TFOS DEWS II Management and Therapy Report.

The members of the Management and Therapy Subcommittee undertook an evidence-based review of current dry eye therapies and management options. Management options reviewed in detail included treatments for tear insufficiency and lid abnormalities, as well as anti-inflammatory medications, surgical approaches, dietary modifications, environmental considerations and complementary therapies. Following this extensive review it became clear that many of the treatments available for the management of dry eye disease lack the necessary Level 1 evidence to support their recommendation, often due to a lack of appropriate masking, randomization or controls and in some cases due to issues with selection bias or inadequate sample size. Reflecting on all available evidence, a staged management algorithm was derived that presents a step-wise approach to implementing the various management and therapeutic options according to disease severity. While this exercise indicated that differentiating between aqueous-deficient and evaporative dry eye disease was critical in selecting the most appropriate management strategy, it also highlighted challenges, based on the limited evidence currently available, in predicting relative benefits of specific management options, in managing the two dry eye disease subtypes. Further evidence is required to support the introduction, and continued use, of many of the treatment options currently available to manage dry eye disease, as well as to inform appropriate treatment starting points and understand treatment specificity in relation to dry eye disease subtype.

Antimicrobial in vitro evaluation of corneal storage media using a closed chamber study model.

PURPOSE: To evaluate in vitro the antimicrobial influence of the corneal storage media containing antibiotics using a closed chamber study model under the closest simulated environment of corneal preservation process. MATERIALS AND METHODS: Samples of cornea storage media containing streptomycin and gentamicin (Optisol-GS) were analyzed at different moments after its contamination with Staphylococcus aureus (ATCC25923). Samples were analyzed at 1, 2, 3, 4, 5, 6, 24, 48, 72 hours; 7 days; and 14 days after contamination. The samples were analyzed using a new study model system that consists of two closed coupled chambers. The upper chamber contained two culture media (chocolate agar and Sabouraud agar) and CO(2) indicator (indication of bacterial aerobic activity). The inferior chamber contained supplemented solution with an antimicrobial inhibitor. The bacterial growth parameters were analyzed by the presence or absence of bacteria in chocolate agar and by color change of CO(2) indicator when positive. First reading was performed after 24 hours, and, in the absence of bacterial growth, a second reading was carried out after 48 hours. RESULTS: Color change in CO(2) indicator was found in samples contaminated after 1, 2, and 3 hours on the first reading. On the second reading, we observed color change in all remaining samples, except for samples contaminated after 14 days. CONCLUSION: Samples of cornea storage media containing gentamicin sulphate and streptomycin sulphate in vitro showed viable Staphylococcus aureus for up to 7 days of contamination.

Schirmer test performed with open and closed eyes: variations in normal individuals.

PURPOSE: To analyze the difference between measurements of Schirmer test I (STI) and basal Schirmer test (STB) with open and closed eyes. METHODS: Sixty eyes of 30 normal volunteers, 12 males and 18 females aged 28 +/- 9 years were recruited for the study. All ST were carried out in a closed environment with the absence of airflow (humidity 60 +/- 2.34% and temperature 20.72 +/- 1.52 degrees C). STI and STB were performed with the individuals' both eyes open and closed with an interval of 6 hours. All ST were conducted in 5 minutes. For statistical analysis, the ST strip's wetting velocity (STV) (in millimeters per minute) was calculated, dividing the ST values by its wetting time. If ST values were 35 mm before 5 minutes, wetting time was recorded to obtain STV. RESULTS: STV measurements of STI performed with closed eyes (10.30 +/- 11.55) were statistically different from those performed with open eyes (18.85 +/- 17.88) and STV measurements of STB performed with closed eyes (3.74 +/- 3.14) were statistically different from those performed with open eyes (6.19 +/- 5.86). CONCLUSION: ST performed with open or closed eyes can have an important influence in the results of STI and STB in normal individuals.

Schirmer test performed with open and closed eyes: variations in normal individuals / Comparação entre os testes de Schirmer em olhos abertos e fechados em indivíduos normais

PURPOSE: To analyze the difference between measurements of Schirmer test I (ST I) and basal Schirmer test (STB) with open and closed eyes. METHODS: Sixty eyes of 30 normal volunteers, 12 males and 18 females aged 28 ± 9 years were recruited for the study. All ST were carried out in a closed environment with the absence of airflow (humidity 60 ± 2.34 percent and temperature 20.72 ± 1.52ºC). ST I and ST B were performed with the individuals' both eyes open and closed with an interval of 6 hours. All ST were conducted in 5 minutes. For statistical analysis, the ST strip's wetting velocity (ST V) (in millimeters per minute) was calculated, dividing the ST values by its wetting time. If ST values were 35mm before 5 minutes, wetting time was recorded to obtain ST V. RESULTS: ST V measurements of ST I performed with closed eyes (10.30 ± 11.55) were statistically different from those performed with open eyes (18.85 ± 17.88) and ST V measurements of STB performed with closed eyes (3.74 ± 3.14) were statistically different from those performed with open eyes (6.19 ± 5.86). CONCLUSION: ST performed with open or closed eyes can have an important influence in the results of ST I and STB in normal individuals.

OBJETIVO: Analisar a diferença das medidas dos testes de Schirmer I e Schirmer basal realizados com os olhos abertos e olhos fechados. MÉTODOS: Foram analisados 60 olhos de 30 indivíduos normais com idade média de 28 ± 9 anos. A umidade média do ar foi de 60 ± 2,34 por cento e a temperatura média de 20,72 ± 1,52ºC. No primeiro dia, foi feito o teste de Schirmer I com os olhos abertos. Após um intervalo de 6 horas, foi realizado o teste de Schirmer I com os olhos fechados. No segundo dia, foi realizado o mesmo procedimento com o teste de Schirmer basal. Para fins de comparação, as medidas das tiras de papel foram divididas pelo tempo de umedecimento das tiras (velocidade) para análise estatística. RESULTADOS:No teste de Schirmer I realizado com os olhos abertos, a medida de umedecimento das tiras mostrou ser estatisticamente maior quando comparado com a medida do mesmo teste realizado com olhos fechados (p<0,0001). No teste de Schirmer basal realizado com os olhos abertos, a medida de umedecimento das tiras mostrou ser estatisticamente maior quando comparado com a medida do mesmo teste realizado com olhos fechados (p<0,0001). CONCLUSÕES: As medidas do teste de Schirmer I com olhos fechados foram estatisticamente diferentes do realizado com olhos abertos. As medidas do teste de Schirmer basal com olhos fechados foram estatisticamente diferentes do realizado com olhos abertos.