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Purpose The unifying characteristic of dry eye is the loss of tear film homeostasis, and the tear lipid layer is a key component for maintaining film stability. The detection of tear lipid is of great significance for the diagnosis of dry eye. In this study, we explored a new test strip for the detection of tear lipid. Methods The tear lipid test strip was prepared by coating the strip material with hydrophobic nano-silica. We tested its physical properties with iodine vapor chromogenic and cobalt chloride test methods. Its biosafety was evaluated by an ocular irritation test in rabbits. Finally, we established a rabbit meibomian gland dysfunction model and measured both eyes with the tear lipid test strip at the first, third, seventh, 14th, 16th, and 21st day after surgery. Results The tear lipid test strip had fine lipophilicity and hydrophobicity. It can extract lipid from tear, and the tear lipid can be quantified by measuring the length of lipid infiltration. In the ocular irritation test, the test strip had no obvious eye irritation. The length of lipid infiltration between experimental and control rabbit eyes began to show statistical difference since the third day after surgery. Conclusions The novel tear lipid test strip has great lipophilicity, hydrophobicity, and biological safety. It might be effectively applied in diagnosis of dry eye.

OBJECTIVE This study aimed to investigate the ocular surface and symptoms of dry eye in individuals who wear face masks on a daily basis. METHODS This prospective study evaluated 52 right eyes of 52 subjects (26 men, 26 women) who routinely wore face masks for at least 8 hrs a day. Mean age was 30.48±6.01 years. All patients were assessed with Schirmer-1 test, Tear Break-up Time (TBUT), Oxford staining grade, and Ocular Surface Disease Index (OSDI) at initial clinical admission (T1), after 8 hrs of face mask use (T2), and after 15 days of greater than 8 hrs daily wear of face masks with the open portions of the mask taped down (T3). RESULTS Mean TBUT was 13.03±2.18 seconds(s) at T1, 9.12±1.85 sec at T2, and 12.78±2.05 sec at T3. Mean Schirmer-1 test results were 16.87±3.01 mm at T1, 12.97±2.74 mm at T2, and 17.01±2.95 mm at T3. There was a significant difference between T1 and T2, and between T2 and T3 in TBUT (P

Purpose To evaluate the effectiveness of conjunctival cyst removal using a modified method of argon laser photoablation. Methods Seventeen cases of symptomatic conjunctival cysts were included. After staining the surface of a conjunctival cyst with a dark purple marker, the cyst was incised using a 26-gauge needle. Low-energy argon laser photoablation was then applied around the incision site for a mean of 100 times. Results During a mean follow-up period of 13.3 months (range 6-28 months), all conjunctival cysts were successfully corrected by applying either one or 2 laser sessions. Complete resolution occurred after a single laser session in 14 eyes (82.4%). There were 3 cases of recurrence with medium to large cysts, and repeating the same procedure produced surgical success in all of these cases; the conjunctival cyst recurred again after the second laser session in one of the 3 eyes, but this spontaneously regressed without further treatment. No postoperative complications such as conjunctival scarring or persistent ocular irritation were observed. Conclusions Our modified method of argon laser photoablation uses staining of the conjunctival cyst surface to increase the amount of thermal laser energy absorbed by the target. This novel technique is simple and effective for treating conjunctival cysts in an outpatient clinic.

In the current coronavirus disease 2019 (COVID-19) pandemic, important public health measures such as the utilization of face masks has been widely enforced, including community-wide mandatory face mask use. During this period, there have been observations of an increasing number of patients presenting with dry eye symptoms among regular mask users with no history of ocular surface pathology. Individuals have reported being aware of air blowing upward from the mask into their eyes that is likely to increase the evaporation of their tear film leading to ocular irritation. Although face mask use is essential in combatting the COVID-19 pandemic, it is important to recognize the potential effects it may have on ocular health. We report a case of face mask-associated ocular complication. After an initial cornea abrasion from mask use, the patient developed recurrent corneal erosion syndrome that was complicated by microbial keratitis after the enforcement of mandatory mask use in public areas.

To compare the clinical efficacy of sodium hyaluronate eye drops, polyethylene glycol eye drops, and compound dextran eye drops in the treatment of dry eye after phacoemulsification of cataract. A total of 99 patients with dry eye after cataract phacoemulsification combined with intraocular lens implantation were treated in our hospital. Patients were divided into group A (sodium hyaluronate eye drops), group B (polyethylene glycol eye drops), and group C (dextran-70 eye drops). The clinical effect, tear film breakup time, basic tear secretion, corneal staining score, dry eye symptom score, and the incidence of ocular irritation were assessed. On the 3rd, 15th, 30th, and 60th day after operation, the tear film breakup time, corneal staining score, Schirmer I test, and dry eye symptom score in group A and group B were better than those in group C (P .05). At 3 days to 60 days after operation, the incidence of dry eye in group A (12.12%) and group B (18.18%) was lower than that in group C (39.39%), and the incidence of dry eye in group A was significantly lower than that in group B (P

Conjunctival actinic keratosis is rare and difficult to treat, as recurrences are common. Imiquimod, an immune response modulator, is currently Food and Drug Administration-approved for cutaneous actinic keratosis and superficial basal cell carcinomas. Emerging reports have shown it to be effective in treating some periocular and conjunctival lesions. The authors present a case of a 68-year-old white man with recurrent actinic keratosis involving the pretarsal conjunctiva, which was successfully treated with 5% topical imiquimod following previous failure with cryotherapy and interferon α-2b. The patient had ocular irritation that resolved on cessation of treatment. To the authors' knowledge, this is the first report of conjunctival actinic keratosis being treated with and successfully eradicated by topical imiquimod.

Purpose To describe the manual provocation test (MPT), a novel test for intermittent involutional entropion of the lower eyelid. Methods Retrospective review of patients with intermittent entropion who presented with ocular irritation and documented inward eyelid rotation by them or their referring physicians, but who had no apparent entropion at the time of initial consultation. Results of the MPT were recorded for this group, and then evaluated prospectively in an age-matched comparison group of patients presenting for blepharoplasty who had no history of entropion. The essential steps of the MPT are as follows. Step 1: the lower eyelid skin is grasped below the inferior border of the tarsal plate. Step 2: the lid is drawn anteriorly as with the eyelid distraction test. Step 3: the patient is directed to forcefully close the eyelids. Step 4: the eyelid is released and the result is observed for manifest entropion. Results Thirteen eyelids in 12 patients with intermittent involutional lower eyelid entropion were included in this study. Average patient age was 77.3 years (±9.5 SD). The MPT elicited entropion in all 13 eyelids. Of the 12 patients, 9 elected to pursue surgery and, of these patients, all eyelids were successfully treated with subsequent improvement of symptoms. The MPT was thereafter negative in these patients. None of the 20 patients in the blepharoplasty comparison group (average age 71.6 years) demonstrated a positive MPT. Conclusions The MPT can be a valuable and straightforward test in the clinical evaluation of patients with a history of intermittent entropion.

Objective: To analyze the regression of the pterygium tissue quantitatively after intralesional bevacizumab administration in patients with primary pterygium. Methods: Thirty-three eyes of 33 patients with primary pterygium who underwent intralesional bevacizumab (1.25 mg per 0.05 mL) administration were included in this prospective study. The ocular irritation, best-corrected visual acuity (BCVA), slit-lamp and funduscopic examinations, corneal astigmatism, the horizontal length, and the thickness of the pterygium were assessed before and after 2 months of treatment. To evaluate the corneal astigmatism and the thickness of the pterygium, the Pentacam comprehensive eye scanner (Pentacam CES; Oculus GmbH) was used. Results: After 2 months of bevacizumab administration, the average BCVA was improved (P=0.003). The average ocular irritation score, horizontal length, and the thickness of the pterygium were statistically significantly decreased (P,0.001, P,0.001, P,0.001, respectively). Conclusion: After 2 months of intralesional bevacizumab administration, the average amount of decrease in the horizontal length and thickness of the pterygium was 0.6 mm and 37 mm, respectively. Intralesional bevacizumab administration is useful in the management of primary pterygium without having any local or systemic adverse effects; however, repeated administrations are needed to provide clinically more significant results.

PURPOSE To explore the feasibility and compare the outcomes of three wide-angle fundus cameras for imaging the peripheral retina through the Type 1 Boston keratoprosthesis. METHODS The noncontact Optos and the contact RetCam and Panoret wide-angle imaging systems were used to image the retina of eyes implanted with a keratoprosthesis. The failure-to-image rate, ease of acquisition, and quality of the images were noted, and the field of view was compared. Limitations and complications were recorded. Optos was then performed on patients referred for ultrasound B-scan evaluation, and the imaging findings were correlated. RESULTS Retinal images with all three cameras were obtained on four eyes. Optos could be performed on all four eyes, RetCam on three, and Panoret on two. The field of view was comparable between the three different cameras. The best quality images were obtained with Optos. The external illumination of the Panoret made it impossible to image the only darkly pigmented individual in the series. Both contact devices failed to image another patient who was too agitated. Two patients had some ocular irritation from the coupling agent that resolved with replacement of the contact lens. Optos images were obtained on an additional six eyes, and findings correlated well with those on B-scan. Optos was superior to B-scan in an eye with silicone oil filling. CONCLUSION Wide-angle fundus imaging through the keratoprosthesis is possible, and all three cameras performed similarly. The good quality of pictures obtained with the noncontact Optos, as well as its ease of use, comfort, and safety make it a preferred choice. Optos complements B-scan in the examination of the peripheral retina through the keratoprosthesis, and it may even be superior in certain settings.

OBJECTIVES: Pediatric exposures to concentrated laundry detergent packs may result in serious adverse affects. This study compared pediatric exposures to laundry detergent packs and traditional laundry detergents. METHODS: Cases were exposures among patients 5 years or younger to laundry detergent packs during January to June 2012 and traditional laundry detergents during January to December 2011 reported to Texas poison centers. Comparisons between the 2 types of products were made for various variables. RESULTS: Of 187 laundry detergent pack and 452 traditional laundry detergent exposures, the patient was already at or en route to a health care facility in 21.4% of the laundry detergent pack and 9.3% of the traditional laundry detergent exposures. Of those exposures where the poison center could potentially influence where the patient was managed, 23.8% of laundry detergent pack and 3.7% of traditional laundry detergent exposures were referred to health care facilities. Potentially serious outcomes were reported in 12.3% of laundry detergent pack and 2.4% of traditional laundry detergent exposures. The most commonly reported clinical effects in laundry detergent pack and traditional laundry detergent exposures were vomiting (54.5% vs 17.0%), cough (11.2% vs 2.2%), ocular irritation (7.0% vs 6.4%), red eye (7.0% vs 5.3%), nausea (7.0% vs 2.7%), and oral irritation (7.0% vs 2.2%). CONCLUSIONS: Pediatric exposures to laundry detergent packs were more likely to be managed at a health care facility. Moreover, the laundry detergent pack exposures were more likely to result in serious outcomes and involve the most common clinical effects. Language: en

OBJECTIVES: Fire-bellied toads (genus Bombina) secrete toxins from their skin that may cause problems to humans, particularly if they get in the eye. This study aimed to describe pediatric exposures to fire-bellied toads reported to a large poison center system. METHODS: Cases were fire-bellied toad exposures among patients aged 13 years or younger reported to Texas poison centers during 2000-2014. The distribution by various demographic and clinical factors was determined. RESULTS: Of 20 total exposures, the mean patient age was 5.8 years (range, 2-13 years); 70% of the patients were boys. The exposure route was ocular (70%), dermal (55%), and ingestion (20%). Eighty-five percent of the exposures occurred at the patient's own residence. Sixty percent of the patients were managed onsite, and 40% were already at or en route to a health care facility. The medical outcome was as follows: minor effects (45%), moderate effects (5%), and not followed but judged to have minimal clinical effects (50%). The most common reported symptoms were ocular irritation/pain (65%), dermal irritation/pain (30%), and red eye (20%). Decontamination by dilution/irrigation/wash was reported in 95% of the patients. CONCLUSIONS: Few pediatric exposures to fire-bellied toads were reported. Those that were reported were most likely to involve ocular followed by dermal routes. The exposures tended not to be serious and could be managed outside of a health care facility. Language: en

Purpose - To identify and characterize moderate dry eye in non-contact lens wearers with a new scoring system-based dry eye questionnaire and to determine which objective tests better differentiate patients with moderate dry eye from healthy patients. Methods - Fifty-two healthy subjects (21 women and 31 men with a mean age of 27.8 +/- 9.2 years) and 37 subjects with moderate dry eye (33 women and 4 men with a mean age of 36.4 +/- 12.9 years) completed a 42-item dry eye questionnaire. Seventeen healthy subjects (11 women and 6 men with a mean age of 30.5 +/- 9.7 years) and 28 subjects with moderate dry eye (24 women and 4 men with a mean age of 38.50 +/- 3.8 years) underwent additional objective assessment of ocular surface health, tear osmolality, tear stability, and tear volume. Results - Subjects with moderate dry eye scored significantly higher (49.8 +/- 20.3, P

BACKGROUND Lower eyelid malposition is the most common complication after lower eyelid blepharoplasty. Although the traditional techniques were effective for correcting lower eyelid malposition, they had potential disadvantages, including additional trauma, additional scar, and long recovery period. OBJECTIVE To evaluate the efficacy of a minimally invasive surgical technique using Aptos thread for postblepharoplasty lower eyelid malposition. METHODS A retrospective review of all patients undergoing lower eyelid malposition surgery via a minimal invasive, Aptos thread technique from June 2005 to June 2010. Symptoms, including epiphora, ocular irritation, conjunctivitis, and measurement of lower eyelid scleral show (measured from the inferior limbus of cornea) were recorded. Presurgery and postreconstruction photographs were reviewed for functional and cosmetic outcome. RESULTS A total of 15 patients (24 eyelids) underwent successful lower eyelid malposition surgery using this minimally invasive technique. On clinical examination, all cases of lower eyelid retraction stemmed from overzealous excision of skin and orbicularis. After a follow-up interval of 12 to 25 months (mean, 15 months), inferior corneal exposure and ocular symptoms were corrected thoroughly. The decrease in lower eyelid retraction was 2.7 ± 0.9 mm. The functional and cosmetic result was satisfactory in all cases. CONCLUSIONS Aptos thread technique is a safe, effective, and the least invasive method of managing mild and moderate postblepharoplasty lower eyelid malposition secondary to shortening anterior lamella.

The purpose of this study was to develop a pilot survey to evaluate ocular irritation symptom frequency, severity, and impact on daily activity in patients previously diagnosed with dry eye.Forty-five patients previously diagnosed with dry eye (ICD-9 code 375.15) completed the 17-item symptom survey. Analog-scale response questions concerning the frequency, severity, and effect on daily activity were asked for the following symptoms: dryness, scratchiness and soreness, burning and stinging, light sensitivity, blurry vision, and ocular itching.Dryness and soreness were the most frequently reported symptoms of ocular irritation. Although the occurrence of symptoms of ocular irritation was reported as frequent by patients diagnosed with dry eye, the symptoms had minimal to moderate impact on daily activity.Patient expression of the symptoms of dryness and soreness at more frequent and/or more severe levels may lend more validity to a diagnosis of dry eye.

Conjunctival entrapment of cilia is form of ocular irritation that to our knowledge has not yet been described. Scarring predisposes the conjunctiva to this phenomenon by creating blind recesses in which loose cilia can become entrapped. Once caught, the rigid cilia can act as a mechanical irritant or act as a nidus for microbial growth. We present herein three patients with entrapped cilia and discuss their pathophysiology and management. The symptoms in all three patients resolved with conjunctivoplasty and removal of the cilia.

Purpose To report a case of impending recurrent pterygium treated with topical bevacizumab eyedrops. Methods A 53-year-old woman with impending recurrent pterygium was treated with topical bevacizumab eyedrops (25 mg/mL) administered 4 times daily for 3 weeks. Two months previously, she had undergone excision of a primary ptergyium in the same eye by bare sclera recision and application of mitomycin C. Results Treatment with topical bevacizumab for 3 weeks produced prominent regression of limbal-conjunctival neovascularization. At 6-month follow-up, no recurrent pterygium was noted. Symptoms were resolved with no ocular irritation, burning, or any systemic adverse effects. Conclusions These data suggest that off-label short-term use of topical bevacizumab may be effective to prevent recurrence in a patient with impending recurrent pterygium. We believe that this is the first known successful use of topical bevacizumab in such a patient.

A 70-year-old woman presented with a corneal ulcer resulting from aberrant and exuberant eyelash growth. She had recently been diagnosed with recurrent non–small-cell lung cancer for which she had begun a chemotherapeutic regimen that included erlotinib HCl. After several months of treatment, she noted the onset of escalating ocular irritation, which culminated in her presentation. Examination of her ocular adnexa revealed coarse, brittle, irregular aberrant eyelash growth. She has been successfully treated with regular epilation and eyelash trimming and has remained symptom free.

This week's Writ e Click submitters offer their own data to either support or question the conclusions of 2 studies. In response to the study by Dr. Defazio et al. linking ocular pathology and the development of blepharospasm, Dr. Kurlan proposes, as a possible mechanism, that chronic ocular irritation could lead to abnormal sensory feedback that disturbs central motor control signals, thereby causing blepharospasm. He provides supportive examples from his own research into patients with Meige syndrome. Dr. Kashyape, in response to the study by Dr. Sharma et al. …

Symptoms of dry eye are relatively prevalent in the population. However, current clinical tests for dry eye are relatively non-specific, poorly repeatable. and show only a weak association with symptoms. The dearth of information about general ocular surface symptoms and knowledge of their daily fluctuations in the population further limits our understanding of dry eye symptoms. This study characterized symptoms of ocular irritation from a large multi-centered survey of patients in optometric practices in the United States and Canada.

Riot control agents (tear gases) cause intense eye irritation and reflex squeezing of the eyes. The intraocular pressure under these circumstances is unknown, but animal and human studies of ocular irritation and forces acting upon the eye indicate a transient increase in intraocular pressure which is not necessarily detrimental to vision.

SENILE entropion is a common and troublesome clinical entity. It is as troublesome to the ophthalmologist as to the patient, because minor measures are usually ineffective and yet the clinical manifestations frequently do not seem severe enough to the patient to warrant major surgical intervention. Unfortunately, only operation can effect a permanent cure, though even this is not always certain. Most textbooks define senile entropion as a form of spastic entropion of the lower lid, or, conversely, the commonest form of spastic entropion is described as occurring in the lower lid of older people. It is usually attributed to a spasm of the orbicularis brought on by ocular irritation, either inflammatory or traumatic. Over the years, many procedures have been suggested for the correction of this condition. However, the armamentarium of remedies offered is larger than it is effective. The commonest of these methods may be summarized as follows: 1.