The effect of off-pump coronary bypass graft surgery on subfoveal choroidal thickness, ganglion cell complex, and retinal nerve fiber layer thickness.

Background: Cardiac surgery has been associated with adverse ocular events. Off-pump coronary artery bypass graft surgery evades the systemic inflammatory response seen in extracorporeal circulation and is superior to on-pump surgery with regard to end-organ dysfunction and neurological outcomes. Objectives: To determine the effects of off-pump (without extracorporeal circulation) coronary artery bypass graft surgery on choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer. Design: Prospective, longitudinal study. Methods: Patients who underwent off-pump surgery were examined preoperatively and postoperatively at 1 week and 6 weeks after surgery. Choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer measurements were recorded, and the effects of off-pump coronary artery bypass on these parameters were assessed. Results: A total of 44 eyes of 44 patients were included in the study. There was a statistically significant increase in subfoveal choroidal thickness from 252.84 ± 56.24 µm preoperatively to 273.82 ± 39.76 µm at 1 week and 301.97 ± 44.83 µm at 6 weeks after off-pump coronary artery bypass graft surgery (p = 0.044; p ⩽ 0.001). Ganglion cell complex and retinal nerve fiber measurements showed no significant difference compared to preoperative values. Conclusion: Off-pump coronary artery bypass graft surgery showed no negative effects on ganglion cell complex and retinal nerve fiber measurements. A significant increase in subfoveal choroidal thickness was seen after off-pump surgery, which might be advantageous in patients who are at high risk or have preexisting ocular diseases that are affected by the choroid.

Decreased choroidal vascularity index and subfoveal choroidal thickness in vitamin D insufficiency.

BACKGROUND: To present the effects of vitamin D insufficiency on the choroidal vascularity index, central choroid and central macula. METHODS: 42 eyes of 42 patients with vitamin D insufficiency and 51 eyes of 51 age- and sex-matched healthy subjects were included in this retrospective, cross-sectional, and comparative study. The macular layer was examined using the retinal mapping mode of the spectral domain Optical coherence tomography (Optovue RTVue XR, Optovue Inc., Fremont, CA). Optical coherence tomography (OCT) images were taken in Enhanced Deep Imaging mode and transferred to Image J program. choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) measurements were evaluated. RESULTS: The mean age of volunteers was 35.4 ± 7.2 years. There was a significant difference in CVI values 67.75±2.4 in the patients with vitamin D insufficiency and 69.22±1.75 in the control group. The SCFT of patients with vitamin D insufficiency and control group were 295.25±42.3 and 335.71±11.6 (p = 0.001, p<0.001 respectively). CONCLUSION: OCT examination of patients with vitamin D insufficiency showed a decrease in CVI and SCFT values. These results are important in demonstrating the retinochoroidal effects of vitamin D insufficiency.

The effect of baseline intraocular pressure and anterior segment parameters on intraocular pressure after intravitreal bevacizumab injection.

PURPOSE: We aimed to compare the predictive effect of pre-injection intraocular pressure (IOP) and anterior segment parameters on post-injection IOP values after intravitreal bevacizumab injection for neovascular age-related macular degeneration (NVAMD) in phakic and pseudophakic patient groups. MATERIAL AND METHODS: This retrospective cross-sectional study included 65 eyes of 65 treatment-naive NVAMD patients. Patients were divided into two groups according to their lens status (35 phakic and 30 pseudophakic patients). Pre-injection IOP, anterior segment parameters measured with PENTACAM, and post-injection IOP values measured at the 5th minute were recorded. Univariate and multivariate regression analyses were used to recognise the predictive effect of pre-injection IOP and anterior segment parameters on post-injection IOP for each group. RESULTS: Multivariate regression analyses showed that the decrease in anterior chamber depth (ACD), and the increase in pre-injection IOP were significantly correlated with higher post-injection IOP in the phakic patient group (p = 0.019 and 0.031; respectively). No correlation was found in the pseudophakic patient group. CONCLUSION: Pre-injection ACD and IOP values may be predictive of higher post-injection IOP in phakic patients. Preoperative assessment of these parameters could be beneficial in patients at risk of glaucoma.

Foveoschisis associated with gyrate atrophy in ornithine aminotransferase deficiency: A case report.

Ornithine aminotransferase (OAT) deficiency is an autosomal recessive disease characterized by elevated serum ornithine levels caused by mutations in genes encoding for ornithine aminotransferase, a vitamin B6-dependent mitochondrial matrix enzyme. Gyrate atrophy (GA) is characteristic findings in OAT that characterized by sharply demarcated circular, pigmentary, brain-like areas of chorioretinal atrophy in the peripheral retina. This case report presents rare assosiation between OAT and GA and describes the characteristic imaging findings of this unique, not fully understood clinical entity. The coexistence of GA and foveoschisis is extremely rare in OAT deficiency. We report a case of foveoschisis in a patient with OAT, and we will discuss the possible mechanisms that lead to it. A 24-year-old male patient presented with complaints of decreased vision and nictalopia for 1 year. The patient, who was diagnosed with oat 6 years ago, had typical gyrate atrophy in his Fundus floresein angiography and foveoschisis in his Optical coherence tomography. He was diagnosed with gyrate atrophy and foveoschisis. GA caused by OAT deficiency may present with macular involvement in the form of foveoschisis causing central visual impairment. Ophthalmologists should not ignore detailed fundus examination in children and young patients with visual impairment and should be aware of possible systemic diseases.

Impact of Valsalva manuever on choroidal vascularity index, central choroid and central macula.

BACKGROUND: Evaluation of the effects of the Valsalva maneuver on choroidal vascularity index, central choroid and the central macula. METHODS: Eighty-four eyes of 42 healthy volunteers were evaluated in this prospective study. The central macular layer was assesed using the retinal map mode of the spectral domain OCT (Optovue RTVue XR, Optovue Inc., Fremont, CA), OCT images taken in the Enhanced Deep Imaging mode were transferred to the Image J program and the choroidal vascularity index and subfoveal choroidal thickness measurements were calculated. RESULTS: The mean age of volunteers was 35.4±7.2 years. Choroidal vascularity index, subfoveal choroidal thickness, central macular thickness and intraocular pressure measurements in the resting position were 67.99±2.1%, 337.73±12.8 µm, 232.04± 8.4 µm, 14.04±2.5 mmHg respectively, during Valsalva maneuver were 69.44±2.1%, 351.15±12.2 µm, 238.84±8.1 µm, 19.4±5.4 mmHg respectively. There was a statistically significant increase during Valsalva maneuver. CONCLUSION: The Valsalva maneuver may cause temporary changes in choroidal vascularity index, subfoveal choroidal thickness, central macular thickness and intraocular pressure. These measurements may be misinterpreted in situations where patients breath-hold inadvertantly causing the Valsalva maneuver.

YouTube as a source of information on keratoconus: a social media analysis.

CLINICAL RELEVANCE: Keratoconus (KC) treatment in the early stage is usually with glasses or soft toric contact lenses, in advanced stages rigid gas-permeable corneal or scleral contact lenses are used. Optometrists should be aware of misleading information from online platforms when providing information to keratoconus patients. BACKGROUND: Keratoconus is a progressive corneal disease characterised by stromal thinning and corneal ectasia. To the best of our knowledge, there is no study evaluating the popularity, quality, and reliability of videos about keratoconus disease and its treatment published on YouTube. In our study, we aimed to evaluate the credibility, quality, and popularity of YouTube videos about keratoconus. METHODS: This is a retrospective, cross-sectional, register-based study. A YouTube search was performed using the keywords 'keratoconus', 'keratoconus disease', 'keratoconus treatment', 'keratoconus cross linking'. The quality and reliability of video content were measured using the DISCERN questionnaire, the Journal of the American Medical Association (JAMA) score, and the Global Quality Score (GQS). The video power index was used to evaluate the popularity of the videos. RESULTS: One hundred videos were included in the study. The average duration was 6.33 min and average total number of views was 14,940. The mean DISCERN, JAMA, and GQS scores were 42.57 ± 12.04 (intermediate quality), 1.77 ± 0.51 (poor quality), and 3.63 ± 1.03 (intermediate quality), respectively. The mean video power index was 11.02 ± 24.55 (range, 0-193). The DISCERN score was significantly positively correlated with GQS and JAMA scores (p ≤ 0.001). CONCLUSIONS: This study showed that YouTube videos about keratoconus contain moderately useful information for patients. So, physicians, being aware of the quality and diversity of online information, should correct any misinformation they encounter while face-to-face with patients.

Is serum vitamin D associated with diabetic retinopathy and its severity or with diabetes itself ?

CLINICAL RELEVANCE: Vitamin D (VitD) deficiency, which is found in approximately one-third of the population of the world, may play a role in the pathogenesis of diabetic retinopathy. Physicians following diabetes patients should be aware of this relationship and should refer patients to for ophthalmic care for control in a timely manner. BACKGROUND: Diabetic retinopathy is one of the most common complications of diabetic microvascular disease. VitD deficiency has been implicated in the pathogenesis and progression of diabetes and may have a role in development and severity of diabetic retinopathy. The aim of this study was to examine the relationship of serum VitD and some laboratory parameters with the presence of diabetes and retinopathy. METHODS: In this study, which has a retrospective epidemiological study design, comprehensive ophthalmologic examination data from the eye clinic, laboratory data from fasting blood tests, and internal medicine outpatient clinic examination data were reviewed. All participants were divided into four groups: 109 healthy controls, and 165 patients with type 2 diabetes of whom 54 did not have retinopathy, 64 had proliferative diabetic retinopathy, and 47 had non-proliferative diabetic retinopathy. Participants were also divided into four groups according to their serum VitD levels. Serum 25(OH)D, HbA1C, creatine, calcium, phosphate, triglyceride, low-density lipoprotein, and high-density lipoprotein levels were evaluated. RESULTS: In the whole study cohort, 152 (55.5%) were female and 122 (44.5%) were male. A statistically significant difference was observed in VitD between the healthy group and the diabetic and proliferative diabetic retinopathy groups (p ≤ 0.001). However, no significant correlation was observed between the presence of diabetes and retinopathy and serum VitD in logistic regression analyses (p > 0.05). CONCLUSION: Diabetic patients have lower 25(OH)D than non-diabetic patients and there is no direct relationship between 25(OH)D and the development of diabetic retinopathy.

Tear instability in the fellow eye of unilateral nasolacrimal obstruction and resolution with dacryocystorhinostomy.

PURPOSE: To determine the effect of unilateral primary acquired nasolacrimal obstruction (PANDO) on ocular surface parameters in PANDOeyes and fellow eyes and changes in these parameters after dacryocystorhinostomy. METHODS: Tear osmolarity, tear break-up time (TBUT), Schirmer's test, Meibomian gland score, and Lissamine Green staining of PANDO eyes and fellow eyes were measured preoperatively and postoperatively at Day 15, 1 month, and 3 months. Lacrimal irrigation and epiphora symptomatology were evaluated at all follow-up visits, and patients who did not meet surgical success criteria were excluded from the study. RESULTS: Twenty-nine patients who underwent successful dacryocystorhinostomy surgery were included in the study. Preoperative and postoperative Day 15 Schirmer (p = .019, p = .001) and TBUT (p = .039, p = .043) were significantly lower in the fellow eye compared to PANDO eyes. The differences observed between PANDO eyes and fellow eyes in all other parameters were not significant (p > .05). Preoperatively PANDO eye parameters were normal, whereas TBUT (7.59 ± 5.39 s) and tear osmolarity (308.59 ± 17.32 mOsm/L) values of the fellow eye may be indicative of tear film instability. TBUT and tear osmolarity of the fellow eye showed significant improvement 3 months postoperatively compared to preoperative values (p = .010; p = .027 respectively). CONCLUSION: Schirmer and TBUT values of the fellow eye were significantly lower than PANDO eyes preoperatively, one month after surgery there was no significant difference. TBUT and tear osmolarity of the fellow eyes may be indicative of tear instability preoperatively with improvement 3 months after dacryocystorhinostomy.

Reduced tear break-up time in the fellow eye of patients with unilateral primary acquired nasolacrimal duct obstruction.

PURPOSE: To measure tear osmolarity, Schirmer I test and tear break-up time (TBUT) values in the obstructed and non-obstructed fellow eye of unilateral primary acquired nasolacrimal duct obstruction (PANDO) patients and compare them with healthy controls. METHODS: In this prospective noninterventional study, the tear osmolarity, Schirmer I test, and TBUT values from unilateral PANDO eyes, fellow eyes, and control eyes of all subjects were measured. RESULTS: The study included 114 eyes of 30 PANDO patients as well as 27 healthy controls. There was a significant difference between TBUT and Schirmer values of fellow eyes and PANDO eyes (p = 0,035; p = 0,001). There was no significant difference in any of the ocular surface parameters between PANDO eyes and control eyes (p > 0.05). When fellow eyes were compared to control eyes, there was a significant difference in TBUT (p = 0.046). CONCLUSIONS: Decreased TBUT was exhibited by the fellow eye of unilateral PANDO patients, compared to the PANDO side and controls. Compensatory changes in PANDO eyes due to a decrease in the tear secretion reflex may lead to tear dysfunction of the fellow eye. Clinicians should assess tear stability in the fellow eye of PANDO patients as this could be leading to added symptomatic complaints.

20% Autologous serum vs. 0.05% cyclosporine and preservative-free artificial tears in the treatment of Sjögren related dry eye.

PURPOSE: To compare the 3-month results of treatment with 20% autologous serum or combination treatment with preservative-free artificial tears and 0.05% cyclosporine in patients with dry eye disease due to primary Sjögren's syndrome. METHODS: A total of 130 eyes of 65 patients with newly diagnosed dry eye disease due to primary Sjögren's syndrome were included in the study. The patients were divided into two treatment groups: 66 eyes of 33 patients were assigned to the autologous serum treatment group, and 64 eyes of 32 patients were assigned to the combination treatment group. Schirmer test, tear break-up time and Ocular Surface Disease Index (OSDI) scores were recorded at pretreatment and at 3 months of treatment. RESULTS: At 3 months of treatment, the mean Schirmer value and the mean tear break-up time were significantly higher in the combination treatment group (p<0.0001 and p=0.034, respectively). The OSDI score at 3 months was significantly lower in the autologous serum Group (p=0.004). When the two groups were evaluated separately, the improvements in Schirmer, tear break-up time test, and OSDI scores from before to after treatment were statistically significant: p<0.0001, p<0.001, and p<0.0001, respectively, for the authologus serum Group, and p<0.0001, p<0.001, and p<0.0001, respectively, for the combination treatment group. CONCLUSIONS: In short-term treatment of dry eye disease due to primary Sjögren's syndrome, treatment with autologous serum was significantly superior to -combination treatment with preservative-free artificial tears and 0.05% cyclosporine in terms of improvement in OSDI scores. Improvements in Schirmer test and tear break-up time scores were significantly superior in the group treated with preservative-free artificial tears and 0.05% cyclosporine.

#Ophthalmology: Popular ophthalmology hashtags as an educational source for ophthalmologists, an Instagram study.

Purpose: This study aims to determine the content and intent of posts published under popular ophthalmology hashtags and to determine whether these posts were educational for ophthalmologists. Methods: A web-based, cross-sectional study design was used to evaluate the top public posts of five popular hashtags on three consecutive days by two ophthalmology specialists. The first 100 relevant English posts of each hashtag were studied. Selected hashtags were #Ophthalmology, #ophthalmosurgery, #ophthalmologyresident, #ophthalmologist, and #ophthalmicphotography. Posts were classified according to the type of post, post author, post intent, and whether the post was educational. Posts deemed educational were then categorized separately using the same classification system as above to determine whether there were defining characteristics of educational posts. Results: One thousand posts were recorded and analyzed and a total of 500 posts were included in the study. The majority of posts 79.8% (n = 399), were by medical doctors with 95% (n = 379) being ophthalmology specialists. Sixty-three percent of posts (n = 315) were deemed educational, 25% promotional (n = 127), and 12% (n = 58) were entertainment posts. Medical retina (n = 119) and anterior segment (n = 90) were the most common subspecialties explored. #ophthalmicphotography (P = 0.001) was the hashtag with the highest number of educational posts (n = 91). The least educational hashtag was #ophthalmologist with only 44% of posts (n = 44) that were deemed to be educational. One hundred percent of glaucoma posts (n = 19), 98% of cornea posts (n = 41), and 99% of medical retina posts (n = 118) were found to be educational which was significantly more educational than the other topics posted (P ≤ 0.001). Conclusion: Ophthalmologists are the main authors of posts in popular ophthalmology hashtags. The majority of posts were educational posts with promotional posts being the second most common intent. The authors conclude that while Instagram is a possible source of ancillary education for the visual specialty of ophthalmology, careful selection of hashtags and post authors are needed for maximum benefit.

Intraocular pressure outcomes after 23-G vitreoretinal surgery with two different transconjunctival sutureless sclerotomy techniques: vertical versus tunnel entry.

PURPOSE: Comparison of postoperative intraocular pressure (IOP) course and early complications in 23-gauge (23-G) pars plana vitrectomy (PPV) using vertical entry sclerotomy and scleral tunnel sclerotomy in uncomplicated rhegmatogenous retinal detachment (RRD). METHOD: A prospective, randomized, comparative, interventional clinical trial of 103 23-G vitrectomy cases using two different transconjunctival sutureless sclerotomy techniques performed by a single vitreoretinal surgeon for uncomplicated RRD. Fifty-two eyes underwent PPV using a three-port 23-G single stage, vertical trocar entry without creating a scleral tunnel (Group 1), while in 51 eyes, a two-stage, oblique trocar entry with creation of a scleral tunnel was performed (Group 2). Sulfur hexafluoride (SF6) gas (20%) was used in all cases as a buffer. Intraocular pressure measurements and detailed biomicroscopic examination of the groups were recorded on the postoperative first day, first week, and first month. Visual acuity and fundoscopic examinations were recorded at one month. The effects of the two methods on postoperative intraocular pressure and early complications were compared. RESULTS: There was no significant difference between the two groups in terms of age and gender (p > 0.05). The mean postoperative intraocular pressure on the first day was 15.06 ± 3.71 for Group 1 and 16.14 ± 3.09 mmHg for Group 2. The lowest recorded IOP was 6 mmHg. Postoperative visual acuity did not differ between the two groups (p > 0.05). In addition, IOP values did not differ statistically between the two groups (p > 0.05). In both groups, the mean IOP values measured at different intervals did not differ statistically (p > 0.05). CONCLUSION: There was no significant difference in terms of postoperative IOP between vertical entry 23-G sclerotomy and 23-G tunnel entry sclerotomy for PPV with 20% SF6 tamponade surgery.

Do serum vitamin D levels correlate with Macular Edema or with Diabetic Retinopathy?

PURPOSE: To compare serum vitamin D (25(OH)D) levels according to the presence of diabetic macular edema (DME) in Diabetes Mellitus (DM) patients with different retinopathy conditions. METHODS: The files of all DM patients presenting for examination at the ophthalmology clinic between October 2018 and March 2020 were retrospectively examined. Data was collected from the files and included a comprehensive ophthalmological examination, laboratory results from fasting blood tests, and the internal medicine outpatient clinic examination. Patients were divided into two groups according to the presence of DME, they were divided into three groups in terms of retinopathy and DME, and in terms of retinopathy severity and presence of DME, they were divided into five groups. RESULT: Ninety one (51.1%) of the age-sex matched participants were female and 87 (48.9%) were male. There was a statistically significant difference in vitamin D levels between the group with DME and the group without DME (p ≤ 0.001). In the comparison made according to the presence of retinopathy and DME; a significant difference was found between the DME group and the group with retinopathy but no DME (p ≤ 0.001). When the severity of retinopathy and the presence of DME were evaluated, a significant difference was found between the proliferative diabetic retinopathy (PDR) group with DME and the PDR group without DME in terms of vitamin D levels (p = 0.004). CONCLUSION: Our study shows that the presence of DME is associated with lower serum 25(OH)D levels.

Outcomes of customized topographic guided epithelial debridement for corneal collagen cross-linking.

PURPOSE: To evaluate the outcomes of corneal collagen cross-linking performed with customized epithelial debridement technique in progressive keratoconic corneas. MATERIALS AND METHODS: Forty eyes of 40 patients were included in the study. We performed an ophthalmologic examination and recorded the uncorrected visual acuity, best corrected visual acuity (BCVA), central corneal thickness at the thinnest point (t-CCT), flat meridian keratometry (K1), steep meridian keratometry (K2), endothelial cell density (ECC), hexagonal cells (HEX), and coefficient of variation of cell areas (CV) measured preoperatively and at the 1st, 3rd, 6th and 12th months postoperatively. RESULTS: The mean UCVA and BCVA were increased (p < 0.05). The mean flattest and steepest K readings were decreased (p < 0.05). The mean t-CCT decreased in the first months after treatment and increased after 6 months. The mean t-CCT was thicker at 12 months compared to pretreatment status (p < 0.05). The mean ECC and CV were not significantly different between follow-up intervals (p > 0.05). The mean HEX was statistically increased (p > 0.05). CONCLUSIONS: Corneal collagen cross-linking performed with customized epithelial debridement technique is a successful alternative method for stopping the progression of keratoconus after 12 months of treatment.

Increased Endothelial Cell Density in Childhood Patients With Thalassemia Major.

PURPOSE: We aimed to compare specular microscopy, biometric, refractive, and anterior segment topographic parameters in children with thalassemia major (TM) with normal children of the same age. MATERIAL METHOD: This cross-sectional study included 55 eyes of 55 patients with TM and 63 eyes of 63 age-sex-matched healthy children; all patients with TM were receiving treatment with blood transfusions every 3 to 4 weeks and an oral iron chelator deferasirox (DFX) (ICL670) tablet. A comprehensive ophthalmic examination was performed, including refraction (spherical equivalent), best-corrected visual acuity, slit-lamp bio microscopy, specular examination, optical biometry, intraocular pressure, anterior segment topography, and fundus examination. RESULTS: Endothelial cell density (ECD) was 3,138 in the TM group and 2,996 in the control group (P=0.003). The mean central corneal thickness was significantly thinner in the TM group (P=0.010). Flat keratometry (K1) was 43.5 D in the study group and 42.9 D in the control group (P=0.039). The mean anterior chamber depth (ACD) was shallower in the TM group (P=0.004); axial length (AL) was significantly shorter in the TM group (P=0.002). CONCLUSION: This study shows that there are differences in ECD, AL, keratometry values, ACD, and anterior segment parameters of pediatric patients with TM compared with healthy controls.

The Effect of Low-Dose Aspirin on Dry Eye Parameters and Ocular Surface Disease Index Questionnaire.

PURPOSE: To evaluate the effects of acetylsalicylic acid (aspirin) on tear film parameters and dry eye disease. METHODS: Fifty-seven patients using low-dose aspirin regularly for antiaggregant purposes as well as 49 controls, who required antiaggregant treatment but who had not yet started, were included in the study. Tear osmolarity, tear break-up time (TBUT), Schirmer and Oxford grading of ocular surface staining were performed on all patients and dry eye symptomatology was assessed using the ocular surface disease index questionnaire (OSDI). RESULTS: The mean osmolarity was 302.11 ± 16.22 mOsm/L in the aspirin group and 313.88 ± 19.57 mOsm/L in the control group (P < 0.01). The mean Schirmer's score was 24.16 ± 10.52 mm and 21.94 ± 10.11 mm (P = 0.232), TBUT was 13.61 ± 3.31 s and 10.39 ± 4.46 s (P < 0.01), OSDI score was 5.15 ± 5.98 and 16.94 ± 14.17 (P < 0.01), and Oxford score was 0.12 ± 0.33 and 0.12 ± 0.44 in aspirin and control groups, respectively (P = 0.99). Dry eye diagnosis was lower in the aspirin group, but statistical significance was present only in TBUT and osmolarity-based dry eye diagnosis (P ≤ 0.01). In terms of symptom-based dry eye diagnosis with the threshold of OSDI ≥23, none of the aspirin group had dry eye diagnosis, whereas 32.6% of the control group had the diagnosis (P < 0.01). CONCLUSIONS: The use of low-dose aspirin might be great option for treatment of ocular surface inflammatory disease through increasing TBUT and decreasing tear osmolarity with a resultant symptomatic satisfaction.

Dry Eye Disease in Patients with Newly Diagnosed Depressive Disorder.

PURPOSE: Psychiatric conditions and not just the treatments themselves might be involved in the pathophysiology of dry eye disease (DED). The aim of our study was to evaluate the association between depression and DED using objective and subjective tests in patients with newly diagnosed depressive disorder who were not using any medication which may help us to determine the sole effect of depression on dry eye. METHODS: Thirty-six patients from the psychiatry clinic with a new diagnosis of depressive disorder and 32 controls were included in the study. All met the Diagnostic and Statistical Manual IV criteria for depression. Beck Depression Inventory (BDI) was used to measure depression severity and the State-Trait Anxiety Inventory (Stai1, Stai2) for concomitant anxiety symptoms. The Ocular Surface Disease Index (OSDI) and Visual Functioning Questionnaires (VFQ25) were completed and used to confirm diagnosis of DED in conjunction with the tear break up time (TBUT), ocular surface vital dye staining, and Schirmer's test. RESULTS: The comparison of depressive and control groups revealed significantly lower Schirmer (20.3 ± 9.9 vs. 25.7 ± 9.3 mm) and TBUT (7.8 ± 5.7 vs. 12.5 ± 7.8 s) scores with a consistently higher Oxford score (1.8 ± 3.2 vs. 0.2 ± 0.4) in the depressive group. Although the parameters were affected in the depressive group, this did not influence OSDI (86.1 ± 13.6 vs. 86.6 ± 13.3) and VFQ25 (30.8 ± 21.6 vs. 38.5 ± 29.1) scores. In both groups, the three psychological test scores (Stai1-2 and BDI) were correlated to each other but none of these tests were correlated to OSDI, VRQL, Schirmer, TBUT, and Oxford staining scores. CONCLUSION: Our study shows a definite association between depression and DED. We feel that it is important that psychiatrists take this into account especially while prescribing antidepressants which may aggravate dry eye signs.