Ocular manifestations of liver disease: an important diagnostic aid.

PURPOSE: This review examined existing literature to determine various ocular manifestations of liver pathologies, with a focus on metabolic deficiencies as well as viral and immune liver conditions. METHODS: Recent data were compiled from PubMed from 2000 to 2020 using keywords that were relevant to the assessed pathologies. Ocular presentations of several liver pathologies were researched and then summarized in a comprehensive form. RESULTS: Several ocular manifestations of liver disease were related to vitamin A deficiency, as liver disease is associated with impaired vitamin A homeostasis. Alcoholic liver cirrhosis can result in vitamin A deficiency, presenting with Bitot spots, xerosis, and corneal necrosis. Congenital liver diseases such as mucopolysaccharidoses and peroxisomal disorders are also linked with ocular signs. Viral causes of liver disease have associations with conditions like retinal vasculitis, keratoconjunctivitis sicca, retinopathies, Mooren's ulcer, and Sjogren's syndrome. Autoimmune hepatitis has been linked to peripheral ulcerative keratitis and uveitis. CONCLUSIONS: Building strong associations between ocular and liver pathology will allow for early detection of such conditions, leading to the early implementation of management strategies. While this review outlines several of the existing connections between hepatic and ophthalmic disease, further research is needed in the area in order to strengthen these associations.

Novel Management of Ocular Surface Inflammation in Patients With Ocular Graft-Versus-Host Disease in the Setting of Cataract Surgery.

PURPOSE: To report the outcomes of cataract surgery in patients with ocular graft-versus-host disease (oGVHD) using a novel preoperative immunomodulatory regimen in a collaborative subspecialty care setting. METHODS: Retrospective case series of patients with oGVHD who underwent cataract surgery using a novel preoperative immunomodulatory regimen in a collaborative care setting. A preoperative regimen consisting of pooled human immune globulin 1%, autologous serum 50%, and methylprednisolone 1% eye drops was prescribed. Outcome measures included visual acuity (VA), ocular surface disease index (OSDI) score, lissamine green staining, and complications with a minimum of 2 years of follow-up. RESULTS: Thirty-five eyes from 20 patients with oGVHD were studied. The mean age was 59 years (range 30-70 years). A healthy comparison group included 35 eyes from 24 patients with a mean age of 63 years (range 44-74 years). At the 2-year follow-up, the mean corneal staining score was 2.3/15, the mean OSDI score was 37.5, and the mean VA was 20/30 (logarithm of the minimal angle of resolution 0.17). The global complication rate was 2.8% at the last follow-up with no difference versus a healthy comparison group. CONCLUSIONS: A collaborative care model improving ocular surface health before cataract surgery with dry eye and cataract subspecialists can optimize outcomes in patients with oGVHD.

Association between dry eye and periodontal disease in community-dwelling Japanese adults: data from the Uonoma cohort study.

BACKGROUND: While research has explored the risk of periodontal disease in various eye conditions, the link between dry eye and periodontal disease remains underexplored, especially in Japanese adults. This study aims to investigate the association between dry eye and periodontal disease in community-dwelling Japanese adults. METHODS: This study is a subset of the Uonuma cohort study, which includes Japanese adults aged 40 years and older residing in the Uonuma area of Niigata Prefecture, Japan. Participants completed a self-administered, paper-based questionnaire. Statistical analyses, including the chi-square test, independent t test, ANOVA test, and logistic regressions, were employed to assess the association of periodontal disease with independent variables. RESULTS: Among 36,488 participants (average age 63.3 years, 47.4% men), 39.3% had a history of periodontal disease, and gender differences were statistically significant (p < 0.001). Significant associations were found between periodontal disease and dry eye diagnosis or symptoms. Univariable logistic regression revealed links between periodontal disease and age, gender, living status, alcohol consumption, remaining teeth, bite molar availability, and history of dry eye disease or symptoms. Multiple-adjusted regression found that doctor-diagnosed dry eye was associated with a higher likelihood of periodontal disease (odds ratio, 1.12; 95% confidence interval, 1.03-1.22). Participants who never experienced dryness or foreign body sensation had lower ORs of periodontal disease than those who always experienced such symptoms across all models. CONCLUSION: A significant correlation was found between dry eye and periodontal disease in Japanese adults. Regular check-ups, early detection, and effective management of both conditions are strongly recommended.

Occurrence of Dry Eye Disease in Patients With Concomitant Strabismus: A Preliminary Cross-sectional Analysis.

PURPOSE: To determine the effects of strabismus on dry eye parameters. METHODS: In this cross-sectional study, the preliminary assessment of ocular parameters related to dry eye disease was performed in patients with untreated concomitant strabismus. In total, 204 patients with concomitant strabismus and 125 volunteers without strabismus (4 to 30 years old, 170 male and 159 female) were enrolled. The Ocular Surface Disease Index questionnaire (OSDI) was administered, and ocular surface was examined using the Oculus Keratograph 5M (Oculus Optikgeräte GmbH) to collect data on tear film break-up time (TBUT), ocular redness index (based on bulbar conjunctival blood vessel engorgement), and meibomian gland atrophy. Subgroup analysis was performed based on strabismus type (concomitant exotropia, concomitant esotropia, and non-strabismus); age (juvenile versus adults age > 18 years); and 5- to 10-year and 10- to 20-year strabismus course, according to an age of 12 years. RESULTS: Concomitant exotropia and esotropia were reported in 134 and 70 patients, respectively. A total of 125 healthy volunteers were recruited. The three groups showed significant differences in the ocular redness index (right eye: P = .012, left eye: P = .018). In contrast, other parameters were not significantly different. Similarly, no statistical differences in ocular surface indicators were observed when patients were divided by age (P > .05 for all) and the 5- to 10-year and 10- to 20-year strabismus course. The meibomian gland showed varying degrees of atrophy in both the strabismus and non-strabismus groups. CONCLUSIONS: Strabismus does not affect tear film stability with age in this cohort with constant strabismus up to 30 years, indicating that strabismus may not increase the risk of dry eye disease. [J Pediatr Ophthalmol Strabismus. 2024;61(1):30-37.].

In vivo confocal microscopy findings of cornea and tongue mucosa in patients with Sjögren's syndrome.

INTRODUCTION AND OBJECTIVES: We aimed to investigate whether Sjögren's syndrome (SS) had distinctive findings in tongue confocal microscopy in a non-invasive manner. MATERIALS AND METHODS: This retrospective case-control study evaluated corneal and tongue confocal microscopy findings of the right eyes of 25 patients with aqueous deficient dry eye and 12 healthy volunteers without dry eye findings. There were a total of 14 patients diagnosed with SS-associated dry eye (SSDE), while 11 cases were evaluated as non-Sjögren dry eye (NSDE). RESULTS: A significant difference was observed in the dendritic cell count at the corneal subbasal nerve level between the SSDE and NSDE groups (P=.018). In SSDE group, the confocal microscopy images of dendritiform hyperreflective inflammatory cells in the tongue mucosa were in favor of inflammation. However, these findings were not found in patients with NSDE or in controls. CONCLUSIONS: This study showed that confocal microscopy provided a non-invasive evaluation of the inflammatory cells in the tongue of SS patients.

[Sjögren's syndrome combined with cold agglutinin disease: A case report].

Sjögren's syndrome(SS)is a chronic autoimmune disease that affects exocrine glands, especially salivary and lacrimal glands. The main clinical manifestations are dry mouth and dry eyes, but also multi-organ and multi-system can be involved. Cold agglutinin disease(CAD)is an autoimmune disease characterized by red blood cell agglutination in the blood vessels of extremities caused by cold agglutinin at low temperature, resulting in skin microcirculation disturbance, or hemolytic anemia. Cold agglutinin disease is divided into two categories, primary cold agglutinin disease and secondary cold agglutinin disease. Primary cold agglutinin disease is characterized with cold agglutinin titer of 1 ∶4 000 or more and positive Coomb's test. However, the Coomb's test is not necessarily positive and the cold agglutinin titer is between 1 ∶32 and 1 ∶4 000 in secondary cold agglutinin disease. Here, we reported an elderly patient admitted to hospital due to fever. He was diagnosed with respiratory infection, but he showed incompletely response to the anti-infection treatment. Further laboratory tests showed the patient with positive ANA and anti-SSA antibodies. Additionally, the patient complained that he had dry mouth and dry eyes for 1 year. Schirmer test and salivate gland imaging finally confirmed the diagnosis Sjogren's syndrome. During the hospital stay, the blood clots were found in the anticoagulant tubes. Hemolytic anemia was considered as the patient had anemia with elevated reticulocytes and indirect bilirubin. In addition, further examination showed positive cold agglutination test with a titer of 1 ∶1 024, and cold agglutinin disease was an important type of cold-resistant autoimmune hemolytic anemia. Furthermore, the patient developed cyanosis after ice incubating at the tip of the nose. Hence, the patient was diagnosed as CAD and he was successfully treated with glucocorticoids instead of anti-infection treatments. Hence, the patient was diagnosed with SS combined with secondary CAD. SS combined CAD are rarely reported, and they are both autoimmune diseases. The abnormal function of B lymphocytes and the production of autoantibodies might be the common pathogenesis of them. Cold agglutinin disease can lead to severe hemolytic anemia, even life-threatening. In clinical practice, timely recognizing and dealing with CAD might promote the prognosis of the patient.

A single-center study of clinical features of pediatric Sjögren's syndrome.

OBJECTIVE: Sjögren's syndrome (SS) is a rare disease with unclear diagnostic criteria among the children and adolescents. The purpose of this study is to describe the clinical features of pediatric Sjögren's syndrome and validate with Japanese diagnostic guidelines criteria of 2018. METHODS: We conducted a retrospective analysis of the clinical data of a cohort of 54 patients with pediatric Sjögren's syndrome admitted to our hospital over a total of 10 years from September 2013 to September 2022. RESULTS: The ratio of females to males was 49:5 among the 54 children (34 cases of primary SS and 20 cases of secondary SS), the average age of onset of symptoms for the first time was 9.9 years, and the average age at diagnosis was 10.2 years. In terms of subjective symptoms, 7 cases (13.0%) presented with dry mouth and 5 cases (9.3%) reported dry eyes. The positive rates were 9.3% for Schirmer I test, 70.4% for salivary gland function test, and 55.6% for salivary gland ultrasonography. The positive rates were 94.4% for Anti-Ro/SSA antibodies, 66.7% for Anti-La/SSB antibodies, 88.9% for ANA, 59.3% for RF, and the elevation rate of IgG was 63.0%. Among the EULAR Sjögren's syndrome disease activity index (ESSDAI) domains, the biological, constitutional, glandular, cutaneous, and lymphadenopathy domains were most involved. Treatment consisted of glucocorticoids in 88.9% of the patients in our study and hydroxychloroquine in 92.6%. As per the Japanese version of the clinical practice guidance for Sjögren's Syndrome in pediatric patients (2018), 5 cases were identified as Definite SS, 35 cases as Probable SS, and 14 cases as Possible SS. With respect to primary and secondary SS, there was essentially no significant difference between the groups in any of the above aspects. CONCLUSIONS: Patients with pediatric SS presented with a wide spectrum of clinical features, a low prevalence of reported symptoms of dry mouth and dry eyes, and various clinical manifestations with multi-system involvement. These are similar to other pediatric study cohorts in terms of epidemiology, auxiliary investigation results, disease activity scores, and treatment. The coincidence between our study and the Japanese version of the clinical practice guidance for Sjögren's Syndrome in pediatric patients (2018) is good for the diagnosis of pediatric SS.

Relationship between ocular surface pain and corneal nerve loss in dry eye diabetics: a cross-sectional study in Shenyang, China.

BACKGROUND: Diabetes mellitus has been associated with increased dry eye disease (DED) and exacerbates DED pathology. OBJECTIVE: To investigate the potential relationship between corneal nerve loss and ocular pain among diabetic patients with dry eye (DE). DESIGN: A cross-sectional study. SETTING: He Eye Specialist Hospital, Shenyang, China. PARTICIPANTS: This study recruited 124 eyes of 62 diabetic patients diagnosed with DED between August and October 2022. MAIN OUTCOME MEASURES: Best-corrected visual acuity, intraocular pressure, non-invasive tear breakup time, tear meniscus height, tear film lipid layer, conjunctival hyperaemia (redness score), conjunctivocorneal epithelial staining (CS score), central corneal sensitivity and vitro confocal corneal microscopy was assessed in all subjects. The Ocular Surface Disease Index Questionnaire assessed DE symptoms and ocular pain. RESULTS: The study's final analysis included 26 patients (52 eyes) without ocular pain and 36 patients (72 eyes) with ocular pain. The corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fibre length (CNFL) in patients with ocular pain were significantly lower than those without (p<0.001, p=0.004, and p<0.001, respectively). CNFD, CNBD and CNFL negatively correlated with ocular pain (r=-0.385, r=-0.260, r=-0.358, respectively). Moreover, CNFD, CNBD and CNFL have a significant (p<0.05) positive correlation with corneal sensitivity (r=0.523, r=0.330, r=0.421, respectively). CONCLUSIONS: Corneal nerve loss was associated with ocular pain and decreased corneal sensitivity in diabetic patients with DE. Further studies into the neurological role of ocular surface diseases can elaborate diagnostics, prognosis and treatment of diabetic patients with DE. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT05193331).

Beyond dry eye: The greater extent of Sjögren's systemic disease symptoms, the impact of COVID-19 and perceptions towards telemedicine identified through a patient co-designed study.

BACKGROUND: Sjögren's ('SHOW-grins') is a chronic debilitating autoimmune disease characterised by dry eyes and dry mouth, secondary to reduced exocrine function of both the lacrimal and salivary glands. The persistent, severe and serious systemic complications of Sjögren's are poorly understood and often unappreciated, resulting in significant morbidity and treatment burden. This study aimed to explore the experiences of those living with Sjögren's, specifically access to healthcare and attitude towards telemedicine. Additionally, we sought to collect information regarding the impact of the pandemic on their quality of life (QoL). METHODS: One hundred and ninety-four individuals attended an Irish Sjögren's Webinar. Attendees were invited to participate in two online surveys after the webinar. The first survey gathered information related to demographics, disease and experiences during the COVID-19 pandemic. A combination of bespoke items and validated questionnaires (EULAR Sjögren's Syndrome Patient Reported Index [ESSPRI], COVID-19 Impact on Quality of Life [COV19-QoL]) was used. The second survey consisted of a shortened Telehealth Usability Questionnaire. Both were prepared in collaboration with a patient advocate. RESULTS: Survey 1: n = 76; response rate = 39.2%. Thirty-one respondents (41.4%) to survey 1 reported a delay of ≥5 years between the onset of symptoms and diagnosis. Dry mouth was the most common symptom experienced (76.8%, n = 63), followed by dry eye (74.4%, n = 61), fatigue (57.3%, n = 47) and joint pain (53.7%, n = 44), but a range of other symptoms were also reported. COV19-QoL results indicated that the pandemic had a detrimental effect on participants' overall QoL (4.0 ± 1.0) and physical health (4.0 ± 0.8) in particular. COV19-QoL and ESSPRI scores were moderately correlated (0.36, p = .002). Over 70% of respondents had a medical appointment cancelled, delayed or rescheduled (n = 60). Survey 2: n = 57; response rate = 29.4%. Those that had interacted with telemedicine reported largely positive experiences with the virtual model. CONCLUSION: Clinicians should be aware of the range of symptoms experienced by patients with Sjögren's beyond those of sicca (dry eye and dry mouth) and fatigue. COVID-19 has negatively influenced the self-reported health and well-being of those with Sjögren's, particularly those with higher symptom scores. It is vital that optimised telemedicine models are implemented to ensure continuity in the provision of healthcare for those with chronic illness such as Sjögren's and in preparation for possible future pandemics. PATIENT OR PUBLIC CONTRIBUTION: A group of people living with Sjögren's co-designed the structure and content of the webinar where the survey was shared. A public and patient involvement (PPI) contributor also collaborated in the selection of questionnaires used in the study, ensuring that the questions asked would best reflect the priorities of patients. They contributed to the writing of this manuscript as co-authors. Additionally, the research team and Sjögren's patients who contributed to this work have gone on to establish Sjögren's Research Ireland, a collaboration between patient advocates, researchers and PPI facilitators.

The Autoimmune Rheumatic Disease Related Dry Eye and Its Association with Retinopathy.

Dry eye disease is a chronic disease of the ocular surface characterized by abnormal tear film composition, tear film instability, and ocular surface inflammation, affecting 5% to 50% of the population worldwide. Autoimmune rheumatic diseases (ARDs) are systemic disorders with multi-organ involvement, including the eye, and play a significant role in dry eye. To date, most studies have focused on Sjögren's syndrome (one of the ARDs) since it manifests as two of the most common symptoms-dry eyes and a dry mouth-and attracts physicians to explore the relationship between dry eye and ARDs. Many patients complained of dry eye related symptoms before they were diagnosed with ARDs, and ocular surface malaise is a sensitive indicator of the severity of ARDs. In addition, ARD related dry eye is also associated with some retinal diseases directly or indirectly, which are described in this review. This review also summarizes the incidence, epidemiological characteristics, pathogenesis, and accompanying ocular lesions of ARD's related dry eye, emphasizing the potential role of dry eye in recognition and monitoring among ARDs patients.

Developing and validating a questionnaire to assess the symptoms of blepharitis accompanied by dry eye disease.

PURPOSE: To propose additional items for established dry eye disease (DED) instruments that cover blepharitis-specific signs and symptoms and to determine the association between the clinical findings and subjective complaints. METHODS: Thirty-one patients with blepharitis and DED were prospectively included in the pretest period for selecting suitable questions. In the main phase of the study, the selected questions were then tested on 68 patients with blepharitis and DED and 20 controls without blepharitis or DED. Pearson's coefficient of correlation was calculated between the blepharitis-specific questions, tear break-up time (TBUT), the Schirmer test score, and the ocular surface disease index (OSDI) score; and the similarity between the blepharitis-specific questions, OSDI questions, and objective parameters for DED was assessed via hierarchical clustering. Furthermore, the discriminatory power of the blepharitis-specific questions was investigated with the receiver operating characteristic (ROC) curve. RESULTS: The additional question about heavy eyelids revealed a significant correlation with the OSDI score (r = 0.45, p < 0.001) and Schirmer score (r = - 0.32, p = 0.006). Cluster analysis demonstrated the similarity between the question about heavy eyelids and TBUT. In addition, the OSDI questionnaire had the highest discriminatory power in ROC analysis, and the OSDI score significantly correlated with the specific questions about eyelids sticking together (r = 0.47, p < 0.0001) and watery or teary eyes (r = 0.34, p = 0.003). CONCLUSIONS: The blepharitis-specific additional questions were closely associated with objective parameters for DED. The question about heavy eyelids might be well suited for recording the symptoms of hyposecretory and hyperevaporative dry eye with blepharitis.

Management of cataract in dry eye disease: Preferred practice pattern guidelines.

Cataract surgery is one of the most commonly performed ophthalmic surgeries in the world. Dry eye disease (DED) is found to coexist in most patients with cataracts due to the overlapping age groups of both these conditions. Preoperative evaluation for DED is important to improve outcomes. A pre-existing DED affecting the tear film is likely to affect biometry. Moreover, special intraoperative considerations are needed in eyes with DED to reduce complications and improve postoperative outcomes. Dry eye disease (DED) is known to occur following an uneventful cataract surgery or a pre-existing DED is likely to worsen following cataract surgery as well. In these situations, despite a good visual outcome, patient dissatisfaction is common owing to the distressing DED symptoms. This review aims to summarize the preoperative, intraoperative, and postoperative considerations when performing cataract surgery in the presence of a coexisting DED.

Study of dry eye disease in type 2 diabetes mellitus and its association with diabetic retinopathy in Western India.

Purpose: The study was conducted to evaluate occurrence of dry eye disease (DED) in type 2 diabetes mellitus (DM) and its association with diabetic retinopathy (DR) in the affected patients in western India. Methods: One hundred and five type 2 diabetic patients referred to a tertiary eye care center were consecutively selected. A detailed systemic history was evaluated. DED was assessed by Ocular Surface Disease Index questionnaire, Schirmer's test, tear breakup time (TBUT), and fluorescein staining of cornea and conjunctiva, graded according to the National Eye Institute workshop grading. All patients underwent detailed fundus evaluation and DR, if present, was graded according to Early Treatment Diabetic Retinopathy (ETDRS) criteria. Results: Prevalence of DED in type 2 diabetics was 43.81% (92/210 eyes). The prevalence and severity of DED was found to be more in patients having higher glycosylated hemoglobin levels (P < 0.0001). Prevalence of DED was found to be high in those not taking any treatment (P < 0.0001). A statistically significant association was found between duration of DM and presence of DED (P = 0.02). Among the patients with DED, a majority had proliferative diabetic retinopathy (PDR; 57/92 eyes, 61.96%). Conclusion: The study highlights a significant correlation between DED and DM, and hence, examination for DED with fundus examination should be an integral part of the assessment of type 2 diabetics.

Tear film dysfunction after clear corneal phacoemulsification in diabetics and non-diabetics.

Purpose: A prospective cohort study was conducted in a tertiary eye care centre to study the incidence of tear film dysfunction and its recovery in diabetics and non-diabetics after clear corneal phacoemulsification. Methods: A total of 50 diabetics and 50 non-diabetics underwent clear corneal phacoemuslfication. Schirmer's I test (SIT), tear film break-up time (TBUT), corneal staining, tear meniscus height (TMH), and ocular surface disease index (OSDI) assessment were done preoperatively, postoperatively at 7 days, 1 month, and 3 months in both groups to assess tear film function. Results: Both groups showed decreased SIT and TBUT values on postoperative Day 7, after which they gradually improved. SIT and TBUT values in diabetics were significantly lower than that in non-diabetics postoperatively (P < 0.001). SIT in non-diabetics reached baseline levels at postoperative 3 months. OSDI scores reached peak levels in both groups on postoperative Day 7, but were higher in diabetics than non-diabetics (P < 0.001). OSDI scores gradually improved over 3 months but remained over baseline levels in both groups. Corneal staining was positive in 22% diabetics and 8% non-diabetics at postoperative Day 7. However, none of the patients had corneal staining at 3 months. Tear meniscus height (TMH) did not reveal any significant difference between the two groups at any time interval. Conclusion: We concluded that tear film dysfunction after clear corneal incision occurs in both groups, but is more severe and recovers more slowly in diabetics than non-diabetics.

Evidence of Disruption in Neural Regeneration in Dry Eye Secondary to Rheumatoid Arthritis.

The purpose of our study was to analyze abnormal neural regeneration activity in the cornea through means of confocal microscopy in rheumatoid arthritis patients with concomitant dry eye disease. We examined 40 rheumatoid arthritis patients with variable severity and 44 volunteer age- and gender-matched healthy control subjects. We found that all examined parameters were significantly lower (p < 0.05) in rheumatoid arthritis patients as opposed to the control samples: namely, the number of fibers, the total length of the nerves, the number of branch points on the main fibers and the total nerve-fiber area. We examined further variables, such as age, sex and the duration of rheumatoid arthritis. Interestingly, we could not find a correlation between the above variables and abnormal neural structural changes in the cornea. We interpreted these findings via implementing our hypotheses. Correspondingly, one neuroimmunological link between dry eye and rheumatoid arthritis could be through the chronic Piezo2 channelopathy-induced K2P-TASK1 signaling axis. This could accelerate neuroimmune-induced sensitization on the spinal level in this autoimmune disease, with Langerhans-cell activation in the cornea and theorized downregulated Piezo1 channels in these cells. Even more importantly, suggested principal primary-damage-associated corneal keratocyte activation could be accompanied by upregulation of Piezo1. Both activation processes on the periphery would skew the plasticity of the Th17/Treg ratio, resulting in Th17/Treg imbalance in dry eye, secondary to rheumatoid arthritis. Hence, chronic somatosensory-terminal Piezo2 channelopathy-induced impaired Piezo2-Piezo1 crosstalk could result in a mixed picture of disrupted functional regeneration but upregulated morphological regeneration activity of these somatosensory axons in the cornea, providing the demonstrated abnormal neural corneal morphology.

TFOS Lifestyle: Impact of the digital environment on the ocular surface.

Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as "the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing". Digital eye strain prevalence of up to 97% has been reported, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires which fail to differentiate such symptoms from those arising from non-digital tasks. Objective signs such as blink rate or critical flicker frequency changes are not 'diagnostic' of digital eye strain nor validated as sensitive. The mechanisms attributed to ocular surface disease exacerbation are mainly reduced blink rate and completeness, partial/uncorrected refractive error and/or underlying binocular vision anomalies, together with the cognitive demand of the task and differences in position, size, brightness and glare compared to an equivalent non-digital task. In general, interventions are not well established; patients experiencing digital eye strain should be provided with a full refractive correction for the appropriate working distances. Improving blinking, optimizing the work environment and encouraging regular breaks may help. Based on current, best evidence, blue-light blocking interventions do not appear to be an effective management strategy. More and larger clinical trials are needed to assess artificial tear effectiveness for relieving digital eye strain, particularly comparing different constituents; a systematic review within the report identified use of secretagogues and warm compress/humidity goggles/ambient humidifiers as promising strategies, along with nutritional supplementation (such as omega-3 fatty acid supplementation and berry extracts).

Is a Dry Eye Disorder in Firefighters an Occupational Disease?

BACKGROUND: To examine firefighters (FFs) exposed to high levels of fire smoke and, as a result, to uncover risk factors for dry eye disorder (DED) compared to age-and gender-matched healthy individuals. METHODS: In this cross-sectional study, 51 FFs from the Afyonkarahisar Municipality Fire Department were chosen at random (group 1). A control group (group 2) included 51 age- and gender-matched healthy individuals. The Ocular Surface Disease Index (OSDI) questionnaire was administered after all participants were thoroughly explained the study's objectives and procedures. Then, using a portable hand biomicroscope, an ocular exam was performed on-site. DED was defined as a non-anesthetic Schirmer test result of <10 mm and/or a tear film break-up time (TBUT) of <5 seconds. RESULTS: Groups 1 and 2 had mean ages of 44.82±7.29 and 44.73±7.41 years, respectively (p=0.946). The median work duration in group 1 was 14 years (min-max: 1-27 years). TBUT test revealed a significantly increased DED prevalence in group 1 than group 2 (p=0.046). Despite the non-significant difference (p=0.276), Schirmer test revealed that group 1 had a higher DED prevalence than group 2. The OSDI score revealed that group 1 had more mild, moderate, and severe DED than group 2 (p=0.359). Longer work duration was associated with a higher DED prevalence (p=0.179). CONCLUSIONS: Given the high prevalence of fire smoke-induced DED in FFs, preventive measures such as regular ocular exams, encouraging personal protective equipment usage, and health education programs can assist in avoiding complications and reducing the burden of ocular diseases.

Systemic Lupus Erythematosus and Risk of Dry Eye Disease and Corneal Surface Damage: A Population-Based Cohort Study.

Systemic lupus erythematosus (SLE) potentially involves multiple parts of the ocular system, including the lacrimal glands and the cornea. The present study sought to assess the risk of aqueous-deficient dry eye disease (DED) and corneal surface damage in patients with SLE. We conducted a population-based cohort study using Taiwan's National Health Insurance research database to compare the risks of DED and corneal surface damage between subjects with and without SLE. Proportional hazard regression analyses were used to calculate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for the study outcomes. The propensity score matching procedure generated 5083 matched pairs with 78,817 person-years of follow-up for analyses. The incidence of DED was 31.90 and 7.66 per 1000 person-years in patients with and without SLE, respectively. After adjusting for covariates, SLE was significantly associated with DED (aHR: 3.30, 95% CI: 2.88-3.78, p < 0.0001) and secondary Sjögren's syndrome (aHR: 9.03, 95% CI: 6.86-11.88, p < 0.0001). Subgroup analyses demonstrated that the increased risk of DED was augmented among patients with age < 65 years and female sex. In addition, patients with SLE had a higher risk of corneal surface damage (aHR: 1.81, 95% CI: 1.35-2.41, p < 0.0001) compared to control subjects, including recurrent corneal erosion (aHR: 2.98, 95% CI: 1.63-5.46, p = 0.0004) and corneal scar (aHR: 2.23, 95% CI: 1.08-4.61, p = 0.0302). In this 12-year nationwide cohort study, we found that SLE was associated with increased risks of DED and corneal surface damage. Regular ophthalmology surveillance should be considered to prevent sight-threatening sequelae among patients with SLE.

Abnormal brain function in photophobic patients with dry eye disease: An fMRI study.

BACKGROUND AND OBJECTIVES: Photophobia, a frequent and disabling symptom observed in various neurological conditions and eye diseases, is thought to involve maladaptive brain functioning. We assessed this hypothesis, using functional magnetic resonance imaging (fMRI) in photophobic patients with minimal-to-severe dry eye disease (DED), as compared to healthy controls. METHODS: This prospective, monocentric, comparative, cohort study included eleven photophobic DED patients compared to eight controls. Photophobic patients had a complete evaluation of DED to exclude any other cause of photophobia. All participants were scanned with fMRI under intermittent light stimulation with a LED lamp (27s. ON, 27 s. OFF), and cerebral activations were studied with univariate contrasts between the ON and OFF conditions, and with functional connectivity methods. RESULTS: Firstly, stimulation activated the occipital cortex more strongly in patients than in controls. Moreover, stimulation deactivated the superior temporal cortex in patients less than in controls. Secondly, functional connectivity analysis showed that light stimulation induced lesser decoupling between the occipital cortex and the salience and visual networks in patients than in controls. DISCUSSION: The current data shows that DED patients with photophobia have maladaptive brain anomalies. There is hyperactivity in the cortical visual system, associated with abnormal functional interactions, both within the visual cortex, and between visual areas and salience control mechanisms. Such anomalies show similarities with other conditions such as tinnitus, hyperacusis, and neuropathic pain. Those findings support novel neurally oriented methods for the care of patients with photophobia.

The role of temperament in evaluating the relationship between symptoms and signs in dry eye disease.

OBJECTIVES: In this study, we aimed to evaluate the relationship between symptoms and objective findings and dry eye (DE) patients' personalities and levels of depression and anxiety. METHODS: The study group consisted of 67 DE patients who presented to the ophthalmology clinic with symptoms of dry eye disease (DED) and were first diagnosed. Patients underwent a complete ophthalmologic examination, including tear-film break-up time (TBUT), Schirmer 1 and Ocular Surface Disease Index (OSDI). All subjects also completed the Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). RESULTS: No relationship was found for the Schirmer 1 Test and TBUT with psychological parameters or OSDI scores. When compared with the normal values for the Turkish population, sub-dimensions of temperament in DED; novelty seeking (NS) was significantly lower (P<0.001); harm avoidance (HA) (P=0.014), and persistence (P<0.001) were significantly higher. Significant positive correlation with HA and significant negative correlation with NS were found for the OSDI results. Furthermore, our mediation model revealed that anxiety mediated the effect of NS and HA on OSDI. CONCLUSION: The significant association of temperament sub-dimensions with OSDI scores in the DED group may play a role in explaining the inconsistency between symptoms and signs. Professionals who care for DED should consider temperament sub-dimensions when they detect discordance between symptoms and signs.