Friday, October 28, 2011

Abstract: Pollution and the tear film

Can air pollution affect tear film stability? A cross-sectional study in the aftermath of an explosion accident.

After an explosion and fire in two tanks containing contaminated oil and sulphur products in a Norwegian industrial harbour in 2007, the surrounding area was polluted. This caused an intense smell, lasting until the waste was removed two years later. The present study reports examinations of tear film break up time among the population. The examinations were carried out because many of the people in the area complained of sore eyes. The purpose of the study was to assess the relationship between living or working close to the polluted area and tear film stability one and a half years after the explosion.

All persons working or living in an area less than six kilometres from the explosion site were invited to take part in the study together with a similar number of persons matched for age and gender living more than 20 kilometres away. Three groups were established: workers in the explosion area and inhabitants near the explosion area (but not working there) were considered to have been exposed, and inhabitants far away (who did not work in the explosion area) were considered to be unexposed. A total of 734 people were examined, and the response rate was 76 percent. Tear film stability was studied by assessing non-invasive break-up time (NIBUT) using ocular microscopy. In addition Self-reported Break Up Time (SBUT) was assessed by recording the time the subject could keep his or hers eyes open without blinking when watching a fixed point on a wall. Background information was obtained using a questionnaire. Non-parametric Wilcoxon-Mann-Whitney-tests with exact p-values and multiple logistic regression analyses were performed.

Both NIBUT and SBUT were shorter among the male exposed workers than among the inhabitants both near and far away from the explosion area. This was also found for SBUT among males in a multiple logistic regression analysis, adjusting for age and smoking.

Reduced tear film stability was found among workers in an area where an explosion accident had occurred.

BMC Public Health. 2011 Apr 14;11:235.
Moen BE, Norbäck D, Wieslander G, Bakke JV, Magerøy N, Granslo JT, Irgens A, Bråtveit M, Hollund BE, Aasen T.
Occupational and Environmental Medicine, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.

Abstract: Rheumatoid arthritis and dry eye

[Ocular involvement and its' manifestations in rheumatoid arthritis patients].
[Article in Hebrew]

To study the type, occurrence and nature of ocular involvement amongst patients with rheumatoid arthritis (RA), and to identify demographic, clinical and/or laboratory variables associated with eye involvement in RA. RESEARCH TYPE: Cross sectional research, retrospective

The research was conducted among 61 patients diagnosed with rheumatoid arthritis. The subjects were recruited for the research during their periodic visits to the Soroka Hospital Rheumatology Clinic. Comprehensive rheumatologic tests were administered and general health was examined with a prepared questionnaire. Additionally, the subjects' personal files were examined with data collected from general serum rheumatologic tests and details regarding medications administered. The patients were given a comprehensive eye examination, including a visual acuity examination, test for anterior and posterior fragments, a slit lamp examination after pupil dilation, for epithelial cell filaments, tests for dry eye symptoms, including a Schirmer's test, a tear breakup time test, and a corneal examination for epithelial cells and the existence of superficial punctate keratopathy. The subjects were also questioned regarding their dry eye syndrome and a specular microscopy test was performed. The assembled data was processed and analyzed with the aim of finding correlations between the subjective and objective sensations of dry eye symptoms and the activity of rheumatoid arthritis disease, blood tests, medications taken, and the patient's general state of health.

The majority of the research subjects (90.2%) were women. Their average age was 51.9 +/- 13.21 years; 31.1% of the subjects complained of eye dryness and, during the eye examination, 85% were found to be suffering from dry eye. The study found a correlation between the objective indicators of keratitis sicca and the following parameters: laboratory values for SGOT (p < 0.03), ESR (p < 0.05), Cr (p < 0.05), TG (p < 0.03), LDL (p < 0.02), Hb (p < 0.01), ALP (p < 0.01), in addition to prednisone medication (p < 0.03, df = 2, x2 = 7.02) and methotrexate (p < 0.03, df = 2, x2 = 8.88). No correlation was found with the following parameters: age, disease duration, smoking, disease severity, other background diseases, and additional laboratory findings including RF and ANA measurements, and consuming other anti-rheumatoid arthritis medications. Similarly, no relation was found with the patients' various subjective syndromes. The average results of the specular microscopy test were 2116.15 +/- 416.59 for the right eye and 2125.67 +/- 446.14 for the left eye.

The significance of the specular microscopy test results is that corneal damage found in rheumatoid arthritis patients occurs only to the external layer and does not affect the endothelial layer. The study indicates that keratitis sicca is prevalent among rheumatoid arthritis patients and must be taken into account regardless of the degree that the disease has progressed, because the severity of the dryness is not dependent on disease progression. Additionally, a discrepancy exists between the patients' subjective sensation of their eye condition and the objective findings of the study.

Harefuah. 2011 Sep;150(9):713-8, 751.
Markovitz E, Perry ZH, Tsumi E, Abu-Shakra M.
Department of Ophthalmology, Shaare-Zedek Medical Center, Ben-Gurion.

Wednesday, October 26, 2011

Abstract: Systemic drugs and dry eye

Non-hormonal Systemic Medications and Dry Eye.

Many drugs used for chronic illnesses can contribute to dry eye syndrome, and elderly patients who have dry eye may concurrently be on systemic medications that worsen the condition. Such medications include anticholinergic drugs, eg, antidepressant, antipsychotic, anti-Parkinson's disease, and antihistamine drugs. Other drugs such as anti-acne preparations and antihypertensives can also cause dry eye. In some cases, the adverse effects of the drug on dry eye is dose-related and can be relieved by reducing the dosage. Alternatively, a different drug within the same drug family may alleviate the dry eye problem. Awareness of the drugs that contribute to dry eye will allow ophthalmologists and other physicians to better manage patients who have this common problem.

Ocul Surf. 2011 Oct;9(4):212-26.
Wong J, Lan W, Ong LM, Tong L.
From the Department of Ophthalmology, Tan Tock Seng Hospital.

Abstract: Osmolality and tear film dynamics

Osmolality and tear film dynamics.

The tear film is a nourishing, lubricating and protecting layer that bathes the ocular surface. It is continuously replenished through cycles of production and elimination via evaporation, absorption and drainage. These processes are often referred to as tear film dynamics. Osmolality is an objective clinical measurement that provides insight into the balance of these complex tear film dynamics. Balanced tear production and elimination is vital for tear film integrity, stability and normal osmolality. Imbalances cause alterations of the tear film structure and composition, ultimately leading to tear film instability and measurable tear film hyperosmolality. Elevated tear film osmolality is considered a core mechanism in dry eye, forming the basis of dry eye symptoms and leading to ocular surface damage. Despite its immense potential in the diagnosis of dry eye, tear film osmolality is not commonly assessed. This review will focus on the current knowledge of tear film dynamics and tear film osmolality.

Clin Exp Optom. 2011 Oct 25. doi: 10.1111/j.1444-0938.2011.00634.x. [Epub ahead of print]
Stahl U, Willcox M, Stapleton F.
Vision Cooperative Research Centre, Sydney, Australia School of Optometry and Vision Sciences, University of New South Wales, Sydney, Australia Institute for Eye Research, Sydney, Australia. E-mail:

Abstract: Looking at MGs of GvHD patients with a confocal

Morphologic evaluation of meibomian glands in chronic graft-versus-host disease using in vivo laser confocal microscopy.

To evaluate the morphological changes of the meibomian glands (MGs) using in vivo laser confocal microscopy (CM) in dry eye (DE) patients with chronic graft-versus-host disease (cGVHD).

Seventeen eyes from 9 patients with a diagnosis of DE associated with cGVHD (DE/cGVHD group; 6 males, 3 females; median 50.5 years) and 16 eyes of 8 hematopoietic stem cell transplantation (HSCT) recipients without DE (non-DE/non-cGVHD group; 5 males, 3 females; median 47.0 years) were enrolled. CM was used to investigate the MG and MG acinar unit density (MGAUD), MG acinar longest diameter (MGALD), MG acinar shortest diameter (MGASD), and the fibrosis grade. Clinical findings of the lid margin were obtained. Tear dynamics, ocular surface vital staining, meibography, and MG expressibility were also examined. Data were compared between the 2 groups using the unpaired t and Mann-Whitney tests.

The mean MGAUD value was significantly lower in the DE/cGVHD group than in the non-DE/non-cGVHD group (p=0.01, 57.8±38.3 glands/mm(2), 88.8±26.6 glands/mm(2), respectively), and the mean MGALD and MGASD were significantly shorter in the DE/cGVHD group than in the non-DE/non-cGVHD group (p=0.0018, 37.3±24.4 μm and 60.4±11.8 μm, p=0.0106, 17.7±11.8 μm and 26.6±6.03 μm, respectively). The mean fibrosis grade was significantly higher in the DE/cGVHD group than the non-DE/non-cGVHD group (p<0.0001, 1.39±0.71 grade, 0.06±0.25 grade, respectively). Clinical findings in the lid margin, tear dynamics, and ocular surface findings were significantly worse in the DE/cGVHD group than in the non-DE/non-cGVHD group.

CM clearly depicted the morphological changes of the MG in the DE/cGVHD group, and revealed the severity of the meibomian gland dysfunction. Patients with severe DE after HSCT showed atrophic MG and excessive fibrosis.

Mol Vis. 2011;17:2533-43. Epub 2011 Sep 29.
Ban Y, Ogawa Y, Ibrahim OM, Tatematsu Y, Kamoi M, Uchino M, Yaguchi S, Dogru M, Tsubota K.

Abstract: The use of punctal plugs in children

The use of punctal plugs in children.

To evaluate the safety and efficacy of punctal plugs in children with dry eye syndrome.

A retrospective case series of patients who had an insertion of silicone punctal plugs for dry eye syndrome. Data collected included presenting symptoms, signs, systemic disorders if present, type of anaesthesia and complications by the time of last follow-up.

Twenty-five patients (median age at insertion 7 years, range 1.5-13.8 years) were identified. Median follow-up was 18 months. The commonest symptoms were photophobia, soreness and blepharospasm, and the commonest sign was punctate epithelial erosions. Concurrent systemic disease was present in 18/25 patients. Repeated procedures were carried out in eight of 25 patients. Twenty-four of 35 insertions were performed under general anaesthesia. A substantial improvement in ocular surface disease was noted in all cases: frequency of lubricant use was reduced in eight of 25 and visual acuity improved in 15/25 patients. Spontaneous extrusion was the commonest complication and occurred within 6 months in 19% of cases.

Dry eye syndrome in children is often accompanied by systemic disease, so in a child with persistent symptoms this should be explored. Punctal plugs offer a safe and effective form of treatment especially as compliance of frequent lubrication is limited in children.

Br J Ophthalmol. 2011 Oct 22. [Epub ahead of print]
Mataftsi A, Subbu RG, Jones S, Nischal KK.
Great Ormond St Hospital for Children, London, UK.

Monday, October 24, 2011

Abstract: Plasma rich in growth factors

Important topic... have been hearing from more patients recently pursuing these alternatives to classic autologous serum.

Efficacy of Plasma Rich in Growth Factors for the Treatment of Dry Eye.
To evaluate the efficacy of plasma rich in growth factors (PRGF) for the treatment of moderate/severe dry eye.

PRGF treatment was administered to 16 patients who had moderate/severe dry eye diagnosed and who had not responded previously to other standard treatments. We quantified several growth factors present in the PRGF of each patient and obtained quantitative registers of the symptoms (modified score dry eye questionnaire), both before and after PRGF treatment. We also performed impression cytology to determine the degree of squamous metaplasia before and after PRGF treatment.

PRGF treatment was associated with a statistically significant improvement in score dry eye questionnaire values (P < 0.001). Results from impression cytology corroborated this improvement, but the reduction in the degree of squamous metaplasia was not statistically significant. In 75% of patients treated with PRGF, no further treatments were required, whereas in the remaining 25% other ocular treatments could be reduced.

PRGF led to symptom improvement in patients with moderate/severe dry eye. Surprisingly, the symptoms recorded in the dry eye questionnaire do not always agree with the degree of squamous metaplasia measured by impression cytology.

Cornea. 2011 Oct 15. [Epub ahead of print]
López-Plandolit S, Dsci MC, Freire V, Grau AE, Durán JA.
From the Instituto Clínico-Quirúrgico de Oftalmología, Bilbao, Vizcaya, Spain.