Association between dryness sensation and ocular surface temperature and conjunctival blood flow in soft contact lens wearers.

PURPOSE: To investigate the association between dryness, ocular surface temperature (OST), and conjunctival blood flow (CBF) in soft contact lens (SCL) wearers after airflow stimulation. METHODS: After recruiting 21 SCL wearers (mean age, 25.3 ± 4.2 years), subjects used two different daily disposable silicone hydrogel SCLs (narafilcon A and delefilcon A lenses). On three of four measurement days, excluding the first, OST, CBF, tear meniscus height (TMH), and non-invasive tear break-up time (NIBUT) were measured after airflow stimulation at a rate of 3 m/s for 10 min. The measurements were conducted without SCLs on the first and second days, and with different SCLs on the third and fourth days. Dryness was evaluated using the visual analogue scale (VAS). These parameters were compared between the two types of SCLs, and their association with the dryness sensation was then investigated. RESULTS: Dryness was significantly weakly correlated with OST (r = -0.375, p < 0.05) and CBF (r = 0.339, p < 0.05). TMH, NIBUT, and VAS scores for dryness with the delefilcon A lens (0.15 ± 0.05 mm, 3.7 ± 01.7 s and 29.4 ± 16.9) were significantly higher, longer, and lower, respectively, than those with the narafilcon A lens (0.12 ± 0.05 mm, 2.3 ± 1.7 s and 35.9 ± 17.0; p < 0.05, p < 0.01 and p < 0.01). The changes in the OST and CBF between with and without the delefilcon A lens (-0.36 ± 0.35 °C and 0.99 ± 0.19) were significantly small compared to the narafilcon A lens (-0.60 ± 0.42 °C and 1.11 ± 0.21; p < 0.01 for both comparisons). CONCLUSION: Dryness was correlated with OST and CBF, which indicates that when dryness was high, OST was low and CBF was high. These results suggest that OST and CBF assessments are effective for evaluating dryness sensation.

Novel findings on the anatomy of medial canthus in dogs.

PURPOSE: Severe entropion of the medial canthus results in ocular surface diseases and tear staining syndrome. However, detailed anatomical structures of the medial canthus and lacrimal ducts in dogs are poorly understood. We aimed to understand the anatomical structures of the medial canthus by analyzing the distances from the medial palpebral commissure to the superior lacrimal punctum (DSP) and to the inferior lacrimal punctum (DIP) and by histological examinations of the medial canthal anatomy. METHODS: Dogs that underwent modified medial canthoplasty (MMC) between April 2017 and March 2021 were studied. As a reference, non-brachycephalic dogs that underwent other surgeries were also examined. DSP and DIP were measured preoperatively in all dogs in both the non-everted and everted positions. Histological examinations of the medial canthal anatomy were performed in four eyes isolated from beagles. RESULTS: The ratios of DIP to DSP (mean ± SD) at the non-everted and everted positions in 242 MMC eyes of 126 dogs were 2.05 ± 0.46 and 1.05 ± 0.13, respectively (p < .01). The ratios of everted to non-everted positions for DIP and DSP were 0.98 ± 0.21 and 1.93 ± 0.49, respectively (p < .01). Histological findings indicated that the orbicularis oculi muscle (OOM) circumjacent lacrimal canaliculus transformed into collagen fibers and were attached to the lacrimal bone. CONCLUSIONS: Histological studies revealed that the OOM circumjacent lacrimal canaliculus transformed into collagen fibers and these collagen fibers may be related to the difference between DSP and DIP.

Association between mask-associated dry eye (MADE) and corneal sensations.

To determine the risk of mask-associated dry eye (MADE), we investigated the fluorescein tear break-up time (FBUT), ocular surface temperature and blood flow, along with corneal sensitivity, in mask wearers. We enrolled 60 mask wearers (mean age, 27.1 ± 5.2 years) and then measured FBUT, corneal temperature and conjunctival blood flow without wearing masks (no mask), with masks, and with taped masks. We defined MADE as the condition in which dry eye symptoms appeared and the FBUT with mask was less than 5 s. The FBUT with a mask was significantly shorter compared to the no mask and taped mask groups (P < 0.01 and P < 0.05). The corneal temperature difference and conjunctival blood flow difference were significantly higher after wearing a mask than after wearing a taped mask (P < 0.01). Of the 60 subjects, 13 were diagnosed with MADE. Pain sensitivity and the Ocular Surface Disease Index (P < 0.05 and P < 0.01) were significantly higher in the MADE group, with the FBUT without masks (P < 0.05) significantly shorter than in the non-MADE group. MADE may be associated with corneal hypersensitivity. Wearing masks decreased FBUT and increased ocular surface temperature and blood flow. Taping the top edge of masks prevented these changes. Fitting masks properly may reduce MADE risk.

A review of diagnostic tests for qualitative and quantitative tear film deficiency in dogs.

Dry eye disease (DED) is a complex multifactorial condition caused by loss of ocular surface homeostasis from quantitative and/or qualitative tear film deficiency. Schirmer tear test (STT) is often the only diagnostic test used to assess for DED in veterinary practice. STT is invaluable in the diagnosis and monitoring of quantitative tear film deficiency (i.e., keratoconjunctivitis sicca); however, it is not sufficient to optimize therapy and fully recognize other contributing factors for the disturbance in ocular surface homeostasis. The present work reviews diagnostic tests for assessing aqueous tear production in veterinary medicine, as well as the quality of tears, corneal epithelial barrier integrity, and the lacrimal functional unit.

Evaluation of the Lubricating Effect of Hyaluronic Acid on Contact Lenses Using a Pendulum-Type Friction Tester Under Mimicking Physiological Conditions.

OBJECTIVE: To evaluate the lubricating effect of hyaluronic acid (HA) on soft contact lenses (SCLs) measured using a pendulum-type friction tester. METHODS: We measured the coefficient of friction (CoF) of narafilcon A, delefilcon A, and etafilcon A with polyvinylpyrrolidone (PVP), daily disposable SCL material, using a modified pendulum-type friction tester. Sample SCLs were set on an acrylic plastic half-ball and placed into the polyethylene terephthalate hemisphere cup filled with 0.4 mL of test lubricants that included saline and 0.05%, 0.1%, 0.2%, 0.3%, 0.4%, and 0.5% (wt/vol) HA (molecular weight, 850 kDa). The viscosities of saline and HA were measured using an Ubbelohde viscometer. RESULTS: The CoF of the SCL under a low concentration (0.05%) of HA was the lowest and significantly lower than saline in narafilcon A and delefilcon A (P<0.05, Steel multiple comparison test). Under higher HA concentrations (0.3%, 0.4%, and 0.5%), the CoF was significantly higher than that of saline (P<0.01, Steel' multiple comparison test) in all three SCLs. There were no significant differences of CoF among three SCLs in saline and all concentrations of HA. The HA viscosities increased exponentially with the concentration (Y=1.2829e9.286X). CONCLUSION: The viscosity of a high concentration of HA may increase the friction of SCLs, which may have a deleterious effect on the ocular surface.

Long-term vision outcomes and breed differences of Ahmed Glaucoma Valve implantation in 132 eyes of 122 dogs.

OBJECTIVE: To evaluate the long-term vision outcomes of Ahmed glaucoma valve (AGV) implantation in dogs. PROCEDURES: The medical records of dogs that underwent AGV implantation from January 2010 to December 2019 were reviewed to assess the duration of post-surgical vision preservation (PVP). The relationship between PVP and the underlying cause of glaucoma, implant placement, and preoperative intraocular pressure was evaluated. RESULTS: One hundred and thirty-two eyes of 122 dogs (mean age, 8.3 ± 2.6 years) were included. The mean ± standard error of PVP for all eyes was 57.5 ± 3.9 months. PVP in the dogs with primary acute glaucoma and prior history of cataract surgery was 56.4 ± 4.7 and 59.3 ± 5.9 months, respectively (p = .712). The PVP of the Shiba Inu, American Cocker Spaniel, and other breeds was 63.1 ± 5.5, 33.7 ± 5.3, and 59.1 ± 6.3 months, respectively (p < .05). The PVP in dogs with medial implantation was 61.9 ± 4.7 months, and in those with lateral implantation was 45.4 ± 6.4 months (p = .034). Among the 132 eyes investigated, 48 (36.4%) lost vision by the last follow-up, and 18 eyes retained vision for more than 5 years. Two of the total number of eyes retained their vision for more than 8 years. CONCLUSIONS: The vision outcomes regarding the use of AGV for the management of canine glaucoma were favorable in dogs.

Evaluation of In Vitro Wettability of Soft Contact Lenses Using Tear Supplements.

OBJECTIVE: To evaluate the interaction between tear supplements and soft contact lenses (SCLs), we measured the contact angles (CAs) on the SCLs using commercially available tear supplements. METHODS: We used four daily disposable conventional hydrogel lenses (etafilcon A, etafilcon A+ polyvinylpyrrolidone, nelfilcon A, and omafilcon A containing 2-methacryloyloxyethyl phosphorylcholine [MPC]) and four silicone hydrogel lenses (narafilcon A, senofilcon A, delefilcon A, and stenfilcon A). The CAs on the SCLs were measured using a sessile drop technique and four different types of sessile drops, including saline, artificial tears, lubricants containing 2-MPC (MPC solution), and 0.1% hyaluronate acid (HA). RESULTS: The CA values associated with the silicone hydrogel lenses were significantly (P<0.001) lower than those associated with the conventional hydrogel lenses with all four solutions. The mean CA of 0.1% HA was significantly (P<0.01) higher than that of saline. The mean CA of the MPC solution was significantly (P<0.01) lower than that of saline with the conventional hydrogel lenses but significantly (P<0.05) higher than that of saline with the silicone hydrogel lenses. CONCLUSIONS: The CAs associated with the silicone hydrogel SCLs were higher with the use of the MPC solutions and HA in vitro. The measured CAs may depend on ingredient agents, surface treatment of the CLs, and components of the tear supplements.

Punctate fluorescein staining scores in dogs with or without aqueous tear deficiency.

OBJECTIVE: To compare the superficial punctate fluorescein staining in dogs with and without aqueous tear deficiency. PROCEDURES: An eye from each client-owned dogs presented to Triangle Animal Eye Clinic between January and December 2018 underwent tear and ocular surface tests, which included the Schirmer tear test (STT), phenol red thread test (PRT), and strip meniscometry tube tear test (SMT). Punctate fluorescein staining of the cornea (PFS-C) and the upper palpebral conjunctiva (PFS-UPC) were also performed. Fifty-seven dogs with STT results of <15 mm/min had aqueous tear deficiency (AD); 31 dogs had <10 mm/min and 26 dogs had ≥10 mm/min. The 162 dogs with STT results of ≥15 mm/min did not have AD. The test results of the groups were compared using Kruskal-Wallis and Steel-Dwass multiple comparison tests. RESULTS: Two hundred and nineteen eyes from 219 dogs were enrolled in this study. The PRT and SMT results, presented as mean ± SD, were significantly lower in the AD group than in the non-AD group (PRT: 29.5 ± 8.1 vs 36.9 ± 5.6 mm/15 s; SMT: 6.2 ± 3.8 vs 10.8 ± 2.8 mm/5 s). The PFS scores were significantly higher in the AD group than in the non-AD group (PFS-C: 4.4 ± 0.7 and 3.7 ± 0.8; PFS-UPC: 2.3 ± 0.5 and 1.7 ± 0.5). CONCLUSIONS: These results suggest that aqueous tear deficiency is not only reflected by PRT and SMT but also PFS-C and PFS-UPC.

Comparison and Evaluation of Prelens Tear Film Stability by Different Noninvasive in vivo Methods.

PURPOSE: Prelens tear film stability of soft contact lens (SCL) play an important role for contact lens discomfort. In this study, we investigated the association between two types of noninvasive methods and evaluated the tear film stability with SCL using the methods. PATIENTS AND METHODS: In experiment 1, images of ring mire were recorded with a keratograph after focusing the pigment located at the front or back of the SCL. Interferometry and videokeratoscopy were used for the assessment of tear film stability in the right eye of 10 women, with two different cosmetic daily disposable SCLs: polymacon and etafilcon A with polyvinylpyrrolidone. Time to first distortion by noninvasive keratograph break up time (NIKBUT-first) was compared to noninvasive interferometry break up time (NIBUT). In experiment 2, ten normal females wore two different daily disposable SCLs: samfilcon A and narafilcon A. NIKBUT-first and NIBUT were compared between the lenses after 8 hours of SCL wearing. RESULTS: In experiment 1, NIBUT-first without SCL was significantly correlated to NIBUT without SCL (r=0.445, P=0.0488, Pearson's correlation coefficients). However, NIKBUT-first with SCL was not significantly correlated with NIBUT with SCL. In experiment 2, although NIKBUT-first was not significantly different between SCLs, samfilcon A had significantly longer NIBUT than narafilcon A (P=0.0315, paired t-test). CONCLUSION: NIKBUT-first with SCL could be related to tear film stability between the lens and the corneal surface, but not to prelens tear film stability. NIIBUT could be a suitable method to evaluate prelens tear stability.

Comprehensive Prospective Analysis of the Factors Contributing to Aspiration Pneumonia Following Endoscopic Submucosal Dissection in Patients with Early Gastric Neoplasms.

Endoscopic submucosal dissection (ESD) has become the first-line treatment for early gastric neoplasms; however, a subset of patients treated by this method develop aspiration pneumonia. We conducted a comprehensive prospective analysis of the factors contributing to post-ESD aspiration pneumonia in early gastric neoplasms in this study, with special focus on whether pre-treatment oral care can prevent aspiration pneumonia. Sixty-one patients who underwent ESD for gastric neoplasms were randomly assigned to the oral care or control groups. ESD was performed under deep sedation. Of 60 patients whose data were available for analysis, 5 (8.3%) experienced pneumonia confirmed either by chest radiography or computed tomography. Although no difference in the rate of pneumonia was found between the control and oral care groups, the post-oral care bacteria count was significantly higher in the saliva of patients who developed pneumonia compared to those without pneumonia. In addition, the presence of vascular brain diseases and the dose of meperidine were also significantly associated with the occurrence of pneumonia. These results suggest that the number of oral bacteria as well as pre-existing vascular brain diseases and high-dose narcotics can affect the incidence of post-ESD pneumonia.

Correlation between Blood Flow and Temperature of the Ocular Anterior Segment in Normal Subjects.

PURPOSE: To determine a correlation between temperature and blood flow in the ocular anterior segment, and their effects on corneal temperature. METHODS: In experiment 1, we recruited 40 eyes and measured the temperature and blood flow in the ocular anterior-segment (upper/lower eyelid skin, palpebral and bulbar conjunctiva, and cornea) before and after application of warm compresses. In experiment 2, we recruited 20 eyes and measured the same tissues before and during stimulation using water and capsaicin solution in the oral cavity. RESULTS: In experiment 1, the temperatures of the upper/lower eyelid skin and cornea increased significantly until 15 min after the application of the warm compress; the temperatures of the palpebral and bulbar conjunctiva increased significantly until 10 min. The blood flow in the upper/lower eyelid skin and bulbar conjunctiva increased significantly until 10 min, and that of the palpebral conjunctiva increased significantly until 15 min. In experiment 2, the temperatures were correlated significantly with the blood flow in the upper and lower eyelid skin and palpebral and bulbar conjunctiva. The temperature of all locations and palpebral conjunctival blood flow contributed independently to the corneal temperature. CONCLUSIONS: In the ocular anterior segment, the temperature and blood flow were correlated significantly, and contributed to the corneal temperature.

Breed prevalence of canine ulcerative keratitis according to depth of corneal involvement.

OBJECTIVE: To investigate the breed prevalence of canine ulcerative keratitis (UK) according to the depth of corneal involvement. PROCEDURES: Dogs diagnosed with ulcerative keratitis from 2008 to 2017 at the Triangle Animal Eye Clinic were included in this study. Only breeds with more than 20 eyes affected were selected. UK lesions were classified as superficial (Grade 1), stromal (Grade 2) or descemetoceles and perforations (Grade 3) and compared between brachycephalic (BC) and non-BC dog breeds. RESULTS: Of 8877 dogs evaluated at Triangle Animal Eye Clinic from 2008 to 2017, 1109 eyes of 1018 dogs (male, 326 eyes; neutered male, 253 eyes; female, 211 eyes; spayed female, 316 eyes; and unknown sex, 3 eyes) aged between 0.1 and 19.2 years (mean ± standard deviation [SD], 8.33 ± 4.24 years) were diagnosed with UK. The number of eyes that was classified as Grade 1 was 359 eyes (187 non-BC and 172 BC), Grade 2 was 373 eyes (60 non-BC and 313 BC) and Grade 3 was 377 eyes (47 non-BC and 330 BC). Significant differences were observed between BC and non-BC dogs for all grades of UK. BC dogs were significantly more frequently affected by Grades 2 and 3 and less frequently by Grade 1 UK (P < .01). French bulldogs are more likely to be affected with Grade 1. CONCLUSIONS: Brachycephalic dogs are more likely to have deeper corneal involvement in UK. This study provides novel data on the prevalence of superficial UK, which was low in BC dogs and high in non-BC breeds.

Histopathologic changes associated with Meibomian Gland dropout in a dog.

PURPOSE: To perform histopathologic analysis of tissue manifesting meibomian gland dropout on noncontact infrared meibography in a dog. METHODS: A 14-year-old intact male Cairn terrier was evaluated at Triangle Animal Eye Clinic for dense corneal opacity of the right eye. A complete ocular examination was performed, including slit-lamp biomicroscopy, tonometry, and noncontact meibography. Pigmentary glaucoma with elevation of intraocular pressure was diagnosed, and meibography revealed morphological changes suggestive of gland dropout in the middle of the upper right eyelid. RESULTS: The globe was enucleated by the transpalpebral method, and palpebral tissue was subjected to histopathologic analysis. The analysis revealed an almost complete loss of meibomian gland structure accompanied by slight enlargement and proliferation of fibroblasts as well as by infiltration of plasma cells and lymphocytes. CONCLUSIONS: Meibomian gland dropout as detected by meibography can be associated with chronic inflammation.

A novel strip meniscometry method for measuring aqueous tear volume in dogs: Clinical correlations with the Schirmer tear and phenol red thread tests.

OBJECTIVES: The strip meniscometry test (SMT) is a novel method for quantitative measurement of tear volume with only five seconds. We aimed to evaluate clinical correlations of SMT with the gold standard Schirmer tear test (STT) and phenol red thread test (PRT) in dogs, including normal and tear-deficient eyes. ANIMALS STUDIED: Left eyes from 621 outpatient dogs with and without ocular disorders were evaluated. PROCEDURES: Each subject underwent SMT, PRT, and STT without topical anesthesia in the described order with five-minute intervals. The total population was divided into four groups by classifying tear deficiency severity based on STT results: "severe" (0-5 mm/min), "moderate" (6-10 mm/min), "subclinical" (11-14 mm/min), and "normal" (15 or more mm/min). RESULTS: The strongest correlation coefficient was found between SMT-STT (0.676), followed by PRT-STT (0.637) and SMT-PRT (0.600) pairs. Mean(SD) scores of SMT, PRT, and STT in total population were 9.47 (4.08) mm/5 s, 33.30 (8.52) mm/15 s, and 16.47 (7.01) mm/min. Significant differences were found among STT-classified groups, both using SMT and PRT results. Receiver operating characteristic (ROC) curves revealed that SMT better agreed with STT than PRT; agreement increased with increasing STT severity. A cutoff for SMT was identified at 10 mm/5 s to discriminate normal eyes from tear-deficient eyes, yielding high sensitivities and acceptable specificities. CONCLUSIONS: SMT could be superior to PRT for discriminating tear-deficient eyes. The high sensitivity of SMT could be useful as an initial diagnostic tool to rule out normal eyes with the short testing time.

Assessment of meibomian gland morphology by noncontact infrared meibography in Shih Tzu dogs with or without keratoconjunctivitis sicca.

OBJECTIVE: To investigate meibomian gland (MG) morphology by noncontact infrared meibography in Shih Tzu dogs with or without keratoconjunctivitis sicca (KCS). PROCEDURES: Fourteen eyes of 12 Shih Tzu dogs (mean age of 10.7 years, range of 7-13 years) presented to Yakumo Animal Hospital or Triangle Animal Eye Clinic from 2011 to 2017 with clinical signs and a Schirmer tear test (STT) result consistent with KCS (<10 mm/min) were examined. Twenty-eight eyes of 16 Shih Tzu dogs (mean age of 12.4 years, range of 8 to 15 years) with a STT > 15 mm/min served as healthy controls. Both groups of dogs underwent routine slitlamp biomicroscopy followed by noncontact infrared meibography of the upper eyelid with both desktop-type and mobile-type systems. Results Meibography revealed morphological abnormalities of MGs in 13 eyes of 11 dogs with KCS. The abnormalities included gland shortening in 64% and gland dropout in 64% of the 14 eyes in the KCS group. Morphological changes were also observed in MGs of 16 eyes of 10 dogs in the control group. These changes included shortening in 46% and dropout in 17.8% of the 28 eyes in the control group. Dropout was significantly more common in eyes with KCS than in control eyes (P < 0.01). Conclusions The frequency of MG abnormalities is increased in Shih Tzus with KCS compared with control animals. A reduced quality of the tear film associated with increased evaporation and reduced retention of tear fluid likely exacerbates the effects of a reduced tear volume in animals with aqueous deficiency.

Clinical features of cats with aqueous tear deficiency: a retrospective case series of 10 patients (17 eyes).

OBJECTIVES: The aim of this study was to describe the clinical findings, diagnostic test results and response to therapy of cats with Schirmer tear test 1 (STT-1) values below the reference interval. METHODS: The medical records of three institutions were searched for cats with ocular surface disease and STT-1 values <9 mm/min, confirmed at two or more separate visits. RESULTS: Ten cats (17 eyes) were included. The mean ± SD (range) age and STT-1 values in affected eye(s) were 6.1 ± 5.7 (0.2-16) years and 2.4 ± 3.1 (0-8) mm/min, respectively. Concurrent ocular surface disease was bilateral in 5/10 cats. Clinical signs included conjunctivitis (14/17 eyes), corneal ulceration (6/17 eyes), non-ulcerative keratitis (4/17 eyes), symblepharon (4/17 eyes), eosinophilic keratitis (3/17 eyes), corneal sequestrum (3/17 eyes), corneal fibrosis (2/17 eyes) and meibomitis (2/17 eyes). Management included: topically applied lacrimomimetics, antiviral drugs, corticosteroids or immunomodulatory drugs; orally administered famciclovir; or surgical procedures, in various combinations. Response to therapy (defined as an increase in STT-1 value of ⩾5 mm/min) was transient (seen at a single reassessment) in 65% of eyes and sustained (seen at ⩾2 consecutive reassessments) in 18% of eyes. CONCLUSIONS AND RELEVANCE: Clinical features seen in cats with low STT-1 values are described, although the association between aqueous deficiency and the reported ocular changes is unknown at this time. We encourage clinicians to assess the tear film in cats with ocular surface disease, and initiate therapy with lacrimomimetics if STT-1 values are repeatedly below normal. Such information will further define aqueous tear deficiency in cats, providing a better understanding of disease prevalence, pathogenesis and treatment.

Association Between Ocular Surface Temperature and Tear Film Stability in Soft Contact Lens Wearers.

Purpose: To investigate the correlation between the changes in the ocular surface temperature (OST) and tear film stability over soft contact lenses (SCLs). Methods: We enrolled 20 eyes of 20 normal SCL wearers (20 men; 24.4 ± 4.1 years). We used four different daily disposable SCLs: one silicone hydrogel lens (delefilcon A) and three hydrogel lenses (etafilcon A with polyvinylpyrrolidone [PVP], etafilcon A, and polymacon). OST was measured every second during 10 seconds without blinking. We defined the difference in the OST from 0 to 10 seconds as ΔOST. To evaluate tear film stability, we measured noninvasive tear break-up time (NIBUT) and tear interference patterns on the contact lenses (TIPCL) using tear film interferometry. The parameters were measured before and 15 minutes after wearing each SCL. Results: ΔOST was correlated significantly with NIBUT without (r = 0.411, P < 0.01) and with SCL (r = 0.642, P < 0.01). TIPCL grade was correlated significantly with ΔOST over SCLs (r = -0.636, P < 0.01). ΔOST was significantly smaller with silicone hydrogel delefilcon A than hydrogel etafilcon A and polymacon lenses (P < 0.05 and P < 0.01, respectively). Delefilcon A and etafilcon A with PVP lenses had significantly smaller NIBUT than etafilcon A (P < 0.05 for both comparisons). TIPCL grade of delefilcon A lens was significantly smaller than those of etafilcon A and polymacon (P < 0.01 for both comparisons). Conclusions: The changes in OST over SCLs are related to tear film stability. Measurements of OST can be used to evaluate tear film stability for SCL wearers.