Query: dry eyes

title: Dry Eyes, Ocular Lubricants, and Use of Systemic Medications Known or Suspected to Cause Dry Eyes in Residents of Aged Care Services
abstract: Ocular issues are common, burdensome, and under researched among residents of aged care services. This study aims to investigate the prevalence of dry eyes or use of ocular lubricants among residents, and the possible association with systemic medications known or suspected to cause dry eyes. A cross sectional study of 383 residents of six aged care services in South Australia was conducted. Data were extracted from participants' medical histories, medication charts, and validated assessments. The main exposure was systemic medications known to cause, contribute to, or aggravate dry eyes. The primary outcome was documented dry eyes or regular administration of ocular lubricants. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between systemic medications and dry eyes/use of ocular lubricants. Dry eyes were documented for 53 (13.8% residents and 98 (25.6% residents were administered ocular lubricants. Overall, 116 (30.3% residents had documented dry eyes/used ocular lubricants. Of these, half (n 58) were taking a medication known to cause, contribute to, or aggravate dry eyes. Taking one or more medications listed as known to cause dry eyes was associated with having dry eyes/use of ocular lubricants (OR 1.83, 95% CI 1.15 2.94) In sub analyses, no individual medication was associated with dry eyes/use of ocular lubricants. Dry eyes and use of ocular lubricants are common in residential aged care. Our hypothesis generating findings suggest the need for further research into the clinical significance of systemic medications as a possible cause of dry eyes.

title: Prevalence of dry eyes in patients with Type 2 diabetes mellitus
abstract: To estimate the prevalence of dry eyes in patients with Type 2 diabetes mellitus and to compare various tests of dry eye.  An analytical cross sectional study was conducted on 150 patients diagnosed with Type 2 diabetes mellitus. Dry eyes symptoms were assessed using Ocular surface disease index (OSDI) questionnaire and graded according to severity. The diagnosis was confirmed by positive Ocular surface staining pattern with fluorescein, Tear film breakup time test (TBUT) or Schirmers test. Severity of dry eyes was determined and prevalence calculated.  The prevalence rate of dry eye disease among diabetics was calculated as 36% on the basis of Ocular surface disease index. Mild, moderate and severe dry eyes were present in 16% 16% and 4% patients respectively. TBUT showed very good agreement with highest diagnostic accuracy. Schirmers test and Fluorescein test had good and moderate agreement respectively.  Diabetes mellitus associated dry eye disease (DMDES) is the most frequent diabetic complication in clinical practice. Clinical trials are warranted to confirm the effects of the currently applied drugs in diabetes associated DES for a better outcome in such patients. Our study can act as a stepping stone for larger multi centric studies to gain more information about this largely unrecognized problem of diabetes associated dry eye disease.  Ary eye, Diabetes, Fluorescein, OSDI, Schirmers test, TBUT, Tear film.

title: Dry eyes, gritty or not?
abstract: To study the prevalence of dry eye in a hospital based population and to study the tear film parameters in dry eye patients presenting with symptoms of grittiness and foreign body sensation attending the ophthalmology outpatient department of Karpaga Vinayaka Institute of Medical Sciences, Chengalpattu, Tamil Nadu.  Cross Sectional study conducted in the out patient department of our department among patients presenting with symptoms suggestive of dry eyes both male and female patients consenting to the study were included.  A total of 125 participants were enrolled, of these 38 had dry eye, 67 had long duration of work. 86 patients had complaints suggestive of dry eye. 38 had all 3 parameters tested abnormal. Tear film was evaluated with Schirmer test, TBUT, TMH and a proforma to record patient demographic details, symptoms, test values and dry eye diagnosis.  our study showed 86 participants with symptoms such as grittiness, foreign body sensation, dryness, burning sensation and 38 patients had dry eye and required treatment such as lubricants. Poor quality and function of tears, combined with subnormal ocular surface, makes patients symptomatic and on evaluation show ocular surface disease dry eye which can be treated accordingly to relieve the patient of symptoms and improve the quality of life. Thus routine and early examination of tear function and ocular surface parameters should form a part of the workup of all patients with symptoms of dry eye.  Dry eye, Grittiness, Schirmer test, TMH, TBUT.

title: Dry eyes in patients with pseudoexfoliation A descriptive study
abstract: Pseudoexfoliation syndrome is seen commonly above 60 years of age. It can lead to various complications such as poor dilatation of pupil, increased IOP and intraoperative complications such as zonular dehiscence or capsular rupture, vitreous loss and subluxation of intraocular lens. Pseudoexfoliative glaucoma is one of the common types of secondary open angle glaucoma. Pseudoexfoliation syndrome can also cause ocular surface disorders due to tear film instability. Hence this study was done to assess the prevalence of dry eyes in patients with pseudoexfoliation.  This was a descriptive study which involved 150 eyes with pseudoexfoliation syndrome. Tear secretion assessment was done using Schirmer's test I. Then the tear film stability was evaluated using Tear break up time(TBUT) Ocular surface damage was assessed using Fluorescein staining and Lissamine green staining.  Schirmer's test I, 144 eyes out of 150 eyes had Schirmer's test value more than 15 mm (96% 4 eyes (2.6% had value between 10 15 mm .2 eyes (1.4% had value between 5 10 mm. Six eyes with dry eye syndrome were identified by Schirmer's test I. Tear breakup time was decreased in 3 eyes (between 7 9 seconds) Three eyes with dry eye syndrome were identified by TBUT test. Fluorescein staining was positive in one eye. Lissamine staining was positive in 2 eyes with score of 2 and 3. In this study of pseudoexfoliation patients, there were 9 eyes(6% with dry eye syndrome.  Early recognition of dry eye syndrome in patients with pseudoexfoliation syndrome can reduce ocular morbidity and prevent a significant compromise in their quality of life.

title: Polyarthritis, Tenosynovitis and Dry Eyes after Treatment by Immune Check Point Inhibitors
abstract: Immune checkpoint inhibitors targeting programmed death protein 1 and cytotoxic T lymphocyte antigen 4 have revolutionized the treatment of various cancers. Despite their effectiveness, these therapies can lead to immune related adverse events.  We reported a case of a 43 year old white woman who was referred to our department for a management of acute polyarthritis. She was followed for a relapsing metastatic melanoma (stage IIIb) by surgery and Pembrolizumab, an immune checkpoint inhibitor targeting programmed death protein 1. After receiving her 4th cycle of this therapy she developed arthritis of the knees and the ankles, tenosynovitis and dry eyes with keratitis. After exclusion of other causes of polyarthritis such as connective tissue disease, the diagnosis of rheumatologic immunerelated adverse events was retained. She was treated by 20 mg of prednisone daily, Pembrolizumab was discontinued. The evolution was favorable.  Rheumatologic manifestations secondary to immune checkpoint inhibitors have been less well described in the literature. Their management requires the collaboration of oncologists and rheumatologists to limit the diagnostic delay and for an appropriate therapeutic choice according to their severity.

title: Assessment of mucin related gene alterations following treatment with rebamipide ophthalmic suspension in Sjogren's syndrome associated dry eyes
abstract: Ocular surface mucins are thought to play vital roles in maintaining the homeostasis of the pre ocular surface tear film. We performed ocular surface tests with impression cytology to assess the expression levels of mucin related genes on the ocular surface in healthy eyes. In addition, we investigated alterations in mucin related gene expression secondary to treatment with rebamipide ophthalmic suspension in patients with Sjogren's syndrome associated dry eyes (SS DE) Thirty three healthy individuals (control group) and 13 patients from our hospital with SS DE were enrolled. Impression cytology was performed using Schirmer's test paper for RNA sampling. The mRNA levels of SAM pointed domain containing ETS like factor (SPDEF) mucin 5AC (MUC5AC) and mucin 16 (MUC16) were determined using a real time reverse transcription polymerase chain reaction. The ocular surface test was performed once for the control group, and at baseline as well as 2, 4, 8, and 12 weeks after treatment in the Sjogren's syndrome associated dry eyes group. mRNA levels of SPDEF, MUC5AC, and MUC16 were not significantly different between the control and SS DE groups before rebamipide ophthalmic suspension treatment. SPDEF mRNA levels in control subjects were significantly correlated with levels of MUC5AC. Among SS DE patients, SPDEF mRNA levels were significantly increased at 2, 4, and 8 weeks after treatment compared with baseline levels. MUC16 mRNA levels were significantly decreased from baseline levels at 4 and 8 weeks post treatment. Ocular surface test using impression cytology is a clinically useful tool for assessing mucous conditions on the ocular surface and can be used to determine the effects of instillation treatment with eye drops that affect mucin production at the ocular surface.

title: Mucoadhesive Bletilla striata Polysaccharide Based Artificial Tears to Relieve Symptoms and Inflammation in Rabbit with Dry Eyes Syndrome
abstract: Dry eye syndrome (DES) is a multifactorial disorder of the ocular surface affecting many people all over the world. However, there have been many therapeutic advancements for the treatment of DES, substantial long term treatment remains a challenge. Natural plant based polysaccharides have gained much importance in the field of tissue engineering for their excellent biocompatibility and unique physical properties. In this study, polysaccharides from a Chinese ground orchid, Bletilla striata, were successfully extracted and incorporated into the artificial tears for DES treatment due to its anti inflammatory and mucoadhesive properties. The examination for physical properties such as refractive index, pH, viscosity and osmolality of the Bletilla striata polysaccharide (BSP) artificial tears fabricated in this study showed that it was in close association with that of the natural human tears. The reactive oxygen species (ROS) level and inflammatory gene expression tested in human corneal epithelium cells (HCECs) indicated that the low BSP concentrations (0.01 0.1% v/v) could effectively reduce inflammatory cytokines (TNF, IL8) and ROS levels in HCECs, respectively. Longer retention of the BSP formulated artificial tears on the ocular surface is due to the mucoadhesive nature of BSP allowing lasting lubrication. Additionally, a rabbit's DES model was created to evaluate the effect of BSP for treating dry eye. Schirmer test results exhibited the effectiveness of 0.1% (v/v) BSP containing artificial tears in enhancing the tear volume in DES rabbits. This work combines the effectiveness of artificial tears and anti inflammatory herb extract (BSP) to moisturize ocular surface and to relieve the inflammatory condition in DES rabbit, which further shows great potential of BSP in treating ocular surface diseases like DES in clinics in the future.

title: Characteristics and Utility of Fluorescein Breakup Patterns among Dry Eyes in Clinic Based Settings
abstract: To evaluate the characteristics of fluorescein breakup patterns (FBUPs) among patients with dry eye disease (DED) and efficacy of FBUPs as a diagnostic test for DED subgroups.  The study enrolled 449 patients with DED. FBUPs were categorized as follows: area break (AB) line break (LB) spot break (SB) dimple break (DB) and random break (RB) Schirmer value, fluorescein breakup time (FBUT) keratoconjunctival score, DED subgroups and subjective symptoms were examined.  LB patients presented with short FBUT and high keratoconjunctival score. AB patients presented with short FBUT, high cornea and keratoconjunctival scores. SB patients were young with short FBUT. DB patients exhibited low keratoconjunctival score. RB patients were young, with long FBUT and low keratoconjunctival scores. Among DED subgroups, LB and AB constituted 74.7% of aqueous deficiency dry eye (ADDE) SB and DB constituted 42.4% of short FBUT dry eye (short FBUT DE) Post test probabilities and positive likelihood ratios for ADDE were 58.7% and 1.63, respectively; those for short FBUT DE were 46.3% and 2.02, respectively. Patients with SB and AB exhibited significantly severe subjective symptoms than other FBUPs.  FBUPs are associated with both objective findings and symptoms of DED and may be a clinical tool for identification of DED subgroups.

title: Psychological contribution to understanding the nature of dry eye disease: a cross sectional study of anxiety sensitivity and dry eyes
abstract: Dry eye disease (DED) represents a common health problem in the general population. Previous studies have demonstrated that the subjective symptoms of dry eye are associated with several psychological factors, including depression, anxiety and post traumatic stress disorder. However, there is a lack of empirical information about the mechanisms underlying the relationships between DED and various psychological symptoms. In light of emerging evidence of its trans diagnostic nature, anxiety sensitivity (i.e. AS) represents one promising factor for further understanding DED. The present study aimed to explore whether anxiety sensitivity plays a role in the perception of DED symptoms in a community based sample of adults aged 20 89 years (N 381; M 39.72, SD 12.6) A dry ocular surface was reported by 22.8% of the participants. As expected, women more often reported symptoms of dry eye that could be categorized as moderate to severe. The findings demonstrated that AS, and the AS psychological concerns dimension in particular, predict the intensity of dry eye symptoms above and beyond depressive and anxiety symptoms. These findings add to a growing body of work underscoring the relevance of AS in increasing the risk of chronic medical conditions.

title: High Molecular Weight Hyaluronan Promotes Corneal Nerve Growth in Severe Dry Eyes
abstract: The purpose of this study was to investigate the effect of high molecular weight hyaluronan (HMWHA) eye drops on subbasal corneal nerves in patients suffering from severe dry eye disease (DED) and to evaluate the damage of subbasal corneal nerves associated with severe DED. Designed as an international, multicenter study, 16 patients with symptoms of at least an Ocular Surface Disease Index (OSDI) score of 33, and corneal fluorescein staining (CFS) of at least Oxford grade 3, were included and randomized into two study arms. The control group continued to use their individual optimum artificial tears over the study period of eight weeks; in the verum group, the artificial tears were substituted by eye drops containing 0.15% HMWHA. At the baseline visit, and after eight weeks, the subbasal nerve plexus of 16 patients were assessed by confocal laser scanning microscopy (CSLM) The images were submitted to a masked reading center for evaluation. Results showed a significant increase of total nerve fiber lengths (CNFL) in the HMWHA group (p 0.030) when compared to the control group, where the total subbasal CNFL did not significantly change from baseline to week 8. We concluded that in severe DED patients, HMWHA from topically applied eye drops could cross the epithelial barrier and reach the subbasal nerve plexus, where it exercised a trophic effect.