Role of corneal cold thermoreceptors in the occurrence and development of dry eye / 中华实验眼科杂志

Dry eye is a multifactorial disease caused by changes in tear quality, volume and dynamics.Disturbance of tear film as the main character is accompanied by discomfort, visual disorder, and damage to the ocular surface and nerves.Cold thermoreceptors existing on the ocular surface are sensitive to alterations in corneal temperature and tear osmolality.They can give rise to the sensations of cold and pain, and regulate tear secretion, and are considered to be associated with the clinical manifestations of dry eye in some ways.This article reviewed the progress of corneal cold thermoreceptors in the regulation of corneal sensation and tear secretion, the related factors of corneal sensory regulation, and the clinical applications of TRPM8-related drugs, so as to provide ideas for the treatment of dry eye.

Is dacryocystectomy effective in reducing epiphora?

Purpose: To study the efficacy of dacryocystectomy (DCT) in reducing epiphora in cases of primary acquired nasolacrimal duct obstruction. Methods: This was a prospective, nonrandomized, interventional study conducted over a period of 12 months. All cases who either opted or satisfied our criteria for DCT in primary acquired nasolacrimal duct obstruction (age above 70 years) were included in the study. Patients with secondary nasolacrimal duct obstruction and those undergoing revision surgeries were excluded. Patients were asked to report the percentage improvement in postoperative watering subjectively. Munk score and fluorescein dye disappearance test (FDDT) were recorded pre? and postoperatively. Wilcoxon signed ranked test was used for analysis. Results: Eighty?two eyes of 65 patients were included. Most of the patients (46, 70.8%) were females. The mean age was 68.46 ± 5.7 years (range: 60–85 years). The mean subjective improvement in watering was 86.8%. The P value for preoperative and postoperative difference in Munk score and FDDT score was highly significant (P = 0.00001). Conclusion: Apart from providing relief from ocular discharge, DCT also provides significant improvement in watering. Patients can be preoperatively counseled regarding chances of reduction in epiphora following surgery

Efficacy observation of acupuncture for dry eye syndrome of lung-yin deficiency pattern / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of combining two needling manipulations, Er Long Xi Zhu (two dragons playing with a pearl) and Guo Yan Re (heat produced to reach the eyes), in treating dry eye syndrome (DES) of lung-yin deficiency pattern. Methods: Fifty-six eligible DES patients of lung-yin deficiency were randomized into an observation group and a control group, with 28 cases in each group. Same acupoints were selected in the two groups: Cuanzhu (BL 2), Sizhukong (TE 23), Taiyang (EX-HN 5) and Fengchi (GB 20) were chosen as the major points and Feishu (BL 13) and Chize (LU 5) as the adjuvant. Er Long Xi Zhu and Guo Yan Re needling manipulations were applied in the observation group while twirling reinforcing manipulation was used in the control group. Treatment was conducted once per day in both groups, for two sets of 15 consecutive days at a 2-day interval. Changes in the symptom score, tear break-up time (BUT) and tear production were observed afterwards, and the clinical efficacy was also compared between the two groups. Results: The total effective rate was 92.8％ in the observation group, higher than 71.4％ in the control group, and the between-group difference was statistically significant (P<0.05). After treatment, the symptom score, tear BUT and tear production showed significant improvements in both groups (all P<0.05); the symptom score, BUT and tear production in the observation group were significantly different from those in the control group (all P<0.05). Conclusion: Given the same acupoint selection, combining Er Long Xi Zhu and Guo Yan Re needling manipulations can produce more significant clinical efficacy than twirling reinforcing manipulation in treating DES of lung-yin deficiency pattern.

Therapeutic effect of anti-inflammatory tripeptide KdPT on ophthalmoxerosis in mice / 中国药科大学学报

@#This study was designed to investigate the therapeutic effect of anti-inflammatory tripeptide KdPT on ophthalmoxerosis. Male BALB/c mice, 8-week old, were treated with 0.2% benzalkonium chloride solution to establish the ophthalmoxerosis model. Four weeks after modeling, the mice were randomly divided into control group, positive group and the low, medium, high dose groups of KdPT. Each group was given normal saline, artificial tears and 1, 10, 100 μg/mL KdPT, respectively. After 3, 5, 7, 10 and 14 days of treatment, the morphology of the eye surface was observed, and the fluorescein sodium staining score was performed. The amount of tear secretion was measured by phenol red cotton thread and the right corneas were taken out for histopathological analysis after 14 days of treatment. Data showed that there was no significant abnormality in general state and the weight of mice in each group at each time point of treatment. After 14 days of treatment, KdPT can promote the secretion of tear, repair the damaged corneal epithelium, and showed a significant therapeutic effect on ophthalmoxerosis in mice. Based on the data, it is possible for KdPT to be developed as a novel drug for ophthalmoxerosis.

Tear film measurements in four different ethnic groups: Malay, Chinese, Indian and Nigerian / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the non-invasive tear film break-up time(NIBUT), tear break up time(TBUT), basal tear secretion(BTS)and blink rate in four ethnic groups: Malay, Chinese, Indian and Nigerian.<p>METHODS: Totally 120 healthy(61 males and 59 females)subjects(without dry eye symptoms and ocular surface disorder)with the age 20 to 39 years were recruited; 30 were Malays, 30 were Chinese, 31 were Indians and 29 were Nigerians. Based on McMonnies questionnaire and clinical examination, normal subjects were selected. NIBUT, TBUT, BTS were assessed in only one eye(right)of each subject and blink rate was also assessed.<p>RESULTS: There was significant difference in the NIBUT, TBUT, BTS and blink rate among 4 different ethnic groups(<i>P</i>=0.018),(<i>P</i>=0.001),(<i>P</i>=0.011), and(<i>P</i>=0.004)respectively. No statistically significant difference of NIBUT, TBUT, BTS and blink rate was found between the genders among different ethnic groups. Indian had higher median for NIBUT(10±6s), TBUT(7±5s)and BTS(20±20 mm)than others races. Chinese had lower median for NIBUT(7.5±4s)and TBUT(4±2s)while Malay had low BTS(9.5±16 mm)among the groups. There was no significant correlation of blink rate with NIBUT, TBUT and BTS(<i>r</i>= -0.119, <i>P</i>=0.195),(<i>r</i>=-0.086, <i>P</i>=0.352),(<i>r</i>= -0.123, <i>P</i>=0.180)respectively.<p>CONCLUSION: This study showed the variability in tear-film measurements values in four ethnic groups.

Clinical features of eyelid demodex infection in patients with meibomian gland dysfunction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To analyze the clinical features of ectopic demodex infection in patients with meibomian gland dysfunction. <p>METHODS: A retrospective study. Totally 220 patients(440 eyes)with meibomian gland dysfunction were selected from November 2016 to June 2018. They were divided into uninfected group and infected group according to the concurrence of eyelash demodex infection. 110 patients(220 eyes)in each group. The ocular function indexes of the two groups were tested and compared, and the clinical characteristics of eyelash demodex infection were evaluated.<p>RESULTS: The incidence of itching, foreign body sensation, eye pain, dryness and astringency in the infected group was significantly higher than that in the non-infected group(<i>P</i><0.05), and there was no significant difference in the incidence of symptoms such as redness, secretion increase, fatigue and photophobia(<i>P</i>>0.05); the average tear film rupture time and basic tear secretion in the two groups were significantly lower than that in the normal level, and the infected group was significantly lower than that in the non-infected group(<i>P</i><0.05). Corneal staining score and tarsal gland secretion function score in non-infected group were significantly lower than those in infected group(<i>P</i><0.05).<p>CONCLUSION: Patients with tarsal gland dysfunction are more likely to suffer from itching, dryness, eye pain and other symptoms after eyelash demodex infection, which increases the damage of corneal and conjunctival epithelium. It is of great significance to pay attention to demodex infection examination for patients with tarsal gland dysfunction.

Xerophthalmia of and deficiency treated with needling technique / 中国针灸

<p><b>OBJECTIVE</b>To explore the differences in the clinical therapeutic effects on xerophthalmia of and deficiency between the needling technique (the combined reinforcing technique to induce warm sensation) and the reinforcing needing technique achieved by rotating needle.</p><p><b>METHODS</b>A total of 54 patients of xerophthalmia were randomized into an observation group (28 cases) and a control group (26 cases). In both of the groups, the main acupoints included Cuanzu (BL 2), Sizhukong (TE 23), Taiyang (EX-HN 5) and Fengchi (GB 20); the combined acupoints were Danzhong (CV 17), Sanyinjiao (SP 6), Taixi (KI 3) and Taichong (LR 3). In the observation group, the needling technique was used and in the control group, the reinforcing needing technique achieved by rotating needle was adopted. The treatment was given once every day. 10 treatments made one course and 2 courses were required. Before and after treatment, the score of eye symptoms, tear secretion and the breakup time of tear film were observed in the two groups. The clinical therapeutic effects were compared between the two groups after treatment and in 4-week follow-up after treatment separately.</p><p><b>RESULTS</b>After treatment, the total effective rate was 92.9% (26/28) in the observation group and was 80.8% (21/26) in the control group, without significant difference in comparison (>0.05). In 4-week follow-up after treatment, the total effective rate was 85.7% (24/28) in the observation group and was 61.5% (16/26) in the control group, indicating the significant difference in comparison (<0.05). After treatment, the differences were significant in the score of eye symptoms, tear secretion and the breakup time of tear film as compared with those before treatment in the two groups (all <0.01). After treatment, the improvements of the score of eye symptoms, tear secretion and the breakup time of tear film in the observation group were better remarkably than those in the control group, indicating the significant differences (all <0.05).</p><p><b>CONCLUSION</b>The needling technique achieves the significant therapeutic effects on xerophthalmia of and deficiency and the recurrence rate of the disease is low.</p>

Effect of different types of pterygium surgery and on tear film in patients with type 2 diabetes mellitus / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the effect of three types of pterygium surgery and on tear film in patients with type 2 diabetes mellitus. ·METHODS:A total of 102 patients ( 102 eyes ) with pterygium combined with type 2 diabetes mellitus treated in our hospital from March 2013 to March 2016 were analyzed retrospectively. The patients were divided into three groups including the 34 cases ( 34 eyes ) with simple excision of pterygium ( resection group ) , pterygium excision combined with conjunctival flap transplantation in 34 cases (34 eyes, as conjunctival flap group ) and pterygium excision combined with limbal stem cell transplantation in 34 cases ( 34 eyes, as stem cell group ) . The wound repair time, complications, recurrence rate, uncorrected visual acuity (UCVA), tear film break-up time ( BUT ) and basal tear secretion test (SⅠt) were observed before, and 6 and 12mo after surgery in the three groups, respectively. ·RESULTS:The postoperative UCVA of the three groups was significantly higher than that preoperation ( P =0. 039, 0. 013, 0. 024 ), and there was no significant difference among the three groups ( P = 0. 317 ). The wound repair time was 5. 67 ± 1. 45d in the resection group, which was significantly higher than that in the conjunctival flap group (4. 18 ± 0. 76d) and the stem cell group (4. 09±0. 79 d) (P<0. 001), there was no significant difference between the conjunctival flap group and the stem cell group ( P = 0. 937 ). There were 4 cases in resection group reappeared, and the recurrence rate was 11. 8%, which was significantly higher than the other two groups ( P = 0. 037 ). There were 1 recurrences in the conjunctival flap group, and the recurrence rate was 2. 9%, while the patients in the stem cell group had no obvious recurrence. SⅠt and BUT increased significantly after operation (P<0. 05), especially in conjunctival flap group and stem cell group (P<0. 001). There was no significant difference between the conjunctival flap group and the stem cell group (P=0. 845, 0. 894). · CONCLUSION: Pterygium excision combined with conjunctival flap transplantation or limbal stem cell transplantation for the treatment of type 2 diabetic patients with normal blood glucose and tear film function has the similar effect, and is better than simple pterygium excision.

Experimental study on reparation of conjunctival and skin laceration with α-cyanoacrylate / 中华实验眼科杂志

Background The effectiveness of medical tissue adhesive for the reparation of operative incision has been recognized,but its influence to ocular surface microenvironment is not quite clear.Objective This study was to appraise the safety and efficacy of α-cyanoacrylate,a medical issue adhesive,for the reparation of the conjunctival and skin laceration.Methods Twenty healthy New Zealand rabbits were randomly divided into suturing group and medical glue group.Routine ophthalmic examination,the level of tear secretion and breakup time of tear film (BUT) were tested before operation.The upper bulbar conjunctiva of each right eye was cut apart about 1.0 cm after surface anesthesia and the skin of back was incised about 2.5 cm length after local anesthesia.The conjunctival and skin lacerations were adhered with compound medical adhesive in the medical glue group,and continuous suture was done to repair the conjunctival laceration and interrupted suture to the skin laceration with 5-0 chorda serica chirurgicalis in the suture group.The routine ophthalmic examination,level of tear secretion,BUT and the states of wound healing were examined 1 day,2 days and 7 days postoperatively.Pathologic examination of the corresponding tissues was also carried out 1 week after the animals were sacrificed.The data were analyzed by SPSS 13.0 statistical software.This experiment followed the Administration of the Care and Use of Experimental Animals of Shanghai City.Results The conjunctival and skin lacerations healed well both in the suture group and the medical glue group.The levels of tear secretion 1 day and 2 days postoperatively in the medical glue group were (12.70±2.21)mm and (12.70±2.00)mm respectively,showing a significant lowness in comparison with (14.90±2.38)mm and (14.90±2.33)mm of the suture group (q =-4.02,P =0.03;q =-4.02,P =0.03).Compared with the baseline,the difference of the levels of tear secretion in the medical glue group was not statistically significant in various time points after operation (P=1.00,1.00,0.51).The BUT values at 2 days and 7 days postoperatively in the medical glue group were (4.50 ± 1.18) seconds and (4.10±0.88) seconds respectively,being significantly longer than (3.30 ± 1.06) seconds and (3.00±1.25) seconds in the suture group (q=4.37,P=0.02;q=4.19,P=0.03).Compared with the baseline,there was not statistically significant difference at each time point postoperatively in the medical glue group (P =0.28,0.59,0.21).However,BUT at each time point after operation in the suture group was significantly shorter than that of the baseline (P=0.01,0.01,0.00).Pathological examination showed that all the conjunctival and skin lacerations healed well.Trivial collagen hyperplasy was seen in the eyes of the suture group and infiltration of a few of inflammatory cells was found in the medical glue group.In the pathological result of the skin test,there was conspicuous scar and severe collagen hyperplasy in the suture group,but in the medical glue group,the skin structure was almost normal.Conclusions α-Cyanoacrylate is safe and effective for the repair of the conjunctival incision with little affection to ocular surface microenvironment.

Tear Secretion and Tear Film Function in Diabetics.

In the present study, the evaluation of the amount of the tear production, the stability of the tear film and the condition of the conjunctival surface by the use of impression cytology in the diabetics and the non diabetic individuals was done to detect the possible tear film anomalies in the Type 2 diabetic patients. We performed Schirmer 1 test, TFBUT (Tear film break up time) and CIC (Conjunctional Impression Cytology) on each subject in both groups. The mean values for Schirmer 1 test, TFBUT were significantly decreased in diabetes patient as compared to healthy controls. The CIC revealed pronounced degree of metaplasia with loss of goblet cells in diabetic patients. We found decreased tear production, unstable tear film and squamous metaplasia in diabetic patients.

The Effect of Topical Pilocarpine on Basic Tear Secretion

PURPOSE: To evaluate the effect of topical pilocarpine on basic tear secretion, using the Schirmer test. METHODS: The Schirmer test was performed in 22 eyes of 11 healthy volunteers before instillation and at 10, 20, and 30 minutes after instillation of 1% pilocarpine and in 22 eyes of 12 healthy volunteers before instillation and at 10, 20, and 30 minutes after instillation of 2% pilocarpine. As for control group, the Schirmer test was performed in 22 eyes of 11 healthy volunteers by the same method except with normal saline. RESULTS: The ratio of tear secretion was calculated by dividing the wet length of a Schirmer strip after instillation by the wet length before instillation for comparative analysis. In the control group, the mean ratio decreased with time to 0.78 at 10 minutes, 0.64 at 20 minutes, and 0.63 at 30 minutes after instillation of normal saline. In the 1% pilocarpine group, the mean ratio decreased with time, but there was no significant difference in comparison to the ratio of the control group. In the 2% pilocarpine group, the ratio increased significantly to 1.28 (p<0.001) at 10 minutes, 1.07 (p=0.002) at 20 minutes, and decreased to 0.63 (p=0.041) at 30 minutes after instillation. CONCLUSIONS: The basic tear secretion did not change significantly after instillation of 1% pilocarpine but increased significantly at 10 minutes after instillation of 2% pilocarpine to the highest level observed, which was followed by a decrease in basic tear secretion.

Study on the change of tear secretion and the surface of cornea on the official personnel using computers

62 people (124 eyes) age from 21 to 49 (35 males, 27 females) are divided into 2 groups: in the first group 18 objects (36 eyes) with conjunctivitis, in the second group 44 objects (88 eyes) without conjunctivitis. All objects have taken Shirmer test (I and II), BUT, test of Rose-bengal and fluorescein. All are applied with Sanlein (Santen Agency). And those tests are measured after 1 and 3 months. Results: The Shirmer I and II, and BUT in the group 2 is higher than in the group 1, though BUT of both groups is at under normal level. Test of Rose-bengal 1 and 2 in group 1 is higher than in group 2. The intergrity of epithelial cells is also changed. Tear secretion of both groups at normal physiological level. Sanlein has good effect, partially improves tear indicator

The Change of Tear Flim after laser Epithelial keratomileusis and laser in situ keratomileusis

PURPOSE: To compare the effects of laser epithelial keratomileusis(LASEK) and laser in situ keratomileusis(LASIK) on tear secretion and tear film stability. METHODS: Sixty two eyes went through photorefractive surgery including LASEK(26 eyes, 14 patients) or LASIK(36 eyes, 18 patients) by the same surgeon from January in 2000 to April in 2000. Tear secretion was measured with schirmer test and tear stability was measured with tear breakup time(BUT) preoperatively and 2 months after procedures. RESULTS: In the LASEK group, the preoperative mean values were BUT, 7.46 sec; Shirmer, 11.92 mm, and at postoperative 2 months, they were 6.62 sec and 9.31 mm, respectively. The difference was statistically insignificant(P=0.51, P=0.22). In the LASIK group, the preoperative mean values were BUT, 7.56 sec; Shirmer, 10.56 mm. At 2 months, they were 5.56 sec and 7 mm, respectively. The difference was statistically significant(P=0.02, P=0.02). CONCLUSIONS: Our result showed that tear secretion seemed to be significantly decreased after LASIK, but not after LASEK.

Decreased Basal Tear Production Associated with General Anesthesia

Two types of tear secretion, basic and reflex, have been postulated. Basic secretion is thought to be a constant,slow secretion by the accessory lacrimal glands. Reflex secretion was defined as an increased rate of secretion caused by neural stimulation and thought to be secreted by the main lacrimal gland. The purpose of the present study is to measure the effect of general anesthesia and atropine on basal tear secretion in order to elucidate the association between basal tear secretion and autonomic nervous system. We studied the 84 cases of general operations that were performed between March 1998 and June 1998. Basal tear measurements were made before premedication, 5 minutes after injection of atropine, 10 minutes after general anesthesia and 1 hour after general anesthesia. Basal tear secretion was lower at 5 minutes after injection of atropine than before premedication and markedly decreased after induction of general anesthesia. Therefore, we think that basal tear secretion is closely related to the autonomic nervous system.

Tear Secretion Test by the use of Hamano Fibers

We measured the tear secretion rate in normal and dry eyes by using a cotton thread method. This new method measures basal tears by means of a yellow colored cotton thread(Hamano fiber) impregnated with phenol red. The 3mm bent end of a 70mm long thread is placed in the inferior conjunctival sac on the temporal side of the eye for 30 seconds. The length of the thread that is wet by the tears changes color soon from yellow to red as a result of the change in pH. We obtained the following results by using of Hamano thread test, as a modified Schirmer test. 1. The proper test time of this test was 30 seconds in view of the analysis of the amount of tear secretion with time. 2. Average wet lengths of normal male was 16.6mm, that of female was 15.7mm from 30 seconds test. 3. Distribution of wet lengths in 300 normal eyes were ranged from 4.0mm to 34.0mm and most of them(61%) were within 10 to 20mm. 4. Wet lengths with and without anesthesia showed no statistical significance(paired t-test, p>0.05). 5. Reproducibility of Hamano fiber test that was tested 3 times in same eye represented significance in statatics(paired t-tast, p<0.05).