Effects of aerobic exercise on tear secretion and tear film stability in dry eye patients

Background To study the effects of aerobic exercise (AE) on tear secretion and tear film stability in dry eye patients. Methods This study consisted of two parts, each part included 3 groups, namely dry eye without AE group, dry eye with AE group and pre-clinical dry eye with AE group. In part 1, we studied the variations of Schirmer I test and six tear compositions before and after AE (34 eyes in each group). In part 2, we studied the variations of tear meniscus height, first and average non-invasive tear breakup time (F-NITBUT and A-NITBUT), lipid layer thickness, number of incomplete and complete blinks, partial blink rate (PBR) and visual acuity before and after AE (30 eyes in each group). Results In dry eye with AE group, Schirmer I test at 0 min after AE increased significantly compared to baseline (P < 0.001), the oxidative stress marker 8-hydroxy-2′-deoxyguanosine after AE decreased significantly compared to baseline (P = 0.035, P = 0.045), F-NITBUT and A-NITBUT after AE prolonged significantly compared to baseline (P < 0.001, P = 0.007, P = 0.036; P < 0.001, P = 0.001, P = 0.044), number of incomplete blinks and PBR at 10 min after AE decreased significantly compared to baseline (P < 0.001; P < 0.001) while number of complete blinks increased significantly (P < 0.001). Besides, significant differences were also found between dry eye with AE group and dry eye without AE group at all above corresponding time point (P < 0.05). Conclusion AE promotes tear secretion and improves tear film stability in dry eye patients. AE may be a potential treatment for dry eye. Trial registration Chinese Clinical Trial Registry, ChiCTR2000038673. Registered 27 September 2020,

Repeatability and Reproducibility of SMTube Measurement in Dry Eye Disease Patients

Purpose. To evaluate the intraobserver repeatability and interobserver reproducibility of Strip Meniscometry Tube (SMTube) and determine the correlations among the SMTube measurements and other ocular examinations in dry eye disease (DED) patients. Methods. The study recruited 73 eyes of 49 DED patients. Every subject was subjected to the following five measurements sequentially: the Ocular Surface Disease Index (OSDI) questionnaire, Tear Meniscus Height (TMH) assessment, SMTube measurements, tear film breakup time (BUT) examination, and Schirmer I test (SIT). The repeatability and reproducibility of the measurements were assessed by the intraclass correlation coefficient (ICC) and the Bland–Altman analysis, and the correlations were evaluated by the Spearman rank-order correlation. Results. The repeatability and reproducibility of the SMTube measurements were good in DED patients. The ICCs between the repeatability and reproducibility of the SMTube measurements were 0.789 and 0.741, respectively, and the Bland–Altman 95% limits of the repeatability and the reproducibility were −1.726 to 1.658 and −0.967 to 1.474, respectively (all P < 0.01 ). The SMTube measurements had correlations with TMH, BUT, and SIT. The Spearman rank correlation coefficients between SMTube and TMH; SMTube and Schirmer I test; and SMTube and BUT were 0.632, 0.617, and 0.653, respectively (all P < 0.01 ). Conclusions. The measurements of the SMTube may provide a novel, swift, noninvasive, and convenient approach to screen and diagnose DED with acceptable repeatability and reproducibility and specific correlations with TMH, BUT, and SIT.

Clinical efficacy of OASIS Preloaded Punctal Plug in Comparison to Smart Plug Punctal Plug in Aqueous-Deficient Dry Eye Disease

BackgroundAt present, there are few clinical studies comparing OASIS preloaded punctal plug and Smart Plug punctal plug for dry eye. This study intends to evaluate the effect of OASIS preloaded punctal plug versus Smart Plug punctal plug in the treatment of aqueous-deficient Dry Eye. Methods47 patients with aqueous-deficient dry eye were selected and randomly divided into control group and experimental group. The control group was treated with Smart Plug punctal plug treatment, and the experimental group was treated with OASIS preloaded punctal plug treatment. The OSDI questionnaire score, Schirmer I test and BUT results before and after treatment, and the incidences of postoperative complications were compared between the two groups. Follow up for six months. ResultsThe results of this study showed that compared with before treatment, the OSDI scores of patients were significantly improved at 6 months after treatment in both the experimental group and control group. After treatment, there was no significant difference in OSDI score, Schirmer I test, and BUT level between the two groups. Besides, the Smart Plug punctal plug treatment group had a significant improvement in BUT at 3 months after operation compared with before treatment. ConclusionThe OASIS preloaded punctal plug is comparable to the Smart Plug punctal plug in treating aqueous-deficient dry eye, and both can significantly improve dry eye symptoms. Furthermore, the OASIS preloaded punctal plug can facilitate intraoperative procedures, lacrimal punctum expansion and plug implantation can be completed in one step, and the loss of embolization before implantation and the abnormal implantation due to the expansion of the embolic volume can be reduced, which is worthy of clinical application.Clinical registration number: researchregistry6629; Registered 4 March 2021 - Retrospectively registered

Oral Vitamin D3 Supplementation for Femtosecond LASIK–Associated Dry Eye

Purpose: To assess the effect of oral vitamin D3 supplementation in dry eye after femtosecond laser-assisted in situ keratomileusis (FS-LASIK).Setting: Liuzhou Worker’s Hospital.Design: This prospective study included 90 patients selected between January and December in 2019, who underwent fs-lasik operation in our hospital and had obvious symptoms indicating dry eyes one month after operation. The subjects were randomly divided into two groups: the experimental group (n = 45) received vitamin D3 2000 IU / D continuously for 12 weeks; the control group (n = 45) did not take vitamin D3 orally. Ocular surface disease index（OSDI）, tear breakup time（TBUT）and Schirmer’s Test I were evaluated pre-medication and 1,3,6 months after treatment. Serum vitamin D level, and the mean concentration of cytokine IL-6, IL-17, IL-23 in tears were also measured. Results: One month after treatment, the mean OSDI score of the experimental group (11.67 ± 8.53) was significantly lower than that of the control group (23.82 ± 13.22) (P = 0.007). TBUT (10.71±1.02s) and Schirmer I (9.36±0.40mm) of the experimental group were higher than those of the control group (7.49±1.29 s and 7.51±0.44 mm). The OSDI (10.25 ± 5.49), TBUT (10.75±1.09 seconds) and Schirmer I test value (11.34±0.39 mm) of the experimental group were significantly lower than those of the control group (20.22±6.23, 8.36±1.23， 8.12±0.50) at 3 months after treatment. There were significant differences in OSDI, TBUT (P ＜ 0.05) and Schirmer I test value between the two groups at 6 months after treatment. Serum vitamin D3 level was negatively correlated with OSDI score (r=-0.90；P=0.00), and positively correlated with Schirmer I test (r=0.88；P=0.00), TBUT score (r=0.89；P=0.00) and TMH (r=0.80；P=0.00). IL-17 level was shown to be significantly correlated with TBUT (r=-0.25, P=0.014) and Schirmer I test (r=-0.21, P=0.018). IL-6 level was significantly correlated with OSDI (R=0.18, P = 0.020) and TBUT (R=0.20, P = 0.019).

Reliability and efficacy of maximum fluorescein tear break-up time in diagnosing dry eye disease

This study aims to investigate the reliability and efficacy of maximum fluorescein tear break-up time (FTBUTmax) in diagnosing dry eye disease (DED). 147 participants were enrolled in this study. Ocular symptoms were assessed by Ocular Surface Disease Index (OSDI). The fluorescein tear break-up time (FTBUT) examination, corneal fluorescein staining (CFS), and Schirmer I test were performed on both eyes. Each participant underwent 3 consecutive FTBUT tests, and five types of FTBUT values including FTBUTmax, the minimum FTBUT (FTBUTmin), the first FTBUT (FTBUT1), the average of three FTBUTs (FTBUT123) and the average of the first and second FTBUT (FTBUT12) were recorded. FTBUTmax was larger than the other FTBUT values, but no differences were found among the values of FTBUT1, FTBUT123, FTBUT12 and FTBUTmin. In the ROC analysis, FTBUTmax had the largest or the second largest area under the ROC (AUROC) in all three DED diagnostic criteria, while FTBUTmin had the least AUROC of them. ROC efficacy of FTBUTmax was significantly higher than that of FTBUT123, FTBUT12, FTBUT1 and FTBUTmin in the OSDI criteria and higher than that of FTBUT1 and FTBUTmin in Schirmer I test and CFS tests. FTBUTmax has a close correlation with OSDI, Schirmer I test and CFS, and is an effective tool for the DED diagnosis.

Corneal nerve structure in patients with primary Sjögren’s syndrome in China

Background The aim of this study was to evaluate the in vivo confocal microscopic morphology of corneal subbasal nerves and its relationship with clinical parameters in patients with primary Sjögren’s syndrome in China. Methods This was a case control study of 22 dry eye disease (DED) patients with primary Sjögren’s syndrome (pSS) and 20 control subjects with non-Sjögren dry eye disease (NSDE). Each patient underwent an evaluation of ocular surface disease using the tear film break-up time (TBUT), noninvasive tear film break-up time (NIKBUT), noninvasive tear meniscus height (NIKTMH), corneal staining (National Eye Institute scale, NEI), Schirmer I test, meibography, and corneal subbasal nerve analysis with in vivo confocal microscopy (IVCM). The right eye of each subject was included in this study. Results SS patients showed a shorter TBUT (P = 0.009) and Schirmer I test results (P = 0.028) than the NSDE group. However, there was no significant difference in NIKBUT between the two groups (P = 0.393). The nerve density of subbasal nerves, number of nerves and tortuosity of the SS group were significantly lower than those of the NSDE group (P = 0.001, P < 0.001 and P = 0.039, respectively). In the SS group, the mean nerve length was correlated with age and the Schirmer I test (r = − 0.519, P = 0.013 and r = 0.463, P = 0.035, respectively). Corneal staining was correlated with nerve density and the number of nerves (r = − 0.534, P = 0.013 and r = − 0.487, P = 0.025, respectively). Conclusions Sjögren syndrome dry eye (SSDE) patients have more severe clinical dry eye parameters than non-Sjögren dry eye disease (NSDE) patients. Compared with NSDE patients, we found that SSDE patients showed decreased corneal subbasal nerve density and numbers.

Tear Meniscus, Corneal Topographic and Aberrometric Changes After Botulinum Toxin-A Injection in Patients With Blepharospasm and Hemifacial Spasm

Purpose: To investigate the effect of Botulinum neurotoxin-A (BTX-A) treatment on dry eye symptoms, tear meniscus, corneal topography and corneal aberrometry in patients with benign essential blepharospasm (BEB) and hemifacial spasm (HFS).Materials and Methods: This prospective study comprised of 32 eyes from 8 BEB and 24 HFS patients. Tear meniscus height (TMH) and depth (TMD), tear break-up time (TBUT), corneal fluorescein staining score (CFSS), Schirmer I test, ocular surface disease index (OSDI) score, corneal topography [corneal power of flat axis (K1), corneal power of steep axis (K2), mean corneal power (Km), astigmatism and thinnest pachymetry] and anterior corneal aberrometry [spherical aberration (SA), vertical coma (vcoma), horizontal coma (hcoma), higher order root mean square (hRMS) and total RMS] were evaluated before BTX-A treatment and 3 weeks after BTX-A treatment.Results: 3 weeks after BTX-A injection TMH (265.9±116.4 µm vs. 347.1 ± 172.6 µm; p < 0.001) and TMD (178.1 ± 57.7 µm vs. 221.4 ± 90.3 µm; p < 0.001) showed a significant increase. TBUT, CFSS, Schirmer I test values were similar (p > 0.005). OSDI scores decreased significantly from 27.8 ± 26.1 to 18.4 ± 19.8 (p = 0.04). K2 (44.1 ± 1.7 D vs. 43.9 ± 1.7 D p = 0.009), Km (43.7 ± 1.6 D vs. 43.6 ± 1.6 D p = 0.025) and astigmatism (0.9 ± 0.6 D vs. 0.7 ± 0.5 D; p = 0.02) values improved significantly at 3 weeks. Pachymetry and aberrometric values did not change significantly.Conclusion: BTX-A injection increases tear meniscus and decrease symptoms related to dry eye disease in BEB and HFS patients. It decrease astigmatism and keratometry values but it does not cause a significant change in corneal aberrations.

Correlation between Non-Invasive Tear Breakup Time and Invasive Tear Breakup Time for Dry Eye Syndrome Diagnosis

Introduction: in today’s digital environment, dry eye complaints step forward in all age groups. Along with dry eye syndrome, the diagnosis of which is not complicated, there are other causes of dryness such as dysfunction of the tear film and Meibomian glands, etc. For the early detection of the above conditions, invasive diagnostic methods are mainly used.Aim: to compare Non-Invasive Tear Breakup Time (NITBUT) assessed with LacryDiag ocular surface analyzer to results of invasive tests for dry eye syndrome diagnosis to determine the possibility of a wider use of LacryDiag in practical ophthalmology. Materials and Methods: 50 patients with dry eye, burning and feeling of a foreign body complaints participated in this study. Mean age amounted to 28.85 ± 5.86 years. NITBUT was assessed with LacryDiag ocular surface analyzer. The data obtained was compared to the results of Invasive Tear Breakup Time (TBUT) – Norne test, and Schirmer I test.Results: both quantitative and qualitative values of tear film stability were analyzed in all participants. Based on results of the Schirmer I test, patients were divided into subgroups: where it was greater than 21 mm, between 11 and 20 mm, between 6 and 10 mm, and less than 5 mm/ The mean value of the Schirmer I test result amounted to 15.32 ± 6.05 mm/5 min, NITBUT amounted to 9.59 ± 4.37 s, while invasive TBUT amounted to 8.98 ± 3.79 s. It was found that invasive TBUT is in a strong direct correlation with NITBUT values (p <0.001, r = 0.554). No correlation was discovered between Schirmer I test results and TBUT (p = 0.15, r = 0.207) as well as between Schirmer I test result and NITBUT (p = 0.17, r =0.228). No correlation was found between the optical power of the cornea and the tear film structure abnormalities.Conclusion: a strong correlation was found between results of invasive and non-invasive methods of tear film breakup time assessment. No correlation was found between the optical power of the cornea and the tear film disruption. The non-invasive test was found to be an effective and objective method for diagnosing dry eye.

Reliability and Efficacy of Maximum Fluorescein Tear Break-Up Time in Diagnosing Dry Eye Disease

This study aims to investigate the reliability and efficacy of maximum fluorescein tear break-up time (FTBUTmax) in diagnosing dry eye disease (DED). 147 participants were enrolled in this study. Ocular symptoms were assessed by Ocular Surface Disease Index (OSDI). The fluorescein tear break-up time (FTBUT) examination, corneal fluorescein staining (CFS), and Schirmer I test were performed on both eyes. Each participant underwent 3 consecutive FTBUT tests, and five types of FTBUT values including FTBUTmax, the minimum FTBUT (FTBUTmin), the first FTBUT (FTBUT1), the average of three FTBUTs (FTBUT123) and the average of the first and second FTBUT (FTBUT12) were recorded. FTBUTmax was larger than the other FTBUT values, but no differences were found among the values of FTBUT1, FTBUT123, FTBUT12 and FTBUTmin. In the ROC analysis, FTBUTmax had the largest or the second largest area under the ROC (AUROC) in all three DED diagnostic criteria, while FTBUTmin had the least AUROC of them. ROC efficacy of FTBUTmax was significantly higher than that of FTBUT123, FTBUT12, FTBUT1 and FTBUTmin in the OSDI criteria and higher than that of FTBUT1 and FTBUTmin in Schirmer and CFS tests. FTBUTmax has a close correlation with OSDI, Schirmer I test and CFS, and is an effective tool for the DED diagnosis.

Efficacy of bandage contact lens for the management of dry eye disease after cataract surgery

Purpose We aimed to evaluate the efficacy of bandage contact lens (BCL) for the management of dry eye disease (DED) after cataract surgery. Methods A total of 120 patients (140 eyes) with age-related cataract and DED were enrolled in this study. Patients underwent standard micro-incision phacoemulsification surgeries and were divided into control or BCL groups. Slit-lamp biomicroscopic examination, Ocular Surface Disease Index, keratograph analysis and Schirmer I test were executed, and the levels of tear inflammatory molecules were detected. Results In the control group, the NIAvg-BUT and Schirmer I test scores were significantly decreased at 1 week post-operation compared with baseline levels (P = 0.035 and P = 0.009, respectively). In the BCL group, the NIF-BUT and Schemer I test scores were significantly improved at 1 month after operation compared with the control group (P = 0.012 and P < 0.001, respectively). Levels of IL-6, IL-8 and ICAM-1 were significantly increased in the control group at 1 month after the operation (P = 0.005, P = 0.038 and P = 0.022, respectively), while there was no difference in the BCL group. The increase in the IL-6 level in the control group was significantly higher compared with that in the BCL group (P = 0.047). In DED patients, there were significant correlations between ocular surface parameters and inflammatory molecules. Conclusions Cataract surgery could lead to the development or worsening of DED. The application of BCLs after cataract surgery could stabilize the ocular surface and tear film, improve the corneal healing and reduce the inflammation. Collectively, our findings suggested that proper use of BCLs after cataract surgery played an effective role in the management of DED. Trial registration ClinicalTrials, NCT04100031. Registered 18 September 2019—retrospectively registered