The Features and Treatment Effects on Keratoepitheliopathy for Meibomitis-Related Keratoconjunctivitis.

Meibomitis-related keratoconjunctivitis (MRKC) is characterized by meibomitis with corneal epithelial abnormalities, and can be divided into two types: MRKC accompanied with phlyctenular keratitis, and MRKC accompanied with keratoepitheliopathy that is similar to superficial punctate keratopathy (SPK). The purpose of this retrospective study was to investigate the characteristic features of keratoepitheliopathy and treatment outcomes for MRKC. This study involved 27 eyes of 18 MRKC patients (3 males and 15 females). National Eye Institute (NEI) scores and visual acuity were compared at pre and post treatment. All subjects were treated with a small-dose administration of clarithromycin. Keratoepitheliopathy characteristic to MRKC, yet different in appearance from SPK, was noted in 24 of the 27 eyes. Fluorescein staining revealed granular epithelial lesions generally larger than SPK that coexisted with small dark spots. In 17 eyes, keratoepitheliopathy was located within the pupillary zone, and the visual acuity in 12 eyes was less than 1.0. Our findings showed significant improvement in the NEI score in MRKC (p < 0.0001) and in visual acuity (p = 0.0157) post treatment, and the characteristic features of keratoepitheliopathy in MRKC that are often associated with decreased visual acuity were elucidated. The treatment of clarithromycin was found to be effective for MRKC with keratoepitheliopathy.

Eye Pain Caused by Epithelial Damage in the Central Cornea in Aqueous-Deficient Dry Eye.

In this study, the severity of eye pain (EP) and associated objective findings were evaluated in aqueous-deficient dry eye (ADDE) patients using PainVision®, a quantitative pain-measuring device. This study involved 53 eyes of 53 ADDE patients (6 males and 47 females; mean age: 64.4 ± 13.4 [mean ± SD] years). Of those, 18 eyes of 18 patients underwent punctal occlusion, and EP and objective findings in those patients were evaluated before and after treatment. In all patients, the severity of EP as measured by PainVision® was assessed using the Pain Degree (PD). The median PD for the 53 patients was 30.6 µA/µA (interquartile range, 16.9-93.2), and the nasal and central corneal staining score and the upper lid-wiper epitheliopathy score were significantly correlated with PD (R = 0.33, 0.33, and 0.28, respectively) (all: p < 0.05). Using the least squares method, the central corneal staining score most significantly affected PD. In the 18 cases that underwent punctal occlusion, PD was significantly reduced (median PD: 24.8 to 7.1 µA/µA; p < 0.0001). Using the least squares method, the central corneal staining score and tear meniscus radius were significantly more influential as factors contributing to PD before and after treatment, and central corneal epithelial damage was the factor most associated with ADDE-related EP.

Effect of Punctal Occlusion on Blinks in Eyes with Severe Aqueous Deficient Dry Eye.

Punctal occlusion (PO) is considered to improve both tear-film instability and increased friction during blinking and may consequently affect blinks. The purpose of this study was to investigate the effect of PO on blinks. This study involved 16 eyes of 16 severe aqueous deficient dry eye (ADDE) patients (mean age: 65.7 years). In all eyes, tear meniscus radius (TMR), spread grade (SG) of the tear-film lipid layer (i.e., SG 1-5: 1 being the best), fluorescein break-up time (FBUT), corneal epithelial damage score (CED), conjunctival epithelial damage score, corneal filament (CF) grade, lid-wiper epitheliopathy (LWE) grade, and superior limbic keratoconjunctivitis (SLK) grade were evaluated at before and at more than 1-month after PO. Moreover, using a custom-made high-speed blink analyzer, palpebral aperture height, blink rate, upper-eyelid closing-phase amplitude/duration/maximum velocity, and upper-eyelid opening-phase amplitude/duration/maximum velocity were measured at the same time point. After PO, TMR, SG, FBUT, CED, and the CF, LWE, and SLK grades were significantly improved, and upper-eyelid opening/closing-phase amplitude and maximum velocity significantly increased (all p < 0.04). The findings of this study suggest that PO improves ocular surface lubrication and that blink-related parameters can reflect the friction that occurs during blinking in eyes with severe ADDE.

Effectiveness of Single-Dose Oral Pilocarpine Administration in Patients with Sjögren's Syndrome.

In this study, we evaluated the effectiveness of a single-dose oral pilocarpine administration on tear film (TF), as well as dry eye and dry mouth symptoms, in 53 eyes of 27 Sjögren syndrome (SS) patients who were experiencing dry mouth. To evaluate the changes in tear volume, a digital video-meniscometer was used to measure the radius of the lower central tear meniscus curvature (R, mm) of each eye at prior to the administration of 5 mg oral pilocarpine, and at 15 (R:(15)), 30 (R:(30)), and 60 (R:(60)) minutes after administration. The fluorescein breakup time (FBUT, seconds) and ocular and oral dryness symptoms were evaluated before and at 60 min after administration using a visual analogue scale (VAS, mm). A significant increase in R was observed at 15 and 30 min after administration compared to that at prior to administration. FBUT showed significant improvement at 60 min after administration, and the VAS score for ocular and oral dryness symptoms was found to have decreased significantly at 60 min after administration. A single-dose administration of 5 mg oral pilocarpine had a beneficial effect on TF, as well as on ocular and oral dryness symptoms, in patients with SS.

Clinical Factors for Determining the Severity of Lid Wiper Epitheliopathy in Dry Eye.

PURPOSE: Lid wiper epitheliopathy (LWE) is an epitheliopathy of the marginal conjunctival portion of the eyelids that wipes the ocular surface during blinking. Although LWE is often observed in patients with dry eye, the factors determining LWE severity in dry eye remain unknown. Therefore, we investigated the relationship between LWE, tear abnormalities, and blinks in dry eye. METHODS: This study involved 76 eyes of 76 female patients with dry eye (mean age: 57.2 yrs). In all eyes, tear meniscus radius, spread grade (SG) of the tear film lipid layer (ie, SG 1-5, with 1 being the best), fluorescein breakup time (FBUT), fluorescein breakup pattern, corneal and bulbar conjunctival epithelial damage (CED: 15 points maximum; CjED: 6 points maximum, respectively), upper eyelid LWE grade (3 points maximum), and Schirmer 1 test were evaluated. Blink rate, palpebral aperture height, upper eyelid opening/closing-phase amplitude, upper eyelid opening/closing-phase duration, and upper eyelid opening/closing-phase maximum velocity were measured by the use of a custom-made high-speed blink analyzer. Finally, the factors that determine the LWE grade were investigated by multiple regression analysis, in which the parameters were chosen using the stepwise procedure. RESULTS: Significant correlations were found between LWE grade and tear meniscus radius, SG, FBUT, CED, CjED, and Schirmer 1 test (P < 0.002). LWE grade was found to be described as -0.001 + (0.283 × SG) - (0.253 × FBUT) + (0.003 × upper eyelid closing-phase maximum velocity) (R2 = 0.57, P < 0.0001). The prevalence and grade of LWE were significantly higher in aqueous deficient dry eye. CONCLUSIONS: Tear volume, tear film stability, and blink should be considered as factors for determining LWE severity.

Clinical Implication of Patchy Pattern Corneal Staining in Dry Eye Disease.

Corneal fluorescein staining in a form that is commonly called a "patchy pattern (PP)" is sometimes seen with or without superficial punctate keratopathy (SPK) in dry-eye diseases (DEDs). Here, we investigated the differences in the clinical features of DED patients with and without PP corneal staining (PPCS). This study involved 35 DEDs with PPCS (PPCS group) and 30 DEDs with SPK and without PPCS (non-PPCS group). The tear meniscus radius (TMR, mm), spread grade (SG) of the tear-film lipid layer (i.e., SG 1-5, 1 being best), noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal epithelial damage (CED, 15 points maximum), conjunctival epithelial damage (CjED, six points maximum), the Schirmer's 1 test (ST1, mm), and the prevalence of Sjögren's syndrome (SS) were examined, and then compared between the two groups. Our findings revealed that between the groups (PPCS vs. non-PPCS), there was a statistically significant difference (p < 0.05) in CjED (3.1 ± 1.9 vs. 1.3 ± 1.6), ST1 (5.6 ± 7.4 vs. 14.8 ± 11.4), and the prevalence of SS (60.0% vs. 16.7%). Our findings suggest that DEDs and dry-eye patients with PPCS may indicate not only SS itself, but also the ophthalmological characteristics compatible with SS.

Evaluation of Eye-Pain Severity between Dry-Eye Subtypes.

The aim of this study was to assess eye pain between dry eye (DE) subtypes using questionnaires and the PainVision® (Osachi) apparatus. This study involved 52 eyes of 52 DE patients with eye pain (43 females and 9 males; mean age: 64.2 ± 13.2 (mean ± SD) years) who were classified into three DE subtypes (aqueous deficient DE (ADDE); decreased wettability DE (DWDE); and increased evaporation DE (IEDE)) based on fluorescein breakup pattern. In all subjects, severity of eye pain was evaluated using PainVision®, the DE-symptom-questionnaire visual analog scale (DSQ-VAS), and the Short-Form McGill Pain Questionnaire 2 (SF-MPQ-2). The severity of eye pain was compared between the three DE subtypes. PainVision® findings revealed greater severity of eye pain in ADDE and DWDE than in IEDE (p < 0.05, respectively), despite no difference being found in each questionnaire. A significant correlation was found between eye pain in DSQ-VAS and continuous pain, intermittent pain, neuropathic pain, and total pain in SF-MPQ-2 (R = 0.50, 0.49, 0.47, and 0.56, respectively) (all: p < 0.001). Greater severity of eye pain was found in ADDE and DWDE than in IEDE, and PainVision® was found useful for the objective assessment of eye pain.

The Relationship between Subjective Symptoms and Quality of Life in Conjunctivochalasis Patients.

The purpose of this study was to evaluate the differences in subjective symptoms between patients with conjunctivochalasis (CCh) and dry eye (DE), and examine the relationship between subjective symptoms and quality of life (QOL). In 75 eyes of 75 CCh patients and 122 eyes of 122 DE patients, 12 subjective symptoms classified into four groups depending on the mechanisms associated with symptoms (ITF: instability of tear film, IF: increased friction, R: reflex, and DTC: delayed tear clearance) were evaluated by use of a visual analogue scale (VAS). Fifteen items related to DE symptoms and their influence on daily life were evaluated by use of the dry eye-related quality-of-life score (DEQS) questionnaire, with overall degree of QOL impairment calculated as a QOL score. The correlation between the Total VAS score and QOL score were evaluated. Between the CCh and DE patients, significant differences in subjective symptoms were found in eye dryness, pain, tearing sensitivity to light, and heavy eyelids, while tearing was higher in CCh. A significant strong correlation was found between QOL score and Total VAS score, ITF, and IF in CCh patients. The QOL of CCh patients is strongly determined by decreased tear-film stability and increased friction during blinking.

Characteristics of tear abnormalities associated with benign essential blepharospasm and amelioration by means of botulinum toxin type A treatment.

PURPOSE: To investigate the characteristics of tear abnormalities with benign essential blepharospasm (BEB) and the effect of botulinum toxin type A (BTX-A) treatment. STUDY DESIGN: Prospective and clinical study. METHODS: Forty eyes of 40 patients (12 men and 28 women, ages 63.5 ±12.9) with BEB and tear abnormalities were enrolled. RESULTS: The average scores for subjective symptoms as evaluated by the visual analog scale (VAS) were 46.3 and Dry Eye-Related Quality-of-Life Score (DEQS) were 63.7. The fluorescein breakup time (FBUT) was 2.7 ± 1.6 sec. Among fluorescein breakup patterns (FBUPs), dimple break, with the corresponding mechanism of decreased wettability was the most frequent, observed in 29 eyes (73%). The NEI score was 0.4 ± 0.7 and the van Bijesterveld score was 0.6 ± 0.8; the Schirmer 1 test value was 13.1 ± 9.4 mm. Eighteen patients received BTX-A treatment, and significant improvement was found in severity of subjective symptoms both on VAS and DEQS as well as for FBUT. The main FBUPs changed from dimple break to random break. CONCLUSION: Tear abnormalities seen in BEB correspond to short BUT-type dry eye (DE), subclassified into decreased wettability DE in view of FBUPs.

Relationship Between Ocular Surface Epithelial Damage, Tear Abnormalities, and Blink in Patients With Dry Eye.

PURPOSE: Considering that tears play the role of a lubricant, it is speculated that in the pathophysiology of dry eye, increased friction during blinking results in corneal and conjunctival damage, which may subsequently affect the blink. The purpose of this study was to investigate the relationship between ocular surface epithelial damage, tear abnormalities, and blinks in patients with dry eye. METHODS: This study involved 45 eyes of 45 female patients with dry eye (mean age: 57.6 years). In all eyes, tear meniscus radius (mm), spread grade of the tear film lipid layer (SG: 1-5: 1 being the best), fluorescein breakup time (FBUT, seconds), corneal and bulbar conjunctival epithelial damage (CED: 15 points maximum and CONJUNCTIVAL EPITHELIAL DAMAGE (CjED): 6 points maximum, respectively), and Schirmer I test (ST1, mm) were evaluated. Blink rate (BR, blinks per minute), palpebral aperture height (mm), upper-eyelid opening-phase amplitude/upper-eyelid closing-phase amplitude (mm), upper-eyelid opening-phase duration/upper-eyelid closing-phase duration (ms), and upper-eyelid opening-phase maximum velocity/upper-eyelid closing-phase maximum velocity (mm/s) were measured using a custom-made high-speed blink analyzer. Finally, the factors that determine CED and CjED were investigated by multiple regression analysis, in which the parameters were chosen using the stepwise procedure. RESULTS: CED and CjED were found to be described as 2.687 + (1.816 × SG) - (0.937 × FBUT) (R = 0.656, P < 0.0001) and 0.684 + (0.801 × SG) - (0.526 × FBUT) - (0.041 × ST1) + (0.010 × upper-eyelid closing-phase maximum velocity) (R = 0.714, P < 0.0001), respectively. CONCLUSIONS: Although CED was significantly related to only tear abnormalities, CjED was significantly related to tear abnormalities and blinking.

A new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle.

PURPOSE: Surgical punctal occlusion is indispensable for the treatment of severe dry eye in cases where punctal-plug insertion is not applicable due to an enlarged or deformed punctum. However, permanent punctal occlusion is difficult in some cases. In our aim to establish a more reliable punctal occlusion, we have devised a new surgical approach for punctal occlusion. PATIENTS AND METHODS: This study involved 20 puncta of 12 eyes of 12 patients (1 male and 11 females; mean age: 65.2 years) with severe aqueous-tear-deficient dry eye. A new surgical procedure for punctal occlusion using fibrous tissue from under the lacrimal caruncle into the diathermy-induced deepithelialized canaliculus as supporting tissue for punctal closure was performed. In all patients, the assessment of eye symptoms, as well as the condition of punctal occlusion by slit-lamp biomicroscopy, tear volume (tear-meniscus radius [TMR] measurement by meniscometry), the condition of precorneal tear film (graded by interferometry [IG]), measurement of fluorescein breakup time (FBUT), and scoring of ocular surface staining (fluorescein score of area [FSA] and density [FSD], and lissamine green score [LGS]) were performed, and the preoperative and 6-month-postoperative values were compared. RESULTS: In regard to the postoperative improvement of symptoms, 11 patients showed remarkable improvement, 1 patient showed improvement, and no reopening of the closed punctum was found in any patient. Test values were all significantly improved post surgery (all: P<0.05) as compared to those prior to surgery (respective values [mean ± SD], and the pre- and postoperative P-values were: TMR (mm) [0.18±0.08; 0.56±0.28, P=0.002], IG [4.3±0.9; 2.7±0.8, P=0.009], FBUT [0.4±0.6; 4.1±2.9, P=0.004], FSA [1.6±0.7; 0.7±0.9, P=0.03], FSD [2.7±0.7; 0.6±0.7, P=0.003], and LGS [5.1±2.7; 1.1±2.1, P=0.005]). Moreover, no postoperative complications were observed. CONCLUSION: The findings of this study showed that our novel surgical procedure for punctal occlusion is highly successful and that it results in improved and more complete punctal occlusion.

Classification of Fluorescein Breakup Patterns: A Novel Method of Differential Diagnosis for Dry Eye.

PURPOSE: To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. DESIGN: Cross-sectional study. METHODS: In 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19); spot (SB, n = 22); line (LB, n = 24); dimple (DB, n = 19); random (RB, n = 22 eyes); and dry eye-related symptoms using the visual analog scale (VAS, 100 mm = maximum), tear meniscus radius (TMR, mm), tear film lipid layer interference grade (IG) (grades 1-5; 1 = best) and spread grade (SG) (grades 1-4; 1 = best), tear film noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points = maximum), ocular surface epithelial damage (OSED) score (9 points = maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP. RESULTS: In each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, and foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB, and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and -RB; SB-DB and -RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (P < .05 in each comparison). CONCLUSIONS: The 5 different FBUPs constituted different groups, reflecting different pathophysi-ologies.

Meibomian Gland Physiology in Pre- and Postmenopausal Women.

Purpose: The purpose of this study was to assess the change of meibomian gland physiology during the menstrual cycle and compare its physiology among pre- and postmenopausal women and men. Methods: This study involved 18 healthy subjects: 6 premenopausal women with a regular 28- to 30-day menstrual cycle, 6 postmenopausal women, and 6 men who were age-matched to the premenopausal women. All subjects measured basal body temperature every day at home and were seen once weekly for 5 weeks, and the menstrual state of the premenopausal subjects was masked until after the investigation. At each visit, the meibomian gland orifice (MGO) diameter, lid margin meibum level as meibometry value, meibomian gland morphology, and fluorescein breakup time (F-BUT) of tear film were evaluated, and serum samples were obtained for analysis of sex steroid hormones. Results: The meibomian gland physiology showed cyclic change during the menstrual cycle. The MGO diameter and meibometry value of the meibomian glands decreased in the latter half of the luteal phase until menstruation, correlating well with a shortening of F-BUT. The MGO diameter and meibometry value were significantly higher in postmenopausal women and men than in premenopausal women; however, F-BUT was significantly longer in men than in pre-/postmenopausal women. Conclusions: The findings of this study show that meibomian glands exhibit a cyclic change in premenopausal women, as well as sex- and age-related physiologic differences.

Impact of Cigarette Smoking on Tear Function and Correlation between Conjunctival Goblet Cells and Tear MUC5AC Concentration in Office Workers.

The first aim of this study was to clarify whether cigarette smoking affects tear secretion, goblet cell density, and tear MUC5AC concentration. The second purpose was to evaluate the correlations of conjunctival goblet cell density with tear MUC5AC concentration and other ocular surface evaluation factors. This cross-sectional study included 88 office workers. All subjects were required to fill in dry eye and smoking questionnaires, in addition to ocular surface evaluation. Tear wash fluid was collected from inferior fornix, and conjunctival epithelium was obtained by impression cytology. Tear MUC5AC concentration was quantified using enzyme-linked immunoassay, and conjunctival goblet cell density was counted after Periodic-acid Schiff staining. Tear MUC5AC concentration had significant positive correlation with conjunctival goblet cell density (r = 0.181, P = 0.03). In current smokers, Schirmer I test value, goblet cell density and tear MUC5AC concentration were significantly lower than non-smokers. Pack-years of smoking have significant negative correlation with goblet cell density (r = -0.174, P = 0.036) and tear MUC5AC concentration (r = -0.183, P = 0.028). We concluded that smoking might decrease tear secretion, goblet cell density and tear MUC5AC concentration. In addition, MUC5AC concentration in tears depends on goblet cell density in the conjunctiva among office workers.

The association of sleep quality with dry eye disease: the Osaka study.

PURPOSE: To investigate the association of dry eye disease with sleep quality. METHODS: In 2011, a cross-sectional survey was conducted among all the employees, mainly young and middle-aged Japanese office workers, who used visual display technology, at a company in Osaka, Japan (N=672; age range =26-64 years). The participants were classified according to the Japanese dry eye diagnosis criteria by dry eye examination results including the Schirmer test, fluorescein and lissamine green staining, tear film break-up time, and symptom questionnaire into three groups as follows: definite dry eye disease, probable dry eye disease, and no dry eye disease. To determine sleep quality, Japanese version of the Pittsburgh Sleep Quality Index (global score) was implemented. The global score (range =0-21) was calculated by summing seven sleep variable scores (scale, 0-3); scores ≥5.5 indicated poor sleep. RESULTS: The total mean global score was 5.1±2.3 (completed N=383); 45% of the dry eye disease participants reported having poor sleep quality, while 34% of the no dry eye disease participants did so, with a significant difference found in the global score (P=0.002). Furthermore, a statistically significant association was observed between the global score and dry eye disease (P=0.005). CONCLUSION: Poor sleep quality is associated with dry eye disease, especially with dry eye symptoms.

Associations between subjective happiness and dry eye disease: a new perspective from the Osaka study.

IMPORTANCE: Dry eye disease has become an important health problem. A lack of concordance between self-reported symptoms and the outcome of dry eye examinations has raised questions about dry eye disease. OBJECTIVE: To explore the association between subjective happiness and objective and subjective symptoms of dry eye disease. DESIGN: The study adopted a cross-sectional design. SETTING: All the employees of a company in Osaka, Japan. PARTICIPANTS: 672 Japanese office workers using Visual Display Terminals (age range: 26-64 years). METHODS: The dry eye measurement tools included the Schirmer test, conjunctivocorneal staining, the tear film break-up time, as well as the administration of a dry eye symptoms questionnaire. Happiness was measured by the Subjective Happiness Scale. MAIN OUTCOME MEASURES: Dry eye examination parameters, dry eye symptoms questionnaires, and the Subjective Happiness Scale score. RESULTS: Of the 672 workers, 561 (83.5%) completed the questionnaires and examinations. The mean Subjective Happiness Scale score was 4.91 (SD = 1.01). This score was inversely correlated with the dry eye symptom score (r = -0.188, p < 0.001), but was not associated with objective findings which include conjunctivocorneal staining, low Schirmer test score, or low tear film break-up time. The level of subjective happiness was the lowest in the group without objective results, but reported subjective symptoms of dry eyes (p < 0.05). CONCLUSIONS AND RELEVANCE: There is evidence of the relationship between subjective happiness and self-reported symptoms of dry eyes. Findings of this study revealed a new perspective on dry eye disease, including the potential for innovative treatments of a specific population with dry eye disease.

Importance of tear film instability in dry eye disease in office workers using visual display terminals: the Osaka study.

PURPOSE: To evaluate the relationship between subjective symptoms and clinical signs in dry eye disease (DED) in office workers using visual display terminals (VDTs). DESIGN: Cross-sectional study. METHODS: This study involved 672 Japanese young and middle-aged office workers who use VDTs. The subjects completed questionnaires designed to detect subjective symptoms and risk factors for DED. Dry eye tests, including tear film break-up time (TBUT), corneal-conjunctival staining with fluorescein and lissamine green, and the Schirmer test, were performed. Based on the Japanese diagnostic criteria for DED, the subjects were classified into 3 groups: definite DED, probable DED, and non-DED. Between each group, subjective symptoms and clinical signs were compared. RESULTS: Of the 672 subjects, 561 (374 male, 187 female) completed the questionnaire (response rate: 83.5%). Definite DED was diagnosed in 65 subjects (11.6%), probable DED in 303 subjects (54.0%), and non-DED in 193 subjects (34.4%). The mean subjective symptom score was significantly less in subjects with probable DED (2.05 ± 0.42) and non-DED (1.63 ± 0.38) than in those with definite DED (2.19 ± 0.40) (P < .05 and P < .01, respectively). In the subjects with probable DED, a subgroup with positive subjective symptoms and abnormal TBUT (≤5 seconds) was categorized as short TBUT-type DED, and it was found that they had a higher subjective symptom score (2.09 ± 0.40), equivalent to that of those with definite DED (P = .269). CONCLUSIONS: Despite no or minor epithelial damage, the severity of subjective symptoms was greater in short TBUT-type DED, most likely attributable to tear film instability. Thus, it might prove important to evaluate TBUT to successfully treat those patients.

The Association between Dry Eye Disease and Physical Activity as well as Sedentary Behavior: Results from the Osaka Study.

Purpose. To assess the association of dry eye disease (DED) with physical activity and sedentary behavior. Methods. The cross-sectional survey conducted included Japanese office workers who use visual display terminals (n = 672). DED was assessed according to the Japanese Dry Eye Diagnostic Criteria, and participants were categorized into "definite DED," "probable DED," or "non-DED" groups based on the results of DED examinations. Physical activity and sedentary behavior of participants were assessed using the International Physical Activity Questionnaire (IPAQ), and physical activity level was calculated in metabolic equivalent units per week (MET, min/week). Participants were classified as having a high, moderate, or low level of physical activity. Results. Participants with abnormal tear break-up time (BUT) (≤5 s) were involved in sedentary behavior for significantly longer duration than those with normal BUT (P = 0.035). Non-DED participants (14.5%) tended to have higher levels of physical activity than definite DED participants (2.5%). Participants with definite DED had significantly lower MET scores than those with non-DED (P = 0.025). Conclusions. Our findings suggest that a lower level of physical activity and sedentary behavior are associated with DED; however, longitudinal/intervention studies with large groups of participants are needed to validate these findings.

[Clinical investigation of extrusion rate and other complications associated with Punctal Plug F].

PURPOSE: To investigate the effectiveness, extrusion rate and other complications of Punctal Plug F (PPF) compared with Punctal Plug (PP), Super-Flex plug (SFP) and SuperEagle plug (SEP). SUBJECTS AND METHODS: This study involved 31 eyes of 24 dry-eye patients treated with PPF at the dry-eye clinic of Kyoto Prefectural University of Medicine, Kyoto, Japan. Intracanalicular migration rate, extrusion rate, granulation rate, accumulation of soft whitish material and enlargement of punctum size after punctal-plug extrusion were investigated and compared with previously published results of PP, SFP and SEP. RESULTS: No migration was observed in the PPF cases at the time of insertion. The extrusion rate was 43.5% during follow-up periods. The average time to extrusion was 158.2 +/- 175.7 (mean +/- SD) days, and the time until 50% of plugs were extruded was 234 days, longer than that in the SFP cases (p = 0.0012). Granulation was seen in 4.3% of the eyes, but the frequency was lower than in the PP(19%, p = 0.015) and SEP cases (34.5%, p < 0.0001). No soft whitish material was seen around the PPF-cases' plugs yet significant, post-extrusion punctum size (mm) enlargement (0.78 +/- 0.14) was observed compared to pre-insertion(0.61 +/- 0.18, p < 0.001). CONCLUSION: Our findings show that insertion of the PPF was easy and without intracanalicular migration, harder to extrude, similar to the PP, yet less susceptible to granulation formation compared with the PP.

[Treatment progress of large-size puncta and clinical investigation of the extrusion rate and other complications associated with large-size punctal plugs].

PURPOSE: One complication of punctal plug occlusion (PPO) is enlargement of the punctum. The purpose of the present study was to investigate large-size (over 1.0 mm) puncta after punctal plug extrusion. SUBJECTS AND METHODS: This study involved the treatment progress of 74 large-size (over 1.0 mm) puncta in 55 eyes of 46 patients who underwent PPO. The extrusion rate and other complications of the total 133 punctal plugs used for those puncta were investigated. RESULTS: Of the 74 puncta, 33 (44%) achieved occlusion by PPO alone, 20 (27%) achieved perfect occlusion of granulation, and 21 (29%) required surgical punctal occlusion. Although larger or longer punctal plug sizes have been used for PPO, the average elapsed time until extrusion was 143.5 +/- 217.0 (mean +/- SD) days, and the time until 50% of the plugs were extruded was 50 days. No significant extrusion rate was found among the punctal plugs, and there was 0% migration rate. Granulation was observed in 20.3% of the plugs, yet no soft whitish material was seen around the plugs. CONCLUSION: The findings of this study show that large-size puncta can successfully be occluded for a fixed period of time following PPO.