Análise do filme lacrimal e dos sintomas de olho seco em pacientes submetidos à facoemulsificação / Analysis of the tear film and dry eye symptoms in patients undergoing phacoemulsification

RESUMO Objetivo: Avaliar o filme lacrimal e os sintomas de olho seco antes e após a realização da facoemulsificação. Métodos: Participaram deste estudo clínico 51 pacientes diagnosticados com catarata (55% mulheres; 78% brancos; 71,2 ± 6,5 anos de idade; sem uso de colírio lubrificante) que foram submetidos à facoemulsificação em um hospital na cidade de Aparecida (SP). A análise do filme lacrimal foi feita pelo teste de ruptura do filme lacrimal, e os sintomas de olho seco foram avaliados pelo Índice de Doença da Superfície Ocular, ambos antes da cirurgia e 30 e 60 dias de pós-operatório. Resultados: Na análise pré-operatória, 25,5% dos pacientes tinham olho seco pelo critério subjetivo (Índice de Doença da Superfície Ocular ≥ 25%), enquanto a proporção de pacientes com olho seco foi de 92,2% pelo critério objetivo (teste de ruptura do filme lacrimal < 10 segundos). Não houve correlação entre o teste de ruptura do filme lacrimal e o Índice de Doença da Superfície Ocular (r = −0,14; p = 0,33). Não foi observada redução dos sintomas de olho seco (15,9 ± 17,6 versus 12,2 ± 13,2 versus 7,8 ± 11,5; p < 0,001) e nem do tempo de ruptura do filme lacrimal (6,2 ± 2,2 vs. 4,3 ± 2,0 versus 6,9 ± 2,0 segundos; p < 0,001) no pré, 30 e 60 dias após a cirurgia. Conclusão: A facoemulsificação desencadeia sintomas de olho seco e altera os valores do teste de ruptura do filme lacrimal e do Índice de Doença da Superfície Ocular, havendo melhora depois da cirurgia, com o passar dos dias. Observou-se que, após os 60 dias, os sintomas de olho seco avaliados pelo Índice de Doença da Superfície Ocular apresentaram melhora. Em relação ao filme lacrimal, avaliado pelo teste de ruptura do filme lacrimal, observou-se que houve piora estatisticamente significativa aos 30 dias, seguida de melhora no pós-operatório de 60 dias. Os resultados sugerem que a análise clínica do olho seco deve ser realizada por diferentes métodos, preferencialmente objetivos.

ABSTRACT Objective: To evaluate the tear film and dry eye symptoms before and after phacoemulsification. Methods: Fifty-one patients diagnosed with cataracts participated in this clinical study (55% female; 78% white; 71.2 ± 6.5 years old; without the use of lubricating eye drops) and underwent phacoemulsification at a hospital in Aparecida (SP). Tear film analysis was performed by the tear film break-up test and dry eye symptoms were assessed by the Ocular Surface Disease Index, both before surgery and 30 and 60 days after surgery. Results: In the preoperative analysis, 25.5% of the patients had dry eye according to the subjective criterion (Ocular Surface Disease Index ≥ 25%), while the proportion of patients with dry eye was 92.2% according to the objective criterion (tear film break-up test < 10 seconds). There was no correlation between tear film break-up test and Ocular Surface Disease Index (r = −0.14; p = 0.33). There was no reduction in dry eye symptoms (15.9 ± 17.6 versus 12.2 ± 13.2 versus 7.8 ± 11.5; p<0.001) nor in tear film break-up time (6.2 ± 2.2 versus 4.3 ± 2.0 versus 6.9 ± 2.0 seconds; p < 0.001) before, 30 and 60 days after surgery. Conclusion: Phacoemulsification triggers dry eye symptoms and changes Ocular Surface Disease Index and tear film break-up test values, with improvement over the postoperative days. Sixty days after surgery, the symptoms of dry eye assessed according to the Ocular Surface Disease Index improved. Regarding the tear film, evaluated by tear film break-up test, it was observed that there was a statistically significant worsening at 30 days, followed by an improvement in the postoperative period of 60 days. The results suggest that the clinical analysis of dry eye should be performed using different methods, preferably objective ones.

Inter-eye osmolarity differences in patients with symptomatic and non-symptomatic dry eyes / Diferenças de osmolaridade entre olhos de pacientes com olhos secos sintomáticos e não sintomáticos

ABSTRACT Purpose: To analyze whether inter-eye osmo larity differences were related to dry eye symptomatology. Methods: A total of 135 participants were randomly recruited from those who visited in the Optometry Clinic of the Optometry Faculty (Universidade de Santiago de Compostela). In a single scheduled session after the recruitment, Ocular Surface Disease Index was filled out following the standard instructions and TearLab measurements were made in both the participants' eyes (10-15 min lapse). Osmolarity values were compared between the right and left eyes and the absolute inter-ocular difference (-OD-OS-) correlated with the Ocular Surface Disease Index score for the whole sample. Based on the Ocular Surface Disease Index score, the sample was divided into four symptomatic subgroups, and differences in the -OD-OS- values were calculated. Results: The whole sample showed a statistically significant inter-eye osmolarity difference (p=0.025; -OD-OS- = 9.2 ± 9.3 mOsm/l) and the correlation between Ocular Surface Disease Index and -OD-OS- (r=0.369; p<0.001). A statistically significant difference was found in the -OD-OS- value between symptomatic subgroups (Kruskal-Wallis, p=0.003). Mann-Whitney U test showed a significant difference between asymptomatic vs. moderate (p=0.006) vs. severe symp tomatic patients (p=0.001) and between mild vs. severe symptomatic patients (p=0.045), whereas no difference on -OD-OS- was found between participants with contiguous symptomatic subgroups (all p³0.174). Conclusion: Tear film inter-eye osmolarity differences are significantly higher in severe dry eye disease symptoms.

RESUMO Objetivo: Analisar se as diferenças entre osmolaridade entre os olhos foram relacionadas à sintomatologia do olho seco. Métodos: Um total de 135 participantes foram recrutados aleatoriamente entre os indivíduos da Clínica de Optometria da Faculdade de Optometria (Universidade de Santiago de Compostela). Em uma única sessão agendada após o recrutamento, o Índice de Doenças da Superfície Ocular foi preenchido seguindo as instruções padrão e as mensurações do TearLab foram feitas em ambos os olhos dos participantes (lapso de 10 a 15 min). Os valores de osmolaridade foram com parados entre os olhos direito e o esquerdo e a diferença absoluta ocular (-OD-OS-) correlacionada com a pontuação do Índice de Doença da Superfície Ocular para toda a amostra. Com base na pontuação do Índice de Doença da Superfície Ocular, a amostra foi dividida em quatro subgrupos sintomáticos, e as diferenças nos -OD-OS- os valores foram calcula dos. Resultados: A amostra total mostrou uma diferença de osmolarida de entre os olhos estatisticamente significativa (p=0,025; -OD-OS- = 9,2 ± 9,3 mOsm/l) e a correlação entre o Índice de Doença da Superfície Ocular e -OD-OS- (r=0,369; p<0,001). Diferença estatisticamente significativa foi encontrada no valor -OD-OS- entre os subgrupos sintomáticos (Kruskal-Wallis, p=0,003). O teste U de Mann-Whitney mostrou uma diferença significativa entre pacientes assintomáticos versus moderados (p=0,006) versus sintomáticos graves (p=0,001) e entre pacientes sinto máticos leves e graves (p=0,045), enquanto que nenhuma di ferença de -OD-OS- foi encontrada entre os participantes de subgrupos sintomáticos contíguos (todos p³0,174). Conclusão: As diferenças entre osmolaridade inter-ocular do filme lacrimal são significativamente maiores nos sintomas graves da doença do olho seco.

Impact of environmental pollution on the ocular surface of Sjögren's syndrome patients / Impacto da poluição ambiental na superfície ocular de pacientes com síndrome de Sjögren

ABSTRACT Purpose: To evaluate the effect of air pollution on the ocular surface of patients with Sjögren's syndrome. Methods: We investigated the ocular surfaces of thirty patients with Sjögren's syndrome and thirty healthy volunteers (control group) living in the Metropolitan Area of Buenos Aires. We used nitrogen dioxide as an indicator of exposure to air pollution. An ocular symptoms questionnaire was answered by all subjects, who also underwent a complete ocular surface ophthalmic examination-including an Ocular Surface Disease Index questionnaire, biomicroscopy, tear breakup time, Schirmer 1 test, corneal and conjunctival vital staining with fluorescein and lissamine green, tear lysozyme concentration, and impression cytology. Results: In almost all ocular surface test findings, we found a positive and significant correlation between higher levels of exposure to air pollution and higher levels of ocular surface damage in both the control group and Sjögren's syndrome patients. In Sjögren's syndrome patients, the Ocular Surface Disease Index questionnaire, tear breakup time, vital staining and impression cytology showed a significant correlation between high levels of air pollution and ocular surface disease. In the control group, the Ocular Surface Disease Index questionnaire, tear breakup time, and impression cytology showed a significant correlation between high levels of air pollution and ocular surface disease. Conclusions: Here we demonstrated that in patients with dry eye syndrome associated with Sjögren, abnormalities of the ocular surface and eye irritation related to air pollution are more severe than those in the control group. We believe that measuring air quality should be not only an integral part of the evaluation of ocular surface disease but also a therapeutic consideration.

RESUMO Objetivo: Avaliar o efeito da poluição do ar na superfície ocular de pacientes com síndrome de Sjögren. Métodos: Foram investigadas as superfícies oculares de trinta pacientes com síndrome de Sjögren e trinta voluntários saudáveis (grupo controle) residentes na Região Metropolitana de Buenos Aires. Usamos o dióxido de nitrogênio como um indicador de exposição à poluição do ar. Um questionário de sintomas oculares foi respondido por todos os indivíduos, que também foram submetidos a um exame oftalmológico completo da superfície ocular - incluindo um questionário do Índice da Doença da Superfície Ocular, biomicroscopia, tempo de ruptura do filme lacrimal, teste de Schirmer 1, coloração da córnea e conjuntiva com fluoresceína e lissamina verde, concentração de lisozima lacrimal e citologia de impressão. Resultados: Em quase todos os achados do teste de superfície ocular, encontramos uma correlação positiva e significativa entre níveis mais altos de exposição à poluição do ar e níveis mais elevados de danos na superfície ocular tanto no grupo controle quanto nos pacientes com síndrome de Sjögren. Em pacientes com síndrome de Sjögren, o questionário do Índice da Doença da Superfície Ocular, tempo de ruptura do filme lacrimal, coloração vital e citologia de impressão mostraram uma correlação significativa entre altos níveis de poluição do ar e doença da superfície ocular. No grupo controle, o questionário do Índice de Doenças da Superfície Ocular, tempo de ruptura do filme lacrimal e citologia de impressão mostraram uma correlação significativa entre altos níveis de poluição do ar e doença da superfície ocular. Conclusões: Aqui demonstramos que, pacientes com síndrome de olho seco associada a Sjögren, as anormalidades da superfície ocular e a irritação ocular relacionadas à poluição do ar são mais graves do que aquelas no grupo controle. Acreditamos que a medição da qualidade do ar não deve ser apenas uma parte integral da avaliação da doença da superfície ocular, mas também uma consideração terapêutica.

Reference values for selected ophthalmic tests of the blue-and-yellow macaw (Ara ararauna) / Valores de referência para selecionados testes oftálmicos para a arara canindé (Ara araruna)

The aim of this study was to establish reference values for selected ophthalmic diagnostic tests in healthy blue-and-yellow macaws. We investigated a total of 35 adult macaws (70 eyes) of undetermined sex and with an average weight of 1 kg, who were living in captivity in the Federal District, Brazil. Tear production using the Schirmer tear test (STT), normal conjunctival flora, intraocular pressure (IOP) using a rebound tonometer and horizontal palpebral fissure length (HPFL) were evaluated. In this study, 84.1% of samples were positive for microbial growth. Bacteria, fungi and yeasts were isolated, and Staphylococcus spp. (21.9%) and Bacillus spp. (26.8%) were the most frequently isolated microorganisms. The mean value for STT was 7.6±4.6mm/min in the right eye (OD) and 6.6±4.4mm/min in the left eye (OS) (median = 7,11±0,76mm/min). Mean IOP was 11.4±2.5mm Hg OD and 11.6±1.8mm Hg OS (median = 11.49±0.22mm Hg), prior to anesthesia, and 7.6±2.4mm Hg OD and 7.8±1.8mm Hg OS (median 7.71±0.08mmHg) after anesthesia. The IOP was significantly lower when the animals were under anesthesia as compared to when they were conscious (p≤0.05). Horizontal palpebral fissure length was 11.7±0.1mm OD and 11.8±0.1mm OS (median = 11.72±0.07mm). The STT showed a positive correlation with palpebral fissure measurement for this species. These selected ophthalmic reference values will be particularly useful in diagnosing pathological changes in the eyes of blue-and-yellow macaws.(AU)

Objetivou-se determinar os valores normais para testes oftálmicos diagnósticos selecionados para a Arara Canindé. Trinta e cinco Ara ararauna (70 olhos), de sexo indeterminado, adultas, com peso médio de 1kg e provenientes de cativeiro no Distrito Federal, foram avaliadas. Aferiram-se a produção lacrimal pelo Teste lacrimal de Schirmer (TLS), a avaliação microbiológica da conjuntiva ocular, a pressão intra-ocular (PIO) utilizando a tonometria de rebote e o comprimento horizontal da rima palpebral Neste estudo 84.1% das amostras analisadas foram positivas para crescimento microbiológico. Bactérias, fungos e hifas foram isolados e Staphylococcus spp. (21.9%) e Bacillus spp. (26.8%) foram isolados mais frequentemente. Os valores médios do teste de Lacrimal de Schirmer (TLS) foram de 7.6±4.6 e 6.6±4.4mm/min para olhos direito (OD) e esquerdo (OE), respectivamente (média = 7,11±0,76mm/min). A pressão intraocular média foi de 11.4±2.5 (OD) e 11.6±1.8mmHg (OE) anteriormente à anestesia (média 11,49±0,22 mmHg) e 7.6 ± 2.4 mmHg (OD) e 7.8 ± 1.8 mm Hg (OE) (média 7,71±0,08mm Hg) após a anestesia, verificando-se que a PIO foi significativamente menor quando os animais se encontravam sob anestesia comparativamente ao momento em que não estavam anestesiados. O comprimento horizontal da rima horizontal palpebral foi de 11.7±0.1mm OD e de 11.8±0.1mm OE (média 11,72±0,07mm). Verificou-se correlação positiva do TLS com o comprimento da fissura palpebral para a espécie estudada. Estes valores de referencia serão úteis no diagnóstico de alterações oculares da Arara Canindé.(AU)

Tear osmolarity and ocular surface parameters in patients with psoriasis / Parâmetros de osmolaridade lacrimal e da superfície ocular em pacientes com psoríase

ABSTRACT Purpose: The aim of this study was to evaluate tear osmolarity, tear film function, and ocular surface changes in patients with psoriasis. Methods: At a single center, 30 eyes of 30 patients with psoriasis (group 1) and 30 eyes of 30 healthy individuals (group 2) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT) test, scoring of ocular surface fluorescein staining using a modified Oxford scale, and tear osmolarity measurement. Results: Tear osmolarity values, OSDI, and Oxford scale scores were significantly higher in group 1 (309.8 ± 9.4 mOsm, 38.9 ± 1.1, and 0.7 ± 1.1, respectively) than in group 2 (292.7 ± 7.7 mOsm, 4.2 ± 0.3, and 0.1 ± 0.3, respectively; p<0.01 for all). TBUT was significantly lower in group 1 (8.7 ± 3.6 s) than in group 2 (18.1 ± 2.8 s; p<0.001). No significant differences were detected in Schirmer I test values between the groups (16.2 ± 2.5 mm in group 1 and 16.6 ± 2.3 mm in group 2; p=0.629). Conclusions: The results of this study showed that psoriasis may influence tear osmolarity and tear film function. Patients with psoriasis showed tear hyperosmolarity and tear film dysfunction.

RESUMO Objetivo: O objetivo deste estudo foi avaliar a osmolaridade da lágrima, função do filme lacrimal e alterações da superfície ocular em pacientes com psoríase. Método: Em um único centro, 30 olhos de 30 pacientes com psoríase (grupo 1) e 30 olhos de 30 indivíduos saudáveis (grupo 2) foram avaliados pelo questionário do Índice de Doença da Superfície Ocular (OSDI), teste de Schirmer tipo I, tempo de ruptura do filme lacrimal (TBUT), coloração por fluoresceína da superfície ocular utilizando a escala de Oxford modificada e osmolaridade lacrimal. Resultados: Os valores de osmolaridade lacrimal, OSDI e escores da escala de Oxford foram significativamente maiores no grupo 1 (309,8 ± 9,4 mOsm, 38,9 ± 1,1 e 0,7 ± 1,1, respectivamente) em comparação com o grupo 2 (292,7 ± 7,7 mOsm, 4,2 ± 0,3 e 0,1 ± 0,3, respectivamente) (p<0,01 para todos). TBUT no grupo 1 (8,7 ± 3,6 s) foi significativamente menor em comparação com o grupo 2 (18,1 ± 2,8 s) (p<0,001). Não foram detectadas diferenças significativas nos valores de teste de Schirmer (16,2 ± 2,5 mm no grupo 1 e 16,6 ± 2,3 mm no grupo 2, p=0,629). Conclusões: Este estudo mostrou que a psoríase pode influenciar osmolaridade lágrima e função do filme lacrimal. Os pacientes com psoríase apresentaram hiperosmolaridade lágrima e disfunção do filme lacrimal.

Angiogenin for the Diagnosis and Grading of Dry Eye Syndrome

PURPOSE: To investigate the properties of angiogenin (ANG) as a potential tool for the diagnosis and grading of dry eye syndrome (DES) by analyzing tear protein profiles. METHODS: Tear samples were collected with capillary tubes from 52 DES patients and 29 normal individuals as controls. Tear protein profiles were analyzed with an immunodot blot assay as a screening test. To confirm that the tear ANG levels were in inverse proportion to the disease severity grade, the ANG and lactoferrin (LF) tear contents of normal controls and DES patients were compared in an enzyme-linked immunosorbent assay. RESULTS: In the immunodot blot assay, the ANG area was lower in patients with grades 3 and 4 DES than in normal controls. The areas of basic fibroblast growth factor, transforming growth factor β2, and interleukin 10 were significantly greater than those of normal controls only in grade 4 DES patients, but these proteins were not linearly correlated with dry eye severity. Upon enzyme-linked immunosorbent assay analysis, the mean concentrations of ANG and LF decreased significantly as dry eye severity increased, except between grades 1 and 2. In addition, the ratios of ANG and LF to total tear proteins were correlated significantly with DES severity. CONCLUSIONS: ANG level was significantly lower in DES patients than in normal controls, and was significantly correlated with the worsening severity of DES, except between grades 1 and 2, as was LF. Therefore, ANG may be a useful measure of DES severity through proteomic analysis.

Inflammatory Cytokine and Osmolarity Changes in the Tears of Dry Eye Patients Treated with Topical 1% Methylprednisolone

PURPOSE: To evaluate changes in clinical outcomes, inflammatory cytokine levels, and tear osmolarity in the tears of patients with moderate to severe dry eye syndrome before and after the application of topical 1% methylprednisolone. MATERIALS AND METHODS: Thirty-two patients with moderate to severe dry eye unresponsive to previous aqueous enhancement therapy were enrolled. Five patients were lost to follow up, and twenty-seven patients were eligible for analysis. Patients were instructed to apply topical 1% methylprednisolone four times per day, as well as to continue applying their current therapy of preservative-free 0.1% sodium hyaluronate four times per day. Corneal and conjunctival staining scores, tear film breakup time (TFBUT), Schirmer test, and tear osmolarity were assessed at baseline, 4 weeks, and 8 weeks. Tear samples were collected at every visit for cytokine analysis. RESULTS: Corneal and conjunctival staining scores and TFBUT showed significant improvement at 4 (p<0.001, <0.001, <0.001 respectively) and 8 (p<0.001, <0.001, <0.001 respectively) weeks. Tear osmolarity decreased significantly at 8 weeks (p=0.008). Interleukin (IL)-1beta, IL-8, and monocyte chemoattractant protein-1 were significantly decreased at 8 weeks compared with those at baseline (p=0.041, 0.001, 0.008 respectively). CONCLUSION: Short-term treatment with topical 1% methylprednisolone not only improved clinical outcomes, but also decreased tear osmolarity and cytokine levels. By measuring the changes in cytokine levels and tear osmolarity, we could objectively evaluate the anti-inflammatory effects of topical methylprednisolone applied in the treatment of patients with moderate to severe dry eye syndrome.

Dynamics of tear fluid desiccation on a glass surface: a contribution to tear quality assessment

BACKGROUND: Fern-like crystalloids form when a microvolume of tear is allowed to dry out at ambient conditions on a glass surface. Presence of crystalloids in tear "microdesiccates" is used to evaluate patients with Dry-Eye disease. This study aims to examine morphologically the desiccation process of normal tear fluid and to identify changes associated with accelerated tear evaporation. Tear microdesiccates from healthy (Non-Dry Eye) and Dry Eye subjects were produced at ambient conditions. Microdesiccate formation was monitored continuously by dark-field video microscopy. Additionally, accelerated desiccation of tear samples from healthy subjects was conducted under controlled experimental conditions. Particular morphological domains of tear microdesiccates and their progressive appearance during desiccation were compared. RESULTS: In normal tear microdesiccates, four distinctive morphological domains (zones I, II, III and transition band) were recognized. Stepwise formation of those domains is now described. Experimentally accelerated desiccation resulted in marked changes in some of those zones, particularly involving either disappearance or size reduction of fern-like crystalloids of zones II and III. Tear microdesiccates from Dry Eye subjects may also display those differences and be the expression of a more synchronous formation of microdesiccate domains. CONCLUSION: Morphological characteristics of tear microdesiccates can provide insights into the relative rate of tear evaporation.

Comparison of two methods of tear sampling for protein quantification by Bradford method / Comparação de dois métodos de coleta de lágrima para quantificação proteica pelo método de Bradford

The aim of this study was to compare two methods of tear sampling for protein quantification. Tear samples were collected from 29 healthy dogs (58 eyes) using Schirmer tear test (STT) strip and microcapillary tubes. The samples were frozen at -80ºC and analyzed by the Bradford method. Results were analyzed by Student's t test. The average protein concentration and standard deviation from tears collected with microcapillary tube were 4.45mg/mL ±0.35 and 4,52mg/mL ±0.29 for right and left eyes respectively. The average protein concentration and standard deviation from tears collected with Schirmer Tear Test (STT) strip were and 54.5mg/mL ±0.63 and 54.15mg/mL ±0.65 to right and left eyes respectively. Statistically significant differences (p<0.001) were found between the methods. In the conditions in which this study was conducted, the average protein concentration obtained with the Bradford test from tear samples obtained by Schirmer Tear Test (STT) strip showed values higher than those obtained with microcapillary tube. It is important that concentration of tear protein pattern values should be analyzed according the method used to collect tear samples.

Compararam-se dois métodos de coleta de lágrima para quantificação proteica, utilizando-se 58 olhos de 29 cães hígidos. As amostras foram coletadas utilizando-se fitas de teste da lágrima de Schirmer (Schirmer tear test - STT) e tubos microcapilares. Após obtidas, as amostras foram congeladas a -80º C e posteriormente analisadas pelo método de Bradford. Os resultados foram analisados pelo teste T de Student. A média da concentração proteica e desvio padrão das amostras obtidas com microcapilar foi de 4,45mg/mL ±0,35 e 4,52mg/mL ±0,29 para olhos direito e esquerdo, respectivamente. Para as amostras obtidas com STT os resultados foram 4,45mg/mL ±0,35 and 4,52mg/mL ±0,29 para olhos direito e esquerdo, respectivamente. Diferenças estatisticamente significativas (p<0,001) foram encontradas entre os dois métodos. Nas condições em que o trabalho foi conduzido, a média da concentração proteica pelo método de Bradford das amostras obtidas através das tiras do STT foi superior à obtida com o tubo microcapilar. Os valores padrão da concentração protéica da lágrima obtida pelo método de Bradford devem ser analisados considerando-se o método de coleta da lágrima, uma vez que este interfere significativamente nos resultados obtidos.

Microdesiccates produced from normal human tears display four distinctive morphological components

Desiccation of human tears on glass surfaces results in fern-like crystalloids. This phenomenon has been associated with tear normality (Tear Ferning Test, TFT) and is used as a diagnostic aid to evaluate patients with Dry-Eye disease. However, TFT is focused on the assessment of only a minor fraction of desiccated tear samples and considers only the relative abundance and density of fern-like crystalloids. The aim of this study was to characterize morphologically entire desiccated micro volumes of tears from healthy donors. Tear samples were collected from 23 healthy young adult volunteers. Tear aliquots (1-3 μL) were allowed to dry on glass surfaces under ambient conditions of temperature (15-25°C) and relative humidity (40-45%). Dry samples were analyzed by dark-field microscopy. Morphometric data were acquired with Image J software. Tear volume was positively correlated with both area and time of desiccation. Morphological features of multiple microdesiccates produced from a single subject displayed striking similarities whereas tear microdesiccates from different healthy subjects displayed consistent differences but shared a common general design. This design may be mostly represented by the occurrence of four distinctive zones, named as zones I, II, III and Transition band. The main features of these zones are described.

Tear ascorbic acid levels and the total antioxidant status in contact lens wearers: A pilot study.

Aims: The tear ascorbate owing to its high concentration, functions as an effective antioxidant against the oxidative damage of cornea. Contact lens wearers (CLW) are prone to oxidative stress due to the lens-induced hypoxic conditions. A pilot study was done to compare the tear ascorbic acid level and the total antioxidant capacity give as in normal and CLW. Materials and Methods: In this study 21 CLW (Mean age 23 ± 3 years; M-2, F-19), who were daily wear users, with duration of wear not more than four years, along with age-matched 28 controls (Mean age 28 ± 3; M-15, F-13) were recruited in the study for collection of reflex tears using Schirmer's strip. Ascorbic acid in tears was determined using high-performance liquid chromatography (HPLC), total antioxidant capacity (TAC) and total protein assay by spectrophotometric analysis. Results: CLW showed no significant change in the tear ascorbic acid levels (0.4 ± 0.26 mM) compared to the control subjects (0.61 ± 0.59 mM). The amount of ascorbic acid in tears did not correlate with the TAC or the total protein of the tears. The mean TAC in CLW was 0.69 ± 0.16 mM, with a total protein of 1.35 ± 0.46 mg/ml while in controls it was 0.7 ± 0.18 mM and 1.21 ± 0.47 mg/ml respectively. Conclusions: Soft contact lens wear did not show any significant change in tear ascorbic acid, TAC and total protein levels compared to controls.

La hiperosmolaridad del film lagrimal en el ojo seco: [revisión] / Tears osmolarity in dry eye: [review]

El ojo seco es una compleja enfermedad multifactorial de la película lagrimal y de la superficie ocular caracterizada por síntomas de desconforto, alteraciones de la visión e inestabilidad del film lagrimal que puede provocar daño potencial sobre la superficie ocular. La inestabilidad del film producirá aumentos en la osmolaridad de la película lagrimal, lo que desencadena a su vez lesiones osmóticas epiteliales e inflamación. Al producirse estos cambios sobre la superficie ocular, los mecanismos neurofisiológicos de homeostasis se verán alterados lo que complicará aún más el proceso, con la aparición de circuitos viciosos fisiopatológicos.

Dry eye is a complex multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. Inestability of the tear film may also cause an increased osmolarity of the tear film, thus triggering epithelial osmotic lesions and inflammation. The occurrence of such changes on the eye surface results in disturbances of homeostatic neurophysiologic mechanisms which further worsen the process and vicious pathophysiological cycles occur.

Reprodutibilidade na classificação do teste de cristalização do filme lacrimal em pacientes com síndrome de Sjõgren / Reproducibility of the classification of ocular ferning patterns in Sjogren's syndrome patients

OBJETIVO: Verificar a reprodutibilidade da classificação dos padrões do teste de cristalização do filme lacrimal utilizando cinco examinadores diferentes e comparar os padrões de cristalização de pacientes portadores da síndrome de Sjõgren com os de indivíduos não portadores de doenças da superfície ocular. MÉTODOS: Análise da cristalização da lágrima de 29 pacientes com Sjõgren e 45 pacientes sem doenças da superfície ocular, através de microscópio com luz polarizada, utilizando a classificação de Rolando. Para fins estatísticos foi estudada a curva ROC (Receiver Operating Characteristic) para determinar a melhor nota de corte do exame que separa indivíduos normais dos portadores da síndrome, índice de concordância Kappa (p<0,0001) para averiguar a reprodutibilidade da classificação dos padrões de cristalização e tabelas de contingência para comparação dos resultados entre os grupos. RESULTADOS: Com os padrões agregados (I com II e III com IV) a concordância dos examinadores foi alta (Kappa=0,82 a 0,97 e p<0,0001). Por meio da curva ROC obtivemos nota de corte de 2,50 para o diagnóstico de Sjõgren. Na comparação entre os grupos, o grupo normal recebeu predominantemente classificações de padrões I e II, ao passo que o grupo com Sjõgren, padrões III e IV. CONCLUSÕES: Houve concordância com a literatura quanto aos padrões encontrados nos pacientes com Sjõgren e nos pacientes sem doença da superfície ocular. A classificação do teste de cristalização é reprodutível quando utilizada a classificação de Rolando.

PURPOSE: To verify the reproducibility of Rolando's classification of the tear ferning test using five different examiners and to compare the patterns of crystallization found in Sjõgren's syndrome patients and normal subjects. METHODS: Tear ferning analysis of 29 patients with Sjõgren's syndrome and of 45 patients without ocular disease were done using polarized light microscopy and the Rolando classification for tear ferning. Five examiners classified the ferning patterns of all the patients. ROC curve (Receiver Operating Characteristic) was used to find out the best score for the correct syndrome diagnosis. Kappa index (p<0.0001) was used to compare the results of the examiners among them and check the test's reproducibility. Charts were drawn to compare the two groups' results. RESULTS: Throught the ROC curve the score of 2.50 for diagnosis of Sjõgren's syndrome was stabilished. Considering the aggregated patterns I with II and III with IV, the examinors' level of pattern agreement was excellent (Kappa ranging from 0.82 to 0.97, p<0.0001). The group with Sjõgren's syndrome was classified mostly as patterns III and IV and the patients without ocular disease mostly as I and II. CONCLUSION: The patterns associated with Sjõgren's syndrome and normal patients matched the ones in the literature. The tear ferning test classification is reproductible when the Rolando classification was used for Sjõgren's syndrome patients.

[Iohexol effects on tear biochemical profiles in normal large animal model]

Dacryocystography or visualization of nasolacrimal duct has been widely used in the assessment of the nasal lacrimal system. The water-soluble agent iohexol is currently widely used in nervous and vascular lesion in diagnostic radiology and also employed in dacryocystography. This study was performed to determine the effects of iohexol on tear parameters in normal donkey as a large animal model. We examined 10 normal donkeys mean age approximately 4.5 years. The donkeys received iohexol once a day. All donkeys were housed out doors throughout the study. Different tear parameters [total protein, lysozyme, sodium, and potassium and protein electrophoresis of tear] were measured at 0, 2 hours and 2 weeks after dacryocystography with iohexol. The results showed that mean and standard deviation of total protein of tear were 5.88 +/- 2.15 mg/ml before dacryocystography and after 2 hours was 4.10 +/- 0.96 and after two weeks was 7.36 +/- 3.68. Mean and standard deviation of lysozyme was 858.39 +/- 170.88 units in Mg of protein of tear and after two hours was 1013.19 +/- 178.67 and after two week was 702.54 +/- 360.50. Mean +/- SD of sodium of tear before dacryocystography was 3084.90 +/- 725.44 micro/ml and after two hours and two weeks were 3508.40 +/- 1372.52 and 8026.20 +/- 2953.88 respectively. Mean +/- SD of Potassium of tear before dacryocystography was 863.37 +/- 52.55 micro/ml and after two hours and two weeks were 753.84 +/- 46.81 and 1564.20 +/- 276 +/- 41 respectively. Results of SDS-PAGE of donkeys tear confirmed that nine protein bands with molecular weights between 10 kDa and 15 kDa are present. No differences found in protein electrophoresis pattern before and after iohexol administration. No significant changes were present in measured factors at different times. In conclusion iohexol is a safe and suitable contrast media for dacryocystography

Potencial antioxidativo da lágrima de adultos jovens / Tear antioxidant potential in young adults

OBJETIVO: Estudar os antioxidantes da lágrima humana, estimulada pelo corte de cebola e a possível influência dos hábitos de vida sobre estas medidas. MÉTODOS: A amostra consistiu de dez adultos jovens, que responderam questionário sobre o hábito de fumar, de ingerir bebidas alcoólicas, frutas, vegetais e cereais, de usar vitaminas e/ou drogas e de praticar exercícios. O potencial reativo antioxidante total (TRAP) foi analisado por meio da quimioluminescência do luminol, a superóxido dismutase (SOD) foi medida pela inibição do piragolol e a absorbância de H2O2 a 240 nm foi utilizada para identificar a catalase. RESULTADOS: A média ± DP dos valores de potencial reativo antioxidante total foi 33,8±11,5 µM e de superóxido dismutase foi 10,8±1,9 U/mL. Não foi identificada atividade da catalase. Detectou-se associação entre a prática regular de exercícios e aumento nos valores de potencial reativo antioxidante total (p=0,021), com diferença de 18,6 µM entre os indivíduos que se exercitavam pelo menos uma vez por semana e os sedentários. Sexo masculino e aumento na concentração de potencial reativo antioxidante total também se associaram estatisticamente (p=0,013), com diferença de 16,3 µM entre os sexos. Houve associação entre hábito tabágico e aumento na superóxido dismutase (p=0,041), com diferença de 3,3 U/mL entre fumantes de mais de cinco cigarros/dia e não fumantes. O uso de vitamina C também demonstrou associação com a superóxido dismutase (p=0,018); a diferença para os que tomavam vitamina C foi de 3,3 U/mL a mais. CONCLUSÃO: Os antioxidantes do lacrimejamento reflexo foram mensuráveis em adultos jovens, e diferentes variáveis parecem ter influenciado nos resultados.

PURPOSE: To study the antioxidant status of human tears, stimulated by onion fumes and the possible influence of the life habits thereon were measured. METHODS: Subjects were ten healthy young adults, who answered a questionnaire about smoking, alcohol ingestion, fruit, vegetable, cereal, and vitamin intake and/or intake of other drugs, and physical exercise habits. Chemoluminescensce of luminol was used to analyze the total reactive antioxidant potential (TRAP), inhibition of piragollol was used to measure superoxide dismutase (SOD) and absorbance of H2O2 at 240 nm was used to identify catalase. RESULTS: Mean ± SD value for total reactive antioxidant potential was 33.8±11.5 µM and for superoxide dismutase 10.8±1.9 U/mL. Catalase was not identified. Regular exercise was associated with increased total reactive antioxidant potential values (p=0.021), with a difference of 18.6 µM between individuals who exercise at least once a week and sedentary individuals. Male gender and total reactive antioxidant potential values were statistically associated (p=0.013), with a difference of 16.3 µM between genders. There was an association between smoking and increased superoxide dismutase values (p=0.041), with a difference of 3.3 U/mL between smokers of more than five cigarettes/day and non-smokers. Also, vitamin C intake and superoxide dismutase values were associated (p=0.018); the difference for vitamin C takers was 3.3 U/mL. CONCLUSION: Reflex tearing antioxidants were measurable in healthy young adults, and different variables apparently influenced their values.

Effects of Smoking on Tear Film and Ocular Surface

This study was performed to evaluate the changes of tear film and ocular surface caused by smoking. Symptom scoring, tear film break-up time (BUT), basal tear secretion test, corneal sensitivity test, keratoepitheliopathy scoring, and conjunctival impression cytology were performed in 29 smokers (58 eyes) and 26 non-smokers (52 eyes). Tear film BUT, basal tear secretion, corneal sensitivity, and squamous metaplasia were 7.71 +/- 2.66 sec, 6.29 +/- 2.85 mm, 53.69 +/- 5.69 mm, and 2.45 +/- 1.26 in smokers and 9.62 +/- 3.14 sec, 10.04 +/- 3.87 mm, 56.46 +/- 4.79 mm, and 1.12 +/- 0.83 in non-smokers, respectively (p< 0.05). Symptom score, keratoepitheliopathy score, and goblet cell density were not significantly different between the two groups. Tear film BUT was shorter, basal tear secretion and corneal sensitivity were lower, and squamous metaplasia was higher in heavy smokers than in light smokers. In conclusion, smoking deteriorates the tear film and ocular surface with decreased quantity and quality of tear film, decreased corneal sensitivity, and squamous metaplasia, and this deterioration is related to the amount of smoking.

Estimation of tear glucose level and its role as a prompt indicator of blood sugar level.

Tear glucose level was measured by glucose oxidase method to determine the relationship between tear glucose and corresponding blood glucose levels in 200 patients. It was observed that this test had a definite value in finding the hyperglycaemics semiquantitatively.

Status of the tear film in trachoma

To evaluate the value and usefulness of the clinical and laboratory diagnostic tests in trachoma, forty three patients [86 eyes] with trachoma cicatrized, trachoma trichiasis and corneal opacities in accordance with the WHO-1987 grading system, Were evaluated for Schirmer's test, tear osmolarity and tear lysozyme level. In the 86 eyes [43 patients] of normal eyes, tear fluid osmolarity was 303.4 +/- 9.1 mOsm.IL. In 86 eyes [43 patients] of trachomatous cases it was 311.9 +/- 12.3 mOsm./L. Tear lysozyme level noted in trachomatous cases was 1.68 +/- 0.81 mg/ml. This value was around normal range [1.5-2.5 mg/mi]. The average value of the Schirmer's test in normal cases was 15.1 +/- 8.9 mm/5 mm., whereas in trachomatous cases it was 11.9 +/- 6.8 mm/5 mm. Because of being correlate decreased Schirmer's test and tear osmolarity in trachomatous cases, it is assumed that the status of tear fluid may only be assessed by tear film osmolarity measurements

An evaluation of the tear function in menopausic women

Dry Eye is one of the most common eye disorders. Although this occurs in both men and women at any age, women in their menopausic years are often afflicted with this condition. This may be due to the loss of hormonal support after menopause. The purpose of this study is to determine the tear function of menopausic women and also to determine whether there is a correlation between advancing age and tear function. 62 menopausic women between the ages of 55-78 years underwent four different types of tear function tests (Schirmer Test, Tear Breakup Time, Vital Staining with Fluorescein Dye and the Ferning Test). These women were not under any type of medication. Results showed that in both the Schirmer Test and the Tear Breakup Time Test, there was a significant decrease in the tear function as age progressed. Although there were no statistically significant changes in the corneal uptake with increasing age, it was noted that the number of subjects with significant fluorescein dye uptake increased in the older age group. Likewise, there was no significant change in the Ferning test although a decreasing trend in the ferning pattern was observed as the age progressed. Based on the data collected, menopause and aging play a vital role in the development of dry eyes. Although the actual process remains uncertain, this can be attributed to the changes in the sex hormonal levels in menopausic women. (Author)

HPLC analysis of closed, open, and reflex eye tear proteins.

Changes in the closed, open and reflex eye tear proteins of normal subjects were compared and analysed. Tear proteins were resolved by high-performance liquid chromatography (HPLC) utilising both gel filtration (P-300 SW) and reverse-phase (C-18) columns and the HPLC fractions were further analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) under reducing and non-reducing conditions. The protein composition of the closed-eye tear was significantly different from that of the open and reflex-eye tear. Secretory IgA (sIgA) was the predominant protein in closed eye tears constituting 49% of the total protein compared to 11% in reflex tears, whereas lysozyme was the predominant protein (53%) in reflex tears. Levels of lactoferrin, lipocalin and lysozyme were relatively constant in both open and reflex tears. HPLC profiles of the closed-eye tears, upon continuous stimulation of lacrimal glands indicated that sIgA was significantly reduced whereas lactoferrin, lipocalin, and lysozyme were significantly increased. These results indicate that the tear composition upon waking attains that of the open eye within 4 to 5 minutes, and upon continuous stimulation this reflects the reflex-eye tear composition. It also indicates that mechanisms responsible for changes in concentration of constitutive and regulated tear protein with stimulus can be studied successfully using non-invasive methods to collect human tears.