Search Results (166)

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

This study investigates the properties of biopolymer films derived from semolina and farina, focusing on the effect of varying concentrations of glycerol as a plasticizer. The research fills a gap in the study of grains such as semolina and farina, which have the potential to expand the range of biodegradable materials. Mechanical tests revealed significant differences between the two film types. Farina-based films were notably more ductile, exhibiting an elongation at break of up to two times their original length, but with a low tensile strength of only 1–2 MPa. In contrast, semolina-based films were significantly stiffer, with a maximum elongation at break of 10%. A notable exception was the semolina film with a 25% glycerol concentration, which displayed an exceptionally high tensile strength of 17 MPa. This is a significant improvement over the typical potato starch-based film tested, which breaks at 5 MPa under static tearing. Furthermore, the study examined the films’ morphology, color, SFE, and surface roughness. Free surface energy ranged from 40 to 60 mJ/m² in the tests, where the influence of the plasticizer was significant. Color tests clearly show yellow discoloration. 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

When detected early, canthoplasty controls the clinical signs and complications associated with accentuated eye exposure. The aim of this study was to evaluate the reduction in the palpebral fissure to prevent ophthalmic lesions secondary to brachycephalic dog syndrome. A total of 64 eyes of brachycephalic dogs were studied, divided into the control group (22 eyes submitted to traditional clinical treatment) and the treated group (42 eyes submitted to canthoplasty). Tear production, tear film break-up time (TFBUT), tear crystallization time (TCT), and the occurrence of corneal ulcers were assessed prior to treatment (T0), seven days after therapy or surgery (T7), and after 30 days (T30), and reassessments were performed every three months, until month 18. It was observed that the treated animals (treated group) showed an improvement in tear production compared to the control animals (control group). In addition, the treated animals showed a significant increase in TFBUT (T9M), which was higher than the control group. The TCT evaluation scores of the treated group decreased compared to the control group (T12M), and the occurrence of corneal ulcers was significantly higher in the control group in the medium term. We concluded that early canthoplasty in brachycephalic dogs prevented the occurrence of secondary lesions, increased tear production and quality, and reduced the occurrence of ulcers, particularly in the medium term. Full article

Dry eye disease (DED) represents one of the most prevalent ocular manifestations associated with systemic lupus erythematosus (SLE), with reported incidence rates ranging from 15% to 35%. DED constitutes a multifactorial condition that significantly impairs both visual function and health-related quality of life. The objective of this study was to assess the impact of DED symptoms on vision-related quality of life in patients diagnosed with SLE, employing the Ocular Surface Disease Index (OSDI) as a disease-specific instrument. Additionally, the study aimed to evaluate correlations between clinical diagnostic tests and OSDI scores, and to determine the frequency of abnormalities affecting individual ocular structures. This study included 35 SLE patients, identifying DED in 37.1%. Common ophthalmic abnormalities included lens opacification (22.9%) and hyaloid degeneration (34.3%). Astigmatism (>0.50 D cyl) was prevalent (60.0%), being significantly higher in DED patients. While visual acuity and intraocular pressure were comparable, DED patients showed significantly lower Schirmer I test values, reduced tear break-up time, and higher van Bijsterveld scores, indicating impaired tear film and surface integrity. OSDI scores were significantly elevated in the DED group, with 51.4% reporting moderate to severe dysfunction. Strong, statistically significant correlations between the OSDI and objective tear film parameters confirmed a robust association between subjective symptoms and clinical signs. These findings highlight the significant impact of DED on visual function in SLE patients, underscoring the importance of routine ophthalmological evaluation and timely intervention. 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

Background/Objectives: Borderline personality disorder (BPD) is a psychiatric disorder characterized by emotional instability, impulsive behavior, and impaired interpersonal relationships. It is associated with a high prevalence of childhood trauma and neurobiological changes. This study aimed to compare ophthalmologic parameters, namely, optic nerve sheath diameter, intraocular pressure, and dry eye, in patients with BPD with healthy controls and to investigate the relations between these parameters and childhood trauma. Methods: This study included 51 female patients with BPD between the ages of 18 and 35 years, who were not using psychotropic medication, and 51 healthy controls matched for age and educational level. Optic nerve sheath diameter, intraocular pressure, and tear break-up time were measured, and trauma history was evaluated using the Childhood Trauma Questionnaire-Short Form. Independent t-test and Pearson correlation analysis were used in statistical analyses. Results: Patients with BPD were found to have significantly higher mean optic nerve sheath diameter scores (left: 3.94 ± 0.43, right: 3.97 ± 0.47) compared with healthy controls (left: 3.76 ± 0.44, right: 3.78 ± 0.45) (p < 0.05). The groups showed no significant difference in intraocular pressure and dry eye parameters (p > 0.05). A significant positive correlation was noted between emotional abuse scores and the optic nerve sheath diameter of the left eye in patients with BPD (p < 0.05; r = 0.364). Conclusions: An increased optic nerve sheath diameter may be a potential peripheral biomarker reflecting chronic stress or changes in intracranial physiology in patients with BPD. This increase is particularly associated with a history of emotional abuse. Ophthalmological parameters may contribute to understanding the neurobiological basis of BPD and serve as peripheral biomarkers or indicators of neurobiological changes. 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

Objectives: Fluorescein break-up time (FBUT) is commonly used to assess tear film stability. However, the instillation of fluorescein destabilises the tear film, impacting validity and clinical applicability, while the subjective nature and variation in volume and concentration reduces repeatability. Non-invasive break-up time (NIBUT) offers an alternative method with less potential bias. Normal tear break-up time is conventionally accepted as 10 seconds (s); however, FBUT is expected to be lower than NIBUT. This study was designed to compare FBUT and NIBUT values in a pre-operative refractive surgery population, where diagnosis of dry eye disease may alter the risk–benefits ratio and contraindicate surgical procedure(s). Improved understanding of the relationship between these two methods will aid appropriate pre-operative patient counselling and consent. Methods: Data from consecutive participants presenting to a private ophthalmology clinic, for initial refractive surgery pre-operative assessment, were analysed. NIBUT and FBUT were performed. Paired and unpaired comparisons were made using the Wilcoxon signed-rank and Mann–Whitney U tests, respectively, and relationships with demographics were explored using Spearman’s rank correlation coefficient. Results: Median and interquartile range (IQR) for the first NIBUT was 12.5 s (7.0–18.0 s) and 14.2 s (9.4–18.0 s) for the right and left eyes, respectively. Median and IQR for the average NIBUT was 14.0 s (6.9–18.0 s) and 14.6 s (10.1–18.0 s) for the right and left eyes, respectively. Median and IQR for FBUT was 7 s (5–8 s) and 6 s (5–8 s) for the right and left eyes, respectively. There was a statistically significant difference between NIBUT and FBUT (p < 0.001). Conclusions: The findings suggest that the commonly used diagnostic threshold of 10 s cannot be uniformly applied to both FBUT and NIBUT, as FBUT systematically underestimates tear stability. 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

Objectives: Topical lubricants are the fundamental treatment for dry eye disease (DED). However, the molecular mechanisms underlying their efficacy remain unknown. Here, the protective effects of Thealoz^® Duo with 3% trehalose and 0.15% hyaluronic acid are investigated in DED patients by a longitudinal clinical study and subsequent elucidation of the tear proteome and cell signaling changes. Methods: Participants were classified as moderate to severe DED (DRY, n = 35) and healthy (CTRL, n = 23) groups. Specific DED subgroups comprising evaporative (DRYlip) and aqueous-deficient with DRYlip (DRYaqlip) were also classified. Only DED patients received Thealoz^® Duo. All participants were clinically examined before (day 0, T1) and after the application of Thealoz^® Duo at day 28 (T2) and day 56 (T3). Next, 174 individual tear samples from all groups at three time-points were subjected to proteomics analysis. Results: Clinically, Thealoz^® Duo significantly improved the ocular surface disease index at T2 vs. T1 (DRY, p = 1.4 × 10⁻²; DRYlip, p = 9.2 × 10⁻³) and T3 vs. T1 (DRY, p = 2.1 × 10⁻⁵; DRYlip, p = 1.2 × 10⁻⁴), and the tear break-up time at T3 vs. T1 (DRY, p = 3.8 × 10⁻²; DRYlip, p = 1.4 × 10⁻²). Thealoz^® Duo significantly ameliorated expression of inflammatory response proteins (p < 0.05) at T3, which was observed at T1 (DRY, p = 3.4 × 10⁻⁴; DRYlip, p = 7.1 × 10⁻³; DRYaqlip, p = 2.7 × 10⁻⁸). Protein S100-A8 (S100A8), Alpha-1-antitrypsin (SERPINA1), Annexin A1 (ANXA1), and Apolipoprotein A-I (APOA1) were found to be significantly reduced in all the DED subgroups. The application of Thealoz^® Duo showed the therapeutic characteristic of the anti-inflammatory mechanism by promoting the expression of (Metalloproteinase inhibitor 1) TIMP1 in all the DED subgroups. Conclusions: Thealoz^® Duo substantially improved the DED symptoms and restored the functionality of the tear lipid layer to near normal in DRYlip and DRY patients by ameliorating inflammation. Notably, this study unravels the novel mechanistic alterations underpinning the healing effects of Thealoz^® Duo in DED subgroups in a time-dependent manner, which supports the improvement in corresponding clinical attributes. Full article

Background and Objectives: To clinically validate a semi-automatic measurement of Tear Meniscus Central Area (TMCA) to differentiate between Non-Aqueous Deficient Dry Eye (Non-ADDE) and Aqueous Deficient Dry Eye (ADDE) patients. Materials and Methods: 120 volunteer participants were included in the study. Following TFOS DEWS II diagnostic criteria, a battery of tests was conducted for dry eye diagnosis: Ocular Surface Disease Index questionnaire, tear film osmolarity, tear film break-up time, and corneal staining. Additionally, lower tear meniscus videos were captured with Tearscope illumination and, separately, with fluorescein using slit-lamp blue light and a yellow filter. Tear meniscus height was measured from Tearscope videos to differentiate Non-ADDE from ADDE participants, while TMCA was obtained from fluorescein videos. Both parameters were analyzed using the open-source software NIH ImageJ. Results: Receiver Operating Characteristics analysis showed that semi-automatic TMCA evaluation had significant diagnostic capability to differentiate between Non-ADDE and ADDE participants, with an optimal cut-off value to differentiate between the two groups of 54.62 mm² (Area Under the Curve = 0.714 ± 0.051, p < 0.001; specificity: 71.7%; sensitivity: 68.9%). Conclusions: The semi-automatic TMCA evaluation showed preliminary valuable results as a diagnostic tool for distinguishing between ADDE and Non-ADDE individuals. Full article

Background and Objectives: This study reports an association between nasolacrimal duct obstruction (NLDO) and perinasal uptake on radioactive iodine (RAI) whole-body scan. Materials and Methods: This is a retrospective study of 37 patients from May to November 2017 who underwent thyroidectomy and I-131 ablation for papillary thyroid cancer (PTC) and had a follow-up I-123 diagnostic WBS and dacryoscintigraphy. Ophthalmic examinations assessed punctal stenosis, NLDO, tear film break-up time, Schirmer’s test, punctate keratopathy, tear meniscus height, epiphora, and ocular dryness. Perinasal and nasal uptake on whole-body scans (WBSs) were assessed as negative (no uptake) or positive (focal uptake). The associations between perinasal uptake on WBS, dacryoscintigraphy findings, and ophthalmic assessments were assessed. Results: Nasal uptake on I-131 post-ablation WBS were observed in 60 eyes (81%); perinasal uptake was observed in 8 eyes (11%). Nasal uptake on I-123 post-ablation WBS were observed in all eyes; perinasal uptake was observed in 15 eyes (20%). Perinasal and nasal uptake on I-131 post-ablation WBS were significantly associated with delayed excretion on dacryoscintigraphy (p < 0.001 and p = 0.03, respectively). Perinasal uptake on I-123 WBS was associated with both abnormal dacryoscintigraphy findings and ocular dryness (p < 0.001 and p = 0.02, respectively). Conclusions: Perinasal uptake on I-131 post-ablation and I-123 diagnostic WBS was significantly associated with delayed excretion on dacryoscintigraphy, suggesting NLDO. Full article

Dry eye disease (DED) is characterized by tear film instability and oxidative stress-induced epithelial damage. This study was conducted to compare the therapeutic effects of 2% rebamipide (REB) and 3% diquafosol (DQS) on oxidative stress-related apoptotic damage of the ocular surface in DED. Human corneal epithelial cells (HCECs) were exposed to hyperosmotic stress in vitro and treated with REB or DQS. Cell viability and cleaved caspase-3 expression were evaluated using the MTT assay and Western blotting. DED was induced in vivo in C57BL/6 mice using subcutaneous scopolamine injection. Thereafter, the mice were assigned to normal control (NC), dry eye (DE), DQS-treated (DQS), or REB-treated (REB) groups. Clinical evaluations, including measurement of tear film break-up time, corneal smoothness, and the lipid layer, were performed on days 7 and 14. In addition, CD4⁺ IFN-γ⁺ T cells, inflammatory cytokines, reactive oxygen species (ROS), lipid peroxidation markers, and corneal apoptosis were analyzed on day 14. Glycocalyx integrity and goblet cell density were also evaluated. The results indicate that REB improved HCEC survival and suppressed cleaved caspase-3 expression more effectively than DQS (p < 0.05). Both treatments improved clinical outcomes in the murine dry eye model; however, REB showed superior efficacy in reducing ROS levels, lipid peroxidation, and apoptosis, and in preserving corneal glycocalyx integrity and conjunctival goblet cell density. These findings highlight the therapeutic potential and protective effects of REB against oxidative stress-related damage and apoptosis in DED. 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