The influence of the tear film on the intraocular pressure and the corneal biomechanical properties analyzed with the Ocular Response Analyzer / La influencia de la película lagrimal sobre la presión intraocular y las propiedades biomecánicas corneales analizadas con el Analizador de Respuesta Ocular

Purpose: As ocular dryness and glaucoma are more prevalent with increasing age, understanding how the tear film affects tonometry is important. The present study aims to understand the impact that changes in the tear film have on intraocular pressure (IOP), corneal hysteresis, and corneal resistance factor measurements. Methods: Cross-sectional research was conducted and 37 patients were assessed. The tear film lipid layer and the non-invasive break-up time (NIBUT) were evaluated using the Tearscope Plus (Keeler, Windsor, UK). Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. IOP was measured using rebound tonometry and the Ocular Response Analyzer (ORA, Reichert). Corneal biomechanical properties were measured using ORA. Results: It was found that an increase in the IOP measured with the iCare was directly correlated with the subclass that evaluated symptomatology associated with environmental factors (r = 0.414, p<0.05, Spearman). Goldmann-correlated IOP (IOPg) and Corneal-compensated IOP (IOPcc) values were statistically significantly different between the various interferometric patterns (p<0.05). It was also found that an increase in the corneal biomechanical properties measured with ORA was directly correlated with the overall scores obtained when using the OSDI and some of its subclasses. Conclusions: Tear film interferometric patterns were shown to have some impact on the IOP measured using ORA. The IOP measured with iCare seems to be related to the symptomatology obtained from OSDI. Corneal biomechanical properties were related to the OSDI total score and some of its subclasses. An increase in symptomatology was associated with an increase in the measured biomechanical properties of the cornea.(AU)

Prevalence of dry eye disease in the low vision population at the University of Colorado

Purpose: To evaluate the prevalence of diagnosed dry eye syndrome, meibomian gland dysfunction, and blepharitis amongst the low vision population. Methods: A retrospective analysis was conducted on patients seen in the University of Colorado Low Vision Rehabilitation Service between the dates of 12/1/2017 and 12/1/2022. 74 ICD-10 codes were used to identify patients as having dry eye syndrome or not having dry eye syndrome. Data was further analyzed to determine the prevalence of blepharitis and meibomian gland dysfunction using 29 blepharitis and 9 meibomian gland dysfunction ICD-10 codes. Data were also analyzed to determine the age and sex of the patients with diagnosed dry eye syndrome. Results: The percentage of patients with a diagnosis of dry eye syndrome by an eyecare provider was 38.02 %. The prevalence of dry eye syndrome by age group was 3.57 % for 0–19 years, 14.35 % for 20–39 years, 29.07 % for 40–59 years, 43.79 % for 60–79 years, and 46.21 % for 80 and above. The prevalence of meibomian gland dysfunction and blepharitis was 11.90 % and 9.1 % respectively. Dry eye syndrome prevalence amongst males was 31.59 % and 42.47 % for females. Conclusion: This study demonstrates that dry eye syndrome in the low vision population is a significant co-morbidity occurring in over a third of patients in the University of Colorado Low Vision Rehabilitation Service. These findings are meaningful as ocular comfort should not be overlooked while managing complex visual needs. (AU)

Hallazgos de microscopia confocal in vivo de la mucosa de la córnea y la lengua en pacientes con síndrome de Sjögren / In vivo confocal microscopy findings of cornea and tongue mucosa in patients with Sjögren's syndrome

Introducción y objetivos: Nuestro objetivo fue investigar si el síndrome de Sjögren (SS) tenía hallazgos distintivos en la microscopia confocal de la lengua de una manera no invasiva. Materiales y métodos: Este estudio retrospectivo de casos y controles evaluó los hallazgos de la microscopia confocal de córnea y lengua de los ojos derechos de 25 pacientes con ojo seco con deficiencia acuosa y 12 voluntarios sanos sin hallazgos de ojo seco. Hubo un total de 14 pacientes diagnosticados con ojo seco asociado a SS (SSDE), mientras que 11 casos fueron evaluados como ojo seco no Sjögren (NSDE). Resultados: Se observó una diferencia significativa en el recuento de células dendríticas a nivel del nervio subbasal corneal entre los grupos SSDE y NSDE (p=0,018). En el grupo SSDE, las imágenes de microscopia confocal de células inflamatorias dendritiformes hiperreflectantes en la mucosa de la lengua estaban a favor de la inflamación. Sin embargo, estos hallazgos no se encontraron en pacientes con NSDE o en controles. Conclusiones: Este estudio mostró que la microscopia confocal proporcionó una evaluación no invasiva de las células inflamatorias en la lengua de los pacientes con SS.(AU)

Introduction and objectives: We aimed to investigate whether Sjögren's syndrome (SS) had distinctive findings in tongue confocal microscopy in a non-invasive manner. Materials and methods: This retrospective case-control study evaluated corneal and tongue confocal microscopy findings of the right eyes of 25 patients with aqueous deficient dry eye and 12 healthy volunteers without dry eye findings. There were a total of 14 patients diagnosed with SS-associated dry eye (SSDE), while 11 cases were evaluated as non-Sjögren dry eye (NSDE). Results: A significant difference was observed in the dendritic cell count at the corneal subbasal nerve level between the SSDE and NSDE groups (P=.018). In SSDE group, the confocal microscopy images of dendritiform hyperreflective inflammatory cells in the tongue mucosa were in favor of inflammation. However, these findings were not found in patients with NSDE or in controls. Conclusions: This study showed that confocal microscopy provided a non-invasive evaluation of the inflammatory cells in the tongue of SS patients.(AU)

Análisis de pruebas diagnósticas de pacientes con ojo seco e hipotiroidismo: un estudio observacional / Analysis of diagnostic tests in patients with dry eye and hypothyroidism: an observational study

Propósito Colombia es un país con una alta prevalencia de hipotiroidismo, aproximadamente del 18,5% respecto al resto de países latinoamericanos que se estima en un 10%. Es por ello que en la consulta de oftalmología se encuentra una gran proporción de pacientes con esta enfermedad y que además presentan síntomas de ojo seco. Al realizar una búsqueda en la literatura médica, la mayoría de publicaciones se refieren a la presentación clínica de ojo seco del hipertiroidismo. El objetivo de este estudio es describir los hallazgos de las diferentes pruebas para el diagnóstico de ojo seco en pacientes con hipotiroidismo. Métodos Se trata de un estudio observacional, de tipo transversal, realizado en el periodo comprendido entre mayo y diciembre de 2019 en la unidad de superficie ocular del Centro de Tecnología Oftálmica (CTO) en Bogotá. Se evaluaron las pruebas de Test de OSDI (Ocular Surface Disease Index), Schirmer tipo I, altura del menisco lagrimal, NiBUT, Osmolaridad, test de Ferning, test de verde de lisamina de 59 pacientes con enfermedad de ojo seco y antecedente de hipotiroidismo. Resultados Las prueba de Schirmer tipo I y NiBUT fueron los parámetros que presentaron mayor porcentaje de severidad, mientras que la tinción con verde de lisamina y la meniscometría mostraron tendencia a la normalidad. Conclusione La población de este estudio presenta un ojo seco tipo mixto sin daño en las células epiteliales (AU)

Purpose Colombia is a country with a high prevalence of hypothyroidism, approximately 18.5% compared to the rest of Latin American countries, which is estimated at 10%. That is why in the ophthalmology consultation we find a large proportion of patients with this disease and who also present symptoms of dry eye. When conducting a search in the medical literature, most publications refer to the clinical presentation of dry eye in hyperthyroidism, which is why the main objective of this study is to evaluate tear function tests in the diagnosis of dry eye in patients with hypothyroidism. Methods This is an observational, cross-sectional study carried out in the period between May and December 2019 in the ocular surface unit of the Ophthalmic Technology Center (CTO) in Bogotá. The tests of: OSDI test (Ocular Surface Disease Index), Schirmer type I, tear meniscus height, NiBUT, Osmolarity, Ferning test, Lisamine Green test of 59 patients with Dry Eye Disease and history of hypothyroidism. Results Schirmer type I and NiBUT tests were the parameters that presented the highest percentage of severity, while lissamine green staining and meniscometry showed a tendency to normality. Conclusions The population of this study presents a mixed type dry eye without epithelial cell damage (AU)

¿Qué sabemos sobre el manejo y tratamiento del Síndrome Visual Informático? / What do we know about the management and treatment of the Computer Vision Syndrome?

Este trabajo es un comentario del artículo: Singh S, McGuinness MB, Anderson AJ, Downie LE. Interventions for the Management of Computer Vision Syndrome: A Systematic Review and Meta-analysis. Ophthalmology. 2022 Oct;129(10):1192-1215. doi: 10.1016/j.ophtha. 2022.05.009

This text is a commentary on the article: Singh S, McGuinness MB, Anderson AJ, Downie LE. Interventions for the Management of Computer Vision Syndrome: A Systematic Review and Meta-analysis. Ophthalmology. 2022 Oct;129(10):1192-1215. doi: 10.1016/j.ophth a. 2022.05.009 (AU)

Topical review of the relationship between contact lens wear and meibomian gland dysfunction

Contact lens (CL) wearers often suffer from ocular discomfort, which leads to cessation of CL wear. About 30% to 50% of CL wearers complain of dry eye (DE) symptoms. Meibomian gland dysfunction (MGD) is considered the most common cause of evaporative DE. Numerous studies have investigated whether CL wear might affect the meibomian glands. This manuscript reviews studies examining the relationship between CL use and MGD. A PubMed database search was conducted for studies published between 1980-2021 with one or a combination of search terms related to “meibomian gland”, “meibomian gland dysfunction”, “contact lens”, and/or “dry eye”. Of the 115 papers reviewed, 22 articles were identified that examined the association between CL and MGD. Fifteen showed that CL wear affects the morphology and function of meibomian glands (MGs), while seven reported no significant impact of CL wear on MGs. This review provides an overview of these studies, emphasizing the diagnostic tests of MGD and conclusions. The review highlights the need for longitudinal prospective large cohort studies with control non- CL wearers to clarify the ambiguous relationship between MGD and CL wear, with special attention to varying CL material and wear times in order to identify the long-term impact of CLs on MG. (AU)

The Importance of Preventing and Managing Tear Dysfunction Syndrome in Allergic Conjunctivitis and How to Tackle This Problem

Tear dysfunction syndrome, also known as dry eye disease (DED), is a multifactorial disease of the ocular surface characterized by the loss of tear film homeostasis. DED shows a significant clinical overlap with ocular allergy (OA), which alters tear film homeostasis, thus predisposing the patient to DED. Both conditions constitute the most common ocular surface disorders and have a potentially severe impact on patients’ quality of life. Clinical practice guidelines recommend topical therapies as first-line treatment for OA. However, eye drop formulations may contain additional substances that can contribute to ocular surface damage and the development of DED. Therefore, physicians treating ocular allergy should be aware of problems affecting the tear film, the role of tear film disruption in OA, and topical treatment to prevent or minimize DED. The aim of this review is to present an updated overview of the topic. (AU)

El síndrome de disfunción lagrimal, también denominado enfermedad del ojo seco (EOS), es una enfermedad multifactorial de la superficie ocular caracterizada por la pérdida de la homeostasis de la película lagrimal. La EOS y la alergia ocular (AO) son patologías que comparten un abanico de signos y síntomas, y pueden aparecer simultáneamente; además, la AO altera la homeostasis de la película lagrimal, predisponiendo a la EOS. Estas dos afecciones constituyen los trastornos más frecuentes de la superficie ocular y pueden afectar notablemente la calidad de vida de los pacientes. Las guías de práctica clínica recomiendan terapias tópicas como tratamiento de primera línea para la alergia ocular. Sin embargo, las fórmulas de los colirios pueden contener aditivos y conservantes que pueden contribuir al daño de la superficie ocular y a la aparición de EOS. Por lo tanto, los facultativos que tratan la alergia ocular deben conocer las implicaciones que conlleva la alteración de la película lagrimal en la conjunctivitis alérgica, el potencial daño que pueden provocar los conservantes incluidos en los colirios empleados en el tratamiento tópico de esta patología, así como los tratamientos disponibles para manejar la EOS y la AO cuando la disfunción de la película lacrimal ya está establecida. El objetivo de esta revisión es presentar una visión general actualizada del tema. (AU)

Luz pulsada intensa combinada con expresión de las glándulas de Meibomio para el tratamiento del chalación / Intense pulsed light combined with meibomian gland expression for chalazion management

Objetivo Investigar la eficacia y la seguridad del protocolo de luz pulsada intensa (IPL) combinando el protocolo de tratamiento con IPL para la disfunción de las glándulas de Meibomio/enfermedad de ojo seco con IPL aplicada directamente en los párpados, asociada a la expresión de las glándulas de Meibomio (GM) para el tratamiento del chalación. Material y métodos Estudio retrospectivo de serie de casos. Los pacientes que presentaron chalación, recibieron un tratamiento combinado de terapia con IPL que consistió en usar el protocolo habitual de IPL para disfunción de las glándulas de Meibomio/enfermedad de ojo seco empleando una fluencia de acuerdo al tipo de piel según Fitzpatrick, seguido de una segunda fase (en la misma sesión) de aplicación IPL directamente sobre los párpados de ambos ojos empleando una fluencia de 10J/cm2. A continuación, todos los pacientes recibieron expresión de las GM, higiene de los párpados, antibiótico tópico y medicación ocular antiinflamatoria tópica. Los efectos adversos relacionados con este protocolo se evaluaron en cada sesión de IPL. Resultados Se incluyeron 26 chalaciones de diecinueve pacientes (24 ojos) con una edad media de 49,89±20,43 años. Fueron necesarias 2,07±0,97 sesiones de IPL de media para la resolución del chalación. El tratamiento combinado de protocolo IPL y expresión de GM mostró un 96,15% de eficacia y no se observaron efectos adversos. Conclusiones El tratamiento combinado de IPL para disfunción de las glándulas de Meibomio/enfermedad de ojo seco con IPL aplicado directamente sobre los párpados y expresión de GM podría ser eficaz y seguro para el tratamiento de los chalaciones (AU)

Objective To investigate the efficacy and safety of an intense pulsed light (IPL) combined IPL treatment protocol for meibomian gland dysfunction (MGD)/dry eye disease (DED) with IPL applied directly to the eyelids, associated with meibomian gland (MG) expression for the treatment of chalazion. Material and Methods Retrospective case series study. Patients presenting with chalazion received a combined IPL therapy treatment consisting of using the usual IPL protocol for DGM/EOS using a fluence according to skin type according to Fitzpatrick, followed by a second phase (in the same session) of IPL application directly on the eyelids of both eyes using a fluence of 10 J/cm2. All patients then received GM expression, eyelid hygiene, topical antibiotic and topical ocular anti-inflammatory medication. Adverse effects related to this protocol were assessed at each IPL session. Results Twenty-six chalazions from nineteen patients (24 eyes) with a mean age of 49.89 ± 20.43 years were included. An average of 2.07 ± 0.97 IPL sessions were required for chalazion resolution. The combined treatment of IPL protocol and GM expression showed 96.15% efficacy and no adverse effects were observed. Conclusions Combined IPL treatment for DGM/EOS with IPL applied directly on the eyelids and GM expression could be effective and safe for the treatment of chalazions (AU)

Estudio bibliométrico de cirugía refractiva y ojo seco en la literatura científica / Bibliometric study of refractive surgery and dry eye scientific literature

Antecedentes y objetivo La cirugía refractiva es actualmente un procedimiento seguro y eficaz, y es reconocida como factor de riesgo para el desarrollo del ojo seco. El objetivo del estudio es analizar la producción e identificar el estado de conocimiento sobre el ojo seco secundario a cirugía refractiva, sus inicios y su evolución, así como cuales son los autores e instituciones más notorios. Material y métodos Se realizó una búsqueda de referencias a través de la base de datos Scopus, utilizando «cirugía refractiva» como descriptor principal y «ojo seco» como secundario; unidos ambos por el operador booleano AND, y limitándose el campo a la disponibilidad de título, resumen y palabras clave. A las publicaciones seleccionadas se le aplicaron los indicadores y los mapas bibliométricos habituales. Resultados Se recopilaron 78 artículos del periodo 2001-2019. Según la ley de Price, el crecimiento de la producción de la literatura fue lineal. La tasa de crecimiento anual fue del 8,6% con un tiempo de duplicación de 8,4 años. El núcleo de Bradford ofreció 4 revistas, todas con factor de impacto>2. Estas fueron: Journal of Ophthalmology, Investigative Ophthalmology and Visual Science, Journal of Glaucoma y The British Journal of Ophthalmology. El país con mayor producción fue EE. UU. Conclusiones La producción científica sobre el ojo seco secundaria a cirugía refractiva sigue un crecimiento lineal, no cumpliéndose los postulados de Price. Existe una alta transitoriedad de autores. Esto puede indicar una baja productividad por autor, o bien la presencia alta de investigadores que hayan publicado publican ocasionalmente sobre este tema (AU)

Objective Currently, refractive surgery is a safe and effective procedure, and considered as a risk for development of dry eye. The aim of study is to analyze the scientific publications in the field of ocular dryness secondary to refractive surgery through a bibliometric approach. The temporal period goes since 2001 to 2019, years in which first references appeared and search limited selection is done, respectively. The set of publications ranges from the first publication appeared in 2001, to the last one selected in 2019. Methods A search of references was made through Scopus, using «refractive surgery» as main descriptor, and «dry eye» as secondary one; both descriptors were limited to those available in the chosen field for the title, abstract, and keywords. The most common indicators and bibliometric maps were applied for to the selected publications. Results A total of 78 original articles were collected from the timeframe 2001-2019. According to the Price's law, the growth of literature production was linear turned out in a linear growth of literature production. The annual growth rate was 8.6% with a literature doubling time of 8.4 years. The Bradford core, preferred journals chosen by authors were 4 with offered four preferred journals by the authors, all of them with an impact factor >2. These were Ophthalmology, Investigative Ophthalmology & Visual Science, Journal of Glaucoma and British Journal of Ophthalmology. Regarding geographical distribution, the United States had the highest production. Conclusions The scientific production of dry eye after refractive surgery follows a linear growth. In this instance, postulates of the Price's growth law of science are not fulfilled. In addition, there is a high rate of transience. That may indicate low productivity or presence of researchers from other related subjects disciplines, who have published occasionally in this topic (AU)

Effects of wearing swimming goggles on non-invasive tear break-up time in a laboratory setting

Purpose: The use of swimming goggles (SG) has demonstrated to alter different ocular parameters, however, the impact of wearing SG on the tear film stability remain unknown. The main objective of this study was to determine the short-term effects of wearing SG on tear film surface quality break-up time (TFSQ-BUT).Methods: Twenty-eight young healthy adults (14 men and 14 women) wore a drilled SG, and TFSQ-BUT was measured before, during and after SG use. Dynamic-area high-speed videokeratoscopy was used for the non-invasive assessment of TFSQ-BUT.Results: TFSQ-BUT was significantly reduced while SG wear in comparison to the baseline measurement (4.8 ± 4.5 s vs. 8.8 ± 6.9 s; corrected p-value = 0.017, d = 0.57, mean difference = 4.0 [0.6, 7.3]; 45% reduction). Immediately after SG removal, TFSQ-BUT rapidly recovered baseline levels (8.2 ± 5.9 s vs. 8.8 ± 6.9 s; corrected p-value = 0.744). The impact of wearing SG on TFSQ-BUT were independent of the gender of the participants (p = 0.934).Conclusion: The use of SG induces a TFSQ-BUT reduction, with these changes returning to baseline levels immediately after SG removal. These data may be of relevance for the management of dry eye patients, who need to avoid circumstances that exacerbate tear film instability. Nevertheless, these results must be interpreted with caution since the experiment did not entirely mimic real-life conditions (e.g., eye cup piece drilled, time of exposure, environmental conditions). Future studies should consider the inclusion of dry eye patients and older individual in order to explore the generalizability of these findings. (AU)

Revisión sistemática y metaanálisis sobre la relación entre la productividad laboral y la enfermedad de ojo seco en pacientes con ojo seco no relacionado con Sjögren y con el Síndrome de Sjögren / Work productivity among Sjögren's Syndrome and non-Sjögren's dry eye patients: a systematic review and meta-analysis

Este trabajo es un comentario del artículo: Sivakumar GK, Patel J, Malvankar-Mehta MS, Mather R. Work productivity among Sjögren’s Syndrome and non-Sjögren’s dry eye pa-tients: a systematic review and meta-analysis. Eye (Lond). 2021; Online ahead of print. doi: 10.1038/s41433-020-01282-3. (AU)

AbstractThis text is a commentary on the article: Sivakumar GK, Patel J, Malvankar-Mehta MS, Ma-ther R. Work productivity among Sjögren’s Syndrome and non-Sjögren’s dry eye patients: a systematic review and meta-analysis. Eye (Lond). 2021; Online ahead of print. doi: 10.1038/s41433-020-01282-3 (AU)

Why the symptoms and objective signs of dry eye disease may not correlate

Cases of dry eye disease involving a neuropathic basis for symptoms and a poor correlation between symptoms and objective signs of dry eye disease can be associated with unsatisfactory responses to treatments which are limited to attempts to restore lacrimal function unit deficiencies. This review examines a wider range of circumstances under which the same kind of poor correlation between signs, symptoms and treatment results can be found. Some cases of computer vision syndrome can present for examination at times when objective signs related to reported symptoms have dissipated. A thorough history should explain this type of presentation for which symptoms might otherwise appear to be unexplained. However, mental health disorders can also be the basis for apparently unexplained levels of symptoms of dry eye disease. Anxiety, depression, hypochondriasis, stress, sleep and mood disorders as well as neuroticism for example, may be associated with exacerbation of symptoms to degrees that are not consistent with the levels of tear homeostasis anomalies that are assessed. The conclusion is drawn that failure to consider mental health comorbidities may result in symptomatic patients being exposed to less successful attempts to remediate tear dysfunctions when, for example, the symptoms have a somatic basis. Appropriate screening and referral to a psychologist or psychiatrist may be the key to managing some patients whose symptoms do not correlate with objective evidence of dry eye disease

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Comparison of nanoemulsion and non-emollient artificial tears on tear lipid layer thickness and symptoms / Comparación del efecto de las gotas oftálmicas de nanoemulsión vs no emolientes en el grosor de la capa lipídica lagrimal y los síntomas

PURPOSE: Dry eye disease (DED) is often managed with over-the-counter eye drops. This study evaluated the diurnal effects of a single drop of two ocular lubricants (nanoemulsion vs. non-emollient) on tear film lipid layer thickness (LLT) and symptoms of ocular dryness. Subjects were also assessed after 1 month of nanoemulsion eye drop use. METHODS: Part 1 was a cross-over comparison of a nanoemulsion and a non-emollient eye drop. LLT and dry eye symptoms were measured at baseline and at 15min, 1 h, 2 h, 4 h and 6 h after instillation of each drop. Part 2 was a 1-month observational study assessing LLT and symptoms after 30-day use of the nanoemulsion drop four times daily (qid). RESULTS: Total of 20 subjects completed the study (mean age = 45.6 ± 7.9, 15 female). Part 1 found a significant increase in average LLT 15min after nanoemulsion drop instillation in the overall and inferior third of the tear film for subjects with baseline LLT values < 50 nm. Average LLT values did not increase after use of the non-emollient. Symptoms of dryness improved up to 6h following instillation of both drops. Part 2 results found that using the nanoemulsion eye drop for 1 month improved symptoms reported on symptom surveys. CONCLUSION: Nanoemulsion eye drop use increased average LLT in subjects with low baseline levels. Statistically and clinically significant improvement in symptoms were found on symptom surveys after qid-use (four times a day) of the nanoemulsion drop. Results suggest that a nanoemulsion eye drop can benefit subjects with dry eye symptoms

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Efficacy and safety study of an eyelid gel after repeated nocturnal application in healthy contact lens users and non-users

PURPOSE: To evaluate skin biocompatibility of a nighttime hydrating eyelid gel and possible ocular surface effects in contact lens users (CLU) and non-contact lens users (NCLU). The formulation is registered as a medical device as Tridocosahexaenoine-AOX(R) (TDHA-AOX) (a concentrated DHA triglyceride), containing also hyaluronic acid (HA). METHODS: A prospective, randomized, masked clinical trial was performed with 62 participants of both sexes, aged 20-70 years, split into: (1) CLU (n = 30) and (2) NCLU (n = 32). All participants were instructed to apply a single dose of the moisturizing gel (containing TDHA-AOX and HA) nightly to the upper and inner eyelids of their right eye (RE) only, and during 2 consecutive weeks. Personal interviews, questionnaires, ophthalmic examinations and reflex tear collection were performed. Ophthalmological parameters included ocular surface response and contact lens status. Levels of satisfaction/adverse events were also recorded. Biochemical parameters included basal and final determination of pro-inflammatory mediator molecules in tear samples by multiplex analyses. Statistics were done by the SPSS 24.0 program. RESULTS: The CLU group had higher OS dysfunction than NCLU, but overall clinical parameters (corneal staining, and Schirmer/FBUT tests) and OSDI scores showed significant improvement in CLU individuals as compared to the NCLU participants, at the end of study. CLDEQ-8 scores pinpointed significant amelioration in initial risk of developing DEs by applying eyelid gel. Multiplex analyses demonstrated significantly lower VEGF expression levels (p < 0,05) in tears among the CLU compared to NCLU after nightly application of eyelid gel. CONCLUSIONS: Eyelid gel appeared to safely and efficiently provide hydration and decongestion of the skin and amelioration of the ocular surface during sleep

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Efectos y seguridad del perfluorohexiloctano en la superficie ocular y el endotelio corneal / Effects and safety of perfluorohexyloctane on the eye surface and corneal endothelium

OBJETIVO: Evaluar los efectos y la seguridad del perfluorohexiloctano (F6H8) tópico en la superficie ocular y el endotelio corneal. MÉTODOS: Fueron diagnosticados 45 pacientes (90 ojos) de enfermedad de ojo seco, se seleccionaron y se les prescribió tratamiento con F6H8 durante 6 meses. Las variables en la tinción corneal se documentaron usando la escala National Eye Institute/Industry Workshop (NEI), las variables conjuntivales usando la escala Oxford y los parámetros corneales, como el espesor corneal central, la densidad celular, el coeficiente de variación, la hexagonalidad y el área celular promedio, al inicio del estudio, a los 3 meses y a los 6 meses. Se evaluó también el cumplimiento y la satisfacción. RESULTADOS: El tratamiento con F6H8 redujo la tinción corneal promedio en pacientes cumplidores a una media de −0,84 ± 1,95 a los 3meses (p = 0,001) y a −1,65 ± 2,42 a los 6 meses (p < 0,001). La tinción conjuntival a los 6meses mostró una disminución promedio de −0,13 (p = 0,319). Los parámetros endoteliales no mostraron diferencia significativa, excepto el espesor corneal central, que mostró una disminución estadísticamente significativa (era de 545,30 ± 32,25 μm al comienzo del estudio y 538,40 ± 31,36 μm tras 6 meses, p = 0,009). Al final del estudio, el 46% de los pacientes informaron sentirse subjetivamente mejor, el 40,5% no sintió cambios y el 13,5% se sintió subjetivamente peor. CONCLUSIONES: El tratamiento tópico con F6H8 para la enfermedad de ojo seco no alteró las variables medidas del endotelio corneal, aunque sí mostró mejoría en la tinción corneal y en la satisfacción

OBJECTIVE: To evaluate the effects and safety of topical drops of perfluorohexyloctane (F6H8) on the ocular surface and the corneal endothelium. METHODS: Forty-five patients (90 eyes) diagnosed with dry eye disease were recruited and prescribed treatment with F6H8 as part of a six-month prospective multicentre study. Variables in corneal staining were documented using the National Eye Institute/Industry Workshop scale. The conjunctival variables included using the Oxford scale, as well as corneal parameters, such as central corneal thickness, cell density, coefficient of variation, hexagonality, and mean cell area, at the start of the study, and at 3 months and 6 months. Compliance and satisfaction with the treatment were measured. RESULTS: F6H8 drops reduced mean corneal staining based on the NEI scale in compliant patients to a mean of −0.84 ± 1.95 at 3months (P=.001) and to −1.65 ± 2.42 at 6months (P<.001). Conjunctival staining at 6months showed a mean decrease of −0.13 (P=.319). The endothelial parameters did not show a significant difference, in contrast to the central corneal thickness that showed a statistically significant decrease (545.30 ± 32.25 at the start of the study to 538.40 ± 31.36 after 6months, P=.009). At the end of the study, 46% of patients reported feeling subjectively better, 40.5% felt the same, and 13.5% felt subjectively worse. CONCLUSIONS: Topical treatment with F6H8 for dried eye disease did not alter the measured variables of the corneal endothelium, but showed improvement in corneal staining and satisfaction

Luz pulsada intensa: resultados en ojo seco crónico tras LASIK / Intense pulsed light: results in chronic dry eye syndrome after LASIK

Se presentan los resultados clínicos y visuales obtenidos en un estudio retrospectivo de una serie de casos de pacientes con síndrome de ojo seco (SOS) evaporativo crónico, tras cirugía refractiva, manejados con luz pulsada intensa (LPI). Se realizaron 4 sesiones de LPI. Contestaron el cuestionario Ocular Surface Disease Index (OSDI) antes del inicio de LPI y después de la última sesión. Se registró AV, refracción, valoración clínica (grado de severidad DEWS y grado de tinción Oxford) y topografía Orbscan. Se trataron 20 ojos con los siguientes valores pre- y post-LPI: SchirmerI 14,7 ± 5,6; 15,6 ± 3,4 mm, BUT 3,4 ± 1,6; 5,1 ± 1,2 s (p < 0,003), DEWS 3,4 ± 0,5; 1,6 ± 0,7 (p < 0,003), grado Oxford 0,8 ± 0,77; 0,4 ± 0,75 (p > 0,003), AV 0,67±0,26; 0,90 ± 0,15 (p < 0,0001), AVcc 0,83 ± 0,18; 0,92 ± 0,14 (p > 0,003), EE -0,31 ± 0,6; -0,08 ± 0,38D (p > 0,003), OSDI 34 ± 16; 28 ± 11,0 puntos (p > 0,003), uso de lágrimas 3,4 ± 2,0; 2,5 ± 1,9 veces/día (p > 0,03). Se registró mejoría visual y clínica significativa, mejoría sintomática y disminución de uso de lágrimas artificiales, tras LPI, en pacientes operados de LASIK con SOS evaporativo crónico

A report is presented on the visual and clinical results from a retrospective case series of patients with chronic, evaporative, dry eye syndrome (DES), after refractive surgery, and treated with intense pulsed light treatment (IPL). Four sessions were performed, and the Ocular Surface Disease Index (OSDI) questionnaire was completed before initiating treatment and after the last session. Pre- and post-treatment data included: visual acuity (VA), refraction, clinical evaluation (DEWS severity grading, and Oxford corneal staining), and Orbscan topography. Twenty eyes were treated and the following data recorded: SchirmerI 14.7± 5.6; 15.6 ± 3.4 mm, tear breakup time (TBUT) 3.4 ± 1.6; 5.1 ± 1.2s (P > .003), DEWS 3.4 ± 0.5; 1.6 ± 0.7 (P<.003), Oxford grade 0.8 ± 0.77; 0.4 ± 0.75 (P > .003), VA 0.67 ± 0.26; 0.90 ± 0.15 (P < .0001), best corrected VA 0.83 ± 0.18; 0.92 ± 0.14 (P>.003), spherical equivalent -0.31 ± 0.6; -0.08 ± 0.38 D (P > .003), OSDI 34 ± 16; 28 ± 11.0 points (P > .003), frequency artificial tear use 3.4 ± 2.0; 2.5 ± 1.9 times/day (P > .03). A significant clinical and visual improvement was observed, together with a decreased frequency in artificial tear use, in LASIK patients with chronic DES after IPL treatment

Ocular surface response and subjective symptoms associated to lens care solutions in Palestine / Respuesta de la superficie ocular y síntomas subjetivos asociados a las soluciones para el cuidado de las lentillas en Palestina

PURPOSE: To compare the biocompatibility and subjective symptoms of four multipurpose solutions marketed in Palestine with hydrogel contact lenses. METHODS: 50 habitual soft contact lens wearers were recruited in this interventional crossover study. Subjects were asked to attend the optometry clinic five times. A new pair of hydrogel lenses (Bioxifilcon-B) were fitted each time. This pair was soaked randomly overnight in one of the following four-multipurpose solutions (NEOPLUS(R), AvizorUnicaSensitive(R), ReNuMultiPlus(R) and COMPLETERevitaLens(R)) which contain different disinfecting agents (PHMB, Phx, PAPB, and PQ-1 + Alexidine, respectively), or non-preserved saline. At each visit, corneal staining, ocular redness and subjective symptoms were assessed. RESULTS: The percentage of corneal staining increased significantly (P ≤ 0.050) after soaking the lenses with PHMB (86%), PAPB (64%) and Phx (32%) based-solutions. However, a non-significant increase was noticed after the use of PQ-1 + Alexidine based solution (30%, P = 0.083). Ocular redness evaluation showed a significant increase (P ≤ 0.050) in limbal hyperemia after the use of all solutions, while bulbar redness was significantly increased after the use of biguanide-based solutions (P ≤ 0.050). The subjective assessment analysis showed a non-significant change in comfort, dryness, photophobia and scratchiness (P ≥ 0.050) at 2-h intervention using all solutions, except for the PHMB based solution which showed a significant change in subjective symptoms (P ≤ 0.050). Conclusion: The combination of Bioxifilcon-B hydrogel contact lenses and solution containing PHMB, PAPB and Phx-disinfectants induced a significant increase in corneal staining after 2h of CL-wear with a higher severity when the PHMB-based solution was used, while the PQ-1+Alexidine-based solution did not. Only the PHMB-based solution triggered a significant change in subjective symptoms which might which suggests that it might be related to the severity of staining rather than the induction of staining

OBJETIVO: Comparar la biocompatibilidad y los síntomas subjetivos de cuatro soluciones multiusos comercializadas en Palestina con lentillas de hidrogel. MÉTODOS: En este estudio intervencionista cruzado, reunimos a 50 usuarios habituales de lentillas blandas. Solicitamos a los sujetos que acudieran cinco veces a la clínica optométrica. Cada vez ajustamos un nuevo par de lentillas de hidrogel (Bioxifilcon-B). Dicho par se sumergió aleatoriamente por la noche en una de las siguientes soluciones multiuso (NEOPLUS(R), AvizorUnicaSensitive(R), ReNuMultiPlus(R) y COMPLETERevitaLens(R)), que contienen diferentes agentes desinfectantes (PHMB, Phx, PAPB, y PQ-1 + Alexidina, respectivamente), o solución salina sin conservantes. Durante cada visita, valoramos la coloración de la córnea, el enrojecimiento ocular y los síntomas subjetivos. RESULTADOS: El porcentaje de coloración de la córnea se incrementó significativamente (P ≤ 0,05) tras sumergir las lentillas en soluciones basadas en PHMB (86%), PAPB (64%) y Phx (32%). Sin embargo, se observó un incremento no significativo tras utilizar la solución basada en PQ-1 + Alexidina (30%, P = 0,083). La evaluación del enrojecimiento ocular reflejó un incremento significativo (P ≤ 0,05) de la hiperemia limbal tras el uso de todas las soluciones, mientras el enrojecimiento bulbar se incrementó significativamente tras utilizar soluciones basadas en biguanida (P ≤ 0,05). El análisis de valoración subjetiva reflejó un cambio no significativo en cuanto a comodidad, sequedad, fotofobia y picazón (P ≥ 0,05) durante la intervención de dos horas utilizando todas las soluciones, exceptuando la solución basada en PHMB, que reflejó un cambio significativo en cuanto a síntomas subjetivos (P ≤ 0,05). CONCLUSIÓN: La combinación de las lentillas de hidrogel Bioxifilcon-B y la solución con contenido de desinfectantes PHMB, PAPB y Phx indujo un incremento significativo de la coloración de la córnea tras 2 h de uso de lentillas, con una severidad superior al utilizarse la solución basada en PHMB, hecho que no se produjo con la solución basada en PQ-1 + Alexidina. Únicamente la solución basada en PHMB desencadenó un cambio significativo en cuanto a síntomas subjetivos, lo cual podría sugerir que podría guardar relación con la severidad de la coloración, en lugar de la inducción de la misma

Correlation between type 2 diabetes, dry eye and Meibomian glands dysfunction / Correlación entre diabetes tipo 2, ojo seco y disfunción de las glándulas de Meibomio

PURPOSE: To assess the Meibomian glands, ocular surface and tear function in patients with type 2 diabetes, and study the correlation between these conditions. METHODS: Prospective study of 76 males, 37 with type 2 diabetes with an average of duration between 7 ± 5 years, and 36 males from control group. After completing an ocular surface disease index (OSDI) questionnaire, the non-invasive tear film break-up time (NIBUT) and the tear lipid layer pattern was performed using interferometry system and tear meniscus height/TMH. Ocular surface was studied with lissamine green staining and morphology of the glands with evaluation of Marx's line (lid margin abnormalities); meibomian secretion was expressed and was also assessed the quality. The results were analyzed using the statistical Kruskal-Wallis and Mann-Whitney, and correlations by Spearman Rho. RESULTS: The mean age was 59 ± 8 years; 71% of participants presented MGD (76% diabetics and 67% controls). OSDI were significantly higher (p = 0.01) in the diabetic group. A positive correlation was found between glycemia and symptoms (p = 0.0005) and strong correlation between Hb1Ac and OSDI in MGD. NIBUT was lower in the control group (2.47 ± 1.2s) than for the diabetic group (2.9 ± 1.2s), with a significant inverse correlation (52.22%) with MG inflammation. CONCLUSIONS: MGD in type 2 diabetic patients is more severe compared with nondiabetic patients. Longer duration of diabetes is associated with major symptoms and changes in MG. Diabetic group showed major changes in lids and tear function, accounting for evaporative dry eye and presenting a high degree of correlation with MG inflammation and obstruction

OBJETIVO: Evaluar las glándulas de Meibomio, la superficie ocular y la función de la lágrima en pacientes con diabetes tipo 2, y estudiar la correlación entre estas situaciones. MÉTODOS: Estudio prospectivo de 76 varones, 37 de ellos con diabetes tipo 2, con una media de duración de entre 7 ± 5 años, y 36 mujeres como grupo control. Tras completar el cuestionario del índice de enfermedad de la superficie ocular (OSDI), se obtuvieron el tiempo de ruptura lagrimal no invasivo (NIBUT) y el patrón de la capa lipídica de la lágrima utilizando interferometría y altura del menisco lagrimal/AML. Se estudió la superficie ocular con tinción verde de lisamina y la morfología de las glándulas con evaluación de la línea de Marx (anomalías del margen del párpado); se expresó la secreción de las glándulas de Meibomio, así como su calidad. Los resultados se analizaron utilizando la pruebas estadísticas Kruskal-Wallis y Mann-Witney, y las correlaciones con Rho de Spearman. RESULTADOS: La edad media fue de 59 ± 8 años; el 71% de los participantes presentaron DGM (76% diabéticos y 67% controles). OSDI fue significativamente superior (p = 0,01) en el grupo diabético. Se encontró una correlación positiva entre glucemia y síntomas (p = 0,0005), y una fuerte correlación entre Hb1Ac y OSDI en DGM. NIBUT fue inferior en el grupo control (2,47 ± 1,2 s) que en el grupo diabético (2,9 ± 1,2 s), con una correlación inversa significativa (52,22%) con la irregularidad del borde palbebral y queratinización del OM. CONCLUSIONES: DGM en los pacientes con diabetes tipo 2 es más grave, en comparación con los pacientes no diabéticos. La mayor duración de la diabetes se asocia a síntomas mayores y cambios en la GM. El grupo diabético reflejó cambios mayores en los párpados y la función de la lágrima, lo cual supone ojo seco evaporativo, y un alto grado de correlación con irregularidad del margen palpebral y obstrucción de la GM

Escotoma juncional. A propósito de un caso / Junctional scotoma. A case report

Mujer de 55 años que refiere pérdida visual progresiva en el ojo derecho presenta un escotoma juncional en un estudio campimétrico. Se practica resonancia magnética, que muestra un aneurisma de la arteria cerebral media derecha con compromiso quiasmático ipsolateral

The case concerns a 55 year-old female patient with progressive visual decrease in her right eye that showed a junctional scotoma in the visual field study. A magnetic resonance scan was performed, which showed a right middle cerebral artery aneurysm with ipsolateral chiasmatic involvement

Terapia de luz pulsada intensa regulada: un tratamiento complementario prometedor para la enfermedad de ojo seco / Intense pulsed light therapy: A promising complementary treatment for dry eye disease

Objetivo: Presentar los resultados del tratamiento con luz pulsada regulada (IPL) en pacientes con ojo seco. Material y métodos: Estudio retrospectivo. Se analizaron historias clínicas de pacientes con ojo seco sometidos a terapia IPL en quienes no se logró un control satisfactorio de los síntomas luego de terapia médica. Se evaluó previo al inicio y al final de la terapia una escala analógica visual de síntomas y además el tiempo de rotura de la película lagrimal (tBUT), test de Schirmer y puntuación de Van Bijsterveld. Se realizó un análisis de medidas repetidas con SPSS comparando los resultados antes y después de realizar la terapia IPL. Resultados: Se analizaron 50 ojos de 25 pacientes: 9 hombres (36%) y 16 mujeres (64%); se encontró una mediana de edad de 59 años (RIC 52-64). La mediana en la escala de síntomas fue de 8 (RIC 8-9) y 3 (RIC 2-4) antes y después del tratamiento con IPL (p<0,05). El tBUT tuvo una mediana de 4 (RIC 3-5) y 10 (RIC 8-11), el test de Schirmer de 13 (RIC 12-15) y 15 (RIC 13-20) y la puntuación de Van Bijsterveld de 3 (RIC 3-4) y 2 (RIC 2-3) antes y después del tratamiento, respectivamente (p < 0,05 en todos los análisis). Conclusiones: La terapia de IPL para el ojo seco es una excelente opción de tratamiento: muestra mejoría objetiva mediante la estabilización de la película lagrimal y tinción de superficie ocular, así como también mejoría subjetiva evidenciada en los síntomas manifestados por los pacientes

Objective: To propose the Intense Pulsed Light (IPL) therapy as a helpful supplementary treatment in patients with dry eye disease. Material and methods: Retrospective cross sectional design. Medical records of patients in whom dry eye disease symptoms were not satisfactorily controlled with medical therapy alone and who underwent additional IPL with at least three sessions completed. Data were analyzed before therapy and 3weeks after its completion to asses improvement. Determination of symptoms, through a visual analog scale; tear film stability, through tear Break Up Time (tBUT); measurement of tear secretion, through Schirmer Test; and ocular surface staining with Van Bijsterveld score were evaluated. SPSS software and nonparametric analysis of repeated measures were used. The study was approved by the ethics committee. Results: 50 eyes from 25 subjects were reviewed. There were 9 males (36%) and 16 females (64%), with a median age of 59 years (IQR 52-64). The median of the symptoms scale was 8 (IQR 8-9) and 3 (IQR 2-4) before and after the therapy respectively (P < .05). The median of BUT was 4 (IQR 3-5) and 10 (IQR 8-11), Schirmer test was 13 (IQR 12-15) and 15 (IQR 13-20), and Van Bijsterveld score was 3 (RIC 3-4) and 2 (IQR 2-3) before and after the therapy respectively (P < .05, for all measurements). Conclusion: IPL treatment has excellent results regarding both: dry eye disease symptoms improvement and in office objective tests such as tBUT, Schirmer test and Van Bijsterveld score; IPL could be considered as an effective adjunct for dry eye disease