绝经后干眼症妇女泪液与血清雌激素质量浓度的分析

目的测定绝经后干眼症妇女泪液与血清中雌二醇的质量浓度,探讨与干眼症发病的关系。方法取绝经后干眼症32例,正常对照30例,均检测右眼。用化学发光法测定绝经后干眼症患者泪液和血清中的雌二醇的质量浓度,所得数据用非参数检验的Mann-Whitney检验和Spearman秩相关分析。采用印迹细胞学法取得被测定者的球结膜上皮细胞,用扫描电镜观察眼表的超微结构变化。结果绝经后干眼症组泪液和血清的雌二醇质量浓度较正常对照组差异均有统计学意义（P=0.001）。正常对照组泪液与血清中的雌二醇质量浓度呈正相关。绝经后干眼症组泪液与血清中的雌二醇质量浓度无明显相关。绝经后干眼症患者眼表出现明显的病理变化。结论绝经后干眼症患者泪液中雌二醇质量浓度较正常对照组明显降低。血清和泪液中的雌二醇质量浓度在绝经前存在正相关性,而绝经后二者无相关性。     

人工泪液治疗儿童干眼症的疗效观察

目的:观察人工泪液治疗儿童干眼症的疗效及安全性.方法:对58例116眼经泪膜破裂时间(tear break-up time,BUT)、泪液分泌试验(Schirmer Ⅰ test,SⅠt)、泪河高度、角膜荧光染色、睑板腺功能检查方法确诊为干眼症的儿童患者进行人工泪液治疗,疗程为1 mo,复查时再次行上述检查,对各观察指标进行统计分析.结果:儿童于眼症患者58例116眼治疗前BUT为6.03±1.19s,SⅠt为7.67±2.32mm/5min,泪河高度为0.20±0.02mm,角膜荧光染色为1.02±0.13分,睑板腺功能评分为2.45 ±0.86分.其中31例62眼为脂质缺乏型干眼、20例40眼为水液缺乏型干眼、7例14眼为其他类型.根据其分型,给予相应的人工泪液治疗,治疗1mo后患者的临床症状明显改善,BUT为13.72±1.83s,SIt为12.38±3.64mm/5min,泪河高度为0.36±0.08mm,角膜荧光染色为0.03±0.24分,睑板腺功能评分为1.57±0.93分.各观察指标与治疗前相比,差异具有统计学意义(P＜0.05).所有患者在治疗期间均未出现任何不良反应.结论:利用人工泪液治疗儿童干眼是安全、有效的.     

Smart PLUG泪小管栓子对干眼症治疗的初步评价

目的评价Smart PLUG泪小管栓子在干眼症治疗中的效果。方法 13例水液性泪液不足型(aque- ous tear deficiency,ATD)干眼症患者,其中Sjogren’s syndrome(SS)4例(8只眼),非Sjogren's syndrome9例(18只眼),应用Smart PLUG泪小管栓子治疗,在治疗前及治疗后1d、10 d、1m、3m分别对视力、干眼症状、泪河线、泪膜破裂时间(BUT)、Schirmer I a实验、荧光素染色(Fl)、每日需用人工泪液次数及治疗后可能出现的副反应进行检查并记录。结果应用Smart PLUG泪小管栓子治疗干眼后不同时间两组患者的干眼症状均有不同程度改善,每日需用人工泪液次数明显减少,最佳矫正视力不同程度提高,泪河线增加;BUT延长、基础泪液分泌增加、荧光素染色评分下降,与治疗前比较差异均具有显著性(P<0．05)。治疗期间未观察到副反应发生。结论Smart PLUG泪小管栓子可用于干眼的治疗,是治疗干眼症简便、安全的方法。     

干眼症患者泪液中表皮生长因子的含量分析

目的验证干眼症泪液中EGF的含量及与健康人的差别。方法对干眼症患者用放射免疫法检测泪液中的EGF的含量,所得数据利用Independent Sample T Test分析,结果干眼症组泪液中EGF的含量与对照组相比都有统计学意义上的降低（P=0.012）。结论干眼症患者泪液中的EGF含量都比健康人的低,为干眼症的诊断治疗开阔了更广阔的空间。     

干眼症患者泪液清除荧光素钠的临床研究

目的:探讨干眼症患者泪液清除荧光素钠溶液的速率变化。方法:选取干眼症患者30例,将20g/L荧光素钠溶液6μL一次滴入下结膜囊内,在裂隙灯下观察结膜囊内泪液中荧光素钠的消失时间,并与同期正常30人对照。结果:本组干眼症患者泪液荧光素钠的清除时间右眼为2229.18±488.37s,左眼为2239.71±478.99s。正常人泪液荧光素钠的清除时间右眼为1173.35±161.79s,左眼为1188.92±200.32s。经Origin6.0统计软件分析,两组间存在显著性差异(P<0.01)。结论:干眼症患者泪液清除荧光素钠的时限较正常人明显延长。干眼症患泪液清除时间的延长是干眼症发病机制中的一种补偿机制,对干眼症患者有益。     

干眼症患者对比敏感度的测定

目的:研究干眼症对比敏感度的变化及通过对比敏感度测试来评价人工泪液对干眼症患者视功能的影响。方法:确诊为干眼症患者25例50眼和正常人15例29眼,分别测量BUT(泪膜破裂时间)、SⅠt(泪液分泌基础实验)和泪膜干涉图像,并采用OPTEC6500视功能测试仪分别测量干眼症患者和正常人应用人工泪液前后的对比敏感度。主要观察指标包括BUT、SⅠt、泪膜干涉图像及低、中、高频CS。结果:本研究中按临床症状、BUT,SⅠt和泪膜干涉图像试验结果将受试者分为干眼症组和正常对照组,两组年龄比较无统计学差异。干眼症患者低、中、高频CS均低于正常组(P<0.05)。应用人工泪液5min后,发现干眼症组低、中、高频CS都有显著提高(P<0.05);且干眼症组应用人工泪液后的对比敏感度与对照组相近。结论:干眼症的低对比敏感度可以通过人工泪液的使用加以改善,通过人工泪液治疗不但可以缓解症状而且使干眼症的视觉质量接近正常人标准;另外,对比敏感度测试可以作为一种客观的非接触的评价泪膜质量的方法,为干眼症的治疗疗效提供客观依据。     

环孢素滴眼液联合人工泪液治疗干眼症的临床观察

目的：探究环孢素滴眼液联合人工泪液对干眼症的治疗效果。
　　方法：收集2015-01/11间在我院眼科门诊进行治疗的干眼症患者102例204眼作为研究对象,随机分为3组：对照组、人工泪液组、环孢素滴眼液联合人工泪液组,各34例68眼,对照组不做特殊治疗,人工泪液组采用人工泪液滴眼,3次/d ,环孢素滴眼液联合人工泪液组采用环孢素滴眼液联合人工泪液,3次/d ,先滴人工泪液,再滴环孢素滴眼液,两种滴眼液间隔15lin,所有患者连续治疗8wk后,观察比较各组之间泪液羊齿状试验( tear ferning test, TFT)、角膜上皮荧光素染色( corneal fluorescein staining , FL)检查,泪液分泌试验(Schirler l test,Slt)、泪膜破裂时间( break-up tile of tear fill ,BUT)、结膜印迹细胞学检查( conjunctive ilpression cytology,CIC)等指标的变化。
　　结果：(1)治疗4wk环孢素滴眼液联合人工泪液组羊齿状结晶分级优于人工泪液组及对照组,差异具有统计学意义(χ2=16.345,P=0.003),治疗8wk环孢素滴眼液联合人工泪液组羊齿状结晶分级均优于人工泪液组及对照组,差异有统计学意义(P<0.05);(2)治疗8wk对照组染色评分与治疗前比较,染色加重(t=-4.500,P=0.003);人工泪液组、环孢素滴眼液联合人工泪液组角膜染色评分与治疗前比较,染色减轻,评分减少,差异具有统计学意义(P<0.05)。在治疗4、8wk,环孢素滴眼液联合人工泪液组的染色评分均比人工泪液组减少,差异具有统计学意义(t=3.553,P=0.006,t=4.523,P=0.001);(3)环孢素滴眼液联合人工泪液组治疗4、8wk与对照组比较,BUT值延长,差异具有统计学意义(P<0.05),环孢素滴眼液联合人工泪液组和人工泪液组之间BUT值比较差异无统计学意义(P>0.05);(4)环孢素滴眼液联合人工泪液组在治疗8wk 后结膜印迹细胞学检查,分级优于对照组及人工泪液组,差异有统计学意义(P<0.05);(5)治疗4wk,环孢素滴眼液联合人工泪液组Slt值增加,与人工泪液组及对照组比较,差异有统计学意义(χ2=6.384,P =0.012);治疗8 wk环孢素滴眼液联合人工泪液组 S l t 值均优于治疗前,环孢素滴眼液联合人工泪液组Slt值优于人工泪液组,差异均具有统计学意义(P<0.05)。
　　结论：环孢素滴眼液联合人工泪液治疗干眼症,可改善泪液环境,增加泪液分泌量,延长泪膜破裂时间,增强泪膜稳定性。     

干眼症患者增多原因的初步调查

目的:了解干眼症患者的症状及出现干眼症原因的初步调查。方法:对2006-01/2007-01来我院就诊的眼科患者行基础泪液试验和泪膜破裂时间的测定,并分析形成干眼症的原因。结果:在所调查的1500例3000眼(男750例,女750例)门诊患者中,干眼症的患病率为34.60%(519例/1500例),其中男性患病率为13.00%(195例/1500例),女性患病率为21.60%(324例/1500例)。统计学分析显示,与干眼症形成的相关因素包括性别、年龄、职业、环境、眼病及是否伴有全身疾病。结论:眼科门诊患者的泪液分析有助于确定患者眼表的健康状况、影响患者泪液分泌的多种因素。     

干眼症96例病因分析

目的:分析干眼症的发病原因,探讨干眼症的防治措施。方法:对96例干眼症患者的致病原因进行回顾性临床分析,以泪液分泌试验、泪膜破裂时间、角膜荧光素染色结果为诊断标准。结果:干眼症患者96例中长期过量使用多种眼药者23例,长期配戴接触镜者9例,合并类风湿关节炎者9例,患口腔干燥症者4例,神经受损者4例,长期应用免疫抑制剂者2例,外伤及手术后14例,原因不明者31例。结论:症状是干眼症的临床依据,应结合实验室检查和全身系统情况综合分析。     

复明片联合人工泪液局部滴眼治疗肝肾阴虚型干眼症

目的:观察复明片配合人工泪液局部滴眼治疗肝肾阴虚型干眼症的临床疗效。方法:将符合肝肾阴虚型干眼症诊断标准的患者,随机分为治疗组和对照组。治疗组采用口服复明片和局部滴用玻璃酸钠滴眼液治疗;对照组采用单纯滴用玻璃酸钠滴眼液治疗。根据临床症状和基础泪液分泌试验、泪膜破裂时间、角膜荧光素钠染色等检查进行评分。随机抽取干眼症患者60例,治疗组和对照组各30例60眼,治疗观察2mo。结果:两组治疗后BUT,SⅠt、角膜荧光素染色与治疗前比较,差异均有统计学意义(P<0.05或P<0.01),且治疗后治疗组上述指标变化程度明显优于对照组(P<0.01);治疗组总有效率93.3%,对照组总有效率75.0%,治疗组疗效明显优于对照组(P<0.01)。结论:复明片联合人工泪液局部点眼治疗干眼症疗效较单纯使用人工泪液滴眼疗效好。     

The diagnostic significance of Fourier‐domain optical coherence tomography in Sjögren syndrome,aqueous tear deficiency and lipid tear deficiency patients

Purpose: To determine the role of Fourier‐domain optical coherence tomography (FD‐OCT) in tear meniscus imaging and evaluate its diagnostic significance in Sjögren syndrome (SS), non‐Sjögren’s aqueous tear deficiency (ATD) and lipid tear deficiency (LTD) patients. Methods: Two hundred and thirty‐six dry eye patients and 174 healthy controls were enrolled in this study. All subjects were grouped as follows: group A (ATD), group B (LTD), group C (SS) and group D (normal controls). All subjects underwent dry eye questionnaire, FD‐OCT scanning, tear film break‐up time (BUT), corneal fluorescence staining and Schirmer I test (SIT). Tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus cross‐sectional area (TMA) were measured using FD‐OCT (RTVue‐100). The area under the receiver operating characteristic curve and the cut‐off point were determined using a logistic regression model. Results: Mean TMH, TMD, TMA, BUT and SIT of dry eye patients were significantly lower than those of the controls (p < 0.05). Tear meniscus values were significantly decreased in patients with SS compared with ATD and LTD patients. Tear meniscus values were significantly correlated with clinical examination results in all groups. Accuracy of dry eye diagnosis by FD‐OCT is highest in patients with SS and lowest in LTD patients. The clinical diagnostic critical points were quite different between groups. Conclusions: Fourier‐domain optical coherence tomography could provide precise measurement of the tear meniscus with favourable repeatability. Diagnostic significance is more conspicuous in patients with SS. Tear meniscus measurement by FD‐OCT is expected to become a valuable technique in ATD dry eye screening and diagnosis.     

The diagnostic significance of Fourier-domain optical coherence tomography in Sjögren syndrome, aqueous tear deficiency and lipid tear deficiency patients

Purpose: To determine the role of Fourier-domain optical coherence tomography (FD-OCT) in tear meniscus imaging and evaluate its diagnostic significance in Sj?gren syndrome (SS), non-Sj?gren's aqueous tear deficiency (ATD) and lipid tear deficiency (LTD) patients. Methods: Two hundred and thirty-six dry eye patients and 174 healthy controls were enrolled in this study. All subjects were grouped as follows: group A (ATD), group B (LTD), group C (SS) and group D (normal controls). All subjects underwent dry eye questionnaire, FD-OCT scanning, tear film break-up time (BUT), corneal fluorescence staining and Schirmer I test (SIT). Tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus cross-sectional area (TMA) were measured using FD-OCT (RTVue-100). The area under the receiver operating characteristic curve and the cut-off point were determined using a logistic regression model. Results: Mean TMH, TMD, TMA, BUT and SIT of dry eye patients were significantly lower than those of the controls (p?相似文献   

水液缺乏型干眼症患者下泪新月高度临床对比分析

目的　比较水液缺乏型干眼症（ａｑｕｅｏｕｓｔｅａｒｄｅｆｉｃｉｅｎｃｙ,ＡＴＤ）患者与非ＡＴＤ人群的下泪新月高度（ｌｏｗｅｒｔｅａｒｍｅｎｉｓｃｕｓｈｅｉｇｈｔ,ＬＴＭＨ）,并分析ＬＴＭＨ用于ＡＴＤ诊断的可行性。方法　选取２０１３年５月至９月于我院眼科门诊确诊的ＡＴＤ患者４０例（４０眼）作为ＡＴＤ组,另选取３９例（３９眼）非ＡＴＤ人群作为对照组,分别用眼前节光学相干断层扫描仪获取被检者自然瞬目后的下泪新月图像并测量ＬＴＭＨ。通过绘制诊断试验特征曲线并计算线下面积,计算并选择ＬＴＭＨ的“异常”临界值,同时得出相应的敏感性（ＡＴＤ患者中ＬＴＭＨ值呈阳性的比率）与特异性（非ＡＴＤ人群中ＬＴＭＨ值呈阴性的比率）值,以此确定ＬＴＭＨ是否可作为诊断ＡＴＤ的有效指标。结果　ＡＴＤ组的ＬＴＭＨ为（１４１．１±２２．４）μｍ,对照组为（１９３．９±２２．３）μｍ,２者差异有统计学意义（ｔ＝１０．４９５,Ｐ＜０．０１）。当ＬＴＭＨ选择“异常”临界值为０．１６８ｍｍ时,其对于ＡＴＤ的诊断敏感性为９２．３％,特异性为９２．５％。结论　ＡＴＤ患者的泪新月明显小于非ＡＴＤ人群,ＬＴＭＨ对于ＡＴＤ有良好的诊断准确性,因此用作ＡＴＤ的诊断指标具有可行性。     

Decreased tear lipocalin concentration in patients with meibomian gland dysfunction

BACKGROUND/AIM: Recent studies have demonstrated that tear lipocalin (TL) and phospholipids have a crucial role in maintaining tear film stability. The level of TL in patients with meibomian gland dysfunction (MGD) was examined and these data were correlated with the severity of their clinical disorder. METHODS: 12 patients with obstructive MGD, 12 patients with seborrhoeic MGD, and 12 age matched normal control subjects participated in this study. 3 mul of unstimulated tears were collected with a micropipette from the inferior tear meniscus in the right eye of all subjects. Tear samples were fractionated by high performance liquid chromatography, and TL concentrations were assayed with a bicinchoninic acid technique. RESULTS: The mean concentration of TL in patients with obstructive and seborrhoeic MGD was significantly lower than in normal controls. TL concentration correlated positively with tear film break up time and negatively with fluorescein staining scores. CONCLUSION: These results suggest that TL deficiency may be a predisposing factor for the manifestation of symptoms in MGD.     

中药润目灵治疗水样液缺乏性干眼症的临床疗效

目的:观察中药润目灵治疗水样液缺乏性干眼症的临床疗效。方法:水样液缺乏性干眼症121例分为润目灵(49例),必嗽平(24例),泪然(48例)3组。疗程均为4wk。结果:润目灵与必嗽平相比较,对增加泪流量、改善角膜染色作用无统计学差异,润目灵对泪膜破裂时间、眼部症状改善优于必嗽平,统计学上有意义(P<0.05);润目灵对增加泪流量、延长泪膜破裂时间、改善眼部症状优于泪然,统计学上有显著意义(P<0.01)。结论:润目灵有促进泪液分泌、延长泪膜破裂时间和促进角膜病变修复的作用,对水样液缺乏性干眼症有明显的治疗作用。     

Epstein-Barr virus infection and immunologic dysfunction in patients with aqueous tear deficiency

The authors tested their hypothesis that Epstein-Barr virus (EBV) infection is a risk factor for aqueous tear deficiency (ATD) by evaluating 38 ATD patients and 17 controls for serologic evidence of EBV infection. Aqueous tear deficiency was graded clinically as mild or severe. A linear trend toward elevated EBV capsid (P less than 0.05) and early antigen (P less than 0.001) titers was noted from control to severe ATD patients. Rubella and cytomegalovirus antibody titers were poorly correlated with EBV titers, suggesting that the elevated EBV antibodies in ATD patients were not due to nonspecific polyclonal B-cell activation. Epstein-Barr virus antigens were detected in two of six lacrimal gland biopsies from severe ATD patients with Sj?gren's syndrome, but in none of the control glands. Aqueous tear deficiency patients were evaluated for immunologic dysfunction associated with EBV infection. Linear trends of elevated serum IgG (P less than 0.05), autoantibody and immune complex positivity (P less than 0.05), and reduced natural killer cell cytotoxicity (P less than 0.05) were found from controls to severe ATD patients. Furthermore, reduced T-helper lymphocyte counts (P less than 0.06) and an increased percentage of HLA-DR+ CD8 lymphocytes (P less than 0.05) were observed in severe ATD patients compared with the mild and control groups. A multivariate analysis of the data showed a significant correlation between severe ATD and elevated EBV early antigen titers, Sj?gren's syndrome, and an increased percentage of HLA-DR+ CD8 lymphocytes. The authors' findings suggest that EBV infection may be a risk factor for development of ATD in a subset of ATD patients with greater disease severity, Sj?gren's syndrome, and immunologic dysfunction.     

Sequential changes of lipid tear film after the instillation of a single drop of a new emulsion eye drop in dry eye patients

PURPOSE: The lipid tear film stabilizes the tears by lowering the surface tension and preventing aqueous tear evaporation and may be analyzed by kinetic analysis of the tear interference images. This study investigated changes in the lipid film after application of a new emulsion-based eye drop of Refresh Endura (Allergan, Irvine, CA) in normal subjects and patients with dry eyes. DESIGN: Comparative, nonrandomized interventional study. PARTICIPANTS: Five normal subjects and 10 aqueous tear deficiency (ATD) patients with or without lipid tear deficiency were enrolled prospectively. METHODS: A complete eye examination was performed, including symptom score, tear break-up time, dye staining, and fluorescein clearance test. One eye received a single dose of emulsion eye drop (EED), whereas the other eye received nonpreserved saline as a control. Kinetic analysis of tear interference images taken by DR-1 (Kowa, Japan) was performed before and at various times after instillation of the drops. MAIN OUTCOME MEASURES: Symptoms, pattern, thickness, and spread time of the tear film. RESULTS: Compared with the control, all eyes receiving EED showed rapid restructuring of the preexisting lipid film. In normal persons, restructuring resulted in a thick lipid band across the cornea and a significant increase of the lipid film thickness. For ATD patients, EED application resulted in either a scant, irregular tear film, which became covered by the lipid film, or a modified lipid film changed without forming a band or irregularities. Emulsion eye drops tended to be more comfortable in patients with more severe ATD. Kinetic analysis showed that the mean spread time improved for all patients after EED when compared with baseline or with controls (P<0.05). CONCLUSIONS: Emulsion eye drop produces significant changes in the tear film of normal and dry eye patients. Further investigation with a prolonged period of treatment is warranted to establish whether EED may help improve the spread and thickness of the lipid tear film in moderate and severe dry eyes.     

The autoimmune nature of aqueous tear deficiency

Twenty-two patients with aqueous tear deficiency (ATD) were examined for the presence of the following autoantibodies: immunofluorescent antinuclear antibody (ANA) and Sj?gren's syndrome antibodies A and B (SS-A and SS-B). These autoantibodies were found in 17 (82%) patients but not in control subjects, and they correlated with the severity of symptoms and ocular surface changes. Bacterial keratitis, often recurrent and bilateral, and progressive sterile corneal stromal melting developed in six autoantibody-positive ATD patients. Eight antibody-positive patients had labial salivary or lacrimal gland biopsies, and all showed similar histologic features with marked destruction of the glandular architecture by lymphocytic infiltration. Immunoglobulin and complement were not detected in the glandular tissue. Circumstantial evidence suggests that an abnormal immunologic reaction, possibly related to Epstein-Barr viral (EBV) infection, is the cause of the glandular destruction and tear deficiency.     

Tear film osmolarity in patients with thyroid ophthalmopathy

PURPOSE: To compare tear film osmolarity between patients with thyroid ophthalmopathy and normal healthy subjects. METHODS: The tear film osmolarity in 15 normal subjects (15 eyes) (control group) and 21 patients (21 eyes) with thyroid ophthalmopathy was evaluated. Tear film osmolarity in milliosmole (mOsm) was determined by using an auto-osmometer. The palpebral fissure width, degree of proptosis, and tear break-up time (BUT) were also determined. The results for the two groups were compared statistically. RESULTS: The mean palpebral fissure width was 9.13 +/- 0.74 mm in the healthy subjects and 13.33 +/- 1.55 mm in the thyroid ophthalmopathy patients. This difference was statistically significant (P = 0.0001). The mean proptosis was 15.33 +/- 1.39 Hertel units in the healthy subjects and 20.71 +/- 0.95 Hertel units in the patients. This difference was also statistically significant (P = 0.0001). The mean tear BUT was 6.35 +/- 1.56 s in the patients and 18.27 +/- 1.53 s in the healthy subjects, and this difference was also statistically significant (P = 0.0005). The mean tear film osmolarity was 290.80 +/- 13.58 mOsm in the healthy subjects and 340.38 +/- 18.74 mOsm in the patients. There was a statistically significant difference between the groups (P = 0.0001). CONCLUSIONS: The significantly higher tear film osmolarity in patients with thyroid ophthalmopathy was most likely due to the increased proptosis and lid fissure width. These conditions may lead to injury of the ocular surface.     

Basal and Reflex Human Tear Analysis: I. Physical Measurements: Osmolarity,Basal Volumes,and Reflex Flow Rate

Minimally stimulated, retained “basal” tears and stimulated reflex tears were collected from normal controls, keratoconjunctivitis sicca (KCS) patients, and contact lens (CL) wearers. Basal tear samples were collected on small filter paper strips (Periopaper®) over a five-second period, and volume was measured by means of an electronic device (Periotron®). Collected basal tear volumes for KCS patients (0.84 ± 0.42 μl) were significantly lower (P <; 0.01) than normal controls (1.18 ± 0.36) and CL wearers (1.24 ± 0.27). Reflex tear flow rates were measured over a five-minute period on Schirmer strips. Volume was calculated by comparison of wet length with known volumes of 1% egg white lysozyme solution. The reflex tear flow rates in KCS patients (3.29 ± 3.57 μl/minute) were significantly lower than normal controls (5.71 ± 5.86) and CL wearers (6.96 ± 6.07). The elevation in CL wearers was not statistically significant when compared to normals. KCS patients are deficient in both basal and reflex tears compared to normals but have a more significant deficiency of basal tears. Female normals and CL wearers over 40 years of age have a higher tear osmolarity than those under 41 years of age. Female KCS patients over 40 years of age have a tear osmolarity that is not significantly different from female KCS patients under 41 years of age.