Capsaicin-induced pain sensitivity in short tear break-up time dry eye

PurposeTo evaluate transient receptor potential vanilloid 1 (TRPV1)-mediated pain sensitivity in patients with short tear break-up time (TBUT) dry eye (DE) by using the capsaicin stimulus test.MethodsThis prospective cross-sectional comparative study included 22 eyes of 22 patients with short TBUT DE and 11 eyes of 11 non-DE control subjects. Patients were divided into two groups based on response to standard DE treatments: 10 non-responders (intractable DE) and 12 responders (responsive DE). Mechanical touch (M-touch) and mechanical pain (M-pain) were measured using a Cochet-Bonnet esthesiometer. Capsaicin-induced pain (C-pain) and C-pain duration (C-pain DT) were measured using a capsaicin stimulus test. Psychological distress was also assessed.ResultsM-touch sensitivity was similar among all three groups. M-pain sensitivity was higher in the responsive DE group than in the intractable DE and control groups (P < .001). C-pain sensitivity was lower (P < .001) in the intractable DE group than in the responsive DE and control groups, and C-pain DT was shorter (P = .006) in the intractable DE group than in the responsive DE group. Psychological distress was higher in the intractable DE group than in the control group (P < .001).ConclusionsPatients with intractable short TBUT DE were less sensitive to the effects of capsaicin than patients with responsive short TBUT DE and controls. Altered neural activation may contribute to the development of DE symptoms in the short TBUT DE subjects. The capsaicin stimulus test may be used to better understand pain sensitivity in short TBUT DE patients.     

Short tear film breakup time-type of dry eye in India

Purpose:The aim of this study was to describe the clinical characteristics and risk factors of short tear film break-up time (TBUT) type of dry eye disease and compare it with other types of dry eye diseases.Methods:This cross-sectional study included 570 patients (≥ 20 years) from the outpatient department using systematic random sampling.Results:The age-adjusted prevalence of short TBUT type of dry eye disease was 5.4% (95% confidence interval: 3.2–6.8%). There was no difference (P > 0.05) between the total and subscale scores of the Ocular Surface Disease Index^® questionnaire between patients with short TBUT and those with aqueous tear deficiency. Both these groups differed significantly (P < 0.05) in the findings of TBUT, Schirmer I test, and Lissamine green staining score. The common symptoms in patients with short TBUT type of dry eye disease were eye fatigue (25.4%), heaviness in the eye (19.7%), and an uncomfortable sensation (14.1%). The symptoms in the aqueous tear deficiency group were light sensitivity (28.2%), dryness (19.2%), burning (13.0%), foreign body sensation (12.8%), and blurring of vision (14.1%). The risk factors associated with short TBUT type of dry eye disease were the presence of meibomian gland dysfunction (odds ratio: 3.759 [95% confidence interval: 2.135–6.618], P < 0.0001) and female sex [odds ratio: 1.954 (95% confidence interval: 1.042–3.667), P = 0.037].Conclusion:Patients with short TBUT type of dry eye disease have symptom severity similar to aqueous tear-deficient dry eyes, but the pattern is different. The finding of this type of dry eye disease in India indicates its global presence, and ophthalmologists should consider it in their differential diagnoses.     

Autologous platelet-rich plasma eye drop versus artificial tear eye drop for symptomatic dry eye disease: A prospective comparative interventional study

Purpose:To evaluate and compare the efficacy of autologous platelet-rich plasma (aPRP) eye drop and artificial tear (AT) eye drop in moderate to severe symptomatic dry eye disease (DED).Methods:This prospective interventional study included 121 eyes of 61 patients of moderate to severe DED. Patients were divided into aPRP (31 patients) and AT (30 patients) group. Ocular Surface Disease Index (OSDI) score, tear film breakup time (TBUT) (s), corneal fluorescein staining (CFS) score, and Schirmer test score (mm) of both the groups were evaluated and compared pre-treatment and post-treatment at the end of 3 months.Results:The mean age of the aPRP group and AT group was 52.8 ± 12.8 years and 55.5 ± 13.4 years, respectively. At the end of 3 months, OSDI score reduced more in the aPRP group as compared to AT group, and the mean difference (−22.7) was statistically significant (P < 0.001). There was no significant difference in post-treatment Schirmer test score between the two groups (P = 0.44). Post-treatment improvement in TBUT and CFS score in the aPRP group was significantly higher in the aPRP group as compared to that in the AT group (P < 0.05). Bruising at the site of blood withdrawal was noted in two patients in the aPRP group.Conclusion:aPRP is safe and more effective than AT in treating patients with moderate to severe symptomatic DED.     

Role of transient receptor potential melastatin 8 activity in menthol-induced cold sensitivity and its qualitative perception in dry eye

PurposeTo evaluate the role of transient receptor potential melastatin 8 (TRPM8) activity in menthol-induced cold sensitivity and its qualitative perception in patients with dry eye (DE).MethodsThis prospective, cross-sectional, comparative study included 52 eyes of 52 subjects (mean age: 66.8 ± 9.2 years; range: 44–86) with a tear break-up time (TBUT) of ≤5 s. The participants were classified into three groups: 17 patients with DE symptoms and keratoconjunctival (KC) staining scores of ≥3 points (positive KC-DE group), 18 patients with DE symptoms and KC staining scores of <3 points (negative KC-DE group), and 17 individuals with KC staining scores of <3 points and no symptoms (non-DE control group). The menthol-induced cool sensation (M-cool) and TBUT were measured after administration of 2 μl of 1.0 mM menthol eye drops. Furthermore, participants answered a questionnaire regarding their stimulus perception (pleasant, unpleasant, or neither).ResultsM-cool values were similar in the three groups. TBUT significantly increased in the negative KC-DE and control groups (P < 0.05) and remained unchanged in the positive KC-DE group (P > 0.05) after menthol administration. DE patients reported the sensation as pleasant or unpleasant, whereas most control participants were indifferent (P < 0.05).ConclusionsWhile M-cold sensitivity was similar in DE and control groups, its qualitative perception differed between these groups. Thus, TRPM8 activation at the peripheral level alone may not be sufficient to account for the manifestation of discomfort symptoms associated with DE.     

Assessment of Corneal Parameters with Scheimpflug Imaging in Patients with Ankylosing Spondylitis

Purpose: To evaluate corneal parameters of patients with ankylosing spondylitis (AS) by Scheimpflug imaging and also to clarify the associations between disease severity and clinical status of AS and corneal parameters. Methods: Fifty-seven patients with AS and 57 healthy subjects were included in this cross-sectional study. All participants underwent a detailed ophthalmological evaluation. Corneal parameters were measured by Pentacam. In addition, Schirmer test, tear break-up time (TBUT), corneal fluorescein staining, and Ocular Surface Disease Index (OSDI) scores were evaluated. Duration of disease and scores of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Quality of Life scale (ASQoL) of the patients were recorded. The laboratory evaluation consisted of human leukocyte antigen (HLA)-B27, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Results: Corneal parameters were significantly different between patients with AS and healthy controls. The mean central corneal thickness (538?±?26?µm versus 569?±?27?µm, p?3 versus 62.3?±?3.40?mm³, p?p?Conclusion: The AS patients have thinner corneas compared to control subjects, which may be affected by tear disfunction and inflammatory processes.     

The effect of smoking on ocular surface and tear film based on clinical examination and optical coherence tomography

Purpose:Smoking is a global health problem with a high burden of smokers in India and the world as well. Smoking is a known eye irritant that may have a significant effect on the anterior ocular surface. Hence, the present study was aimed to investigate the effect of smoking on dry eye parameters, ocular surface, and central corneal thickness (CCT) and to compare the results with nonsmokers.Methods:In this cross-sectional study, 40 (80 eyes) smokers and 40 (80 eyes) age-matched nonsmokers were included. The severity of ocular surface disease symptoms was assessed by the Ocular Surface Disease Index (OSDI) tool. All participants underwent a series of measurements, that is, the Schirmer’s II test score and tear breakup time (TBUT). Tear meniscus height (TMH) and CCT were measured using anterior segment optical coherence tomography (OCT).Results:The mean value of all dry eye parameters was statistically different among the group of smokers and nonsmokers. The mean score of symptomatic assessment (OSDI) was observed to be significantly higher in smokers than in nonsmokers (P < 0.0001), and dry eye parameters, that is, Schirmer’s score (P = 0.0127), TMH (P < 0.0001), and TBUT (P < 0.0001) were significantly lower among smokers than nonsmokers. There was no significant difference in CCT between smokers and nonsmokers (P = 0.06).Conclusion:Cigarette smoking has deteriorating effects on the ocular surface. Exposure to smoking was found to be associated with dryness of the eye. Further studies are needed on a molecular basis.     

Dry eye and percentage of body fat: a cross-sectional prospective study

Background

Dry eyes are common in the general population. Some studies associate high prevalence of dry eyes with lipid metabolic changes and body fat composition.

Aim

To study the association of dry eye with percentage of body fat.

Methods

One hundred and thirty five individuals (44 males and 91 females; median age of 42 years) were studied in a cross-sectional prospective study. Schirmer test and TBUT (tear breakup time) test were used to access dry eye. Body composition (percentage of lean and fat mass) were calculated using anthropometric measurements that included height, weight, abdominal, waist and neck circumference.

Results

About 44.4% of the sample had abnormal Schirmer test, and 70.3% had abnormal TBUT. Schirmer tests values were associated with age (p?=?0.0006) female gender (p?=?0.04) and percentage of body fat (p?=?0.02). Abnormal TBUT test associated only with age (p?=?0.0005).

Conclusions

Percentage of body fat is associated with abnormal Schirmer but not TBUT test.

     

The association of vitamin D deficiency with tear break-up time and Schirmer testing in non-Sj?gren dry eye

Purpose

To investigate the effect of vitamin D deficiency on tear break-up time (TBUT) and Schirmer test scores and to assess their relationship in non-Sjögren dry-eye patients.

Methods

Thirty-four patients with serum vitamin D deficiency and 21 control subjects with normal vitamin D levels were included in this study. The TBUT and Schirmer-1 test without topical anesthesia were performed to all patients.

Results

The mean TBUT were 5.18±2.15 and 7.36±3.10 s and Schirmer scores were 12.18±6.44 and 18.57±8.99 mm in the study and control groups, respectively. TBUT scores and Schirmer-1 results of the study group were significantly lower than the control group (P=0.01 and 0.007, respectively). The mean vitamin D levels were 11.50±1.8 ng/ml in the study group and 32.8±8.72 ng/ml in control group (P=0.001). Dry-eye symptoms were detected in all patients in the study group and 15% of the patients in the control group.

Conclusions

We demonstrated that vitamin D deficiency decreases the TBUT and Schirmer test values and may be associated with dry-eye symptoms in non-Sjögren syndrome.     

Evaluation of tear osmolarity and tear function in patients with Behçet’s syndrome

Objective

To evaluate the effects of Behçet’s syndrome (BS) on tear osmolarity and tear film function tests.

The ocular surface in children: A review of current knowledge and meta-analysis of tear film stability and tear secretion in children

Purpose

A review of ocular surface and meta-analysis of tear stability (tear break up time, TBUT) and tear secretion (Schirmer test) values in healthy children was conducted.

Evaluation of Plasma Vitamin A and E Levels and Tear Film Changes in Patients with Psoriasis Vulgaris

Purpose

To evaluate whether alterations in plasma vitamin A and E levels in patients with psoriasis have an effect on tear film changes.

Methods

Sixty-two eyes of 31 patients with psoriasis vulgaris (Group A) and 74 eyes of 37 age- and gender-matched control subjects (Group B) were included in the study. Ocular and medical histories and dietary habits were obtained from each patient. The tear film break-up time (TBUT), the Schirmer 1 test results and plasma vitamin A and E levels were evaluated.

Results

The mean Schirmer 1 test score was 14.76 ± 6.12 mm/5 min in Group A and 15.69 ± 3.10 mm/5 min in Group B. The mean plasma levels of vitamins A and E in Groups A and B were 1.86 ± 0.62 µmol/L and 1.88 ± 0.65 µmol/L vs. 26.21 ± 5.13 µmol/L and 27.19 ± 8.89 µmol/L, respectively. The Schirmer 1 test results and plasma vitamin A and E levels were not found to be significantly different between the groups (p > 0.05). The mean TBUT was 9.94 ± 6.18 seconds in Group A and 14.47 ± 5.65 seconds in Group B, a significant difference (p < 0.05). No correlation existed between plasma vitamin A and E levels, TBUT or the severity and duration of the disease (p > 0.05).

Conclusions

Plasma vitamin A and E levels do not seem to be related to tear film changes in patients with psoriasis vulgaris.     

A study of the association between Vitamin D deficiency and Dry Eye Syndrome (DES) in the Indian population

Purpose:A study of the association between vitamin D deficiency and dry eye syndrome (DES) in the Indian population.Methods:This was a cross-sectional, hospital-based observational study. Sixty patients diagnosed with vitamin D deficiency (<20 ng/dl) who met the inclusion criteria were sent to the Eye OPD from the Endocrinology OPD (case) were compared to 60 subjects with normal vitamin D levels (≥20 ng/dl) who attended the Eye OPD (controls). The examination of the tear film was done using Whatman filter paper in Schirmer test I and Schirmer test I (with anesthesia). The tear film break-up time (TFBUT) was determined by slit-lamp examination using the fluorescein stain, and scoring using the ocular surface disease index (OSDI) was done.Results:A significant difference in the mean values of Schirmer I and Schirmer I test (with anesthesia) (P < 0.001) was seen between the case and control groups. A significant difference in the mean values of TFBUT (P < 0.001) and OSDI scores (P < 0.01) was also seen between the two groups.Conclusion:A positive association was found between vitamin D deficiency and dry eye on comparing the above parameters.     

Tear Film and Ocular Surface Evaluation in Gestational Diabetes Mellitus

Background: Dry eye syndrome is one of the complaints of diabetic patients. The aim of the present study was to evaluate the tear functions in pregnant women with gestational diabetes mellitus (GDM) using tests: Schirmer, tear break-up time (TBUT), and tear film osmolarity (TFO) tests and the Ocular Surface Disease Index score (OSDI). Methods: Pregnant women with GDM (Group 1, n=46) and healthy pregnant women (Group 2, n=36) were enrolled. Initially, all participants were asked to answer the OSDI and then they underwent a detailed ophthalmic examination including Schirmer, TBUT, and TFO tests. The individuals with ocular or systemic disorders that might affect the tear function tests and who were using topical medications were excluded. Results: The results of Schirmer, TBUT, TFO tests and OSDI scores were 11.20±4.93 mm, 5.59±2.16 sec, 309.65±14.80 mOsm/L, and 9.59 ± 9.69 in Group 1, respectively, and 12.33±5.33 mm, 5.67±2.68 sec, 308.36±16.00 mOsm/L, and 10.62±8.66 in Group 2, respectively. There was no significant difference in any of the tear function tests and OSDI scores between the study groups (p>0.05). Conclusion: GDM seems to have no negative effects on tear function tests. This may be due to a lack of duration of hyperglycemia long enough to affect the tear function tests of pregnant women.     

HUMAN TEAR VOLUME, QUALITY AND EVAPORATION: A COMPARISON OF SCHIRMER, TEAR BREAK-UP TIME AND RESISTANCE HYGROMETRY TECHNIQUES

Abstract A group of 10 subjects had their tears evaluated by the Schirmer and tear break-up time (TBUT) tests and their rate of tear evaporation measured by resistance hygrometry. No significant relation was found between the evaporation of the tears and the results obtained by either the Schirmer or the TBUT test. No correlation was found between the Schirmer and the TBUT test results. A significant increase in tear evaporation rate was however produced by the instillation of fluorescein during the TBUT test and by the application of Schirmer strips during the Schirmer test. It is concluded that the Schirmer and TBUT tests measure different features of the tears and these features are not related to the rate of tear evaporation.     

Keratoconjunctivitis sicca in juvenile rheumatoid arthritis

PURPOSE: To compare the symptoms, signs, and results of objective tests for keratoconjunctivitis sicca (KCS) in patients with juvenile rheumatoid arthritis (JRA) and controls. METHODS: Sixty-four patients with JRA and 64 age- and sex-matched controls were compared in terms of symptoms, signs, and results of objective tests for KCS. Relation between tear film breakup time (TBUT), Schirmer test results, and JRA-related variables such as age of onset, duration, and type of JRA; presence of antinuclear antibodies (ANAs); and history of uveitis were evaluated. Analysis of variance, multivariate regression analysis, Kruskall-Wallis, Student t tests, and chi tests were used for statistical analysis. RESULTS: Twelve and a half percent of patients with JRA complained of dry eye symptoms compared with 1.5% of the controls (P = 0.031). Dry eye signs were detected in 10.9% of patients with JRA compared with 1.5% of controls (P = 0.038). TBUT and Schirmer test results were lower in the JRA group than in controls (P = 0.032 and P = 0.029, respectively). Seven patients (10.9%) had definite and 1 (1.5%) had probable diagnosis of KCS in the JRA group compared with no children in the control group (P = 0.034). Within the JRA group, Schirmer test and TBUT results were significantly lower in male patients and ones with longer duration of disease. CONCLUSIONS: The prevalence of symptoms, signs, and definite diagnosis of KCS is higher and basal tear secretion and tear film stability are lower in children with JRA than in controls. Among children with JRA, male sex and longer duration of disease are independent risk factors for having decreased basal tear secretion and tear film stability.     

角膜塑形镜对青少年眼表和泪膜的影响

目的：观察夜戴型角膜塑形镜矫正青少年近视对眼表和泪膜的影响及眼表不适症状。

方法：前瞻性研究。选取12～18岁近视患者69例138眼,其中使用框架眼镜者31例,使用角膜塑形镜者38例。分别于戴镜1、3、6、12mo时进行眼表疾病指数(OSDI)和眼表染色评分(Oxford法),检测泪膜破裂时间(TBUT)、非接触性泪膜破裂时间(NIBUT)及基础泪液分泌量。

结果：与框架眼镜组和戴镜前比较,戴镜后各时间点角膜塑形镜组患者OSDI评分升高,TBUT和NIBUT均降低,且戴镜6、12mo时角膜塑型镜组患者眼表染色评分均高于框架眼镜组(均P<0.05),但戴镜前后两组患者基础泪液分泌量无明显差异(P>0.05)。

结论：角膜塑形镜会导致OSDI和眼表染色评分轻度升高,影响泪膜稳定性,应加强眼表和泪膜情况的戴镜前检查和随访,重视患者的不适主诉。     

Tear Condition Following Unilateral Ptosis Surgery

Purpose: To evaluate changes in tear film condition following unilateral ptosis surgery.

Methods: This interventional case series includes patients with unilateral blepharoptosis scheduled for ptosis surgery with no prior history of eye disease and surgery over a 2-year period. Tear film evaluation before surgery were performed, which included Schirmer test with and without anesthesia, and tear break up time (TBUT). Ptosis surgery included levator resection and frontalis sling. The previously mentioned tests were repeated 1, 3, and 6 months after surgery. Subjective symptoms related to dry eye also evaluated before and after surgery.

Results: A total of 83 patients including 46 (55.4%) male subjects with mean age of 26.2?±?16.2 years were enrolled in the study. The most common cause of ptosis was congenital in 77 (92.8%) patients. Surgical intervention included levator resection in 56 (67.5%) cases and frontalis sling procedure in 27 (32.5%) cases. The result of surgery was good in 47 (56.6%) patients while under- and overcorrection were observed in 32 (39.8%) and 3 (3.6%) patients, respectively.

Schirmer’s test with and without anesthesia and TBUT after surgery revealed a decrease in tear quantity and quality after surgery with time. Patients who had subjective complaints from dryness after surgery only had shorter TBUT among the objective signs.

Conclusions: Ptosis surgery can decrease the quantity and quality of tears in operated eyes. Since some of these patients may need other types of operations in future, such as refractive or cataract surgery, evaluation of the tear condition before further surgery is prudent.     

The Correlation of Routine Tear Function Tests and Conjunctival Impression Cytology in Dry Eye Syndrome

Purpose

To establish the strength of the association between routine tear function tests and conjunctival impression cytology (CIC) and to determine whether they simulate the morphological and cytological changes that occur on the ocular surface in dry eye. What are the sensitivity, specificity and positive predictive values of these tests when CIC is considered the gold standard?

Methods

The tear film profile included tear film break up time (TBUT), Schirmer''s-1, Rose Bengal scores (RBS), and impression cytology. CIC samples were obtained from the inferior bulbar conjunctiva and stained with periodic acid-Schiff and counter stained with hematoxylin and eosin.

Results

The mean Schirmer''s value was 11.66 ± 5.90 in patients and 17.17 ± 2.97 in controls (p < 0.001). The mean TBUT in participants was 8.88 ± 3.54 and 13.53 ± 2.12 in controls (p < 0.001). Patients had a mean goblet cell density (GCD) of 490 ± 213, while the value for controls was 1,462 ± 661 (p < 0.001). Abnormal CIC was observed in 46.7% cases of dry eye and in 32.8% of controls. The correlation coefficient (L) for Schirmer''s was 0.2 and 0.24 for participants and controls, respectively, while TBUT values were 0.26 and 0.38, RBS were 0.5 and 0.5, and GCD was 0.8 and 0.6 in cases and controls, respectively.

Conclusions

GCD, RBS, and TBUT were better predictors of morphological and cytological changes in the conjunctiva than Schirmer''s in dry eye syndrome. The sensitivity of tear function tests in diagnosing dry eye was TBUT > Schirmer''s > RBS, and the specificity was Schirmer''s > TBUT > RBS in decreasing order when CIC was considered the gold standard.     

Study of tear function and the conjunctival surface in diabetic patients

ObjectivesThis study was performed to investigate whether different grades of diabetic retinopathy correlate with tear and ocular surface function in diabetic patients without subjective symptoms of dry eye.MethodsA total of 129 eyes of 72 patients without dry eye, assessed using McMonnies questionnaire were recruited to the study. The tear film and ocular surface were evaluated using the Schirmer test, tear film break-up time (BUT), fluorescein and lissamine green staining test, and conjunctival impression cytology. The results were analysed.ResultsA normal Schirmer test and BUT was obtained in 51 and 67% of the eyes of diabetics patients, respectively. Fluorescein and lissamine green staining were negative in 81 and 95% of the eyes. The area and density of goblet cells was 580.46 ± 370 μm² and 235.58 ± 109.03 goblets cell/mm², respectively.ConclusionsDiabetic retinopathy patients without subjective symptoms of dry eye and normal Schirmer and BUT test showed pathological grades of squamous metaplasia.