Evaluation of dry eye disease and corneal epithelial mapping in patients with lower eyelid ectropion.

PURPOSE: To evaluate the corneal epithelial mapping, ocular surface parameters and their relationship with each other in lower eyelid ectropion patients according to severity. METHODS: This retrospective study included 48 lower eyelid ectropion patients and 63 healthy individuals as control group. Ocular surface and tear functions were evaluated with ocular surface staining score, tear film break-up time (BUT), non-invasive tear break-up time (NIBUT) and ocular surface disease index (OSDI). Meibography scores and corneal epithelial thickness (CET) mapping were evaluated. The lower eyelid ectropion was classified and divided into subgroups as follows: mild, moderate and severe. RESULTS: There was no significant differences between the groups for age and gender. Compared to controls, CET was significantly thinner at inferior (p = 0.047) and inferior nasal quadrants (p = 0.023) in the ectropion patients. Lower BUT and NIBUT, higher OSDI scores and higher ocular surface staining were observed in the ectropion patients. In the subgroups determined according to the severity of ectropion, ocular surface damage was found to be significantly higher as the severity of ectropion increased (p < 0.05). CONCLUSION: Patients with lower eyelid ectropion had worse ocular surface findings and more ocular complaints. Furthermore, the inferior and inferior nasal CETs were thinner in patients with lower ectropion.

Effects of full-thickness wedge resection on ocular surface and in vivo confocal microscopy findings in floppy eyelid syndrome patients.

OBJECTIVE: To evaluate the effect of full-thickness wedge resection (FTWR) on ocular surface and in vivo confocal microscopy (IVCM) findings in patients with floppy eyelid syndrome (FES). METHODS: The study included two groups: a surgical treatment (ST) group (26 eyes) consisting of patients who underwent FTWR surgery, and a conservative treatment (CT) group (30 eyes). Pre-treatment and post-treatment ocular surface disease index (OSDI), tear break-up time (TBUT), corneal fluorescein staining (CFS), IVCM findings along with the body mass index (BMI), FES grade, the presence and the treatment of obstructive sleep apnea syndrome (OSAS) were recorded and compared between the groups. RESULTS: The groups were comparable in terms of BMI, FES grade, and OSAS data. After six months, TBUT in the ST group significantly increased to 12.92 ± 1.15, compared to 8.10 ± 1.60 in the CT group (p = 0.000). The CFS and OSDI scores were significantly lower in the ST group (0.15 ± 0.37, 18.0 ± 8.3, respectively) compared to the CT group (0.90 ± 0.61, 27.3 ± 9.3, respectively) (p = 0.000). IVCM analysis revealed a significant decrease in dendritic cell count (ST: 22.0 ± 12.4, CT: 39.5 ± 15.1, p = 0.000) and nerve tortuosity (ST: 1.38 ± 0.64, CT: 2.00 ± 0.59, p = 0.000), with a significant increase in total nerve density (ST: 4.27 ± 0.83, CT: 3.57 ± 0.90, p = 0.002) in the ST group compared to the CT group after six months. CONCLUSION: In our retrospective cohort, FTWR surgery was shown to be an effective and reliable surgical treatment for FES, improving both ocular surface and IVCM findings. Patients with moderate to severe stages of FES not responding to conservative treatment may benefit from eyelid tightening.

The results of Muller Muscle Conjunctival Resection versus Levator Advancement for mild to moderate ptosis.

Purpose: To compare the surgical outcomes of Muller muscle conjunctival resection (MMCR) and levator advancement (LA) in patients with mild to moderate blepharoptosis. Methods: A retrospective review of patients who underwent surgery for mild to moderate ptosis between 2015 and 2020 was performed. The degree of ptosis was graded based on the amount of upper eyelid drooping: mild ≤ 2 mm and moderate < 4 mm. Surgical success was defined as post-operative marginal reflex distance 1 (MRD1) ≥ 4.0 and ≤ 5.0 mm, and a satisfactory eyelid contour. Results: A total of 82 eyes of 65 patients underwent ptosis repair surgeries. MMCR was performed in 48 eyes and LA in 34 eyes. Under-correction was detected in 8.3% and 11.8% of the patients in MMCR group and LA group respectively. There was no patient with over-correction in the MMCR group postoperatively, 3 patients in the LA group had over-correction (0% vs. 8.8% respectively). The success rate in our study was found to be 91.7% in the MMCR group and 72.2% in the LA group. Conclusions: The MMCR and LA procedures are effective approaches in treating patients with mild to moderate eyelid ptosis in our population. Each procedure had its superiority in selected groups of patients. However, the complication rate and duration of surgery were found to be lower in MMCR group. Abbreviations: LA = Levator Advancement, LF = Levator Function, MMCR = Muller Muscle Conjunctival Resection, MRD 1 = Marginal Reflex Distance.

Dexpanthenol/sodium hyaluronate eye drops for corneal epithelial healing following corneal cross-linking in patients with keratoconus.

PURPOSE: To evaluate the effect of dexpanthenol 2%/sodium hyaluronate 0.15% eye drops on corneal epithelial healing and corneal microstructural changes following corneal cross-linking (CXL) in patients with keratoconus. METHODS: The study included 42 eyes of 21 patients with keratoconus who underwent CXL on both eyes. One eye of each patient was instilled dexpanthenol 2%/sodium hyaluronate 0.15% eye drops (DP/SH group) and the fellow eye was instilled unpreserved sodium hyaluronate 0.15% eye drops (SH group). The epithelial healing process was assessed every day until complete reepithelialization was achieved. The in vivo confocal microscopy (IVCM) findings were also recorded. RESULTS: The mean epithelial defect size 48.6 ± 6.7 mm2 for the DP/SH group and 48.2 ± 5.3 mm2 for the SH group. Complete reepithelialization was seen after 2.24 ± 0.44 days (range 2-4 days) in the DP/SH group and 3.43 ± 0.60 days (3 to 5 days) in the SH group. Posterior keratocyte density and endothelial cell density were similar in both groups. The mean subbasal nerve plexus density was significantly higher in the DP/SH group (postoperative 1 month: 1.13 ± 1.51, 3 months: 3.53 ± 2.55, 6 months: 7.07 ± 1.42) compared to the SH group (postoperative 1 month: 0.87 ± 1.43, 3 months: 2.89 ± 2.62, 6 months 6.33 ± 1.29). The DP/SH group revealed faster subbasal nerve regeneration and less edema compared to the SH group. CONCLUSION: Dexpanthenol 2%/sodium hyaluronate 0.15% eye drops were effective and safe for corneal epithelial healing, and promoted faster corneal reepithelialization, nerve regeneration, and keratocyte repopulation with reduced corneal edema compared to sodium hyaluronate eye drops.

Ocular surface and in vivo confocal microscopic findings in patients with active tyhroid eye disease treated with glucocorticoids.

OBJECTIVES: To evaluate the effect of treatment with high-dose glucocorticoids (HDG) on ocular surface parameters and in vivo confocal microscopy (IVCM) findings in patients with active thyroid eye disease (TED). METHODS: This study included 15 active TED patients treated with a cumulative HDG dose of 4.5g (500 mg and then 250 mg for 6 weeks each). Disease activity was assessed by the clinical activity score (CAS), Graves' Orbitopathy-specific Quality of Life (GO-QoL) questionnaire, ocular surface disease index (OSDI), tear break-up time(T-BUT), ocular surface staining and IVCM. RESULTS: The mean follow-up time was 48.6 months. The treatment resulted in a significant improvement in the T-BUT, ocular surface staining values. In comparison to the baseline, a notable reduction in CAS, OSDI and an increase in GO-QoL were seen after one year. IVCM showed a significant decrease in the number of dendritic cells, activated keratocytes, the degree of tortuosity, there was also a significant increase in the number of basal epithelial cells and total nerves over one-year period. All of those changes remained stable during the follow-up period. CONCLUSION: HDG treatment results in a sustained decrease in corneal inflammatory cells, an increase in tear film stability, and an improvement in disease symptoms and QoL scores for up to 4 years.

Effects of lipid-containing eye drops on the ocular surface and in vivo confocal microscopy findings in patients using systemic isotretinoin.

OBJECTIVE: To evaluate the effects of lipid-containing Rohto Dry Aid eye drops and sodium hyaluronate eye drops on the ocular surface and in vivo confocal microscopy (IVCM) findings in patients using systemic isotretinoin. METHODS: This retrospective study included 71 patients using systemic isotretinoin for acne vulgaris. Ocular surface and tear functions were evaluated with the tear break-up time (TBUT), corneal fluorescein staining (CFS), and the ocular surface disease index questionnaire (OSDI). Meibography was used for the staging of Meibomian gland dysfunction (MGD) while IVCM was used for the analysis of corneal micro-structural changes. The data of 36 patients using Rohto Dry Aid (the Rohto group) and 35 patients using sodium hyaluronate (the SH group) were recorded. Pre-treatment, first month and third month data were analyzed. RESULTS: Longer TBUT, lower OSDI score, and less CFS were observed in the first and third months after treatment in the Rohto group (p < 0.001). There was no significant change in TBUT and CFS in the first month (p > 0.05) in the SH group (p < 0.05) but lower TBUT and more CFS were observed in the third month. There was no significant change in the OSDI score in the SH group. There was a significant decrease in dendritic cells, activated keratocytes, and nerve tortuosity with IVCM in both groups. However, no significant difference was found between the two groups. CONCLUSION: Rohto Dry Aid, with its support of the lipid layer, is an effective and safe treatment agent that can improve both ocular surface and IVCM findings in evaporative dry eye cases with MGD.

Evaluation of the Effect of Dermatochalasis and Upper Eyelid Blepharoplasty Surgery on Corneal Epithelial Thickness Alterations.

BACKGROUND: The aim of this study was to assess the effect of different grades of dermatochalasis (DC) and upper eyelid blepharoplasty (UEB) surgery on corneal epithelial thickness (CET), objectively using anterior segment-optical coherence tomography (AS-OCT) measurements. METHODS: 90 eyes of patients with DC were divided into three groups according to the severity of the DC. Forty-one eyes of age and sex-matched patients without DC were randomly selected as the control group. The study did not include patients with more than 2 D of spherical refractive error and more than 1.5 D of astigmatism, a history of previous eyelid surgery, ocular surface disease, contact lens use, and ophthalmic eye drop use. CET measurements of all the patients were performed with an AS-OCT (RTVue-XR, Optovue Inc., USA). RESULTS: There were statistically significant differences in the CET of the superior, superonasal, superotemporal, inferotemporal, and temporal sectors between the DC and control groups (p = 0.001, p = 0.02, p = 0.03, p = 0.02, p = 0.04, respectively). While there were no differences in CET among the sectors of the control group, there was a difference in CET among some sectors of the DC group. When the DC group was subdivided by severity, there was no difference between subgroups for CET across all sectors both preoperatively and postoperatively. In the measurements made 6 months after UEB surgery, the CET in all sectors increased statistically significantly compared to those measured in the preoperative period. CONCLUSION: This study revealed that DC reshaped the corneal epithelium and UEB surgery restored this remodeling 6 months after surgery. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical Performance of Samfilcon A Contact Lenses in Intensive Digital Device Users: A Multicenter, Prospective Clinical Study.

INTRODUCTION: To evaluate patient satisfaction with samfilcon A contact lenses (CLs) in intensive digital device users with myopia and to compare patient satisfaction with samfilcon A lenses to prior experience with senofilcon A or lotrafilcon B CLs. METHODS: This was a comparative, prospective, national study conducted at 14 centers in Turkey. Subjects were adults aged 18 and 45 years with myopia (range -0.25 D to -6.00 D) who spend a minimum of 3 hours viewing digital devices (e.g., computer, smartphone). A subgroup of patients were habitual lens wearers (senofilcon A or lotrafilcon B lens wear for at least 6 months prior to enrollment). The primary assessment was patient satisfaction with samfilcon A lenses (0-100 Likert scale). Secondary assessments included patient satisfaction with samfilcon A lenses compared to patients' habitual lenses, investigator satisfaction with samfilcon A lenses and investigator-evaluated slit lamp examination findings. RESULTS: Samfilcon A lenses were given high overall ratings from both patients and investigators, with a low incidence of ocular symptoms. Overall, patients were highly satisfied with samfilcon A lenses for comfort, vision and overall performance, and stated that they would consider wearing these lenses in the future. Among habitual senofilcon A or lotrafilcon B lens wearers, samfilcon A lenses were rated significantly better than the habitual lenses in regard to comfort, vision and overall performance. Investigator assessments were also highly favorable, both at initial fit and after 4 weeks of follow-up, with no significant findings noted on slit lamp examination. CONCLUSION: Samfilcon A lenses were rated highly by investigators in regard to fit, handling and slit lamp findings, and by novice and habitual lens wearers in regard to comfort, vision and overall performance. These results support the use of samfilcon A lenses among digital device users who seek day-long comfort and good visual acuity.

An overlap case of Parry-Romberg syndrome and en coup de sabre with striking ocular involvement and anti-double-stranded DNA positivity.

Parry-Romberg syndrome (PRS) may overlap localized scleroderma (morphea) lesions with linear depression (en coup de sabre [ECDS]). Overlap case with PRS and ECDS was presented. Enophthalmos, uveitis, ocular torticollis, keratic linear precipitates, and anti-double-stranded DNA positivity were identified. Subendothelial keratic precipitates detected by an in vivo laser scanning confocal microscopy were the first profiled in the literature. Patients must be evaluated and followed up carefully by their clinics to prevent misdiagnosis and unnecessary procedures such as surgery of ocular torticollis as muscular torticollis.

The Presence of Conjunctivochalasis in Obstructive Sleep Apnea Patients.

OBJECTIVES: The aim of our study was to detect the presence of conjunctivochalasis (CCh) in obstructive sleep apnea (OSA) patients. METHODS: We included 54 subjects (41 OSA patients and 14 control subjects) in the study. All the patients were assessed regarding the presence and stage of CCh. RESULTS: The patients were grouped according to their apnea-hypopnea index as determined during nocturnal polysomnography in our laboratory as mild (12 patients), moderate (16 patients), and severe (13 patients) OSA. The CCh rate was 87.8% in the OSA group and 57.1% in the control group (P=0.022). Mean CCh stage was 1.58±1.24, 2.38±0.88, and 2.15±0.98 in the mild, moderate, and severe OSA groups, respectively, and 0.71±0.72 in the control group (P=0.0001). CONCLUSIONS: The moderate and severe OSA groups were associated with higher rates and more advanced stages of CCh. We believe that detailed conjunctival assessment is necessary for patients with complaints such as burning, stinging, and foreign body sensation, which we frequently confront in daily practice. In particular, young patients diagnosed with CCh must be carefully assessed regarding sleep apnea. In light of the above findings, we suggest that patients with ocular surface symptoms that are not relieved by topical medical treatment should be assessed for CCh and OSA. Longitudinal studies monitoring the response of CCh to OSA treatment are needed to clarify the relationship between CCh and OSA.

Alterations in corneal epithelial thickness in patients with congenital myogenic eyelid ptosis.

PURPOSE: To evaluate whether the corneal epithelial thickness (CET) maps obtained by optical coherence tomography (OCT) of the congenital myogenic eyelid ptosis differ from controls. METHODS: CET maps of 13 patients with congenital myogenic eyelid ptosis (m/f = 9/4; mean age 20.5 ± 7.5) and randomly selected one eye of 13 controls (m/f = 7/6; mean age 21.5 ± 6.5) were investigated. Three pachymetry scans of each eye were performed by OCT (RTVue-XR, Optovue Inc., USA), and the scan with the highest signal strength index was selected for the analysis. RESULTS: In ptosis group: Minimum corneal epithelial thickness was thinner (p = 0.029), standard deviation of thickness was higher (p = 0.039), the negative of min-max values were higher (p = 0.007). This difference was originating from the significant thinness of the superior sectors (S, SN, ST) of the corneal epithelium than the inferior counterparts (I, IT, IN) (p = 0.001, p = 0.017, p = 0.002), respectively. There was no difference regarding total corneal thickness measurements. CONCLUSIONS: The mechanic effects of ptotic eyelid to the ocular surface may reshape the corneal epithelium, which can be objectively detected by OCT.

The Effect of Demodex Infestation on Blepharitis and the Ocular Symptoms.

OBJECTIVE: This study aimed to determine the frequency of Demodex infestation of eyelashes in patients with and without blepharitis and to determine the effects of Demodex infestation on blepharitis and the ocular symptoms. METHODS: The study included patients with chronic mixed (anterior + posterior) blepharitis who presented to our clinic. Patients with refractive error and no ocular disease were enrolled as the control group. From each participant, a total of 4 eyelashes were removed and were then examined under a light microscope for Demodex infestation. Symptoms, fluorescein tear breakup time, and ocular surface staining pattern were recorded. RESULTS: The prevalence of Demodex infection in the blepharitis group was 67.2%, versus 54.9% in the control group (P=0.18). The incidence of itching in the blepharitis group was significantly higher in the Demodex (+) patients than in the Demodex (-) patients (P<0.001). Fluorescein tear breakup time in the Demodex (+) patients was significantly shorter than in the Demodex (-) patients (P<0.001). There was not a significant difference in the fluorescein staining pattern between the 2 groups (P=0.57). The incidence of advanced stage blepharitis was significantly higher among the Demodex (+) patients (P=0.007). The incidence of cylindrical eyelash dandruff in the blepharitis group was significantly higher in the Demodex (+) patients (P<0.001). There was a significant difference in meibomian gland dysfunction between the 2 groups (P=0.039). CONCLUSION: Demodex infestation must be investigated in patients with advanced stage blepharitis, itching, and shorter than normal fluorescein tear breakup time.

Choroidal Thickness in Patients with Graves' Ophthalmopathy.

PURPOSE: The purpose of the study is to compare choroidal thickness (CT) in patients with active and inactive Graves' ophthalmopathy (GO) and that in healthy subjects by using spectral domain optical coherence tomography (SD-OCT). METHODS: We conducted an observational, cross-sectional study of 28, 48, and 74 eyes of 14 patients with active GO (group 1), 24 patients with inactive GO (group 2), and 37 age-matched healthy subjects (group 3), respectively. Activity of GO was assessed by using initial clinical activity score (CAS). CT was measured by using SD-OCT. The differences in CT among the groups were compared, and the factors affecting subfoveal CT were analyzed. RESULTS: The mean subfoveal CT was significantly greater in group 1 (395.84 ± 9.68 µm) than that in group 2 and group 3 (319.76 ± 7.07 µm and 314.22 ± 5.74 µm, respectively; p < 0.001) after adjusting for age, axial length, and intraocular pressure (IOP). Subfoveal CT was positively correlated with CAS (p < 0.001; r = 0.567). In multivariate analysis, thicker subfoveal CT was associated with younger age (p < 0.001; correlation coefficient B, -1.67; 95% CI, -2.57 to -0.78); disease activity (p < 0.001; correlation coefficient B, 95.28; 95% CI, 73.14-117.43); and lower IOP ((p < 0.001; correlation coefficient B, -4.09; 95% CI, -8.03 to -0.15). CONCLUSIONS: To our knowledge, this is the first study showing that the mean subfoveal CT increases in patients with active GO. Subfoveal CT may be a useful parameter to monitor disease activity.

Prostaglandin E2 Levels of Aqueous and Vitreous Humor in Ketorolac 0.4% and Nepafenac 0.1% Administered Healthy Rabbits.

PURPOSE: To compare the lowering effects of ketorolac 0.4% and nepafenac 0.1% on aqueous and vitreous humor prostaglandin E2 (PGE2) levels in rabbits. METHODS: Ketorolac and nepafenac ophthalmic solutions were administered to the right eyes of 24 healthy rabbits after randomized division into two groups. The left eyes of these rabbits were considered as controls for the two groups. On the 4th day of the experiment, the samples were taken from the aqueous and vitreous humors of the rabbits bilaterally, and PGE2 levels were measured by an enzyme immune assay kit. RESULTS: Ketorolac and nepafenac achieved a statistically significant decrease (p<0.001, for each) in PGE2 levels in the aqueous (11.75 ± 6.15 and 14.75 ± 7.60 pg/mL, respectively) and the vitreous humor (6.58 ± 4.62 and 9.83 ± 4.55 pg/mL, respectively). CONCLUSIONS: Both ketorolac and nepafenac inhibited PGE2 levels in both the aqueous and vitreous humors of rabbits. Although PGE2-lowering effects were similar in the aqueous humor, nepafenac seemed to be more potent than ketorolac in the vitreous humor.

The effects of anterior palatoplasty on floppy eyelid syndrome patients with obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: To investigate the effects of anterior palatoplasty on the presence and stage of floppy eyelid syndrome (FES) among patients diagnosed with mild or moderate obstructive sleep apnea (OSA) according to the apnea-hypopnea index (AHI). STUDY DESIGN: Prospective controlled trial. METHODS: Those patients whose AHI scores were between 5 and 30 according to full-night polysomnography were included in the study. The patients in whom anterior palatoplasty was performed were included in the study group, whereas those refusing surgery comprised the control group. All patients were evaluated for the presence of FES. The sleep studies were repeated after the third postoperative month, and the results were statistically compared. RESULTS: Sixty-two patients were included in the study. Thirty-five patients who were treated with anterior palatoplasty comprised the study group, and 27 patients were included in the control group. In the surgically treated group, 60% (n = 21) had FES, whereas 55.5% (n = 15) of the control group had FES (P = .798). In the surgically treated group, the FES ratio decreased to 25.7% (n = 9) after the third postoperative month (P = .007). In surgically successful cases, the preoperative-postoperative oxygen desaturation index and preoperative-postoperative lowest oxygen saturation values were 11.755% ± 9.037% and 6.77% ± 5.362% (P = .04), and 86.1% ± 3.89% and 87.8% ± 2.85%, respectively (P = .124). These values were 12.166% ± 5.767% and 14.780% ± 9.924% (P = .385), and 86.13% ± 4.18% and 85.26% ± 4.26%, respectively (P = .579), in patients who underwent unsuccessful surgery. CONCLUSIONS: FES presence and stages were decreased following successful anterior palatoplasty surgery. This effect may have resulted from the correction of tissue hypoxia, which is common in the pathophysiology of both OSA and FES. LEVEL OF EVIDENCE: 2b Laryngoscope, 126:2171-2175, 2016.

Association Between Keratoconus and Familial Mediterranean Fever in Turkey.

PURPOSE: To evaluate the association between familial Mediterranean fever (FMF) and keratoconus (KC). METHODS: This retrospective case-control study was performed to compare the prevalence of KC in patients with FMF with the corresponding prevalence in control patients without FMF referred to Genetic Diagnostic Center at Diskapi Yildirim Beyazit Training and Research Hospital from June 2012 to June 2015. We included all 100 patients with FMF. Each FMF-affected patient was matched to 3 controls. RESULTS: None of the patients in the control group (0%, 0/300) had KC, whereas 4 of 100 patients with FMF (4%) had KC (P < 0.004). Three of 33 patients with a homozygous mutation (9.1%) (M694V/M694V in 2 cases and M680I/M680I in 1 case) and 1 of the 46 patients with a compound heterozygous mutation (2.2%) (M694V/M680I) had KC, whereas none of the 21 patients with a heterozygous mutation (0%) had KC. All patients with KC were women, and mean age was 40.8 years (range, 30-51). Although 1 of the 4 patients with KC had hypertension and type 2 diabetes mellitus, the other 3 patients did not have any systemic illness except FMF. When we compared the prevalence of KC in patients with FMF (4%) with the highest prevalence of KC reported in the literature (0.2%), FMF was a predisposing factor to develop KC [odds ratio: 18.1 (95% CI: 11.9-27.5)] especially in patients with a homozygous mutation [odds ratio: 43.4 (95% CI: 28.6-65.7)]. CONCLUSIONS: Mediterranean fever (MEFV) gene mutations, particularly in homozygous mutations of the MEFV gene, may be a predisposing factor in the development of KC.

Ocular findings in alopecia areata.

Alopecia areata is a T cell mediated disease with which many disorders may be associated. There are few studies reporting ocular findings in alopecia areata. The aim of the study is to assess tear function and ocular surface pathologies in alopecia areata. Thirty-two patients with alopecia areata and 20 age- and sex-matched healthy controls were enrolled in the study. Ocular surface disease index questionnaire, Schirmer, tear break-up time, and corneal staining stage tests were done. The data was analyzed using SPSS 10.0 software. One-way variance analysis and Chi-square tests were used as tests of significance. The patient group had significantly higher ocular surface disease index questionnaire and corneal staining stage test scores and lower tear break-up time test scores compared with the control group (P < 0.05). Dry eye disease (DED) was diagnosed in 27 (84%) of 32 alopecia areata patients and in only 3 (15%) of 20 controls, and there was a significant difference between the groups (P < 0.01). T cell mediated autoimmunity has a prominent role in the etiopathogenesis of alopecia areata and dry eye disease. We think that inflammatory mechanisms causing alopecia areata may trigger dry eye disease or vice versa. All patients with AA should be referred to an ophthalmologist for the evaluation of DED and other possible eye pathologies.

Evaluation of dry eye findings in patients with vitiligo.

OBJECTIVE: To evaluate the association of dry eye and vitiligo diseases with objective parameters and a questionnaire. METHODS: The study was conducted in 30 vitiligo patients and 31 patients with non-complicated refractory complaints. All the patients underwent complete ophthalmologic examinations including fluorescein break-up time (FBU), corneal fluorescein staining (CFS) and Schirmer test-I. The dry eye status was evaluated by means of Ocular Surface Disease Index (OSDI). RESULTS: The groups were similar regarding the age and gender distribution. The vitiligo group had higher OSDI scores (26.1±15.9 vs 14.7±5.4, t-test, p<0.001), shorter FBU (7.8±2.9 vs 9.8±2.2, Mann Whitney U test, p=0.005) and higher CFS positivity (18/30 vs 3/31, chi-square test, p<0.001) than control group. The groups were similar regarding the Meibomian Gland Dysfunction (MGD) and Schirmer test results. Fourteen (46.7%) of vitiligo patients had periocular involvement. The analysis within vitiligo patients revealed that FBU and Schirmer test were shorter in patients with periocular involvement, the OSDI scores and MGD status were similar. CONCLUSION: Our study suggest a possible association of dry eye and vitiligo diseases. The diagnostic tools for dry eye disease are in good correlation with each other. The OSDI questionnaire seems practical for both diagnostic purposes and follow-up.