiter patterns (Jupiter mixed), while 27.8% exhibited crystal patterns (crystal mixed). OSDI values were significantly higher in the crystal-mixed group than in the Jupiter mixed, in which OSDI scores were independently associated with ST1 values only.ConclusionsOur findings indicate that majority of EDE patients also exhibit aqueous deficiency, which can aggravate symptoms even in patients with lipid-deficient mixed-ADDE/EDE. Conventional assessments should be combined with interferometric tear analysis to determine the most appropriate treatment for each DE patient.

AB0162 OCULAR MANIFESTATIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:Rheumatoid arthritis (RA) is the most common systemic autoimmune disease and is associated with a number of extra-articular organ manifestations, including ocular complications.Objectives:The aim of this study is to evaluate the frequency and characteristics of ocular manifestation in patients with rheumatoid arthritis (RA).Methods:The study involved 87 patients with RA. All the study subjects underwent complete ophthalmological examination involving visual acuity assessment, examination of anterior and posterior eye segments, Schirmer’s test, diameter and mobility of pupils, as well as eyeball mobility assessment of intraocular pressure. Data regarding age, gender, disease duration, age at diagnosis, systemic corticosteroid use, blood pressure, ocular symptoms and detailed ophthalmic history were recorded. The presence of rheumatoid factor in serum was evaluated by standard test methods based on principle of agglutination. All patients were seropositive.Results:87 patients (26 male, 59 female, mean age 45,6 ± 13,1 years; mean disease duration 7,4 ± 6,2 years) with RA were enrolled in this study. 31 (35,63 %) of them had no ocular symptoms. Among the patients with ocular symptoms, 39 (69,64 %) complained of decreased vision, 33 (58,93 %) - of dry eye, 32 (57,14 %) - of burning, 29 (51,78 %) -photophobia, 28 (50 %) - of gritty sensation, 27 (48,21 %) - of itching, 18 (32,14 %) - of redness, 13 (23,21 %) - of ocular pain, 3 (5,36 %) - of floaters. Ophthalmological examination revealed higher incidence of the following abnormalities in the study group: myopic astigmatism - in 10 (5,74 %) eyes, vascular abnormalities within fundus - in 22 (12,64 %) eyes, increased intraocular pressure (> 21 mm Hg) - in 11 (6,32 %) eyes. Mean IOP values were 17,34 ± 5,12 mm Hg. In 48 eyes Schirmer’s test results were below 10 mm, and in 18 eyes - below 5 mm. Keratoconjunctivitis sicca was present in 31 (35,63 %) of all patients. Episcleritis was diagnosed in 4 patients (4,6 %), scleritis – in 3 (3,45 %). Retinal vasculitis was present in 2 (2,3 %) patients and involves veins and arteries peripheral branches. Lens opacity was found in 13 (14,94 %) patients (21 eyes), mostly in the form of posterior subcapsular cataract (in 16 eyes) and nuclear cataract (in 5 eyes). The mean age of patients with cataracts was 52,3 ± 14,2 years. 13 of the patients with cataracts were either currently taking or had previously taken systemic corticosteroids.Conclusion:In patients with RA numerous abnormalities within the vision of organ may be found. Ocular symptoms are relatively common complications of RA, and may result in irreversible changes in the organ of vision. Regular ophthalmological examinations are essential among the patients with RA.Disclosure of Interests:None declared

Application of the OMERACT Grey-scale Ultrasound Scoring System for salivary glands in a single-centre cohort of patients with suspected Sjögren’s syndrome

AimTo describe salivary gland involvement in patients suspected of Sjögren’s syndrome (SS) using the OMERACT Ultrasound Scoring System for SS. Next, using different ultrasound cut-offs, to assess the performance of the scoring system for diagnosis and fulfilment of 2016 ACR/EULAR SS classification criteria.MethodsAll patients referred to our department with a suspicion of SS in a 12-month period were included. All underwent grey-scale ultrasound of the parotid and submandibular glands prior to clinical examination, Schirmer’s test, unstimulated salivary flow, blood samples including autoantibody analysis. Labial biopsy was performed according to clinicians’ judgement. Images of the four glands were scored 0–3 according to the scoring system and a consensus score was obtained using a developed ultrasound atlas.ResultsOf the 134 patients included in the analysis, 43 were diagnosed with primary SS (pSS) and all fulfilled the 2016 American College of Rheumatology (ACR)/EULAR classification criteria. More patients with pSS compared with non-pSS had score ≥2 in at least one gland (72% vs 13%; p<0.001). In patients with score ≥2 in any gland, significantly more had positive autoantibodies, sialometry, Schirmer’s test and positive labial biopsy compared with those with scores ≤1. The best ultrasound cut-off value for diagnosing pSS was ≥1 gland with a score ≥2 (sensitivity=0.72, specificity=0.91).ConclusionThe OMERACT Ultrasound Scoring System showed good sensitivity (0.72) and excellent specificity (0.91) for fulfilling 2016 ACR/EULAR criteria using cut-off score >2 in at least one gland. Our data supports the use of ultrasound for diagnosing pSS and supports incorporation of ultrasound in the classification criteria.

The Effectiveness of a Balanced Salt Solution on Dry Eyes in Comatose Patients: A Randomized Trial

Objective: Dry eye is one of the complications of hospitalization in ICUs. This study was conducted to assess the effectiveness of a Balanced Salt Solution (BSS) on dry eyes in comatose patients. This clinical trial was conducted in 2019 on 34 patients admitted to the ICUs. The control group received sterile eye ointment with artificial tears (2 drops every 6 hours) and a tape over the eye. The trial group also received BSS (2 drops every 6 hours) in the opposite eye over five days. The patients' dry eye was examined on first day and sixth day of the study using Schirmer’s Test (ST) and the Tear Breakup Time Test (TBUT). The data were analyzed in SPSS-21.Results: The results of the paired T-test based on ST and TBUT showed no significant change from first day one to sixth day in the BSS-receiving group (P>0.999 and P=0.187, respectively). Furthermore, no significant difference was observed between the two groups in the mean score of dry eye after eliminating the effect of the demographic and clinical variables (P=0.947). The administration of this solution by nurses seems to be an effective method for preventing the progression of dry eye in ICU patients.

Topical Cyclosporine A 0.05% for the Treatment of Dry Eye Disease

Dry eye disease (DED) is a common clinical condition that challenges ophthalmologists. Topical Cyclosporine A is an anti-inflammatory therapy being approved by the Food and Drug Administration (FDA) for the therapy for DED. This study aimed to evaluate the efficacy and pa- tient tolerability of topical Cyclosporine A 0.05% for the treatment of DED. A total of 87 patients diagnosed with DED were included in this study. Dry eye symptoms (foreign body sensation, burn- ing, and pain) were scored. As a baseline measurement, the tear break-up time test (TBUT) and the Schirmer’s test were performed for all the patients. Cyclosporine A 0.05% was given topically twice daily to all the patients for four months. They were followed up every month for a period of four months. The clinical signs (Schirmer’s test, the TBUT), and the symptoms scores, were record- ed for each visit. The mean age of the patients was 57.25±9.70 years (Range 32 - 80 years); 25 males (28.7%) and 62 females (71.3%). Out of them, 23 (26.4%) cases had Sjögren’s syndrome, and 12 (13.7%) cases had previous LASIK (laser in-situ keratomileusis). The symptoms score of the cases improved from (4.95±1.73) pretreatment to (0.40±.70) four months after treatment (P <0.001). The Schirmer’s test results improved from (4.10 ±1.089) pretreatment to (10.80±2.40) four months post-treatment (P <0.0001), and the TBUT test results improved from (5.54±1.77 s) pre- treatment to (12.95±3.12 s) four months post-treatment (P <0.0001). Only seven patients (8%) de- veloped ocular side effects in the form of redness, pain, and systemic side effects in the form of headache. In conclusion, Cyclosporine A 0.05% eye drops is an effective treatment for DED, im- proving both signs and symptoms of DED with few ocular side effects.