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Objectives: To evaluate sarcoidosis-induced tear film changes using subjective and objective diagnostic tests, particularly conjunctival impression cytology (IC), and to compare the results with healthy individuals. Materials and Methods: This study evaluated clinical data collected between January 2019 and January 2021 from 57 right eyes of 57 sarcoidosis patients without ocular involvement (Group 1) and 33 right eyes of 33 healthy individuals with similar demographic characteristics (Group 2). The Schirmer I test, tear break-up time (TBUT), fluorescein staining, and conjunctival IC were all performed as part of the conjunctival and corneal examinations following a thorough ophthalmological examination. The Ocular Surface Disease Index (OSDI) was used to assess subjective ocular symptoms. Results: The mean ages in Groups 1 and 2 were 49.26±3.18 and 51.91±2.89 years, respectively (p=0.720). The mean Schirmer I test, TBUT, and OSDI scores differed significantly (p<0.05 for all), with Group 1 having a significantly higher percentage of dry eyes than Group 2. Group 1 had significantly higher Nelson's grading system grades than Group 2 based on conjunctival IC analysis (p=0.001). There were no significant differences in visual acuity (p=0.17) or intraocular pressure (p=0.14) between groups. Conclusion: Sarcoidosis patients had significantly higher Nelson grades in conjunctival IC, as well as significantly higher percentages of dry eye as determined by the Schirmer I test, TBUT, and OSDI. Reduced tear quantity and quality may destabilize the tear film layer, resulting in a variety of ocular symptoms.

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Dry eye has two basic subdivisions: aqueous deficient dry eye (ADDE), with SS a major cause; and evaporative dry eye (EDE), due to either intrinsic or extrinsic factors. SS is a chronic inflammatory disorder defined by dysfunction of the exocrine glands leading to dry eye and dry mouth. The objective of this article was to carry out a systematic and critical review of several scientific publications on dry eye disease, with the aim of providing general recommendations to distinguish dry eye and its different variants in patients with SS, during the period 1979 to 2020, using search engines for articles indexed in Scopus, Latindex, Scielo, Clinical Trials, Medline, Embase, and Cochrane, allowing the analysis of 132 articles published in indexed journals on the subject of dry eye disease and SS, evidencing its conceptualization, prevalence, risk factors, etiopathogenesis, clinical manifestations, diagnosis, and treatment.

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BACKGROUND: To compare the Ocular surface disease index (OSDI) score, Schirmer I test (SIT), fluorescein break up time (FBUT) and fluorescence staining (FLCS) score of dry eye patients at different ages. METHODS: 90 eyes of 90 patients with mild to moderate dry eye from September 2020 to September 2021 were retrospectively included and were divided into young group (20-39 years, n = 29), middle-age group (40-59 years, n = 30), and elder group (> 60 years, n = 31). Patients were given a 28-day topical lubricating ocular surface and repair-promoting drugs combined with local physical therapy. Patients were followed up at 7, 14 and 28 days. The OSDI score, SIT, FBUT and FLCS score were examined. RESULTS: There were differences between the OSDI score in three groups at each time point (all P < 0.001). SIT were different among the three groups (F = 350.61, P < 0.001), and a time effect was found (F = 80.87, P < 0.001). SIT at 14 and 28 days after treatment in middle-age and elder groups were lower than young group (all P < 0.001). SIT at 7, 14 and 28 days in elder group were lower than middle-age group (all P < 0.001). FLCS score was lower at 28 days than other time points (all P < 0.001). CONCLUSION: Dry eye patients are given a 28-day topical lubricating ocular surface and repair-promoting drugs combined with local physical therapy, which can promote tear secretion, film stability, and the recovery of corneal integrity. Age affects the treatment effect of mild to moderate dry eye, among which tear secretion is the most significant.

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BACKGROUND: The objective of this study was to validate an animal model for dry eye during and after the administration of 1% ophthalmic atropine sulfate (OAS) in New Zealand white (NZW) rabbits. METHODS: OAS (1%) was applied three times per day to 30 eyes of 15 healthy NZW rabbits. Sacrifice, enucleation, and lacrimal gland removal took place on days 15, 21, and 30 (OAS group). A second group (n = 5) was used as control. Clinical evaluations took place on days 3, 10, 15, 18, 21, 24 and 30. The primary endpoints were: Schirmer I test, tear break-up time (TBUT), and corneal fluorescein staining. As secondary endpoints, clinical changes including intraocular pressure, and histopathology were evaluated. RESULTS: While OAS was administered, the Schirmer I test showed a statistically significant reduction for OAS group versus control (p < 0.001), and versus basal production (p < 0.001). TBUT showed statistically significant differences between groups (days 3 and 10; p = 0.001) and versus basal values (day 3; p < 0.001). Fluorescein staining showed a statistically significant difference (day 3; p = 0.001). The most frequent clinical finding was conjunctival hyperemia (76.9% OAS vs. 20% control). For histopathology, all OAS subjects presented some degree of inflammation (86.7% minimal; 13.3% mild) whereas the control presented only 30% minimal inflammation. Goblet cell density showed no difference. CONCLUSIONS: The effectiveness of the OAS dry eye model in NZW rabbits as reported in previous studies was confirmed, provided that the application of the drug is maintained throughout the intervention; it is not a viable model after OAS administration is suspended.

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BACKGROUND: To study the effects of aerobic exercise (AE) on tear secretion and tear film stability in dry eye patients. METHODS: This study consisted of two parts, each part included 3 groups, namely dry eye without AE group, dry eye with AE group and pre-clinical dry eye with AE group. In part 1, we studied the variations of Schirmer I test and six tear compositions before and after AE (34 eyes in each group). In part 2, we studied the variations of tear meniscus height, first and average non-invasive tear breakup time (F-NITBUT and A-NITBUT), lipid layer thickness, number of incomplete and complete blinks, partial blink rate (PBR) and visual acuity before and after AE (30 eyes in each group). RESULTS: In dry eye with AE group, Schirmer I test at 0 min after AE increased significantly compared to baseline (P < 0.001), the oxidative stress marker 8-hydroxy-2'-deoxyguanosine after AE decreased significantly compared to baseline (P = 0.035, P = 0.045), F-NITBUT and A-NITBUT after AE prolonged significantly compared to baseline (P < 0.001, P = 0.007, P = 0.036; P < 0.001, P = 0.001, P = 0.044), number of incomplete blinks and PBR at 10 min after AE decreased significantly compared to baseline (P < 0.001; P < 0.001) while number of complete blinks increased significantly (P < 0.001). Besides, significant differences were also found between dry eye with AE group and dry eye without AE group at all above corresponding time point (P < 0.05). CONCLUSION: AE promotes tear secretion and improves tear film stability in dry eye patients. AE may be a potential treatment for dry eye. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000038673 . Registered 27 September 2020.

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PURPOSE: The objective of this study was to examine the effects of alopecia areata (AA) on the ocular surface and conjunctival cytology. METHODS: A total of 48 subjects were included in the present study. Twenty-three subjects were assigned to group 1 as the patient group, and 25 healthy individuals were included in group 2 as the control group. The ocular surface examination was performed, and the right eyes of all participants were included in the analysis. Both groups underwent the following tests for evaluation of ocular surface: tear break-up time (TBUT), Schirmer I test, Ocular Surface Disease Index (OSDI), and conjunctival impression cytology (CIC). Results obtained from the tests were then analyzed and compared between the groups. RESULTS: The mean TBUT value was significantly lower in Group 1 compared to Group 2 (4.96 ± 3.4 vs 10.52 ± 4.8 s) (p < 0.001). There was no significant difference between Group 1 and Group 2 in terms of the mean Schirmer I test score (p = 0.129). The mean OSDI score was higher in Group 1 compared to Group 2 (15.48 ± 10.4 vs 9.61 ± 13.4), but the difference between both groups was not statistically significant (p = 0.1). The mean CIC score was statistically significantly higher in Group 1 than in Group 2 (1.65 ± 0.7 vs 0.52 ± 0.5) (p < 0.001). CONCLUSION: The results of this study showed that AA was correlated with significant disturbances in conjunctival cytology and the tear function.

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ABSTRACT: Acupuncture is an ancient Chinese form of therapy that involves needle stimulation of specific points on the body for therapeutic and homeostatic effects. In ophthalmology, acupuncture helps as a conventional or adjuvant therapy for numerous eye disorders, including myopia, strabismus, dry eye, and cataracts. This study aimed to evaluate the effect of acupuncture on tear production (TP) and intraocular pressure (IOP) in horses. Ten healthy horses, females and males with ages varying between eight months and nine years, were used. Schirmer's I test and applanation tonometry were used to evaluate the basal TP and IOP of both eyes. The measurements were taken immediately before (T10) the insertion of the needles and 5 (T5), 15 (T15), 30 (T30) and 60 (T60) minutes and 24 (T24) hours after a 20-minute acupuncture session. Mean values of both eyes were analyzed over time. TP increased in 50% of the animals at T5, T15 and T24, in 30% at T30, and in 40% at T60, with an increase of up to 8.5 mm/min at T15 and T60. In addition, there was a significant difference between T24 and T30, with a 14.1% increase in TP at T24. Meanwhile, IOP decreased in 50% of the animals at T5 and T30, in 20% at T15, in 60% at T60, and in 70% at T24. Thus, we suggest that acupuncture is a technique that can benefit horses with diseases that alter these parameters, either alone or as an adjunct in conventional therapeutic protocols.

RESUMO: A acupuntura é uma terapia milenar de origem chinesa que funciona através da estimulação de pontos específicos do corpo com agulhas, visando efeitos terapêuticos e homeostáticos. Na área de oftalmologia a acupuntura tem auxiliado como terapia convencional ou adjuvante de inúmeras afecções oculares, incluindo miopia, estrabismo, olho seco, catarata, entre outras. Esse estudo teve como propósito avaliar o efeito da acupuntura no comportamento da produção lacrimal e da pressão intraocular em equinos. Utilizou-se 10 equinos hígidos, fêmeas e machos, com idades variando entre oito meses e nove anos. O teste lacrimal de Schirmer tipo I e da tonometria de aplanação foram utilizados para avaliar a produção basal de lágrima (PL) e a pressão intraocular (PIO) de ambos os olhos. As aferições foram realizadas imediatamente antes da inserção das agulhas (T0) e cinco (T5), 15 (T15), 30 (T30) e 60 (T60) minutos e 24 (T24) horas após sessão de acupuntura de 20 minutos. Os valores obtidos foram analisados quanto ao seu comportamento ao longo do tempo, utilizando-se a média dos dois olhos de cada animal. A PL aumentou em 50% dos animais em T5, T15 e T24, 30% dos animais em T30 e 40% dos animais em T60, com aumento de até 8,5 mm/min em T15 e T60. Além disso, observou-se diferença significativa entre o T24 e o T30 (p = 0,0128), com aumento de 14,1% na PL no T24. Com relação à PIO, notou-se que 50% dos animais sofreram redução na pressão em T5 e T30, 20% dos animais redução em T15, 60% dos animais em T60 e 70% dos animais apresentaram redução em T24. A estimulação dos acupontos relacionados ao sistema visual foi capaz de aumentar a produção lacrimal e diminuir a pressão intraocular em equinos sadios. Dessa maneira, sugere-se que a acupuntura é uma técnica que poderá trazer benefícios a cavalos portadores de doenças que cursam com a alteração desses parâmetros, tanto quando empregada isoladamente, como quando adjuvante a protocolos terapêuticos convencionais.

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OBJECTIVE: To evaluate the correlations between Single-Photon Emission Computed Tomography (SPECT) parameters of salivary glands and dry eye parameters in patients with Sjögren's syndrome (SS). METHODS: A total of 28 patients with SS participated in this prospective study. Dry eye assessments include tear film break-up time (TBUT), corneal fluorescein staining scoring (CFS), Schirmer's I test (SIT) examination and SPECT of salivary gland. The following quantitative parameters were derived from SPECT imaging for salivary glands: Uptake index (UI), the time needed to achieve the minimum counts after Vit C stimulation (Ts), and excretion fraction (EF). The relation between the aforementioned parameters and TBUT, CFS and SIT were analyzed with SPSS 22.0 software. RESULTS: All the 28 eyes of the 28 subjects were examined. The mean SIT was 6.04 ± 4.64 mm/5 min (0-18 mm/5 min); the mean CFS was 3.07 ± 2.65 (0-10) and the mean BUT was 2.11 ± 1.97 s (0-9 s). The mean EF value was 0.52 ± 0.12 (0.26-0.75) in parotid glands and 0.45 ± 0.10 (0.30-0.67) in submandibular glands, respectively. The mean UI value was 9.33 ± 1.68 (6.03-13.20) in parotid glands and 9.92 ± 1.48 (7.08-12.60) in submandibular glands, respectively. The mean Ts (min) was 5.32 ± 3.01 (2.00-12.00) in parotid glands and 11.09 ± 7.40 (2.00- 29.00 min) in submandibular glands, respectively. It was found that EF positively correlates with SIT in patients with SS (r = 0.499 and 0.426 in parotid glands and submandibular glands, with P < 0.05), while no significant correlation was found between the UI, Ts and CFS, TBUT (P > 0.05). CONCLUSIONS: The EF was positively correlated with SIT in patients with SS, it could reflex the dysfunction of salivary glands in SS patients. So, EF may be a valuable parameter for the diagnosis of SS patients with lacrimal gland secretion dysfunction.

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OBJECTIVE: To observe the effect of acupuncture on expression of transforming growth factor-ß1(TGF-ß1) in lacrimal gland of rabbits with dry eye, so as to explore its underlying mechanism in improving dry eye. METHODS: Healthy male New Zealand rabbits were randomly assigned to 5 groups (n=6 in each group), namely, blank group, model group, western medicine group, acupuncture group and sham acupuncture group. The dye eye rabbit model was estabilished by subcutaneous injection of Scopolamine Hydrobromide solution for 21 days. After modeling, rabbits in the western medicine group were treated with Flumirone eye drops in their eyes 3 times a day, one drop each time. Rabbits of the acupuncture group reveived electroacupuncture(4 Hz/20 Hz, 1 mA) at "Cuanzhu"(BL2) and "Tongziliao"(GB1) for 15 min, and received acupuncture at "Jingming"(BL1), "Taiyang" (EX-HN5) and "Sizhukong"(TE23) for 15 min, once a day. Rabbits of the sham acupuncture group received blunt acupuncture at the surface of the same acupoints once a day. All the treatments were conducted for 14 days. The changes of tear flow, tear film break-up time (BUT) and lacrimal gland morphology in each group were observed. The expression of TGF-ß1 protein and mRNA in lacrimal gland were detected by Western blot and quantitative real-time fluorescence PCR respectively. RESULTS: Following modeling, except for the blank group, the tear flow and BUT in other 4 groups decreased significantly (P<0.01). Compared with their own pretreatment, the tear flow and BUT in western medicine group and acupuncture group increased after the treatment (P<0.05). Compared with the model group, the tear flow and BUT increased in the western medicine group and the acupuncture group(P<0.05). Atrophic lacrimal epithelial cells and the stroma of mucous membrane infiltrated by lymphocytes and plasma cells were found in rabbits of the model group and the sham acupuncture group. By contrast, in the western medicine group and the acupuncture group, the structure of lacrimal epithelial cells was basically normal, and the infiltration of lymphocytes and plasma cells were scattered in the stroma of mucous membrane. In comparison with the blank group, the expression of TGF-ß1 protein and mRNA in lacrimal gland were significantly up-regulated in the model and sham acupuncture groups (P<0.01). Compared with the model group, the expression of TGF-ß1 protein and mRNA were significantly down-regulated in the western medicine and acupuncture groups (P<0.01, P<0.05). CONCLUSION: Acupuncture intervention can increase tear flow and BUT in rabbits with dry eye, which may be related to the regulation of TGF-ß1 expression in lacrimal gland.

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The aim of the study was to analyze the prevalence of ocular demodicosis and ocular surface conditions in patients selected for cataract surgery. Eyelashes from 73 patients selected for cataract surgery were evaluated at × 40 and × 100 magnification using light microscopy. The anterior segment was assessed with the slit lamp. Additionally, Schirmer I and break up time (BUT) tests were carried out before surgery and 1 and 3 months postoperatively. A specially designed questionnaire containing e.g. information about chronic skin and eye diseases, previous ophthalmic surgeries, and patient's hygiene habits was used to assess the demographic variables. A majority of patients were at the age of 70-79 years, and there were more females (83%) in the study group. Demodex folliculorum was found in 48% of the patients. There was a correlation between the number of parasites and the presence of blepharitis, discharge at eyelid margins, and conjunctival hyperemia. Schirmer I and BUT test results were lower in patients with Demodex infestation before and after cataract surgery. The higher number of mites was correlated with lower Schirmer I test results postoperatively. The presence of Demodex mites influences the conjunctiva and lid margins leading to inflammation. The higher number of Demodex mites disturbs the tear film over time after cataract surgery.

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OBJECTIVE: The aim of this study was to investigate the effect of endometriosis on the ocular surface. METHODS: A total of 50 patients were included in the study and divided into two groups. Group 1 consisted of 25 patients with endometriosis. Group 2 had 25 control patients. All patients underwent complete ophthalmic examination, and the right eyes were included in the study. To evaluate the ocular surface, both groups were tested with the following: the Schirmer I test, tear breakup time (TBUT), the conjunctival impression cytology (CIC), and the Ocular Surface Disease Index (OSDI). The results were subsequently compared. RESULTS: The average Schirmer I test results were 8.40 ± 2.74 mm in group 1 and were significantly lower in patients with endometriosis (P < 0.001). The average TBUT test results were 9.04 ± 3.61 s in group 1 and were significantly lower in patients with endometriosis (P < 0.001). The average OSDI results were 24.04 ± 9.29 in group 1 and were significantly higher in patients with endometriosis (P < 0.001). The average CIC results were 1.76 ± 0.88 in group 1 and were significantly higher in patients with endometriosis (P < 0.001). CONCLUSIONS: Ocular surface changes, including squamous metaplasia, may be observed in the conjunctiva of patients with endometriosis.

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OBJECTIVE: To observe the effect of acupuncture on expression of transforming growth factor-β1(TGF-β1) in lacrimal gland of rabbits with dry eye, so as to explore its underlying mechanism in improving dry eye. METHODS: Healthy male New Zealand rabbits were randomly assigned to 5 groups (n=6 in each group), namely, blank group, model group, western medicine group, acupuncture group and sham acupuncture group. The dye eye rabbit model was estabilished by subcutaneous injection of Scopolamine Hydrobromide solution for 21 days. After modeling, rabbits in the western medicine group were treated with Flumirone eye drops in their eyes 3 times a day, one drop each time. Rabbits of the acupuncture group reveived electroacupuncture(4 Hz/20 Hz, 1 mA) at "Cuanzhu"(BL2) and "Tongziliao"(GB1) for 15 min, and received acupuncture at "Jingming"(BL1), "Taiyang" (EX-HN5) and "Sizhukong"(TE23) for 15 min, once a day. Rabbits of the sham acupuncture group received blunt acupuncture at the surface of the same acupoints once a day. All the treatments were conducted for 14 days. The changes of tear flow, tear film break-up time (BUT) and lacrimal gland morphology in each group were observed. The expression of TGF-β1 protein and mRNA in lacrimal gland were detected by Western blot and quantitative real-time fluorescence PCR respectively. RESULTS: Following modeling, except for the blank group, the tear flow and BUT in other 4 groups decreased significantly (P<0.01). Compared with their own pretreatment, the tear flow and BUT in western medicine group and acupuncture group increased after the treatment (P<0.05). Compared with the model group, the tear flow and BUT increased in the western medicine group and the acupuncture group(P<0.05). Atrophic lacrimal epithelial cells and the stroma of mucous membrane infiltrated by lymphocytes and plasma cells were found in rabbits of the model group and the sham acupuncture group. By contrast, in the western medicine group and the acupuncture group, the structure of lacrimal epithelial cells was basically normal, and the infiltration of lymphocytes and plasma cells were scattered in the stroma of mucous membrane. In comparison with the blank group, the expression of TGF-β1 protein and mRNA in lacrimal gland were significantly up-regulated in the model and sham acupuncture groups (P<0.01). Compared with the model group, the expression of TGF-β1 protein and mRNA were significantly down-regulated in the western medicine and acupuncture groups (P<0.01, P<0.05). CONCLUSION: Acupuncture intervention can increase tear flow and BUT in rabbits with dry eye, which may be related to the regulation of TGF-β1 expression in lacrimal gland.

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PURPOSE: To evaluate ocular surface alterations in two populations at different exposure levels to particulate matter (PM) in their living and work environments. METHODS: A cross-sectional study was conducted, including 78 volunteers from Argentina who lived and worked under different pollution levels in an urban (U; n = 44) or industrial zone (I; n = 34). Mean exposure level to PM was evaluated. Responses to the Ocular Symptom Disease Index and McMonnies questionnaire were obtained from all subjects. Subsequently, an assessment through the Schirmer I test (ST), slit lamp microscopy, vital staining, and tear breakup time was conducted. Statistical analyses with Chi-square and Bartlett's tests, as well as Student's t-tests and principal component analysis (PCA), were performed. RESULTS: Particles of size < 2.5 µm (PM 2 . 5 ) level was significantly higher in the I group than the U group (P = 0.04). Ocular surface parameters including bulbar redness, eyelid redness, and the degree of vital staining with fluorescein (SF) and lissamine green (SLG) exhibited difference between the groups. With regards to the tear film, statistically significant differences in the ST value and meibomian gland dysfunction between the groups were detected (P = 0.003 and P = 0.02, respectively). Conjunctival SF and SLG, and ST values were identified as factors which could distinguish groups exposed to different PM levels. CONCLUSION: Subjects exposed to higher levels of PM in the outdoor air presented greater ocular surface alterations. Thus, ST, SF, and SLG values could be used as convenient indicators of adverse health effects due to exposure to air pollution.

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PURPOSE: To determine the significance of dry eye syndrome in benign essential blepharospasm. DESIGN: Retrospective consecutive case series. PARTICIPANTS: One hundred and forty-four patients (288 eyes) with benign essential blepharospasm. METHODS: All subjects had Schirmer I tear tests. Those scores were analysed as a function of patient age, sex, and blepharospasm severity. MAIN OUTCOME MEASURES: Individual Schirmer-test scores in both eyes of all patients. RESULTS: A total of 144 eligible subjects (mean age±SD: 68.3±11.5 years; 76% females) were evaluated. Benign essential blepharospasm was significantly associated with female sex (P=0.0044). The mean Schirmer-test value was 5.9±7.5 (median: 2.5) mm; it was <15mm for 86.8% of the patients and <10mm for 75%, with no difference observed between men and women (P=0.27). Dry-eye syndrome severity was not correlated with age at diagnosis, for men (r=-0.22, P=0.22) or women (r=-0.067, P=0.49), or benign essential blepharospasm severity (P=0.15), but was strongly associated with benign essential blepharospasm independently of age, sex or blepharospasm intensity. CONCLUSION: Dry-eye syndrome and benign essential blepharospasm are strongly linked, independently of age, sex or BEB severity, and should be considered for the diagnosis of benign essential blepharospasm. The useful symptomatic treatment of dry eye will not cure the blepharospasm or the ocular pain, and specific treatment for blepharospasm is required, i.e., quarterly injections of botulinum toxin A into the orbicularis oculi muscle.

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PURPOSE: To measure tear clearance values in patients with meibomian gland dysfunction (MGD) with a dynamic nuclear medicine method, namely, dacryoscintigraphy (DSCI). METHODS: Twenty-four MGD patients and 24 healthy volunteers were examined. During DSCI one drop of a solution with 100 MBq/mL99mTc sodium pertechnetate was instilled with a micropipette into the lacrimal lake of both eyes. Measurements were performed according to a dynamic data acquisition protocol, which resulted in summed DSCI images. Data were also evaluated separately in special regions of interest (ROI), and consecutive time activity curves were created. Tear clearance (T½) values were calculated based on the activity curves. In addition, tear osmolarity measurements, tear breakup time (tBUT), and Schirmer I (STI) tests were performed prior to DSCI examination. RESULTS: The T½ values were 29.91 ± 11.61 min in MGD patients and 6.26 ± 1.5 min in healthy controls. Tear osmolarity parameters were 308 ± 9.41 mOsm/L and 288.9 ± 6.4 mOsm/L, tBUT values were 5.54 ± 2.73 s and 11.4 ± 2.7 s, while the STI test values were 6.17 ± 2.78 mm and 13.58 ± 3.8 mm, respectively. The differences were significant (p < 0.01) in all cases. CONCLUSIONS: Although the MGD patients' lacrimal drainage systems were patent their tear clearance values were significantly higher than those of healthy volunteers, which may be caused by decreased drainage of tears from the eyes towards the nasal cavity. The understanding of new features regarding the altered physico-chemical characteristics of MGD tears has been augmented by the results of this study.

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PURPOSE: To evaluate the changes in tear film osmolarity and Schirmer I test after cataract surgery. METHODS: This single-center, prospective study included patients with no subjective complaints about dry eye disease. Patients with the following conditions were excluded: contact lens wearers, patients with diabetes, pseudoexfoliation, pterygia, and eye drops users. The eye that had not undergone surgery was considered the control group. Tear osmolarity and Schirmer I test were evaluated before surgery and during the first postoperative month. RESULTS: Thirty-seven patients were enrolled in the study. Before surgery, tear osmolarity was 301.2 ± 15.09 Osm/L in the study group and 302.3 ± 14.21 mOsm/L in the control group (P = 0.2), while Schirmer I test averaged 13.4 ± 10.50 mm in the study group and 13.7 ± 10.79 mm in the control group (P = 0.6). The next morning, the tear osmolarity decreased to <275 mOsm/L in the study group while in the control group, the value increased to 303.1 mOsm/L ± 13.68 (P = 0.008). The Schirmer I test in the same morning showed an increase up to 19.9 ± 9.73 mm in the study group and to 15.7 ± 10.19 mm in the control group (P = 0.01). One week later, the tear osmolarity increased to 311.8 ± 14.85 mOsm/L, while the control group averaged 301.7 ± 11.84 mOsm/L (P = 0.013). The Schirmer I test results decreased to 15.8 ± 9.37 mm in the study group and 13.9 ± 10.19 mm in the control group (P = 0.07) one week after the surgery. One month after surgery, tear osmolarity and Schirmer I test results in the study group decreased to the control group level (P > 0.05). CONCLUSIONS: The tear osmolarity results increased to the dry eye disease level in the first postoperative week. Over the course of one month, the difference in tear osmolarity and Schirmer I test values for the study and control groups leveled off.

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PURPOSE: To determine if the Schirmer I test (without anesthesia) cut-off value is a predictor of dry eye severity in a large Norwegian cohort of dry eye disease (DED) patients, which are grouped into six levels of tear production. METHODS: Patients (n = 1090) with DED of different etiologies received an extensive dry eye work-up: osmolarity (Osm), tear meniscus height (TMH), tear film break-up time (TFBUT), ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test (ST), meibum expressibility (ME), and meibum quality (MQ). Classification of dry eye severity level (DESL) and diagnosis of meibomian gland dysfunction (MGD) were also included. The cohort was divided into six groups: below and above cut-off values of 5 (groups 1 and 2), 10 (groups 3 and 4), and 15 mm (groups 5 and 6) of ST. Mann-Whitney test and Chi-Square test were used for group comparison of parameters (p ≤ 0.05). RESULTS: The groups 1, 3, and 5 had values indicating more severe DED than the groups 2, 4, 6 with significant difference in DESL, Osm, TFBUT, OPI, OSS, and TMH. Regardless of the choice of cut-off values, there was no statistically significant difference in ME, MQ, and MGD between groups below and above selected cut-off value. When gender difference was considered in each group, significant difference was only observed for DESL (groups 2, 4, and 5), TFBUT (groups 2, 4, and 5), OPI (groups 2 and 6), and ME (group1). CONCLUSIONS: Schirmer I is a robust discriminator for DESL, Osm, TFBUT, OPI, OSS, and TMH, but not for ME, MQ, and MGD. Patients with lower tear production levels presented with more severe DED at all three defined cut-off values. Interestingly, the differences in the mean values of DESL were minimal although statistically significant. Thus, the clinical value of different Schirmer levels appears to be limited.

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OBJECTIVE: To evaluate the effectiveness of using artificial tears and eye exercise for intervention of dry eye disease in aircrew members. METHODS: A accidental sampling method was used and 86 patients diagnosed with dry eye disease were selected as study subjects. Artificial tears or artificial tears plus eye exercise were used in patients. Symptoms of dry eye disease were investigated. RESULTS: of break up time( BUT) and schirmer I test( SIT) were recorded.RESULTS: The main symptoms of these 86 aviators diagnosed with dry eye disease were visual fatigue( 82. 6%),dry feeling( 60. 5%),and itchy eyes( 29. 1%). Among them,28 patients( 32. 6%) were treated with artificial tears only( artificial tears group) and 58 patients( 67. 4%) were treated with artificial tears plus eye exercise( combined treatment group). The duration of treatment of less than 4 weeks,4-weeks,and 6-9 weeks were 25,36 and 25 cases,respectively.After treatment,the symptoms improved in 71 patients( 82. 6%). All patients of these two groups showed improved SIT and BUT compared with the same group before treatment( P < 0. 01). There was no significant difference in the change of SIT and BUT between the artificial tears group and the combined treatment group after treatment( P > 0. 05). There was statistical significance in the change of SIT in the main effect of treatment time( P < 0. 01),but no significant difference in the main effect of treatment measures and the interaction effect( P > 0. 05). There was no statistical significance in the change of BUT in the main effect of treatment measures,treatment time and the interaction effect( P > 0. 05).CONCLUSION: The intervention using artificial tears or artificial tears combined with eye exercise improved the subjective symptoms of dry eye disease in aircrew members. The SIT and BUT also improved after intervention.

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The aim of this study was to evaluate the association between clinical signs and symptoms of dry eye disease (DED) in patients with systemic sclerosis (SSc). This cross-sectional observational study included 19 SSc patients and 19 normal subjects with no ocular symptoms or ocular surface disorders. Clinical parameters included tear film break-up time (tBUT), Schirmer I, lissamine green (LG) dye, and tear film osmolarity tests, tear production, and tear secretion flow. For assessment of the dry eye symptoms, the Ocular Surface Disease Index (OSDI) questionnaire was administered to all patients. The following mean values were found in SSc patients: OSDI 33.6 ± 19.86; osmolarity of the tear fluid 310.8 mOsmol/l ± 14.47; tBUT time 5.158 ± 2.328 s; Schirmer I test 5.395 mm/5 min; LG grading score 2.026 ± 0.8893; collected tear fluid volume 6.397 ± 2.761 µl. The calculated average tear velocity was 4.654 ± 1.963 µl/min. A significant correlation was found between the OSDI as a subjective parameter and disease duration. Early recognition of dry eye symptoms, a possible extra-intestinal manifestation of SSc, should be included in the check up of the disease to reduce ocular complications. The objective tear functional tests were strongly influenced by individual factors like age and disease duration.

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RESUMEN

AIM: To determine the value of Schirmer I test (S I t) without anesthesia and with topical anesthesia for diagnosing dry eye (DE). METHODS: Totally 220 eyes in 110 patients, male (44) and female (66), (39.56±12.67) years old diagnosed with DE were examined. S I t without anesthesia was performed firstly, and 15 minutes later, it was applied again in the same person after topical anesthesia with 0.5% proparacaine hydrochloride eye drops. The wetting strips counted <10mm per 5 minutes were defined positive, while ≤5mm per 5 minutes were defined strong positive. RESULTS: The wetting length in S I t after topical anesthesia was significantly lower than that in S I t without anesthesia (P<0.001). The positive rate and strong positive rate of S I t after topical anesthesia were significantly higher than that of S I t without anesthesia (P<0.001). The positive rate and strong positive rate of S I t without anesthesia and the strong positive rate of S I t after topical anesthesia in patients with aqueous-deficiency dry eye (ADDE) were significantly higher than those in total patients whereas those in patients with evaporative dry eye (EDE) were significantly lower than those in total patients (P<0.001). CONCLUSION: S I t after topical anesthesia with 0.5% proparacaine hydrochloride eye drops is more objective and reliable than that without anesthesia in reflecting the status of DE, and its diagnostic value in patients with ADDE was even higher, making itself a meaningful evidence for the diagnosis and treatment of DE.