Thursday, January 29, 2009

Abstract: Contact lens wear and decreased MGs

I had to give this study title a triple-take before I could even begin to take it in.

This rates 11 WOWs on a scale of 1 to 10.

Seriously, on the face of it this looks like one of the most significant dry eye studies I've ever come across since I started blogging, no exaggeration. It is basically saying that contact lens wear slowly kills your meibomian glands. Well, gee, that would explain a lot. No doubt it's not that simple, of course.

I am feeling very anxious to see this followed up with additional carefully designed studies. Like Baylor, Schepens, some of those places.

Contact Lens Wear Is Associated with Decrease of Meibomian Glands.
Ophthalmology. 2009 Jan 21.
Arita R, Itoh K, Inoue K, Kuchiba A, Yamaguchi T, Amano S.

PURPOSE: Approximately 30% to 50% of contact lens (CL) wearers report dry eye symptoms. Meibomian gland dysfunction has been recognized as a possible cause of CL-related dry eye. This study investigated the influence of CL wear on the meibomian glands using a newly developed meibographic technique.

DESIGN: Cross-sectional observational case series.

PARTICIPANTS: Contact lens wearers (n = 121; 47 men, 74 women; mean age+/-standard deviation, 31.8+/-8.0 years) and healthy volunteers (n = 137; 71 men, 66 women; mean age+/-standard deviation, 31.4+/-15.1 years).

METHODS: The following tests were performed: slit-lamp examinations of the eyelids, corneal and conjunctival staining using fluorescein, measurement of the tear film breakup time, evaluation of the meibomian glands using noncontact meibography, and measurement of tear production using the Schirmer I test. Partial or complete loss of the meibomian glands was scored for each eyelid using 4 grades (meiboscores): grade 0 (no loss of meibomian glands) through grade 3 (the area characterized by gland dropout was more than 66% of the total area containing the meibomian glands). The meiboscores for the upper and lower eyelids were summed for each subject.

MAIN OUTCOME MEASURES: Score of meibomian gland changes (meiboscore), tear film breakup time, and Schirmer test value.

RESULTS: The meiboscore was significantly higher (P<0.0001) in CL wearers (mean, 1.72; 95% confidence interval, 1.47-1.96) than in the control group (mean, 0.96; 95% confidence interval, 0.73-1.19). The average meiboscore of CL wearers was similar to that of a 60- to 69-year-old age group from the normal population. A significant positive correlation was observed between the duration of CL wear and the meiboscore.

CONCLUSIONS: Contact lens wear is associated with a decrease in the number of functional meibomian glands. This decrease is proportional to the duration of CL wear. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Hm. I wonder what the financial disclosure is about. I have a hard time picturing any contact lens companies funding a study of this nature.

Abstract: Tear film osmolarity & thyroid ophthalmopathy

Jpn J Ophthalmol. 2008 Jul-Aug;52(4):323-6.
Tear film osmolarity in patients with thyroid ophthalmopathy.
Iskeleli G, Karakoc Y, Abdula A.

PURPOSE: To compare tear film osmolarity between patients with thyroid ophthalmopathy and normal healthy subjects.

METHODS: The tear film osmolarity in 15 normal subjects (15 eyes) (control group) and 21 patients (21 eyes) with thyroid ophthalmopathy was evaluated. Tear film osmolarity in milliosmole (mOsm) was determined by using an auto-osmometer. The palpebral fissure width, degree of proptosis, and tear break-up time (BUT) were also determined. The results for the two groups were compared statistically.

RESULTS: The mean palpebral fissure width was 9.13 +/- 0.74 mm in the healthy subjects and 13.33 +/- 1.55 mm in the thyroid ophthalmopathy patients. This difference was statistically significant (P = 0.0001). The mean proptosis was 15.33 +/- 1.39 Hertel units in the healthy subjects and 20.71 +/- 0.95 Hertel units in the patients. This difference was also statistically significant (P = 0.0001). The mean tear BUT was 6.35 +/- 1.56 s in the patients and 18.27 +/- 1.53 s in the healthy subjects, and this difference was also statistically significant (P = 0.0005). The mean tear film osmolarity was 290.80 +/- 13.58 mOsm in the healthy subjects and 340.38 +/- 18.74 mOsm in the patients. There was a statistically significant difference between the groups (P = 0.0001).

CONCLUSIONS: The significantly higher tear film osmolarity in patients with thyroid ophthalmopathy was most likely due to the increased proptosis and lid fissure width. These conditions may lead to injury of the ocular surface.

Abstract: HLA released from a contact lens

Alright now I know a lot of you are going to be interested in this one... The whole concept of a time-release of a polymer-based lubricant from a contact lens is pretty fascinating.

Pharm Res. 2009 Jan 21.
Controlled Release of High Molecular Weight Hyaluronic Acid from Molecularly Imprinted Hydrogel Contact Lenses.
Ali M, Byrne ME.

PURPOSE: Current dry eye treatment includes delivering comfort agents to the eye via drops, but low bioavailability and multiple administration continues to be a barrier to effective treatment. There exists a significant unmet need for devices to treat dry eye and for more comfortable contact lenses.

METHODS: Using molecular imprinting strategies with an analysis of biology, we have rationally designed and synthesized hydrogel contact lenses that can release hyaluronic acid (HA) at a controlled rate.

RESULTS: Delayed release characteristics were significantly improved through biomimetic imprinting, as multiple functional monomers provided non-covalent complexation points within nelfilcon A gels without altering structural, mechanical, or optical properties. The diffusion coefficient of 1.2 million Dalton HA was controlled by varying the number and variety of functional monomers (increasing the variety lowered the HA diffusion coefficient 1.5 times more than single functional monomers, and 1.6 times more than nelfilcon A alone).

CONCLUSIONS: HA can be delivered from a daily disposable lens at a therapeutic rate of approximately 6 mug/h for 24 h. This is the first demonstration of imprinting a large molecular weight polymer within a hydrogel and the effect of imprinting on the reptation of the long chain macromolecule from the structure.

Abstract: Carnitine levels and dry eye

Optom Vis Sci. 2009 Jan 19.
l-Carnitine and Short Chain Ester in Tears from Patients with Dry Eye.
Pescosolido N, Imperatrice B, Koverech A, Messano M.

PURPOSE.: The tear film is essential for the integrity of the ocular surface. In ocular diseases such as dry eye syndrome (DES), tear film osmolarity is increased relative to normal physiological conditions. DES can be caused by deficiency in lachrymation, hyperevaporation, or surface alterations. Carnitines, shown to have osmoregulatory properties, are thought to regulate tear film osmolarity, thus protecting the corneal surface from damage. We investigated the presence of carnitine in tears, compared tear carnitine concentrations in healthy subjects and in DES patients and speculate on carnitine's potential role as a protective agent in the tear film.

METHODS.: Tears were collected from 10 healthy subjects and 10 DES patients. Carnitine levels were assessed by high performance liquid chromatography-mass spectrometry.

RESULTS.: Carnitine and its derivatives were detected in the tear samples. In DES patients, concentrations were substantially lower than in healthy subjects; the mean concentrations were l-carnitine, 3.27+/- 0.80 and 8.94+/- 0.50 muMol/L; l-acetylcarnitine, 1.66+/- 0.50 and 3.05+/- 0.65 muMol/L; and l-propionylcarnitine, 0.30+/- 0.11 and 0.57+/- 0.13 muMol/L, in DES patients and healthy subjects, respectively.

CONCLUSIONS.: Although increased tear film osmolarity has been previously observed in DES patients, our study showed lower carnitine levels in DES patients than in healthy subjects, rather than the increased levels expected, although a causal relationship between carnitine levels and hyperosmolarity has not been established. The damage to ocular surface cells because of exposure to hypertonic tear film observed in DES may be partially because of an imbalance in the concentration of carnitine molecules in the tear film relative to the ocular surface cells. We propose, therefore, that carnitine solutions may have a role in preventing the adverse effects of observed hyperosmolarity and suggest that further studies are now warranted to investigate the clinical application of carnitine in the treatment of DES.

Abstract: Blinking, and end-of-day-dry-eye

Optom Vis Sci. 2009 Jan 19.
Blinking and Tear Break-Up During Four Visual Tasks.
Himebaugh NL, Begley CG, Bradley A, Wilkinson JA.

PURPOSE.: This study investigates the relationship between blinking, tear film break-up, and ocular symptoms for normal and dry eye subjects performing four different visual tasks.

METHODS.: Sixteen control and sixteen dry eye subjects performed four visual tasks (looking straight ahead, watching a movie, identifying rapidly changing letters, and playing a computer game) while blink patterns and fluorescein images of the tear film were videotaped. Pre and posttesting symptom questionnaires, querying the intensity of nine symptoms of ocular irritation, were completed by all subjects. Blink rate and blink amplitude were computed from digitized videos. The percentage of tear film break-up before the blink was calculated.

RESULTS.: Dry eye subjects had a significantly higher blink rate (p = 0.017, t-test). Both groups blinked significantly less during the game and letter tasks (p < 0.04, t-test). Partial blinks were common as were clusters or "flurries" of rapid blinks, but there was no significant difference in blink amplitude for control and dry eye subjects. Tear film break-up in normal subjects was typically inferior; whereas dry eye subjects showed more tear break-up centrally and superiorly. Real-time video recording of tear break-up and blink behavior pointed to complex interaction between the two. Dry eye subjects shifted more toward intense ocular symptoms at posttesting (p < 0.05, Wilcoxon signed rank) than controls. Both groups showed a shift toward more corneal staining at posttesting (p < 0.05, Wilcoxon signed rank), which was typically inferior.

CONCLUSIONS.: Reduced and incomplete blinking along with increased tear film break-up during normal visual tasks may explain the increased level of ocular discomfort symptoms reported at the end of the day, particularly in dry eye patients.

Abstract: Autoimmune dry eye...

Schepens (Harvard) study identifying possible new target in dry eye.

J Immunol. 2009 Feb 1;182(3):1247-52.
Autoimmunity in dry eye is due to resistance of Th17 to Treg suppression.
Chauhan SK, El Annan J, Ecoiffier T, Goyal S, Zhang Q, Saban DR, Dana R.

Dry eye disease (DED), an inflammatory autoimmune disorder affecting the ocular surface, degrades visual performance and the quality of life of >10 million people in the United States alone. The primary limitation in the effective treatment of DED is an incomplete understanding of its specific cellular and molecular pathogenic elements. Using a validated mouse model of DED, herein we functionally characterize the different T cell subsets, including regulatory T cells (Tregs) and pathogenic effector T cells, and determine their contribution to the pathogenesis of DED. Our data demonstrate the presence of dysfunctional Tregs and the resistance of pathogenic T cells, particularly Th17 cells, to Treg suppression in DED. In addition, we clearly show that in vivo blockade of IL-17 significantly reduces the severity and progression of disease, which is paralleled by a reduction in the expansion of Th17 cells and restoration of Treg function. Our findings elucidate involvement of a previously unknown pathogenic T cell subset (Th17) in DED that is associated specifically with Treg dysfunction and disease pathogenesis and suggest a new target for dry eye therapy.
Aaaand here we go with another study of two more glaucoma drugs (Travatan and Xalatan) ravaging the ocular surface.

But I wish they had mentioned in the abstract whether the travoprost was Travatan or Travatan-Z... i.e. BAK-preserved or not. This is not a minor distinction. I don't know whether we're talking the drugs being bad or the preservatives. I've emailed the author to find out. The Xalatan of course is BAK preserved.

Oftalmologia. 2008;52(3):114-9.
[Ocular surface disfunction in glaucoma]

Stefan C, Dumitrica DM.

PURPOSE: To determine the effects of travoprost 0.004% and latanoprost 0.005% treatment on ocular surface in primary open angle glaucoma (POAG) patients.

METHODS: Clinical, observational prospective study, during 6 months on two groups of patients newly diagnosticated with POAG. Group I (10 patients) was treated with travoprost 0.004% and group II (10 patients) was treated with latanoprost 0.005%. The groups were homogeneous about age and sex, exclision criteria being any ocular or general associated pathology Routine ophthalmic examination was performed before and after treatment. At each examination was performed Schirmer 1 test and break up time test. Conjunctival cytology specimen was taken and goblet cells density evaluated.

RESULTS: There was statistically significant difference in goblet cell density Schirmer 1 test and BUT test before and after treatment (p<0.05). For the both groups the decrease of IOP was similar (from 23.7+/-1.5 mmHg to 15.4+/-1.7 mmHg in group I and from 24.3+/-1.5 mmHg to 15.8+/-1.7 mmHg in group II).

CONCLUSIONS: This study showed that travoprost 0.004% and latanoprost 0.005% treatment can have adverse effects on ocular surface and may give rise to dry eye symptoms.

Abstract: Timolol (timoptic) and dry eye

OK, this one was a little worrying. Didn't sound like the most rigorously conducted study I've ever seen but even so... This is the first study I've seen (if there are others and I missed them please let me know) showing adverse ocular surface effects from one of the "safe" i.e. NOT BAK-preserved glaucoma meds.


Afr J Med Med Sci. 2008 Mar;37(1):43-7.
The effect of timolol maleate on tear film break-up time in Nigerians.
Fasina O, Ashaye AO, Ajayi BG.

The aim of this study was to evaluate the effect of Timolol maleate on tear film break-up time in a Nigerian population. 192 eyes of 96 subjects were examined in a hospital based case-control study after being administered pre-coded questionnaires. The mean tear film break-up time was measured. There was significant difference (t = 10.164, P < 0.001) in the mean break-up time of cases (10.45 secs) and controls (30.18 secs). Half of the cases had some ocular discomfort with the instillation of Timolol maleate, a significant number of them having just been commenced on the medication (chi2 = 8.889, P = 0.003). Long-term instillation of Timolol maleate impairs tear film stability. The ocular discomfort experienced by patients on Timolol may contribute to poor drug compliance observed in patients on chronic drug therapy. Regular screening of patients on Timolol maleate for tear film instability and dry eyes is important and drug manufacturers should explore the possibility of incorporating artificial tears in Timolol maleate preparation.

Abstract: Dry eye and GVHD

Sjögren-like syndrome after bone marrow transplantation.
Kosrirukvongs P, Chirapapaisan N, Visuthisakchai S, Issaragrisil S, Gonggetyai V.
J Med Assoc Thai. 2008 Nov;91(11):1739-47.

OBJECTIVE: To study the incidence of dry eye in Sjögren-like syndrome, graft-versus-host disease (GVHD) in hematological patients undergoing bone marrow transplantation (BMT).

MATERIAL AND METHOD: Prospective, cross-sectional study in twenty-six patients that were planned for BMT (group I). Twenty-nine patients undergoing BMT before study were classified as group II no GVHD (9), and group III with GVHD (20). Thirty-two normal subjects were controls. All subjects were examined by slit lamp biomicroscopy and had their tear samples analyzed about tear osmolarity. They were also evaluated for aqueous tear production by phenol red thread test, Schirmer test without anesthesia, tear film stability by tear break-up time (TBUT), and rose bengal staining 2 weeks before BMT (for group I) as well as 6 weeks, 3 months, and 6 months after BMT. The patients with GVHD were followed up 1 month later. Main outcome measures were amount of tear production, tear film stability, and dry eye symptoms.

RESULTS: Average aqueous tear production in group III was less than control and group II (p < 0.001). Mean TBUT in group III was faster than control (p < 0.001) and group I before BMT (p = 0.001). Mean score of rose bengal staining in group III was more than control and group I before BMT (p < 0.001). Keratoconjunctivitis sicca and red eye developed in 27.5%, and 20% of group III, with incidence of dry eye by Schirmer test without anesthesia (67.5%). This compares with group II having incidence of dry eye of 16.7%. However, 42.3% of group I before BMT had dry eye compared with 9.4% in the controls (p < 0.001).

CONCLUSION: Trend of dry eye in patients with BMT and GVHD were higher than no-GVHD group. Doctors should be aware of ocular symptoms and signs of dry eye in patients with BMT and follow-up for proper management.

Abstract: A closer look at tear evaporation

Factors affecting evaporation rates of tear film components measured in vitro.
Borchman D, Foulks GN, Yappert MC, Mathews J, Leake K, Bell J.
Eye Contact Lens. 2009 Jan;35(1):32-7.

OBJECTIVES: With increasing age and in patients affected with dry-eye symptoms, the human tear film becomes more unstable and exhibits shorter tear break-up times. We examined whether the inclusion of proteins and lipids to water affected the evaporation rates measured in vitro and could account for the lower rates reported previously from in vivo measurements. The impact of temperature, air flow, and humidity on the evaporation rate of tears was measured in vitro.

METHODS: Lipid-protein interactions were measured using fluorescence spectroscopy and in vitro rates of evaporation were performed gravimetrically.

RESULTS: Human reflex tears evaporated at a rate similar to that of water. A temperature increase from 25 degrees C to 34 degrees C caused a threefold increase in the evaporation rates of tears in still air. Further increases were observed under a current of dry air. Wax, mucin, lysozyme, or beta-lactoglobulin did not influence significantly the rates of evaporation measured in vitro. In contrast, lipid layered on the surface resulted in a 23% decrease in the rates.

CONCLUSIONS: Environmental factors affect evaporation rates significantly and should be carefully controlled when performing in vivo measurements. The presence of a lipid layer lowers evaporation rates. The significantly lower rates of evaporation of tears measured in vivo suggest that with the lipid layer intact, the high reserve capacity of the lacrimal gland to provide both unstimulated and stimulated tear flow is more than enough to compensate for evaporative loss. However, with dry eye, increased rates of evaporation and decreased lacrimal tear flow could result in decreased break-up times.

Abstract: Sjogrens and MUC16 expression

MUC16 expression in Sjogren's syndrome, KCS, and control subjects.
Caffery B, Joyce E, Heynen ML, Jones L, Ritter R 3rd, Gamache DA, Senchyna M.
Mol Vis. 2008;14:2547-55. Epub 2008 Dec 30.

PURPOSE: To investigate the expression of MUC16 protein in tears and conjunctival cell membranes and MUC16 mRNA in conjunctival cells of Sjogren's syndrome (SS), keratoconjunctivitus sicca (KCS) and non-dry eyed (NDE) subjects. The relationship of tear flow and soluble MUC16 concentration was also measured.

METHODS: Seventy-six subjects were recruited for this study: 25 SS (confirmed via American-European Consensus Criteria 2002), 25 KCS (confirmed by symptoms and Schirmer scores < or =10 mm) and 26 NDE. Tear flow was measured by the Schirmer test without anesthesia for 5 min. Tears were collected using an eye-wash technique. Protein and mRNA were isolated from conjunctival epithelial cells collected via impression cytology. Soluble and membrane bound MUC16 were quantified via western blotting and MUC16 mRNA was quantified by real time qPCR.

RESULTS: The SS group demonstrated significantly higher concentrations of soluble MUC16 (7.28 [SS] +/- 3.97 versus 3.35 [KCS] +/- 4.54 [p=0.004] and versus 1.61 [NDE] +/- 1.22 [p<0.001]) and MUC16 mRNA (4.66 [SS] +/- 5.06 versus 1.84 [KCS] +/- 2.26 [p=0.01] and 1.52 [NDE] +/- 1.04 [p=0.003]) compared to both KCS and NDE groups, respectively. No differences in soluble MUC16 or MUC16 mRNA were found between the KCS and NDE groups. Membrane bound MUC16 was similar in all three groups. No significant correlation was found between mean Schirmer values and any measure of MUC16 expression.

CONCLUSIONS: These results demonstrate that SS subjects display a significant increase in both soluble MUC16 and MUC16 mRNA concentrations compared to other forms of aqueous deficient dry eye and non dry-eyed individuals. There was no correlation between tear flow and soluble MUC16 concentration.

Drug news: CF-101 trial enrollment complete

Can-Fite completes recruitment for dry-eye trial

Can-Fite BioPharma Ltd. (TASE:CFBI) has completed recruitment for the Phase II clinical trial of its CF-101 drug for the treatment of dry-eye syndrome (keratoconjunctivitis sicca). 80 patients will participate in the trial at six Israeli medical centers. Patients will take the drug over twelve weeks and monitored for two more weeks.
Can-Fite expects to publish the results of the trial during the second quarter of 2009.

Drug news: Prolacria heads into Phase III trials

At last! Diquafosol fans will be happy to know that Inspire are still moving forward on new trials of their Prolacria drug with the FDA's blessing despite its chequered history. I wish them the very best success in these upcoming trials.

Inspire Pharmaceuticals initiates Phase III dry eye trial
Jan 28, 2009

Inspire Pharmaceuticals has reached agreement with the FDA through a special protocol assessment on the design of a Phase III clinical trial for Prolacria 2% for the treatment of dry eye disease and has recently initiated enrollment in the trial.
Based on the special protocol assessment agreement (SPA), Inspire has initiated a Phase III, randomized, placebo-controlled, environmental clinical trial to evaluate the efficacy and safety of Prolacria in approximately 450 subjects with dry eye who have a fluorescein staining score of three in the central region of the cornea at baseline, using the National Eye Institute (NEI) scale of zero to three. Subjects will be randomized to Prolacria or placebo administered as eye drops four times daily for six weeks at approximately 60 US and Canadian sites.

The agreed upon primary efficacy endpoint is the proportion of subjects receiving Prolacria that achieve clearing of fluorescein staining of the central region of the cornea in the study eye (a score of zero on the NEI scale) at the six-week trial endpoint, compared to those receiving placebo.

Business news: Inspire stops co-promoting Restasis

Inspire Withdraws From Allergan’s Restasis Effort
Bnet Pharma, 1/8/2009

Inspire has stopped co-promoting Restasis, the dry-eye drug launched by Allergan, according to the Triangle Business Journal. Inspire will still receive royalties on the drug at the same rate as before, but only as long as Allergan and Inspire continue work on a new dry-eye drug, Prolacria. That drug is currently stalled — it’s been turned down by the FDA twice and is now in its third attempt to get approval.

Inspire’s SEC filing says that if the Prolacria joint-venture goes belly up, Inspire will regain the right to co-promote Restasis as long as it provides Allergan with 20 percent of Allergan’s sales force.

New product (UK)?: Blephasteam goggles

I can't remember if I first saw this on the Google news email or on Dry Eye Talk. It sounds (and certainly looks) interesting.

Two things I don't get:

1) How you can "watch TV" while wearing these... how do they NOT fog up, even if they aren't creating steam through the heat mechanism? Even my expensive foam-lined sunglasses will fog up in the car.


2) Other than the feelgood factor, how do they help? Heat is usually associated with MGD treatment... where to be effective heat needs to be applied to the MGs. Personally I wouldn't expect warm air around my eyes to do much of anything for my MGD. On the other hand, when you've got dry eye, the feelgood factor is worth plenty in its own right, if you can afford it.

Daily Mail article
A lack of lubrication in the eye is a common and unpleasant condition. Around 20 per cent of the population over the age of 65 suffers from dry eye, as it is known.
The condition, where you don't produce enough lubricating tears, is age-related. It often affects menopausal women because of the reduced levels of the hormone which helps produce lubrication.
'We prescribe drops to treat it, but the eye is sensitive - drops are chemicals and people can react to them,' explains consultant ophthalmologist Dr Rob Fuller of The Royal Devon and Exeter Hospital.
The other option is to use a hot compress over the eyes. Tears are formed of three layers, one of which is oily. Like all oily substances, when heated, this layer melts, creating better lubrication, says Dr Fuller.
'But using a hot compress is not high-tech and not very convenient. During this time, patients can't see or move about and they have to keep refreshing the towel. I felt in the 21st century there was room for something a bit more user friendly.'
So Dr Fuller developed eye-warming goggles that can be plugged in and used while watching TV or reading. They use the power of moist warm air to warm up the eyes.
The goggles gently warm the eye to a temperature of 40c - warm enough to increase lubrication, but not so hot that they create steam

Abstract: Red eye

Those of you with really stubbornly persistent severe dry eye (and your doctors)... based on the abstract it might be worth getting ahold of this study about differential diagnosis. Or emailing the author (check the link for address).

Allergic rhinoconjunctivitis and differential diagnosis of the red eye.
Granet D.
Allergy Asthma Proc. 2008 Nov-Dec;29(6):565-74

Red eye is a common presentation in clinical practice with conjunctivitis being the most common cause of red eye. Most commonly, conjunctivitis is infective (bacterial and viral) or allergic in origin although other forms of conjunctivitis including toxic and irritative conjunctivitis and conjunctivitis related to systemic conditions or dry eye are prevalent enough to warrant consideration in diagnosis. This article aims to provide a guide for generalists and allergists in the differential diagnosis of conjunctivitis allowing the inclusion of eye treatment into their current practice. With a discussion of important aspects to include in the patient history as well as a systematic guide to examination of the eye for generalists and allergists, this article provides a "plan of action" in the examination protocol for red eye patients. A differential diagnosis table and flowchart are provided as a useful chair-side reference for practitioners. With a particular focus on the more prevalent types of conjunctivitis, typical features, signs, and symptoms of each type are detailed. A general discussion of prognosis and treatment options and conditions that require ophthalmologic referral is included.

Abstract: Workplace dry eye

Nothing special as abstracts go but at least it's adding to the database of documentation out there hopefully providing more leverage for working people to get their HR folks to improve humidity levels in bone-dry workplaces.

"Healthy" eye in office-like environments.
Wolkoff P.
Environ Int. 2008 Nov;34(8):1204-14. Epub 2008 May 21.

Eye irritation symptoms, e.g. dry eyes, are common and abundant symptoms reported in office-like environments, e.g. aircraft cabins. To improve the understanding of indoor related eye symptomatology, relevant knowledge from the ophthalmological and indoor environmental science literature has been merged. A number of environmental (relative humidity, temperature, draft), occupational (e.g. visual display unit work), and individual (e.g. gender, use of cosmetics, and medication) risk factors have been identified, which are associated with alteration of the precorneal tear film (PTF); these factors may subsequently exacerbate development of eye irritation symptoms by desiccation. Low relative humidity including reduced atmospheric pressure further increases the water evaporation from an altered PTF; in addition, work with visual display units may destabilize the PTF by lower eye blink frequency and larger ocular surface. Results from epidemiological and clinical studies support that relative humidity >40% is beneficial for the PTF. Only few pollutants reach high enough indoor concentrations to cause sensory irritation of the eyes, while an altered PTF may exacerbate their sensory effect. Sustained low relative humidity causes impairment of the PTF, while its stability, including work performance, is retained by low gaze and intermittent breaks.

Abstract: Blepharoplasty and dry eye...

...More awareness for dry eye risks in blepharoplasty, from UTSW. Doctors take note!!

Preventing and managing dry eyes after periorbital surgery: a retrospective review.
Hamawy AH, Farkas JP, Fagien S, Rohrich RJ.
Plast Reconstr Surg. 2009 Jan;123(1):353-9.

BACKGROUND: Dry eye syndrome is a common sequela associated with periorbital surgery. As more patients seek periorbital rejuvenation, understanding the pathophysiology, diagnosis, and treatment of this condition perioperatively is essential for managing patient expectations and maximizing outcomes.

METHODS: A retrospective review of charts for 202 consecutive patients (180 women and 22 men) who underwent upper and/or lower blepharoplasty was performed. Additional facial cosmetic procedures were performed in 91 percent of patients. Data were collected identifying associated risk factors and the incidence of persistent dry eye symptoms. Key elements of perioperative care are described and algorithms for detection of those at risk, prevention, and management are outlined.

RESULTS: Dry eyes persisting longer than 2 weeks after surgery were noted in 22 patients (10.9 percent) and longer than 2 months in only four patients (2 percent). In most cases, dry eyes resolved with conservative management, including artificial tears, lubrication, topical and systemic steroids, and night taping. One patient (0.5 percent of all studied patients) eventually needed surgical correction of lower eyelid retraction after failure of the punctate plug. Persistent chemosis occurred in 15 patients (68.2 percent) who had symptomatic dry eyes (p < 0.01).

CONCLUSION: Recognizing and addressing risk factors before surgery and an algorithmic approach to prevention and management of patients undergoing periorbital surgery are essential for minimizing the occurrence of dry eye syndrome.

Abstract: Research on another inflammatory mediator

Something to keep an eye on for further studies.

sPLA2-IIa is an inflammatory mediator when the ocular surface is compromised.
Chen D, Wei Y, Li X, Epstein S, Wolosin JM, Asbell P.
Exp Eye Res. 2008 Dec 16.

sPLA2-IIa is an enzyme at high concentration in tears that has been known as an innate barrier of the ocular surface against microbial infection. sPLA2-IIa and other enzymes in the same protein family are known to hydrolyze fatty acids resulting in the generation of free arachidonic acid (AA) and lysophospholipids, which are the precursors of pro-inflammatory lipid mediators, such as PGE(2). sPLA2-IIa has been shown to be an inflammatory mediator in non-ocular inflammatory diseases such as rheumatoid arthritis (RA). It was also found to be increased in the tears of the patients with dry eye disease, chronic blepharitis and contact lens intolerance. However, the role of sPLA2-IIa in chronic ocular surface inflammation has yet to be determined. In the current study, we examined the potential role of sPLA2-IIa in inflammation of ocular surface diseases. Our results show that the activity of sPLA2-IIa was significantly increased in tears from dry eye disease patients compared with that from normal subjects. Also, sPLA2-IIa stimulated the production of PGE(2) in ocular surface epithelial cell cultures. The stimulating effect was markedly enhanced when the cells or tissues were pre-compromised with TNF-alpha, IL-1beta or desiccation. Furthermore, sPLA2-IIa stimulated inflammatory cytokine production in the ocular surface epithelial cell cultures in vitro. To our knowledge, this is the first report regarding the role of sPLA2-IIa as an inflammatory mediator in ocular surface inflammation. These findings indicate that sPLA2-IIa may play an important role in chronic ocular surface inflammation, especially when the ocular surface is compromised.

Abstract: Dry eye and high altitude

Prevalence of dry eye at high altitude: a case controlled comparative study.
Gupta N, Prasad I, Himashree G, D'Souza P.
High Alt Med Biol. 2008 Winter;9(4):327-34.

High altitude is associated with physiological as well as pathological changes in the eye related to adverse environmental conditions that result in increased tear evaporation and contribute to a higher incidence of dry eye in these regions. We aimed to study the difference in prevalence of dry eye at high altitude and at low altitude. The prevalence of dry eye among the natives and the army soldiers who were recently posted at high altitude was also studied and compared. 200 adults above 20 years of age were enrolled. 100 subjects were recruited at a high altitude region (study group), of which 50 were native Ladakhis and 50 were soldiers recently posted at Leh, Ladakh, India (height; 3300 m above sea level; temperature: 18 degrees C to 24 degrees C). 100 subjects, age and sex matched, were screened at a low altitude region, New Delhi, India (218 m above sea level; temperature: 19 degrees C to 24 degrees C) to serve as the control group. Prevalence of dry eye was assessed through standard questionnaires (McMonnies' Questionnaire (MMI), Ocular Surface Disease Index Questionnaire (OSDI), and Schirmer's basic secretion test. On the basis of the parameters studied (symptoms, MMI, OSDI and Schirmer's test), dry eye was diagnosed in 20% of subjects screened at high altitude and in 9% of subjects in the control group screened at low altitude. In the study group, the prevalence of dry eye was significantly higher amongst the native population (54%) than in the army soldiers who were recently posted at that region (26%). The difference was statistically significant (p < 0.005). In conclusion, dry eye is more common at high altitude, particularly in the native population. Awareness among people residing at high altitude and the treating medical personnel needs to be created for early detection and treatment of dry eye to prevent vision-threatening complications.

Abstract: Ocular surface side effects of systemic isotretinoin

This caught my eye partly because just the other day I spoke with someone who had the rare condition lichenplanus (I gather from a little googling that isotretinoin is used for that in addition to its primary indication of acne).

Conjunctival impression cytology, ocular surface, and tear-film changes in patients treated with systemic isotretinoin.
Cornea. 2009 Jan;28(1):46-50.
Karalezli A, Borazan M, Altinors DD, Dursun R, Kiyici H, Akova YA.

PURPOSE: To evaluate the ocular surface changes and tear-film functions in patients treated with systemic isotretinoin.

METHODS: Fifty subjects treated with 0.8 mg/kg oral isotretinoin were enrolled in this prospective clinical trial. All patients underwent a full ophthalmoscopic examination before, during, and after treatment with isotretinoin. Ocular surface changes of the cell content of the surface conjunctival epithelium were evaluated by conjunctival impression cytology and tear-film functions using the Schirmer test, anesthetized Schirmer test, tear breakup time, and rose bengal staining. Subjective ocular complaints were scored with an Ocular Surface Disease Index questionnaire.

RESULTS: There were no significant differences observed in average Schirmer test scores for patients before, during, or after isotretinoin treatment. Mean anesthetized Schirmer test scores and tear breakup time decreased significantly during treatment (P < 0.001). Mean impression cytology scores, Ocular Surface Disease Index scores, and rose bengal staining scores increased significantly during treatment (P < 0.05, P < 0.001 and P < 0.001, respectively). Blepharitis was seen in 36% of patients. All abnormal findings disappeared 1 month after the cessation of treatment.

CONCLUSIONS: Conjunctival epithelial cells, tear basal secretion, and tear quality are markedly affected in patients during systemic treatment with isotretinoin (0.8 mg/kg). Ocular adverse effects of isotretinoin are generally not serious and are reversible after discontinuation.

Abstract: Volcanos

Golly, what a surprise: If you have dry eye, you probably don't want a volcano in your backyard.

Nurs Res. 2009 Jan-Feb;58(1):23-31.
The Kilauea Volcano adult health study.
Longo BM.

BACKGROUND: Millions of people reside near active volcanoes, yet data are limited on effects to human health. The Kilauea Volcano is the largest point source for sulfur dioxide in the United States, releasing air pollution on nearby communities since 1983. OBJECTIVE:: The objectives of this study were to provide the first population-based epidemiological estimates and qualitative descriptions of cardiorespiratory health effects associated with volcanic air pollution. METHODS: An environmental-epidemiological design was used. Exposure levels of Kilauea's air pollutants were determined by environmental sampling. Prevalence estimates of cardiorespiratory health effects in adults were measured (N = 335) and compared between an exposed and nonexposed reference community. Descriptions of the human-environment interaction with the long-standing eruption were recorded from informants in the natural setting. RESULTS: Ambient and indoor concentrations of volcanic air pollution were above the World Health Organization's recommended exposure levels. There were statistically significant increased odds associated with exposure for self-reported cough, phlegm, rhinorrhea, sore and dry throat, sinus congestion, wheezing, eye irritation, and diagnosed bronchitis. Thirty-five percent of the informants perceived that their health was affected by the eruption, mainly current and former smokers and those with chronic respiratory disease. DISCUSSION: Hypotheses were supported regarding particulate air pollution and the association with adverse cardiovascular functioning. This emerging environmental health issue is under continuing investigation.

Abstract: Nutrition and dry eye

For those that have access to this journal this Part 3 of a series on nutrition and eye disease sounds like a good resource as regards treating lid margin diseases and dry eye.

Nutritional therapies for ocular disorders: Part Three.
Altern Med Rev. 2008 Sep;13(3):191-204.
Gaby AR.

Parts one and two of this series discussed nutritional and botanical treatments for cataracts, glaucoma, and retinal diseases (macular degeneration, diabetic retinopathy, retinopathy of the newborn, and retinitis pigmentosa). This review discusses nutritional treatments for asthenopia, blepharitis, chalazion, conjunctivitis (including giant papillary conjunctivitis), gyrate atrophy of the choroid and retina, keratoconus, myopia, sicca syndrome (dry eyes), and uveitis. The evidence presented in this three-part series indicates natural medicine has an important role to play in the practice of ophthalmology.

Plugs: Anybody tried the FCI "perforated plug" yet?

I'm familiar with the EagleVision Flow Controller plug (the original plug with partial occlusion) but I don't think I've heard any feedback from any doctors or patients who have used the FCI perforated plug. If you have any experience with it please post comments here! Thanks.