Search Results (102)

Background/Objective: Tear hyperosmolarity is the main triggering factor in the immunopathogenesis of dry eye disease (DED). Tear osmolarity is known as the relevant metric to evaluate DED severity; however, measuring tear osmolarity after slit lamp examination (SLE) is known as a contraindication due to variability. In this study, we investigated the effects of SLE and fluorescein staining (FS) on the variabilities of tear osmolarity. Methods: In this prospective observational study sixty-five patients were enrolled in the study, comprising 31 healthy controls and 34 DED patients. The tear osmolarity was measured in the right eye using the TearLab^® system. The initial measurements were performed to establish baseline values before SLE, and additional measurements were performed after 20 s of SLE and followed by 20 s of SLE+FS. There were five-minute intervals between measurements. A correlation analysis was performed between OSDI score, tear film break-up time (TBUT), and tear osmolarity. A linear mixed-effects model was also applied to account for repeated measures and inter-subject variability. Results: The mean ages of the control and DED group were 31.3 ± 11.5 and 50.5 ± 15.5 years. Increased tear osmolarity was significantly associated with greater OSDI score and lower TBUT only in DED patients, but not in normal controls (OSDI:R = 0.378/p = 0.030, TBUT:R = −0.543/p = 0.011). The mean tear osmolarities in the normal controls were 298.3 ± 11.3, 299.1 ± 13.3, and 297.0 ± 12.6 mOsm/L at baseline (group 1), after SLE (group 2), and after SLE+FS (group 3), respectively, with no significant difference (p = 0.379). However, there was a significant difference in the tear osmolarities of the three groups in the DED patients (296.1 ± 11.5, 296.5 ± 11.0, and 291.2 ± 11.3 mOsm/L for groups 1–3, respectively/p < 0.001). The tear osmolarity of group 3 was significantly lower than those of groups 1 and 2 in the DED patients (p = 0.010/0.016). After FS, the mean tear osmolarity decreased by 4.9 ± 9.2 mOsm compared to the baseline in DED group. Conclusions: Tear osmolarity was only decreased in DED patients after SLE+FS, whereas it was unaffected in normal control subjects. Increased tear osmolarity in only DED patients correlated with increased symptom scores and decreased TBUT. These fluctuations in tear osmolarity reflect compromised tear film homeostasis in DED, highlighting the need to contextualize osmolarity data with clinical DED parameters. Full article

Purpose: To investigate regional changes in tear film quality associated with orthokeratology (Ortho-K) lens wear using high-resolution spatial mapping and to evaluate the potential of artificial intelligence (AI) models in anticipating these changes. Methods: This study analysed tear film quality in 92 Ortho-K wearers divided into three groups based on lens wear duration (10–29 days, 30–90 days, and ≥91 days). Placido-based topographer measurement was used to generate regional tear film maps before and after treatment. A custom MATLAB pipeline enabled regional comparisons and statistical mapping. A feedforward neural network was trained to forecast local tear film quality using spatial data. Results: Single-value global mean metrics showed minimal changes in tear film quality across groups. However, regional mean mapping revealed significant mid-peripheral and peripheral deterioration over time, particularly in nasal and temporal corneal zones. These changes were often overlooked by global averaging and remained invisible through tear film breakup time (TBUT) measurements. The AI model predicted spatial tear quality with high accuracy (R ≥ 0.9 in testing), capturing nuanced regional variations. Conclusions: The regional analysis uncovers subtle, clinically relevant tear film disruptions caused by Ortho-K lens wear, particularly in peripheral areas. These insights challenge the adequacy of traditional single-value global mean assessments. The AI model demonstrates the potential for non-invasive, predictive evaluation of tear stability, supporting more personalised and effective Ortho-K care. Full article

Background/Objectives: Dry eye disease (DED) is a prevalent, complex disorder with a major impact on patients’ quality of life. While artificial tears (AT) are still the first-line treatment, their effectiveness is often limited in moderate-to-severe cases. Autologous serum (AS) and platelet-rich plasma (PRP) are now recognized as viable biologic treatments due to their regenerative and anti-inflammatory characteristics. This systematic review and meta-analysis sought to assess and compare the clinical efficacy of PRP, AS, and AT in the treatment of DED, with a focus on comparative studies. Methods: A comprehensive search of PubMed, Scopus, and Google Scholar was conducted until June 2025 for studies directly comparing PRP, AS, and AT. Eligible trials included patients with DED who reported results such as the Schirmer test, tear break-up time (TBUT), and Ocular Surface Disease Index (OSDI). The risk of bias was calculated using ROB 2 for randomized trials and ROBINS-I for non-randomized studies. Meta-analyses were carried out using standardized mean differences (SMDs) and 95% confidence intervals (CIs). Results: Seventeen studies were included in the systematic review. Both PRP and AS demonstrated greater improvements in OSDI, TBUT, and Schirmer test scores compared to AT. PRP showed a trend toward better outcomes than AS, especially in studies using injectable PRP. However, substantial heterogeneity and methodological variability were noted. Conclusions: Comparative research suggests that PRP and AS are more effective than AT in treating DED. Direct comparisons of PRP and AS yield varied results, with the route of delivery impacting outcomes. Given the heterogeneity of current protocols, further standardized, long-term trials are required to confirm the optimal delivery method and ensure safety. Full article

Neurological disorders significantly affect ocular surface homeostasis, influencing parameters such as blink rate (BR), tear production, corneal nerve density, and sensitivity. This review summarizes recent findings on ocular surface alterations associated with neurological diseases, including Alzheimer’s disease (AD), Parkinson’s disease (PD), Guillain-Barré syndrome (GBS), trigeminal neuralgia (TN), multiple sclerosis (MS), and Charcot–Marie–Tooth disease (CMT). Notably, ocular manifestations such as reduced BR, decreased tear break-up time (TBUT), impaired tear secretion, and corneal nerve fiber loss are consistently reported. In AD, elevated tear amyloid-beta and tau proteins emerge as promising biomarkers for early disease detection. PD patients frequently experience dry eye symptoms attributed to reduced BR and tear film instability. GBS is linked to lagophthalmos and corneal nerve impairment, potentially leading to severe ocular surface damage. TN demonstrates bilateral ocular surface dysfunction despite unilateral neuropathic symptoms. MS is associated with significant ocular surface alterations, reflecting broader neuroinflammatory and autonomic disturbances. Similarly, CMT patients show reduced corneal sensitivity and tear production, underscoring the systemic nature of neurological impacts. Awareness of these ocular manifestations is essential for improving patient care and guiding future research into ocular biomarkers and targeted therapies. Full article

Polyhexamethylene guanidine phosphate (PHMG-p), a widely used disinfectant component in household humidifiers, has been implicated in various health issues, including pulmonary toxicity. Many people use humidifiers to improve dry eye disease (DED). The current study was performed to elucidate the effect of PHMG-p on eye dryness in a rat model using metabolomics. Male Sprague Dawley rats were exposed to PHMG-p (0.1% and 0.3%) following a previously established DED induction model using scopolamine hydrobromide and desiccation stress. Ocular surface damage was assessed using corneal fluorescein staining, tear volume measurement, and tear break-up time (TBUT). Plasma and urine samples were analyzed using ¹H-NMR-based metabolomics to identify metabolic alterations associated with PHMG-P-p exposure and DED pathogenesis. PHMG-p exposure exacerbated DED symptoms, as evidenced by a significant reduction in tear volume, shorter TBUT, and increased corneal damage compared to the control group. Metabolomic profiling identified distinct metabolic changes in PHMG-p-exposed groups, including alterations in glutamate, glycine, citrate, and succinate metabolism. These metabolic changes correlated with increased levels of inflammatory cytokines such as IL-1β, IL-6, and TNF-α in the corneal and lacrimal gland tissues. Our findings suggest that PHMG-p exposure contributes to DED pathophysiology by inducing metabolic disturbances and inflammatory responses in the ocular surface. This study highlights the need for further investigation into the potential risks of PHMG-p exposure on ocular health and provides novel insights into the metabolic underpinnings of DED. Full article

Dry eye disease (DED) is a prevalent and disabling condition. Artificial tears are commonly used but often inadequate for moderate-to-severe cases. Secretagogues such as pilocarpine, cevimeline, and diquafosol offer potential alternatives, though their comparative effectiveness remains unclear. To evaluate the safety and efficacy of these secretagogues versus artificial tears in adults with DED, we searched CENTRAL, PubMed, Scopus, LILACS, ClinicalTrials.gov, and WHO ICTRP without language restrictions. Randomized controlled trials (RCTs) comparing secretagogues to artificial tears were eligible. Data extraction and synthesis were conducted using Covidence and the Cochrane RoB 2 tool, and 19 RCTs (n = 2697) were included. Fifteen were analyzed quantitatively; however, only eight trials evaluating diquafosol were suitable for meta-analysis, as data for pilocarpine and cevimeline were insufficient for quantitative synthesis. GRADE was used to assess evidence certainty. PROSPERO registration: CRD42020218407. Diquafosol significantly improved rose bengal staining at 4 weeks and OSDI scores and TBUT in post-cataract patients at 4 and 12 weeks. However, it increased mild adverse events (RR, 1.81; 95% CI, 1.15–2.84). Evidence for pilocarpine and cevimeline was limited. Diquafosol 3% shows greater efficacy than artificial tears in post-cataract DED but with more side effects. Further research is needed for other secretagogues. Full article

Background/Objectives: Dry Eye Disease (DED) significantly impacts quality of life due to the instability of the tear film and reduced tear production. The limited availability of eye care professionals, combined with traditional diagnostic methods that are invasive, non-portable, and time-consuming, results in delayed detection and hindered treatment. This proof-of-concept study aims to explore the feasibility of using smartphone-based infrared thermography (IRT) as a non-invasive, portable screening method for DED. Methods: This study included infrared thermography (IRT) images of 40 subjects (22 normal and 58 DED). Ocular surface temperature changes at three regions of interest (ROIs): nasal cornea, center cornea, and temporal cornea, were compared with Tear Film Break-up Time (TBUT) and Ocular Surface Disease Index (OSDI) scores. Statistical correlations and independent t-tests were performed, while machine learning (ML) models classified normal vs. DED eyes. Results: In these preliminary results, DED eyes exhibited a significantly faster cooling rate (p < 0.001). TBUT showed a negative correlation with OSDI (r = −0.802, p < 0.001) and positive correlations with cooling rates in the nasal cornea (r = 0.717, p < 0.001), center cornea (r = 0.764, p < 0.001), and temporal cornea (r = 0.669, p < 0.001) regions. Independent t-tests confirmed significant differences between normal and DED eyes across all parameters (p < 0.001). The Quadratic Support Vector Machine (SVM) achieved the highest accuracy among SVM models (90.54%), while the k-Nearest Neighbours (k-NN) model using Euclidean distance (k = 3) outperformed overall with 91.89% accuracy, demonstrating strong potential for DED classification. Conclusions: This study provides initial evidence supporting the use of smartphone-based infrared thermography (IRT) as a screening tool for DED. The promising classification performance highlights the potential of this approach, though further validation on larger and more diverse datasets is necessary to advance toward clinical application. Full article

Purpose: The aim of this study was to evaluate the different approaches used in the treatment of meibomian gland dysfunction (MGD). Materials and Methods: This open-label, single-center, prospective pilot study with a parallel-group design was conducted in February 2025. Ninety-two patients presenting to our clinic with symptoms and signs of MGD were enrolled and diagnosed according to Japanese MGD diagnostic criteria. Patients were assigned to five treatment groups: conservative management alone, conservative management plus intense pulsed light (IPL) therapy, conservative management plus oral azithromycin, conservative management plus oral doxycycline, and conservative management plus topical cyclosporine. Conservative management consisted of preservative-free artificial tears containing polyvinyl alcohol and povidone, warm compresses, and eyelid hygiene. Primary outcome measures included ocular surface parameters such as the Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), Standard Patient Evaluation of Eye Dryness (SPEED) scores, and meibomian gland parameters evaluated using a slit-lamp examination. All parameters were assessed at baseline and during follow-up examinations after treatment initiation to observe changes in symptoms and signs. Results: A statistically significant increase was determined in meibum grade plugging (grades 0–3; higher = greater obstruction) and Marx line scores with IPL therapy (p < 0.05). The group receiving doxycycline treatment exhibited a significant improvement in OSDI and SPEED scores, plugging, TBUT, and meibum grades. The group receiving cyclosporine registered a significant improvement in OSDI and SPEED scores, plugging, TBUT, and meibum grades. A statistically significant increase was observed in the conservative treatment group in terms of lid margin irregularity, Marx line score, and OSDI and SPEED scores. In the group receiving azithromycin treatment, plugging, lid margin irregularity, TBUT, and OSDI and SPEED scores increased significantly. Compared with conservative care, the doxycycline group exhibited lengthened TBUT and lowered meibomian gland plugging and symptoms (p < 0.05), and the oral azithromycin group achieved a similar TBUT gain with slightly greater symptom relief. The topical cyclosporine group principally registered improved lid vascularity and meibum quality (p < 0.05), while the IPL group achieved the greatest overall improvements, reducing plugging and Marx line scores and adding ≈3 s to TBUT (p < 0.05 for all endpoints). Doxycycline exhibited notable short-term improvements, with 35.26% meibum grade improvement and a 40.48% foaming response, while IPL therapy demonstrated substantial OSDI improvements at 54.06%, with traditional parameters indicating limited treatment responsiveness. Conclusions: Various methods can be used in the treatment of MGD. All the conservative treatment methods used in this study were successful. Full article

Background and Objectives: Pediatric Sjögren’s syndrome is a rare autoimmune disease with a heterogeneous clinical expression and limited pediatric-specific diagnostic criteria. Ocular involvement often represents an early manifestation, yet it may go unrecognized in children due to poor symptom reporting and the underuse of objective diagnostic tools. This retrospective study evaluated six pediatric patients with Sjögren’s syndrome, integrating systemic and ocular findings with a focus on early immunological and clinical markers. Materials and Methods: All patients underwent ophthalmological assessments, including tear break-up time, Schirmer’s test, and slit-lamp examination. Results: Tear break-up time values consistently indicated tear film instability (mean RE 7.4 ± 2.5 s; LE 7.7 ± 2.3 s), while Schirmer’s test showed greater variability. Slit-lamp examination revealed inhomogeneous tear films in all patients and blepharitis in 66.7%, consistent with Meibomian gland dysfunction. Systemic features included arthralgia, Raynaud’s phenomenon, fatigue, and frequent seropositivity for ANA and anti-SSA/Ro antibodies. Minor salivary gland biopsy confirmed lymphoepithelial sialadenitis in all cases. Conclusions: These findings highlight the importance of combining laboratory and clinical markers with ophthalmological parameters to support an early diagnosis of Sjögren’s syndrome in pediatric patients. Integrating TBUT and slit-lamp evaluation with serological and histopathological data may enhance diagnostic accuracy and guide timely, targeted intervention to prevent long-term complications. Full article

Background/Objectives: Dry eye disease (DED) is a common condition that can significantly impact cataract surgery outcomes. Preoperative management strategies, including the use of moisturizing eye drops, may improve ocular surface health and postoperative recovery. This study aimed to compare postoperative outcomes in 71 patients undergoing cataract surgery between June 2022 and May 2023 at a single center with and without preoperative keratostill moisturizing eye drops (sterile aqueous 0.3% hydroxypropyl methylcellulose solution) determined using the ocular surface disease index (OSDI), tear break-up time (TBUT), and optical coherence tomography (OCT) at diagnosis, on the day of surgery, and at two weeks postoperatively. Methods: A prospective observational study was conducted on 71 patients undergoing cataract surgery at Saint Barbara Hospital Trauma Center, Sosnowiec, Poland, from June 2022 to May 2023. Patients were randomly assigned to a test group (moisturizing eye drops) or a control group (no preoperative eye drops). The OSDI, TBUT, and OCT were evaluated at the baseline, preoperatively, and postoperatively. Results: The test group showed a significant improvement in OSDI scores (preoperative: 6.34 vs. baseline: 11.81; p < 0.001), which further decreased postoperatively (3.30; p < 0.001). TBUT also significantly increased from baseline to the preoperative visit (6.20 s to 7.97 s; p = 0.002) and remained stable after surgery (7.78 s). In contrast, the control group demonstrated only a minimal postoperative change in OSDI (3.92 to 3.70; p > 0.05) and a significant postoperative decrease in TBUT (5.96 s to 5.69 s; p = 0.864). Only the control group showed a significant postoperative decrease in epithelial thickness in operated eyes (p = 0.021), whereas no significant changes were observed in the test group. Conclusions: The preoperative use of moisturizing eye drops significantly improves the tear film stability, ocular comfort, and epithelial integrity, leading to better postoperative outcomes in cataract surgery patients. Full article

Background/Objectives: To investigate the effect of strabismus surgery on ocular surface parameters, meibomian glands, and conjunctival impression cytology. Methods: Preoperative and postoperative (10th day, first month, and third month) tear break-up time (TBUT) tests, Schirmer 1 tests, corneal staining scores (CSS), meibomian gland (MG) loss rates, ocular surface disease index (OSDI) scores, and conjunctival impression cytology (IC) results of 30 patients who underwent strabismus surgery were compared. Results: Significant differences were found between preoperative TBUT test results and those evaluated on the postoperative 10th day and at the postoperative first month (p < 0.0001 for both). There were also significant differences between the preoperative and postoperative first- and third-month Schirmer 1 test results (p = 0.02 and p < 0.0001, respectively). Furthermore, mean OSDI scores significantly differed between preoperative and postoperative 10th-day measurements (p < 0.0001). The mean postoperative 10th-day CSS was found to be significantly higher than the preoperative mean CSS (p < 0.0001). The stages in preoperative conjunctival IC samples were found to be significantly lower than those evaluated at all postoperative times (p < 0.0001 for all). Significant differences were observed between the preoperative lower eyelid MG loss rate and all postoperative MG loss rates (p < 0.0001 for the 10th day and first month and p < 0.001 for the third month). Lastly, the preoperative upper eyelid MG loss rate significantly differed from all postoperative MG loss rates (p < 0.0001 for the 10th day, p < 0.003 for the first month, and p < 0.0001 for the third month). Conclusions: We observed changes indicative of dry eye in the mean OSDI score, TBUT, Schirmer 1 test, MG loss rates, and conjunctival IC findings up to the postoperative third month in patients who underwent strabismus surgery. Therefore, we believe that patients undergoing strabismus surgery should be followed up for ocular surface diseases, particularly dry eye. Full article

Objective: This research seeks to investigate the effects of preoperative intense pulsed light with manual meibomian expression (IPL-MGX) on the refractive accuracy of cataract surgery on dry eyes with meibomian gland dysfunction (MGD-related dry eyes). Methods: Fifty-six MGD-related dry eye cases planned for cataract surgery were analyzed. IPL-MGX (four times at 2-week intervals) was performed before preoperative examination. Axial length (AL), anterior chamber depth (ACD), corneal curvature (mean-K), tear break-up time (TBUT), superficial punctate keratopathy in the central cornea (C-SPK), corneal higher-order aberrations (HOAs), and predicted postoperative spherical equivalent (P-SE) were evaluated pre- and post-IPL-MGX. The postoperative subjective spherical equivalent (S-SE) was evaluated after one month. The absolute difference between the S-SE and P-SE was considered an indication of P-SE accuracy. Changes in all the variables were assessed before and after IPL-MGX treatment. Results: No significant differences were observed in AL or ACD (p = 0.85, 0.56). The differences in mean-K, TBUT, C-SPK, and HOAs were significant (p < 0.01). P-SE accuracy based on post-IPL-MGX data was significantly higher than that based on pre-IPL-MGX data (p < 0.01). P-SE accuracy was within 0.25 diopters (D) in 14.3% of pre- and 55.4% of post-IPL-MGX, within 0.5D in 55.4% of pre- and 92.9% of post-IPL-MGX, within 0.75D in 98.2% of pre- and post-IPL-MGX, and within 1.0D in 98.2% of pre- and 100% of post-IPL-MGX. In the range of 0.25 and 0.5 D, the accuracy of P-SE was significantly higher in post-IPL-MGX (p < 0.01). Conclusions: Preoperative IPL-MGX considerably improved the predicted postoperative refraction accuracy in patients with MGD-related dry eye undergoing cataract surgery. Full article

Background/Objectives: A probiotic Streptococcus thermophilus (iHA318) has been demonstrated to alleviate dry eye symptoms in a mouse model. This study investigated its effects on dry eye mitigation in a clinical trial. Methods: A total of 68 volunteers were recruited in the double-blind clinical trial and randomly divided into a probiotic group and a placebo group. The probiotic group received iHA318 capsules daily for 35 days via oral intake, while the placebo group received microcrystalline cellulose capsules. Assessments before and after the intervention were performed for the tear volume (TV), tear break-up time (TBUT), tear osmolarity (Osmo), serum sialic acid (SA) concentrations, and the Ocular Surface Disease Index (OSDI), and an impression cytology analysis was conducted for immunofluorescence detection of NLRP3 expression. Results: The tear volume was significantly increased in the probiotic group, although a placebo effect was observed in the placebo group. The probiotic group showed a significant reduction in tear osmolarity, an extended TBUT, and an improved OSDI score. These parameters were also observed in the placebo group without statistical significance. In addition, the serum SA was significantly increased in the probiotic group in contrast to a slight non-significant increase in the placebo group. Reductions in NLRP3 inflammasome activation and OSDI were found only in the probiotic group. Conclusions: In conclusion, a significant improvement in major dry eye symptoms after iHA318 treatment was observed compared to the placebo group. Full article

The objectives of the study were to compare the efficacy and safety using ocular surface assessment between preserved and preservative-free brimonidine/timolol fixed-combination eye drops in glaucoma or ocular hypertension patients. Methods: This study was designed as a prospective, multicenter (three institutions), investigator-masked, parallel-grouped randomized clinical trial. The primary outcomes were corneal and conjunctival staining score, ocular surface disease index (OSDI) score, drug tolerance, and adherence rates at 12-week visits. The secondary outcomes were corneal and conjunctival staining score, OSDI score at 4-week visits and intraocular pressure (IOP), tear-film break-up time (TBUT), and bulbar/limbal hyperemia score at the 4- and 12-week visits. For safety assessment, best-corrected visual acuity (BCVA), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and physical examination at 4 and 12 weeks and adverse events during the whole study period were analyzed. Results: Overall, 59 patients were enrolled and randomized into each group (29 preserved and 30 preservative-free). At the endpoint, 5 patients in the preserved group and 2 patients in the preservative-free group dropped out, leaving 24 and 28 patients in the preserved and preservative-free groups, respectively. Baseline characteristics showed no significant difference between the groups including age and sex. At the 12-week visit, intra-group change of OSDI scores did not change significantly compared to the baseline scores in both preserved and preservative-free groups (p = 0.791, 0.478, respectively). On the contrary, the corneal staining score and the conjunctival staining score showed a significant increase compared to the baseline score in the preserved group (p = 0.015, 0.009, respectively). Regarding drug satisfaction, higher proportions of patients in the preservative-free group reported convenience of installation (p = 0.002). Also, stinging and burning sensations in drug tolerance showed better results in the preservative-free group with a significant difference (p = 0.011). Safety assessment regarding systemic side effects such as SBP, DBP, and HR showed similar results between the preserved and preservative-free groups (p = 0.711, 0.232, 0.666, respectively). Conclusions: Preservative-free brimonidine/timolol showed comparable efficacy and safety, better corneal and conjunctival staining score with convenience of installation, and lower stinging and burning sensation. It is expected to be a proper treatment option for patients with glaucoma or ocular hypertension. Full article

This study investigates the effects of levator advancement, with and without upper blepharoplasty, on dry-eye symptoms in patients with unilateral ptosis. A total of 92 patients were included, divided into three groups based on surgical intervention: Group A (ptosis correction alone), Group B (ptosis correction with blepharoplasty), and Group C (blepharoplasty alone). Dry-eye parameters were assessed preoperatively and postoperatively at 1, 3, and 6 months using Tear Break-Up Time (TBUT), Schirmer test, corneal and conjunctival staining, and the Ocular Surface Disease Index (OSDI) questionnaire. Our findings indicate that patients in Groups A and B exhibited a temporary increase in dry-eye symptoms, with the most significant effects observed in Group B at the 1- and 3-month follow-ups. By 6 months, dry-eye parameters in all groups returned close to baseline levels, underscoring the reversible nature of these symptoms. This study highlights the importance of preoperative counseling regarding potential temporary dry-eye symptoms, particularly for patients undergoing combined ptosis and blepharoplasty procedures. The results support the safety of these surgical approaches, provided there is appropriate patient monitoring and management to ensure symptom resolution over time. Full article