Dynamic changes in the tear film in dry eyes

PURPOSE: To examine the dynamics of the tear film in patients with dry eye by measuring the wavefront aberrations of the anterior surface of the film. METHODS: Anterior surface aberrations for a 7-mm pupil were determined in 13 patients with dry eye at 1-second time intervals, for 15 seconds after a blink. The aberrations were calculated from the elevations provided by corneal topography. All data were decomposed using Zernike polynomials. Total, spherical, and comalike aberrations terms were studied separately. Results were compared with those in normal eyes. Outcome measures included comparison with clinical tear breakup time measurements. RESULTS: The total root mean square (RMS) wavefront aberration in patients with dry eye passed through in a minimum of 2.9 +/- 0.4 seconds after a blink in comparison to the minimum at 6.1 +/- 0.5 seconds in normal patients. In both groups, the minimum in total aberration appeared to be associated with similar changes in comalike aberrations, rather than in spherical aberrations, which increased monotonically with time. The time at which minimum RMS aberration occurred correlated reasonably well with the measured tear breakup times. CONCLUSIONS: Measurements of the dynamic changes in the optical aberrations introduced by the anterior tear film surface give valuable insights into tear film changes and may provide a convenient objective method for the diagnosis of dry eye.     

干眼患者使用表面麻醉剂后泪河形态的改变

目的：探讨干眼患者使用表面麻醉剂后泪河的变化。
　　方法：随机选取干眼患者50例。随机选取一眼滴用表面麻醉剂纳入试验组,另一眼用9g/L生理盐水点眼纳入对照组,点药15 min 后通过眼前节相干光学断层扫描仪( anterior segment optical coherence tomography,AS-OCT)记录并比较两组的泪河高度( tear meniscus height,TMH)、泪河深度( tear meniscus depth,TMD)以及泪河横截面面积( tear meniscus area,TMA)。
　　结果：表面麻醉剂使用后TMH为0.173±0.040mm,TMD为0.166±0.019mm,TMA为0.049±0.013mm2,与点药前相比,差异均有统计学意义( tTMH=2.78,P<0.01;tTMD=2.31,P<0.01;tTMA=2.69,P<0.01),点药后两组相比,差异均有统计学意义(tTMH=5.87,P<0.01;tTMD=2.04,P<0.05;tTMA=4.63,P<0.01)。
　　结论：表面麻醉剂减少干眼患者泪液分泌量,临床工作中应加强预防和干预。     

人工泪液对糖尿病干眼患者泪河的影响

目的探讨2型糖尿病干眼患者使用人工泪液后泪河的变化。方法随机选取2型糖尿病干眼患者50例(100眼)、正常对照者50例(100眼)。糖尿病干眼患者使用人工泪液眼液治疗1个月。采用眼前节相干光学断层扫描仪记录并比较治疗前后患者的泪河高度(tear meniscus height,TMH)、泪河深度(tear meniscus depth,TMD)以及泪河横截面面积(tear meniscus area,TMA)。结果治疗前糖尿病干眼组TMH为(0.184±0.036)mm,正常对照组(0.218±0.041)mm(t=6.232,P<0.01);糖尿病干眼组TMD为(0.165±0.017)mm,正常对照组(0.192±0.009)mm(t=14.037,P<0.01);糖尿病干眼组TMA为(0.021±0.082)mm2,正常对照组(0.052±0.013)mm2(t=3.734,P<0.01)。糖尿病干眼组使用人工泪液1个月后TMD为(0.197±0.014)mm,TMH为(0.181±0.012)mm、TMA为(0.049±0.051)mm2,各项均较使用前显著增加(TMH:t=3.366、P<0.01;TMD:t=7.689、P<0.01;TMA:t=2.900、P<0.01)。结论人工泪液可以有效地改善糖尿病干眼患者的泪河状态,眼前节光学相干断层扫描仪可以作为糖尿病干眼诊断和疗效评价的重要手段,但具体的评估标准有待更大样本、更加详细的临床研究。     

Slow-release artificial tear inserts in the treatment of dry eyes in patients with rheumatoid arthritis.

Twenty-two patients with rheumatoid arthritis and moderate to severe bilateral keratoconjunctivitis sicca were treated with artificial tears and a soluble slow-release artificial tear insert in a crossover trial. While using the inserts all but two patients reported an improvement in their symptoms. All the patients showed an improvement in the degree of conjunctival and corneal staining while using the inserts (p = 0.0001 and 0.00001 respectively). Nineteen patients (86%) found the inserts an acceptable form of therapy and 14 (64%) preferred them to other treatment regimens. Placement of the insert was not a problem despite all the patients having rheumatoid changes in their hands resulting in varying degrees of deformity. Two patients experienced initial difficulties with placement, but these were quickly resolved.     

Slow-release artificial tear inserts in the treatment of dry eyes resulting from the oculomucocutaneous syndrome.

Patients with dry eyes resulting from the practolol syndrome present a therapeutic challenge. Very frequent instillation of preservative-free drops are the only therapy in most cases. Using an entirely new agent--a hydrophilic polymer in insert form--we have provided in this open study an alternative therapy which shows some subjective and objective advantages. Few patients experienced problems, and none left the study because of failure of retention of the insert. Some patients preferred the cooling, soothing effects of frequent drops. The problems in mounting a clinical trial of this sort are discussed.     

Effect of topical cyclosporine on tear functions in tear-deficient dry eyes

We evaluated the efficacy of topical 2% cyclosporine drops in the treatment of tear-deficient dry eye because of acquired primary lachrymal disease (APLD; 15 patients) and Sjögren syndrome (SS; 15 patients). Symptoms of dryness tended to improve in patients with SS. Schirmer score improved in patients with APLD. Topical CsA 2% drops appears to be safe and effective in the treatment of dry eye patients because in patients with APLD and SS, there is trend toward improvement.     

应用角膜地形图仪观察老年干眼患者最早泪膜破裂位置

目的:观察老年干眼患者最早泪膜破裂位置的特征。方法:横断面研究。选取2019-07/12在我院诊治的老年干眼患者154例267眼,143眼为右眼,124眼为左眼。其中男71例,女83例,年龄68~90(平均73.40±4.13)岁。应用角膜地形图仪对患者进行最早发生泪膜破裂位置的测量,破裂位置以仪器观察的角膜方位按逆时针顺序分为4个区域,分别对应右眼的鼻上、颞上、颞下、鼻下4个区域和左眼的颞上、鼻上、鼻下、颞下4个区域。记录哪个区域泪膜最先出现破裂,同时记录最早破裂位置距角膜中心的距离。结果:右眼出现泪膜首先破裂最多的区域为鼻下(28.7%),然后是颞下(27.3%)、鼻上(20.3%)、颞上(11.2%),同时出现2~3个区域泪膜破裂占12.6%。左眼出现泪膜首先破裂最多的区域也为鼻下(31.5%),然后是颞下(25.0%)、鼻上(23.4%)、颞上(11.3%),同时出现2~3个区域泪膜破裂占8.9%。双眼之间泪膜破裂区域构成比的比较无差异(χ2=1.443,P=0.837)。双眼鼻下方泪膜破裂位置距角膜中心距离均以>1.5~2mm和>2~2.5mm为主。结论:老年干眼患者泪膜的破裂位置有一定的规律,双眼泪膜首次破裂均以角膜鼻下方为主,双眼没有显著性差异。     

Post-blink tear film dynamics in healthy and dry eyes during spontaneous blinking

Purpose

The aim was to investigate the dynamics of post-blink tear film leveling in natural blinking conditions (NBC) for healthy subjects and those diagnosed with dry eye syndrome (DES) and to relate this phase to the tear film surface quality (TFSQ) before the following blink.

A classification for dry eyes following comparison of tear thinning time with Schirmer tear test.

In a double-blind study a non-invasive method of examining the stability of the precorneal tear film was used to record tear thinning time on a population of 34 independently diagnosed dry eye patients. The results were compared with those for tear output, as inferred from the standard Schirmer tear test, and a correlation coefficient of 0.20 determined. The mean tear thinning time and Schirmer results for the population sample were 6.87 +/- 2.97 sec, and 5.62 +/- 5.69 mm wetting in 5 min, respectively. From a plot of tear thinning time against Schirmer a simple classification for dry eyes can be made. A Type A with normal tear stability and low output accounting for 14.70% of the dry eyes. A Type B with low tear stability and normal output, also accounting for 14.70% of the dry eyes. A Type C with low stability (less than 9.84 sec), and low output (less than 11.31 mm wetting in 5 min) accounting for 70.60% of the dry eyes.     

A new noninvasive tear stability analysis system for the assessment of dry eyes

PURPOSE: This was a prospective case-control study conducted to evaluate the effectiveness of the Tear Stability Analysis System (TSAS) for the assessment of patients with dry eye. METHODS: The TSAS can take 10 consecutive corneal topograms at one per second for 10 seconds. Examinations using the TSAS were conducted in 26 eyes of 26 healthy control subjects and in 27 eyes of 27 patients with dry eye. Examinations were also conducted in 14 eyes of 14 patients before and after the insertion of punctum plugs. Surface regularity and asymmetry indices (SRI, SAI), as well as new tear stability regularity and asymmetry indices (TSRI, TSAI), derived from SRI and SAI, were analyzed. RESULTS: The mean SRI and SAI in dry eyes were significantly greater than in control eyes (P < 0.05). The time-wise change of SRI and SAI was significantly different between dry eyes and control eyes (P < 0.05). TSRI and TSAI in dry eyes were also significantly greater than in control eyes. Punctum plug insertion was associated with a significant decrease in SRI and SAI (P < 0.05). CONCLUSIONS: TSAS was effective in objectively assessing the tear stability in patients with dry eye. This system may be useful in noninvasive diagnosis of dry eye and evaluation of treatment effects.     

The effects of artificial tear application on contrast sensitivity in dry and normal eyes

PURPOSE: To investigate the effects of artificial tear application on contrast sensitivity in dry and normal eyes. METHODS: A total of 55 patients with normal (10/10) corrected or uncorrected visual acuity referring to GATA Gulhane Military Medical Academy Haydarpasa Ophthalmology Outpatient Clinic were evaluated in regard to dry eye diagnostic criteria, and assigned into the dry eye group (Group 1; 35 patients) and the control group (Group 2; 20 patients). All patients were given a contrast sensitivity testing at low and high spatial frequencies using the gradual contrast sensitivity chart before and at 5 minutes after application of artificial tears, and the two groups were compared. Wilcoxon test was used in statistical analysis, accepting a p value of <0.05 as significant. RESULTS: In the dry eye group, there was a statistically significant increase in contrast sensitivity scores both at low and high frequencies after application of artificial tears (p<0.05). In the control group, although there was a significant increase in low frequency scores after artificial tear application (p< 0.05), there was not a significant change in high frequency scores (p>0.05). CONCLUSIONS: The decreased contrast sensitivity in dry eyes improves with application of artificial tears. Therefore, the impeded quality of vision seen in dry eye patients could be restored closer to normal with artificial tear therapy. Besides, contrast sensitivity testing could be used in the follow-up of artificial tear therapy.     

泪液渗透压在干眼发病机制中的作用及诊疗进展

干眼是一种以眼表稳态丧失,泪膜不稳定性增加为特征的多因素疾病,伴有眼干涩、异物感、灼烧感、眼红、疼痛、畏光、流泪、眼疲劳、视力下降、分泌物增多、对外界刺激敏感等眼部症状,其病理生理机制主要是泪膜不稳定、泪液渗透压(tear osmolarity, Tosm)升高、眼表炎症和损伤及神经感觉异常。Tosm是维持泪膜稳定性和眼表舒适度的重要因素。Tosm升高可造成干眼患者眼部不适、角膜上皮损伤、杯状细胞丢失及眼部炎症反应,炎症反应可进一步降低泪膜稳定性和增加Tosm,使干眼陷入恶性循环。为了更全面地了解泪液高渗(tear hyperosmolarity, THO)与干眼的关系,本文将从病理生理学方面,重点讨论THO在干眼发病机制、干眼诊断、干眼严重程度分级中的作用,及其针对性治疗。     

Botulinum toxin A treatment in patients suffering from blepharospasm and dry eye

BACKGROUND: Many patients with essential blepharospasm also show dry eye signs and symptoms. Botulinum toxin A is an effective treatment for reducing spasms in these patients. In this investigation, the effect of botulinum toxin A injections on tear function and on the morphology of the ocular surface in patients suffering from blepharospasm in combination with a dry eye syndrome was investigated. METHODS: Botulinum toxin A injections were applied to 16 patients with blepharospasm. All patients complained of dry eye symptoms and had reduced tear break up time values. A subjective questionnaire and ocular examinations including tear break up time, Schirmer test without local anaesthesia, and rose bengal staining were evaluated before, 1 week, 1 month, and 3 months after injection. Impression cytology was performed before, 1 month, and 3 months after botulinum toxin A treatment. RESULTS: Although all patients were relieved of blepharospasm after botulinum toxin injections, only three noticed an improvement in dry eye symptoms. Eight patients noticed no difference and five complained of worsening. Tear break up time was found to be increased 1 week and 1 month after injections. Schirmer test measurements were reduced up to 3 months. Rose bengal staining slightly increased 1 week after injections. Impression cytology showed no definite change in conjunctival cell morphology 1 month and 3 months after botulinum toxin A injections. CONCLUSION: In the patients presented here suffering from blepharospasm and dry eye, botulinum toxin A injections were effective in relieving blepharospasm but were not successful in treating dry eye syndrome.     

水液缺乏型干眼和混合型干眼患者睑板腺形态及功能差异

目的 探讨水液缺乏型干眼和混合型干眼患者睑板腺形态及功能差异.方法 选取四川大学华西医院2018年9月至12月眼科门诊收治的干眼患者67例(67眼),其中水液缺乏型干眼患者32例32眼(水液缺乏型组),混合型干眼患者35例35眼(混合型组).分别统计两组患者眼表疾病指数问卷调查表得分,采用LipiViewⅡ眼表面干涉仪...     

普拉洛芬滴眼液治疗干眼症疗效观察

目的：观察1g/L普拉洛芬滴眼液治疗干眼症的疗效。方法：选择我院2011-01/12门诊诊断为干眼症的患者100例,随机分成A、B两组,A组：1g/L普拉洛芬滴眼液及1g/L玻璃酸钠滴眼液联合应用,4次/d点眼,1滴/次。B组：1g/L玻璃酸钠滴眼液单独应用,4次/d点眼,1滴/次。试验疗程为14d。所有的患者符合入选标准,用药前及用药后14d观察患者的问卷评分、SchirmerI试验、角膜荧光素染色评分。比较两组的结果,进行统计分析。结果：1g/L普拉洛芬滴眼液及1g/L玻璃酸钠滴眼液联合应用治疗干眼症患者的效果明显优于单纯使用1g/L玻璃酸钠滴眼液治疗组,两组结果差异有统计学意义。结论：1g/L普拉洛芬滴眼液治疗干眼症,对于缓解症状,改善角膜情况效果良好。     

Central corneal thickness of patients with dry eyes

Central corneal thickness was measured in 16 patients with clinical signs and symptoms of dry eyes. When compared to a control group of equal size with normal tear film physiology, no significant difference in central corneal thickness was found.