Friday, December 21, 2012

Abstract: PCOS & dry eye (or not)

This study seems to have found a much poorer correlation between PCOS and dry eye than one or two earlier ones.

To evaluate the tear osmolarity and ocular surface changes in patients with polycystic ovary syndrome (PCOS).
 Materials and Methods:
Forty-eight patients with recently diagnosed PCOS and thirty-three control volunteers were enrolled in this prospective, observational study. Ocular surface disease index (OSDI) score was calculated. Tear osmolarity was measured using the TearLab Osmolarity System (Tearlab, San Diego, CA, USA). All subjects also underwent the following ophthalmologic evaluation: Schirmer I test, tear-film breakup time (TBUT), ocular surface flourescein staining, and conjunctival impression cytology.
Mean OSDI score was significantly higher in patients with PCOS than control subjects (P = 0.001). Tear osmolarity was similar in both groups (P = 0.404). There were no significant differences between groups in Schirmer I test results, TBUT, and ocular surface flourescein staining scores (P > 0.05). Compared to control group, a statistically significant squamous metaplasia was observed in temporal bulbar conjunctival impression cytology specimens in PCOS group (P = 0.032).
In patients with recently diagnosed PCOS, tear volume and osmolarity are not affected but, conjunctival morphology may be affected, though on a limited scale.

Curr Eye Res. 2012 Dec 18. [Epub ahead of print]
Gonen TCelik COznur MAbali RGonen KAHorozoglu FAksu EKeskinbora KH.
Namik Kemal University School of Medicine, Department of Ophthalmology , Tekirdag , Turkey.

Tuesday, December 18, 2012

another Christmas special

Hm, did eyewear, night wear, what else is there... Aha, lid scrubs.

15% off eyelid cleansing products with this coupon, now through Friday. If you haven't already, try the new tea tree oil one from Eye Eco, only $13.50 before discount.

Abstract: SofZia preservative less unkind than BAK to cornea

Purpose:To assess the effect of SofZia-preserved travoprost on ocular surface conditions in comparison with benzalkonium chloride (BAK)-preserved latanoprost.
 Methods:A prospective randomized multicentre single-masked comparative study. Patients with open-angle glaucoma or ocular hypertension who had been treated with BAK-preserved latanoprost 0.005% (Xalatan(®) ) monotherapy for at least 3months. Patients were enrolled at 23 facilities. Patients were randomly divided into the X-X group, continuous use of Xalatan(®) , or the X-T group, switching from Xalatan(®) to SofZia-preserved travoprost 0.004% (TravatanZ(®) ), and followed for 3months. The superficial punctate keratopathy (SPK), conjunctival epitheliopathy, hyperaemia, tear break-up time (TBUT) and intraocular pressure (IOP) were examined for each patient in a masked manner. Changes in the frequency of keratoconjunctival epitheliopathy were evaluated 3months after study initiation. Intra- and intergroup comparisons of changes in SPK, conjunctival epitheliopathy, hyperaemia, TBUT and IOP were also carried out.
 Results:Two hundred twenty patients participated and 215 completed the 3-month study. The frequency of keratoconjunctival epitheliopathy significantly decreased in the X-T group (p=0.036) and the intergroup difference was also significant (p=0.001). SPK scores and TBUT were significantly improved in the X-T group (p=0.034, 0.049), also with significant intergroup differences in the cornea excluding the inferior area and TBUT. There were no significant intergroup differences in changes of the hyperaemia scores and the IOP reduction.
 Conclusion:Switching to SofZia-preserved travoprost after BAK-preserved latanoprost resulted in a lower incidence of keratoconjunctival epitheliopathy, especially in the cornea, with no clinically relevant changes in hyperaemia and IOP.

Acta Ophthalmol. 2012 Dec 13. doi: 10.1111/j.1755-3768.2012.02565.x. [Epub ahead of print]
Aihara M, Oshima H, Araie M; for the EXTraKT study group.
Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

Thursday, December 13, 2012

Night eye protection sale

Four-day-special... 15% off night eye protection items at the Dry Eye Shop. 

Click on this coupon or type "NightStuff" in the coupon code box.


Abstract: Dry eye--is inflammation just the tip of the iceberg?

Slightly melodramatic title but more reports or studies on platelet-rich plasma are always welcome...

Dry eye syndrome (DES) has been described by The International Dry Eye WorkShop as ''multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear instability with potential damage to the ocular surface.'' Inflammation has been recognized as a primary contributor to the disease and was a tremendous step forward in the description and treatment of DES. Although most treatments of DES treat inflammation, the signs and symptoms of DES usually return shortly after discontinuing the use of the anti-inflammatory agent;
We present a case of a 70-year-old patient who presents with significant dry eye symptoms for 2 years. She reports the need to wear sunglasses during all waking hours, both indoors and out, and had discontinued her hobby of gardening. She had ocular rosacea diagnosed at a previous ophthalmology practice and did not respond to any past treatments. The patient was treated with 25% platelet-rich plasma (PRP) and experienced significant improvement and a return to a normal quality of life that has continued for more than a year after discontinuing treatment;
Our group is investigating the use of biologic therapeutics in the treatment of various forms of DES. We suggest that a clinically acceptable dosage of PRP provides the ocular surface with the components necessary to restore normal cellular tensegrity and provides a foundation to eliminate the recurrence of the inflammation associated with DES.

Optometry. 2012 Mar 30;83(3):111-3.
Jarka ES, Kahrhoff M, Crane JB.
Universityof Missouri-St. Louis College of Optometry, One University Blvd., St. Louis, MO 63121-4400. Email:

Dry Eye Shop now accepts Discover

Don't ask me why, for some reason I just never got around to adding it. Anyway, to all those who have asked me to add it, I finally have!

Wednesday, December 12, 2012

Is this part of why...

...we have so many "treatment failures"?

Superficial discussion of medical stuff in the press totally sets people up with unreasonable expectations. Here's a classic example (article below, headline rather). Lipiflow = the twelve minute miracle? Good grief. Though I think Lipiflow has a really important role to play, it's much more complicated than that and we all know it, yet... we'd all like to believe there's a magic bullet to fix things. 

So people read articles like this, or worse, get over-sold on something by a doctor who's more concerned with amortizing an expensive machine than educating patients, and they get an expensive treatment and when it isn't a miraculous permanent cure for the common cold they talk about what a waste of money it was. Sigh.

…NEW TECHNOLOGY:  A revolutionary way to help treat dry eye syndrome is the LipiFlow Thermal Pulsation System.  It helps treat dry eyes by opening and clearing blocked glands, which in turn will allow the eyes to resume the natural production of oils (lipids) needed for the tear film. It’s a fast procedure that works by applying heat and light pressure to the inside of the eye lid, allowing lipids to be released from the Meibomian glands….

Abstract: The peptides in our tears...

Just for fun... part of our tears you hardly ever hear about:

Tear fluid is a complex mixture of biological compounds, including carbohydrates, lipids, electrolytes, proteins, and peptides. Despite the physiological importance of tear fluid, little is known about the identity of its endogenous peptides. In this study, we analyzed and identified naturally occurring peptide molecules in human reflex tear fluid by means of LC-MALDI-TOF-TOF. Tandem MS analyses revealed 30 peptides, most of which have not been identified before. Twenty-six peptides are derived from the proline-rich protein 4 and 4 peptides are derived from the polymeric immunoglobulin receptor. Based on their structural characteristics, we suggest that the identified tear fluid peptides contribute to the protective environment of the ocular surface.

Peptides. 2012 Dec 7. pii: S0196-9781(12)00483-4. doi: 10.1016/j.peptides.2012.11.018. [Epub ahead of print]
Hayakawa E, Landuyt B, Baggerman G, Cuyvers R, Luyten W, Schoofs L.
Research Group of Functional Genomics and Proteomics, KU Leuven, B-3000 Leuven, Belgium. Electronic address:

Abstract: Testosterone & keratinization of MGs

Another interesting study in the world of hormones and dry eye...

[Article in German]

Extensive keratinization appears to play a major role in the dysfunction of the Meibomian gland. This article presents the potential impact of androgens on limiting keratinization in this tissue, thus, contributing to normal Meibomian gland function and a healthy ocular surface.
Orchidectomized mice were systemically treated with either testosterone or placebo for 2 weeks. The mRNA was then extracted from the Meibomian glands and differential gene expression was investigated by microarray hybridization and evaluation with GeneSifter software as well as gene ontology information from the Gene Ontology (GO) Consortium.
By z-score calculations, keratinization was the most significantly gene ontology term influenced by testosterone based on down-regulated genes in the mouse Meibomian gland. In particular, under the influence of testosterone the genes coding for small proline-rich protein (Sprr) 2a, Sprr 2b, Sprr 3, keratins 6a and 17 and periplakin were significantly down-regulated, while Sprr 1a and Sprr 2f were significantly up-regulated.
Testosterone down-regulates the expression of genes promoting keratinization in the Meibomian gland. This may help to prevent Meibomian gland dysfunction by limiting excessive keratinization of this tissue and the adjacent lid margins. The findings elucidate, at least in part, the beneficial impact of androgens on Meibomian gland function and thus on the health of the ocular surface.

Ophthalmologe. 2012 Dec 8. [Epub ahead of print]
Schirra F, Gatzioufas Z, Scheidt J, Seitz B.
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 1, Geb. 22, 66421, Homburg/Saar, Deutschland,

Abstract: Dry eye slows down your reading

Gosh, couldn'ta guessed that one ;-)

Visual disturbance is a common symptom reported by patients with dry eye disease (DED). The purpose of this study was to evaluate visual performance, including reading speed and contrast sensitivity, in control and DED subjects.
 Fifty-two DED patients (mild, n = 17; moderate, n = 22; severe, n = 13; based on corneal staining and the Ocular Surface Disease Index ≥20) and 20 control subjects (Ocular Surface Disease Index <13 18="18" 19="19" 45="45" 84="84" adjusting="adjusting" age="age" among="among" analysis="analysis" and="and" automated="automated" between="between" br="br" characteristics="characteristics" clinical="clinical" coefficients="coefficients" compare="compare" conducted="conducted" contrast="contrast" control="control" corneal="corneal" correlation="correlation" covariance="covariance" ded="ded" determined="determined" for="for" from="from" groups="groups" holladay="holladay" in="in" linear="linear" measure="measure" measured="measured" no="no" of="of" parameters.="parameters." part="part" partial="partial" patients="patients" ranges="ranges" rate="rate" reading="reading" regression="regression" relationship="relationship" respectively.="respectively." sensitivity="sensitivity" sex="sex" site.="site." speed="speed" staining="staining" study.="study." study="study" subject="subject" system="system" test.="test." the="the" this="this" to="to" took="took" used="used" using="using" was="was" were="were" while="while" wilkins="wilkins" with="with" years="years"> RESULTS:
The log of the minimum angle of resolution visual acuities and contrast sensitivity were not significantly different across subject groups. The DED patients (134.9 ± 4.95 words per minute) exhibited slower reading speeds than the control subjects (158.3 ± 8.40 words per minute, p = 0.046). As DED severity increased, the reading speed decreased (141.0 ± 7.96 words per minute, 136.8 ± 7.15 words per minute, and 127.0 ± 9.63 words per minute in mild, moderate, and severe groups, respectively). Reading rate was found to correlate weakly with corneal staining based on a partial correlation coefficient (-0.345, p < 0.001) but not with other DED parameters.
The reading rate was lower in DED subjects than that in control subjects. As the DED severity increased, the reading rate decreased. This finding is consistent with patient-reported symptoms and provides direct evidence for the impact of DED on reading performance. These findings suggest that reading speed may be used to monitor treatment benefit in DED.

Optom Vis Sci. 2012 Dec 4. [Epub ahead of print]
Ridder WH 3rd, Zhang Y, Huang JF.
*OD, PhD, FAAO †PhD Southern California College of Optometry, Fullerton (WHR); and Pfizer, Inc., La Jolla (YZ, J-FH), California.

Abstract: Clobetasone butyrate

New to me.

To study the effects of a low administration rate and low concentration (0.1%) of clobetasone butyrate eyedrops in patients with Sjögren syndrome (SS).
This prospective, double-masked, randomized, placebo-controlled study included 40 subjects divided into 2 treatment groups: group 1 (2% polyvinylpyrrolidone eyedrops and placebo) and group 2 (2% polyvinylpyrrolidone and 0.1% clobetasone butyrate, 1 drop BID). The treatment lasted for 30 days, with visits at enrollment, baseline, day 15, day 30, and after 15 days of treatment discontinuation. At each visit, symptoms questionnaire, tear film break-up time, corneal fluorescein stain, lissamine green stain, conjunctival impression cytology for human leukocyte antigen-DR (HLA-DR) expression, intraocular pressure (IOP) measurement, and fundus examination were performed.
No changes in IOP or fundus examination were observed in either group at each time point. Group 1 patients showed at day 30 a statistically significant amelioration of symptoms and reduction of HLA-DR expression. No changes in other parameters were detected. Group 2 patients showed at day 15 a statistically significant improvement of corneal and conjunctival stain versus baseline values and group 1 at the same time; after 30 days the symptoms score was statistically significantly better than baseline values and group 1 at the same time. The HLA-DR expression and the epithelial cells area were statistically significantly reduced versus baseline and group 1 at the same time.
Anti-inflammatory therapy is critical for the treatment of SS dry eye. Clobetasone butyrate, at low dosage, proved to be safe and effective in treating this condition.
Eur J Ophthalmol. 2012 Nov 19:0. doi: 10.5301/ejo.5000229. [Epub ahead of print]
Aragona P, Spinella R, Rania L, Postorino E, Sommario MS, Roszkowska AM, Puzzolo D.
Ocular Surface Unit, Department of Surgical Specialties, University of Messina, Messina - Italy.

Abstract: Phytoestrogen supplementation for dry eye

Effects of phytoestrogen supplementation in postmenopausalwomen with dry eye syndrome: a randomized clinical trial.
To evaluate the correlation between tear osmolarity and blood levels of 17-β estradiol, estrone, and testosterone in postmenopausal women with dry eye syndrome, and to assess the efficacy and safety of oral supplementation with phytoestrogens, lipoic acid, and eicosapentaenoic acid in this population.
Cross-sectional study including 66 postmenopausal women with dry eye syndrome.
Sixty-six postmenopausal women with dry eye syndrome were enrolled in a randomized, double-blind, placebo-controlled, crossover study. Patients were divided into 2 groups (groups A and B) and treated, respectively, with phytoestrogen (Bioos, Montegiorgio, Italy) tablets or placebo tablets for 30 days. The 2 treatment periods were separated by a 30-day washout. Patients were examined on days 0 and 30 of each period. Assessments included blood levels of sex hormones, the Schirmer test for tear production, and measurement of tear osmolarity and tear film break-up time.
At baseline, all patients had low sex hormone levels, which were correlated with high tear film osmolarity values (r = -0.59,-0.61,-0.58, respectively). After 30 days of therapy, the group treated with Lacrisek® (Bioos) had significantly decreased tear osmolarity (P < 0.005) and significantly increased tear production evaluated with the Schirmer test and tear film break-up time values (P < 0.001) compared with the placebo-treated group.
Our study confirms that steroid hormones play an important role in ocular surface equilibrium and functions. Consequently, reduced blood levels of these hormones can produce changes at the ocular surface. Phytoestrogen supplementation can significantly improve the signs and symptoms of dry eye syndrome in postmenopausal women.

Can J Ophthalmol. 2012 Dec;47(6):489-92. doi: 10.1016/j.jcjo.2012.08.019.
Scuderi GContestabile MTGagliano CIacovello DScuderi LAvitabile T.
Ophthalmic Clinic II, University of Rome "La Sapienza" San't Andrea Hospital, Rome;; Ophthalmic Clinic II, Medical University of Catania, Catania, Italy. 

Abstract: Restasis the second time around

If at first you don't fricassee, then fry, fry an egg.

Or a hen. Or whatever.

Or so my sister used to (mis)quote.

Might be true for eggs, but I don't know about Restasis. Complicated.

Chronic dry eye disease often requires long-term therapy. Tear film alterations in the setting of dry eye may include reduced tear volume as well as an increase in inflammatory cytokines and osmolarity. Topical cyclosporine ophthalmic emulsion 0.05% (Restasis(®); Allergan Inc, Irvine, CA) is indicated to increase tear production in patients with dry eye and reduced tear production presumed to be due to ocular inflammation. This study was designed to evaluate the efficacy of a second trial of topical cyclosporine in patients with dry eye who were previously considered treatment failures.
This multicenter (three cornea practices) retrospective chart review evaluated clinical outcomes in patients with dry eye who received a second trial of cyclosporine after a prior treatment failure, defined as prior discontinuation of topical cyclosporine after less than 12 weeks.
Thirty-five patients, most of whom were female (71.4%) and Caucasian (62.9%), were identified. Prior discontinuation was most commonly due to burning/stinging (60%). The median duration of second treatment was 10 months (range 1 week to 45 months). Physician education was provided in the second trial in 97.1% of cases. At initiation of the second trial of cyclosporine, 10 (28.6%) patients received courses of topical corticosteroids. Physicians reported on a questionnaire that 80% of patients achieved clinical benefit with a second trial of cyclosporine.
A repeat trial with topical cyclosporine can achieve clinical success. Direct patient education via the physician and staff may be key to success. Proper patient education may overcome adherence issues, particularly with respect to the need for long-term treatment of chronic dry eye. This study has the usual limitations associated with a retrospective chart review, and future prospective studies are warranted.

Clin Ophthalmol. 2012;6:1971-6. doi: 10.2147/OPTH.S30261. Epub 2012 Nov 28.
Mah FMilner MYiu SDonnenfeld EConway TMHollander DA.
University of Pittsburgh, Pittsburgh, PA.

Friday, December 7, 2012

Eyewear special in the Dry Eye Shop

Christmas Special!

This coupon gets you 15% off all eyewear purchases of $50 or more in the shop, from now till midnight on December 11th. If you have any trouble with the link, you can type "EyewearDec12" in the Enter Coupon place.

Enjoy! - For those who haven't been in the shop for awhile, I have a full selection of 7Eye and Wiley-X eyewear now with the removable foam-lined gaskets, in addition to the Tranquileyes Moisture Release glasses and a various low-cost favorites (Onion Goggles, Dustbusters) . You can also use the coupon to stock up on spare eyecups.

Lest anyone get confused - bear in mind eyewear means optical products (glasses/sunglasses), not night eye protection (Tranquileyes and such). But don't worry, I'll be running specials on night eye protection a bit later in the month too.


Abstract: Traditional Chinese medicine in dry eye

Dry eye is a common health problem worldwide, causing significant discomfort and inconvenience to sufferers. The conventional treatment of dry eye via topical administration of eye drops is deemed palliative and unsatisfactory to many. Traditional Chinese medicine (TCM) has shown some promise in dry eye treatment; however, the extent of its use and acceptance is uncertain. We evaluated the knowledge, attitude, and practice of institutional TCM practitioners in the treatment of dry eye in Singapore. A questionnaire was generated to address the study aims and sent to TCM practitioners listed in the Singapore TCM practitioners' board database. About three quarters of respondents thought that dry eye was not severe enough to be a public health burden but most thought that TCM was effective in the treatment of dry eye. Acupuncture and herbal medicine were most commonly used TCM modalities in dry eye treatment, and a single TCM treatment session would be charged S$20-50 by the practitioner. The majority of surveyed institutional TCM practitioners in Singapore believe that TCM is relevant in dry eye treatment. Public awareness should be raised regarding the availability of TCM as alternative medicine for dry eye.

ScientificWorldJournal. 2012;2012:923059. doi: 10.1100/2012/923059. Epub 2012 Nov 8.
Lan W, Lee SY, Lee MX, Tong L.
Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore 168751 ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597.

Wednesday, December 5, 2012

Abstract: BAK, again, and, um, why?

I don't get it.

OK it looks like a well done study with important results.


There are approximately a gajillion published studies on the sins of BAK against the cornea and beyond, and we have to kill more bunnies to re-prove it how many more times? Quit using the durned stuff already. It's not like we don't have other effective preservatives. Oh - ever heard of preservative-free?

We investigated in a rabbit model, the eye distribution of topically instilled benzalkonium_(BAK) chloride a commonly used preservative in eye drops using mass spectrometry imaging. Three groups of three New Zealand rabbits each were used: a control one without instillation, one receiving 0.01%BAK twice a day for 5 months and one with 0.2%BAK one drop a day for 1 month. After sacrifice, eyes were embedded and frozen in tragacanth gum. Serial cryosections were alternately deposited on glass slides for histological (hematoxylin-eosin staining) and immunohistological controls (CD45, RLA-DR and vimentin for inflammatory cell infiltration as well as vimentin for Müller glial cell activation) and ITO or stainless steel plates for MSI experiments using Matrix-assisted laser desorption ionization time-of-flight. The MSI results were confirmed by a round-robin study on several adjacent sections conducted in two different laboratories using different sample preparation methods, mass spectrometers and data analysis softwares. BAK was shown to penetrate healthy eyes even after a short duration and was not only detected on the ocular surface structures, but also in deeper tissues, especially in sensitive areas involved in glaucoma pathophysiology, such as the trabecular meshwork and the optic nerve areas, as confirmed by images with histological stainings. CD45-, RLA-DR- and vimentin-positive cells increased in treated eyes. Vimentin was found only in the inner layer of retina in normal eyes and increased in all retinal layers in treated eyes, confirming an activation response to a cell stress. This ocular toxicological study confirms the presence of BAK preservative in ocular surface structures as well as in deeper structures involved in glaucoma disease. The inflammatory cell infiltration and Müller glial cell activation confirmed the deleterious effect of BAK. Although these results were obtained in animals, they highlight the importance of the safety-first principle for the treatment of glaucoma patients.

PLoS One. 2012;7(11):e50180. doi: 10.1371/journal.pone.0050180. Epub 2012 Nov 27.
Brignole-Baudouin F, Desbenoit N, Hamm G, Liang H, Both JP, Brunelle A, Fournier I, Guerineau V, Legouffe R, Stauber J, Touboul D, Wisztorski M, Salzet M, Laprevote O, Baudouin C.

Careful what you get in your eye...

Would I have noticed this if I weren't raising sheep? Hmmm

A 57-year-old abattoir worker was seen at a general practitioner after sheep bile splashed into his left eye. Flourescein examination revealed extensive ulceration involving at least two-thirds of the corneal surface. Copious irrigation with normal saline, application of chloramphenicol ointment and an eye patch resulted in excellent healing within 2 days with return to normal vision for the patient thereafter.

BMJ Case Rep. 2012 Dec 3;2012. pii: bcr2012007439. doi: 10.1136/bcr-2012-007439.
Okullo AT, Low T, Baker LL.
Blacktown-Mt Druitt Hospital, Sydney, New South Wales, Australia.

Tuesday, December 4, 2012

Abstract: Activities that aggravate dry eye disease

We all know it... just a matter of doing it... e.g.

1) Turn off the A/C and ceiling fans OR put on your MCs
2) Get off the computer
3) Consider audio books
4) Get off the computer
5) Put on your moisture chambers when you go outside
6) Get off the computer

Prolonged visually stressful activities aggravate dry eye disease (DED). The duration spent on such activities and their relationship with DED clinical features were investigated. Patients completed an activity log as they performed their usual activities over 1 typical rest day and 1 typical work day. The log included time spent in an air-conditioned environment, windy environment, driving, watching television, computer use, reading, watching a movie in the theatre, and wearing contact lens. Average daily activity hours were calculated and correlated with clinical features of DED. Thirty-five logs were returned. Positive correlation was found between watching television and episodic blurred vision (P < 0.01). Computer use was negatively correlated with episodic blur vision, burning sensation, and gritty sensation (P < 0.05). Negative correlation was found between time spent in windy environments, driving, reading, and certain DED symptoms (P < 0.05). Reading correlated positively with severity of corneal fluorescein staining and reduced Schirmer's values (P < 0.03). The use of air conditioning correlated negatively with episodic blur vision but positively with visual blurring that improves with lubricants (P = 0.02). This study is the first to evaluate the relationship between time spent on DED-aggravating activities and DED clinical features. Negative correlations between certain activities and DED symptoms suggest an unconscious modification of lifestyle to alleviate symptoms.

ScientificWorldJournal. 2012;2012:589875. doi: 10.1100/2012/589875. Epub 2012 Oct 24.
Iyer JV, Lee SY, Tong L.
Ocular Surface Research group, Singapore Eye Research Institute, Singapore 168751 ; Corneal and External Eye Services, Singapore National Eye Centre, Singapore 168751.

Abstract: Lid hygiene and so on


I appreciate that we don’t want to go overboard pushing more consumer products, BUT, can’t we at least ditch the bleeping baby shampoo already? Why would we want soap of any kind in our eyes when our tear film is so unstable anyway?

Disorders of the lacrimal functional unit are common in ophthalmological practice, with meibomian gland dysfunction, blepharitis, and dry eye forming a significant part of the general ophthalmologist's practice. The eyelid and its associated structures form a complex organ designed to protect the fragile corneal surface and improve visual acuity. This organ is subject to a number of disorders, including meibomian gland dysfunction, dry eye syndrome, anterior blepharitis, allergic and dermatological conditions, and disorders associated with contact lens use. Although commonly described separately, disorders of the lacrimal function unit are better considered as a group of interacting pathologies that have inflammatory mediators as a central feature. Eyelid hygiene, in the sense of routine cleansing and massage of the eyelids, is well accepted in the management of many disorders of the eyelid. However, a broader concept of eyelid health may be appropriate, in which eyelid cleansing is but a part of a more complete program of care that includes screening and risk assessment, patient education, and coaching. The ophthalmologist has an important role to play in helping patients persist with routine eyelid care that may be long-term or lifelong. A number of preparations exist to make routine eyelid care both more effective and more pleasant, and might also improve compliance. Several such preparations have been devised, and are being assessed in clinical studies, and appear to be effective and preferred by patients over traditional soap and water or baby shampoo.

Clin Ophthalmol. 2012;6:1689-98. doi: 10.2147/OPTH.S33133. Epub 2012 Oct 25.
Benitez-Del-Castillo JM.
Ocular Surface and Inflammation, Department Ophthalmology, Hospital Clinico San Carlos, Madrid, Spain.


I like wordplay and all that, but, er, this is kind of getting ridiculous.

Abstract: Oral contraceptives, contact lenses and dry eye

PURPOSE:: The aim of this study was to examine the relationship among oral contraceptive pill (OCP) use, contact lens wear, and dry eye signs and symptoms in healthy young women.
 METHODS:: Fifty-two women using OCPs and 45 women not using any form of hormonal contraception were enrolled. Medical, menstrual, and contact lens histories were obtained and dry eye symptoms assessed using the Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE) questionnaires. Tear osmolarity testing was performed using the TearLab Osmolarity System.
 RESULTS:: The mean age of all subjects was 26.0 ± 3.7 years. There were no significant differences in any of the measurements between the follicular and luteal phases. Although SANDE scores were significantly higher in subjects with OCP and recent contact lens use (P < 0.01), there were no significant differences in OSDI and tear osmolarity among the same subject groups. Subjects who reported both OCP and recent contact lens use had significantly higher OSDI and SANDE scores (P = 0.015 and P < 0.001, respectively).
 CONCLUSIONS:: There were no differences between the phases of the menstrual cycle. Tear osmolarity was not affected by OCP or contact lens use in young women. However, the combination of OCP use and contact lens wear may increase the severity of dry eye symptoms.

Cornea. 2012 Oct 18. [Epub ahead of print]
Chen SP, Massaro-Giordano G, Pistilli M, Schreiber CA, Bunya VY.
Departments of *Ophthalmology †Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Abstract: Tear film osmolarity in patients taking IOP lowering meds

To evaluate tear film osmolarity in patients treated with intraocular pressure-lowering medications.
Forty patients treated for glaucoma or ocular hypertension (OHT) were consecutively recruited for the study. Each patient was asked to complete an evaluation of ocular surface disease symptoms, the Ocular Surface Disease Index, and underwent a complete evaluation of the ocular surface including measurement of tear film osmolarity, Schirmer test, tear breakup time (TBUT), and corneal and conjunctival staining.
Twenty-four patients (60%) reported ocular surface disease symptoms. Nineteen patients (47.5%) had a tear osmolarity ≤308 mOsms/L, 11 (27.5%) between 309 and 328 mOsms/L, and 10 (25%) >328 mOsms/L. A tear deficiency was observed in 20 patients (50%). Twenty-seven patients (67.5%) had an abnormal tear quality analyzed with TBUT, and 16 patients (40%) showed positive staining using the Oxford schema. Tear osmolarity was significantly correlated to Ocular Surface Disease Index (r = 0.486; P = 0.002) and TBUT (r = -0.49; P = 0.009). There was a statistically significant correlation between tear osmolarity and the number of drugs (r = 0.409; P = 0.009), the number of instillations (r = 0.405; P = 0.01), and the number of instillations of preserved eye drops (r = 0.629; P < 0.0001). Using the multiple regression method, tear osmolarity remained significantly correlated to the number of instillations of preserved eye drops (P = 0.004).
Tear osmolarity was increased in patients treated for glaucoma or OHT, particularly in those using multiple preserved eye drops. The evaluation of the ocular surface of patients treated for glaucoma or OHT may benefit from such analysis, and future trials for new intraocular pressure-lowering eye drops should thus evaluate tear osmolarity.

Cornea. 2012 Sep;31(9):994-9. doi: 10.1097/ICO.0b013e31823f8cb6.
Labbé A, Terry O, Brasnu E, Van Went C, Baudouin C.
Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.

Abstract: Sclerals instead of tarsorrhaphy

This is one of those studies where just reading the title makes me go "Ahhhh" as I feel muscles relaxing:

...especially since I've been noticing this year, to my horror, that tarsorrhaphy seems to be coming back into vogue. My emphases below:
PURPOSE:: Most ophthalmologists are unaware of the therapeutic applications of gas-permeable scleral contact lenses for the prevention and treatment of ocular complications in patients with facial nerve palsy and concomitant neuroparalysis.

METHODS:: The case reports refer to 3 patients who developed unilateral lagophthalmos and corneal anesthesia after an acoustic neuroma or intracranial tumor resection. Two patients explicitly requested a tarsorrhaphy to be opened because they were incapacitated by the limited visual acuity and visual field. Tarsorrhaphy was not an acceptable aesthetic solution for the third patient. Fluid-ventilated scleral lenses were fitted because they protect the cornea by creating a precorneal fluid reservoir while optimizing visual acuity.
 RESULTS:: The follow-up periods were 3, 17, and 18 years. Two patients wear the contact lenses full time, but the wearing time is limited to 10 hours per day for the third patient. All patients were instructed not to wear their lenses while sleeping. Two eyes required a corneal transplant, but lens wear could be resumed 4 to 6 weeks after transplantation. The learning curve for the insertion and removal of this large-diameter lens is the main obstacle for a patient, especially when there is loss of corneal sensation. 
CONCLUSION:: Scleral lens wear is a valid long-term alternative to standard treatment options such as tarsorrhaphy for patients with corneal exposure and corneal anesthesia as a consequence of postsurgery facial nerve paralysis. Scleral contact lenses provide these patients with effective protection of the ocular surface in an aesthetically acceptable way while optimizing visual function.
 Good show.

Cornea. 2012 Oct 15. [Epub ahead of print]
Weyns M, Koppen C, Tassignon MJ.
*Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium †Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.