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PURPOSE: To use artificial intelligence to identify relationships between morphological characteristics of the Meibomian glands (MGs), subject factors, clinical outcomes, and subjective symptoms of dry eye. METHODS: A total of 562 infrared meibography images were collected from 363 subjects (170 contact lens wearers, 193 non-wearers). Subjects were 67.2 % female and were 54.8 % Caucasian. Subjects were 18 years of age or older. A deep learning model was trained to take meibography as input, segment the individual MG in the images, and learn their detailed morphological features. Morphological characteristics were then combined with clinical and symptom data in prediction models of MG function, tear film stability, ocular surface health, and subjective discomfort and dryness. The models were analyzed to identify the most heavily weighted features used by the algorithm for predictions. RESULTS: MG morphological characteristics were heavily weighted predictors for eyelid notching and vascularization, MG expressate quality and quantity, tear film stability, corneal staining, and comfort and dryness ratings, with accuracies ranging from 65 % to 99 %. Number of visible MG, along with other clinical parameters, were able to predict MG dysfunction, aqueous deficiency and blepharitis with accuracies ranging from 74 % to 85 %. CONCLUSIONS: Machine learning-derived MG morphological characteristics were found to be important in predicting multiple signs, symptoms, and diagnoses related to MG dysfunction and dry eye. This deep learning method illustrates the rich clinical information that detailed morphological analysis of the MGs can provide, and shows promise in advancing our understanding of the role of MG morphology in ocular surface health.

Background: Scleral lenses (SLs) are recommended in DEWS II to treat dry eye (DE) patients that do not respond well to conventional therapies. This study aimed to evaluate the short-term (one month) efficacy and safety of SLs in the management of severe DE. Methods: This single-center prospective study enrolled 15 patients (22 eyes) who were diagnosed with severe DE. The Ocular Surface Disease Index (OSDI), the Chinese version of the 25-item National Eye Institute Visual Function Questionnaire (CHI-VFQ-25), and LogMAR best-corrected visual acuity (BCVA) were evaluated at baseline and one month following SL fitting. DE-related parameters were obtained and analyzed before and after one month of SL treatment, including tear-film breakup time (TBUT), corneal fluorescein staining (CFS), non-invasive breakup time (NIBUT), tear meniscus height (TMH), Schirmer I test (SIT), and meibomian gland (MG) dropout. Complications and adverse events were monitored. Results: OSDI scores (53.9 ± 28.1 vs. 10.4 (4.2–25), p = 0.0001) and CFS scores (10.2 ± 3.9 vs. 7 (0–12), p = 0.001) decreased after one month of SL therapy, while CHI-VFQ-25 scores (74.4 (54.8–83.8) vs. 95 (78.7–98), p = 0.0001) and TBUT (0.6 ± 0.5 vs. 2.2 ± 1.0, p < 0.0001) increased significantly. LogMAR BCVA improved from 0 (0–0.1) to 0 (0–0) (p = 0.0147). The average types of medications per eye decreased from 2.82 ± 1.01 to 1.32 ± 0.64 (p = 0.025), and the proportion of eyes using glucocorticoids significantly decreased from 63.6% to 13.6% (p = 0.001). No severe SL-related adverse events were reported. Conclusions: SL treatment quickly alleviated subjective symptoms as well as clinical signs of DE with good safety and enhanced the visual function and vision-related quality of life, showing its usefulness in the management of severe DE. [ABSTRACT FROM AUTHOR]

Perfluorohexyloctane ophthalmic solution (Miebo) and water-free cyclosporine ophthalmic solution 0.1% (Vevye) are recently approved treatments for dry eye disease (DED). Perfluorohexyloctane (PFHO) uses a novel approach to treat evaporative DED, whereas water-free cyclosporine (CsA 0.1%) is formulated to increase ocular delivery of its active ingredient to improve tear production. The two medications utilize the distinctive properties of two different semifluorinated alkanes (SFAs) to elicit their therapeutic effects. PFHO consists of 100% active ingredient and forms a monolayer on the surface of the tear film to inhibit evaporation. CsA 0.1% utilizes a vehicle consisting of perfluorobutylpentane (PFBP) and ethanol to facilitate delivery of cyclosporine to ocular tissues. The structure of these SFAs determines their differing behaviors and functions. The longer chain length of PFHO results in a slower evaporation rate and facilitates formation of a stable monolayer on the ocular surface. In vitro, PFHO demonstrated a substantially lower evaporation rate versus PFBP or human meibum, as well as a significantly longer ocular surface residence time. Ex vivo, PFHO demonstrated a longer ocular surface residence time than PFBP. The shorter chain length of PFBP enables it to better solubilize cyclosporine and improve drug delivery to ocular tissues. Although both of these ophthalmic drops utilize SFAs, their differences—in physicochemical properties and the mechanisms by which they are understood to intervene in the DED cycle—are important considerations in treatment selection for patients with DED. [ABSTRACT FROM AUTHOR]

Acupuncture is a complementary therapy used in many parts of the world to treat a variety of disorders. Two women aged 61 and 86 years old presented with painless bruising around their right eye for 3 and 10 days, respectively, following acupuncture therapy for dry eye. The younger woman was on oral acetylsalicylic acid 100 mg daily and it was her second episode of ocular bruising from a total of 20 therapy sessions. Clinical examination disclosed severe periocular ecchymosis in their right eye. There was no proptosis or globe perforation. The ecchymosis gradually resolved over a few weeks without any visual sequelae in both cases. Periocular acupuncture can cause severe periocular ecchymoses. Patients should be informed of this and other potentially sight-threatening complications associated with this form of treatment, and both acupuncture practitioners and ophthalmologists should be alert to recognize such complications early so that they can be appropriately managed. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco smoking is the primary avoidable cause of mortality, resulting in the deaths of seven million people worldwide annually. Tobacco smoke is a well-documented ocular irritant that exacerbates Dry Eye Disease (DED) and its associated symptoms. Aim: To compare tear film and corneal surface parameters in chronic smokers and non smokers. Materials and Methods: This cross-sectional study was conducted among chronic smokers and non smokers presenting at a tertiary eye care centre in Northern India. A total of 80 subjects were included in the study and divided into two groups of 40 subjects each, comprising group A (chronic smokers) and group B (non smokers). All participants underwent a series of measurements: Schirmer I test, Tear Breakup Time (TBUT), Central Corneal Thickness (CCT) and endothelial cell count using specular microscopy. Results: The mean age of smokers was 50.15±6.89 years, whereas the mean age of non smokers was 49.25±6.39 years, with a significant male preponderance. The dry eye parameters, such as the Schirmer I test and TBUT, were significantly lower in smokers compared to non smokers, with a statistically significant difference (p-value <0.001). Similarly, CCT and endothelial cell count were significantly lower in smokers than in non smokers, with a statistically significant difference (p-value <0.001). Conclusion: The study highlights the detrimental effects of smoking on ocular surface health. Smoking predisposes users to DED due to lower tear production and an unstable tear film. [ABSTRACT FROM AUTHOR]

Terahertz (THz) waves reside in the electromagnetic spectrum between the microwave and infrared bands. In recent decades, THz technology has demonstrated its potential for biomedical applications. With the highly unique characteristics of THz waves, such as the high sensitivity to water and optimal spatial resolution coupled with the characteristics of the human cornea, such as its high water content, THz technology has been explored as a potential modality to assess corneas and corneal diseases. This systematic review provides an overview of the characteristics of THz waves, the safety profile of THz technology in the field of ophthalmology, and its clinical applications, including the objective evaluation of the corneal hydration, tear film, dry eye disease, corneal endothelium, corneal elasticity, and scarring. The paper also presents our viewpoint on the present challenges and future directions of THz technology prior to its broader integration into clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To study tear film parameters and Meibomian glands in pediatric patients with vernal keratoconjunctivitis (VKC). Methods: Forty-four eyes of 22 patients with VKC and 44 eyes of 22 age-matched controls were studied in a hospital-based cross-sectional study. Each subject underwent a complete ophthalmological examination including slit-lamp biomicroscopy, non-invasive break-up time (NIBUT), fluorescein break-up time (FBUT), corneal fluorescein staining, and Schirmer's test. Non-contact meibography was performed using a Sirius topographer. Results: All patients had VKC grades between 1 and 3 (Bonini scale). The mean NIBUT for cases was 8.83 ± 4.02 s and in controls, it was 15 ± 2.8 s (P value < 0.001). The mean FBUT for cases was 9.41 ± 3.45 s and in controls, it was 16.7 ± 2.5 s (P value < 0.001). Schirmer's values were 32 ± 3.1 mm in cases and 21.4 ± 4.1 mm in controls, which were significantly higher (P value < 0.001). Also, 22.72% of the cases had corneal fluorescein staining in the form of superficial punctuate keratitis, whereas none of the control groups showed corneal staining. The examination of Meibomian glands using non-contact meibography showed a mean Meibomian gland dropout in the upper lid to be 29.7 ± 14.4% in VKC cases and 10.5 ± 3.2% in controls (P value < 0.001). Meibography of the lower lid showed 25.9 ± 10.2% dropout in cases and 20.5 ± 6.1% in controls (P value = 0.004). Conclusion: Tear film parameters were significantly deranged in children with VKC in the active stage as compared to age-matched controls. Children with VKC also had a higher Meibomian gland dropout. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to illustrate a novel method for improving presbyopia by drinking cassiae tea. Materials and Methods: A total of 425 eyes from 425 participants (aged 52.5 ± 9.5 years) were recruited and divided into several experimental groups over a 6-month period. Participants consumed cassiae tea daily (10 g of cassiae semen brewed in 500 cc of water). Meanwhile, control group participants consumed 500 cc of plain water along with 1000 mg of vitamin C each day. Experiments 1 and 2: Participants with severe dry eye and intraocular pressure (IOP) > 30 mmHg were enrolled, and outcomes were assessed for these conditions, respectively. Experiments 3, 4, and 7: These experiments evaluated pupil size, near vision, and serum superoxide dismutase (SOD) levels in two groups of volunteers. Experiment 5: Different quantities of cassiae tea were prescribed to various groups, and near vision was measured. Experiment 6: Three questionnaires assessed presbyopic symptoms after cassiae tea consumption. Experiment 8: The antioxidant activity of cassiae tea compared with other bioactive compounds and Chinese herbs was evaluated using the DPPH test. Results: By the fourth month of the study, participants experienced increased tear volume and reduced IOP. Pupil size constricted, near vision improved, and serum SOD levels increased. Furthermore, greater consumption of cassiae tea was correlated with better near vision. The antioxidant activity of cassiae tea was found to surpass that of anthocyanins, wolfberry, and vitamin C. Conclusions: Drinking cassiae tea improves dry eye symptoms, reduces IOP, regulates pupil size, and enhances near vision due to its excellent antioxidant and pharmacological properties. These benefits may particularly aid individuals with presbyopia and those engaged in near-distance activities, such as smartphone use. [ABSTRACT FROM AUTHOR]

The surface of the eye is constantly exposed to the external environment and is affected by atmospheric conditions and air pollution, and dry eye is a typical ocular surface disease. The aim of this study is to determine whether there are seasonal differences in the number of dry eye operations in Japan and to investigate whether meteorological conditions and air pollutants are related to. The operations were examined using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) database from fiscal years 2019 to 2021. Temperature, atmospheric pressure, relative humidity, volume humidity, wind speed, sulfur dioxide (SO₂), nitrogen oxides X (NOX), photochemical oxidants (OX), carbon monoxide (CO) and particulate matter 2.5 (PM2.5) were considered. The number of dry eye operations was significantly higher in winter than in summer. (p = 0.0023) No significant differences were found among the other seasons. Volume humidity and temperature were strongly negative correlated, NOX and atmospheric pressure were strongly positive correlated. [ABSTRACT FROM AUTHOR]

Introduction: Wearing a face mask is a regular practice in health care workers, however it has increased during and after COVID 19 era. Mask associated dry eye has also increased in prevalence. This paper aims to compare ocular and periocular discomfort among healthcare workers using different types of face masks, including N95 respirators and surgical masks. METHODS: A cross-section observational survey was conducted to compare surgical and N95 mask in terms of dry eye induced in Health care workers. A questionnaire was prepared for the participants regarding general information about the participants; the effects of masks that they use in terms of quality of vision, pain/discomfort, quality of communication with patients and comorbidities. OSDI questionnaire was also provided. Results: Out of 110 participants (males =47, females= 63), average age was 36.67years. 72.73% of the participants were using N95 mask as they were the recommended masks to be used during COVID patient care. Average quality of vision in all the participants was 1.74 out of 5 (max) with no significant difference between N95 and Triple-layered surgical masks (p=0.62). Average discomfort / pain in all the participants was 2.25 out of 5 (max) with no significant difference between N95 and Triple-layered surgical masks (p=0.67). 4% reported foreign body sensation in eyes and 13-26% reported skin rashes around eyes. 79% participants using the masks complained of air leak towards the eyes while using the mask. Conclusion: Both N95 and Triple-layered surgical mask were associated with mild dry eyes, without a significant difference between the two. [ABSTRACT FROM AUTHOR]

Sjogren's disease, well-described in people, is rarely identified in veterinary species. In people, Sjogren's disease is one of the most common systemic autoimmune disorders with an incidence of 0.5% in the female population. The hallmark histopathologic finding of primary Sjogren's disease is lymphomononuclear cell infiltrates aggregating as periductal infiltrate in salivary glands. Sjogren's-like disease has been reported in a domestic shorthair cat and golden retriever dog. However, both lacked positive antinuclear antibody (ANA) titers and the dog showed no clinical evidence of dry eye disease. The following case report describes the clinical and immunohistochemical findings suggestive of Sjogren's disease in a 3-year-old spayed female German shepherd cross that was presented for medically refractory absolute dry eye, xerostomia confirmed with oral atropine response tests, and bilateral mandibular salivary gland enlargement. Routine topical lacrostimulants, anti-inflammatories, heterologous serum, ocular lubrication, and oral pilocarpine failed to improve clinical signs or tear production. The ANA titer at 1:160 was interpreted as positive, while the complete blood count and serum biochemistry panels were unremarkable. Head and neck ultrasound revealed bilateral moderately enlarged mandibular salivary glands with a hypoechoic, mottled echotexture consistent with sialoadenitis and regional lymphadenomegaly; thoracic radiography and abdominal ultrasonography were normal. In vivo confocal microscopy and spectral-domain optical coherence tomography of the cornea confirmed lipid keratopathy presumably secondary to corneal desiccation and steroid administration. Salivary gland histopathological and immunohistochemical analyses supported an immune-mediated etiology. Approximately 60% of the salivary section contained inflammatory cells replacing the glandular structures with a focus score of 12. Immunohistochemical markers CD3, CD204, CD79a, and CD20 were evaluated. The inflammatory infiltrate was a mixture of T-cells and macrophages with rare individual immunoreactive B-cells. CD3 and CD4+ T-cells were confirmed using immunohistochemistry and quantitative PCR, respectively. Clinical signs including ocular discharge and mandibular salivary gland enlargement markedly improved following oral immunomodulatory therapy with prednisone (1 mg/kg/d, tapered over 2 months) and long-term leflunomide (2 mg/kg/d). Ocular discomfort improved dramatically decreasing the need for topical lubricants; however, tear production failed to improve likely due to extensive lacrimal gland atrophy. The aim of this report is to increase awareness of Sjogren's disease in dogs and interpret the pathology involved. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to systematically review the evidence from randomized controlled trials that evaluate the efficacy and safety of perfluorohexyloctane in the treatment of dry eye disease. Methods: Literature search was conducted on PubMed and Scopus in April 2024 with the search strategy (“perfluorohexyloctane” or “NOV03” or “semifluorinated alkane”) and “dry eye.” Extension and paired-eyes study were excluded. The risk of bias was assessed using the Cochrane risk-of-bias tool. Forest plots and a summary of findings were prepared for total corneal fluorescein staining (tCFS), tear film break-up time (TFBUT), eye dryness score (EDS), and Ocular Surface Disease Index (OSDI). Results: The pooled standardized mean difference (SMD) for tCFS after 8 weeks of treatment was −0.53 (95% CI: −0.68 to −0.38; p < 0.001), indicating a significant improvement in patients treated with perfluorohexyloctane. The between-study heterogeneity was moderately high (I2 = 52.0%). No significant differences in TFBUT were observed (SMD = 0.05; 95% CI: −0.16 to 0.25; p = 0.654). Regarding symptoms, patients treated with NOV03 had significantly lower EDS compared to controls (SMD = −0.49; 95% CI: −0.66 to −0.32; p < 0.001), with moderately high heterogeneity (I2 = 71.1%). Conversely, the pooled SMD of OSDI was −0.13 (95% CI: −0.43 to 0.17; p = 0.412), indicating no significant difference. Conclusion: Perfluorohexyloctane is an effective and safe alternative for the treatment of evaporative dry eye disease due to MGD that can significantly reduce tCFS and eye dryness symptoms. More well-designed non-sponsored randomized clinical trials are required to investigate the impact on other ocular surface parameters. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to determine the frequency of neurotrophic keratopathy (NK) among patients presenting for cataract surgery consultation in a suburban US practice. Methods: Patients presenting for cataract consultation were evaluated with corneal staining without anesthetic. Those with grade 1 or greater corneal stain and a tear breakup time (TBUT) of ≤ 10 underwent corneal sensitivity testing with a Cochet Bonnet esthesiometer. The study also evaluated patient SPEED score symptoms, corrected distance visual acuity (CDVA), corneal higher-order aberrations (HOAs), and conjunctival hyperemia. Results: Among the 31 patients enrolled, mean corneal esthesiometry was 40 ± 9.5 mm (range 13 to 55). Esthesiometry of ≤ 40 mm, indicating neurotrophic keratopathy, was detected in 18 (58%, 95% CI 39– 75%) patients. Corneal higher-order aberrations were significantly worse at 0.83 ± 0.22 μ in the group with NK vs 0.67 ± 0.16 among patients without NK (P < 0.028). A nonsignificant correlation was found between reduced corneal sensitivity and reduced symptoms. Older patients had slightly reduced sensation, but this trend was not statistically significant. No trend was seen between reduced sensation and either CDVA or corneal staining. Conclusion: More than half of patients presenting for cataract evaluation with dry eye had stage 1 neurotrophic keratopathy. These patients had significantly worse higher-order aberrations than patients with normal sensitivity. Among patients with NK, symptoms were milder and age was higher, but neither trend was statistically significant. No trend was observed between corneal sensation and either corneal staining or CDVA. Plain Language Summary: We performed this study to determine how common reduced corneal sensation is among patients who present for cataract surgery evaluation when they also have signs of dry eye. Fifty-eight percent of patients met criteria for Stage 1 reduced sensation, and they also had significantly more corneal irregularity than those without reduced sensation. Further study is needed to determine whether patients with reduced sensation should be treated differently from other dry eye patients when preparing their eyes for preoperative biometry. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy of 0.05% cyclosporine A (CsA) eye drops (II) and 3% Diquafosol ophthalmic solution (DQS) in the treatment of dry eye (DE) after cataract surgery (CS). Methods: Clinical data of 123 patients with DE after CS treated at the Fourth Hospital of Hebei Medical University from June 2022 to August 2023 were retrospectively analyzed. Patients were divided into three groups based on the treatment: Conventional group (tobramycin & dexamethasone eye drops combined with pranoprofen eye drops, n=41), DQS group (3% DQS based on the conventional treatment, n=42), and CsA group (0.05% CsA eye drops(II) based on the conventional treatment, n=40). The therapeutic effects; Schirmer I test (SIt), tear film breakup time (TBUT), levels of serum inflammatory factors, and tear cytokine levels before and after treatment were compared between the groups. Results: Chief complaint score, conjunctival congestion score, corneal fluorescein staining score, and ocular surface disease index score of the DQS group and the CsA groups were significantly lower than those of the conventional group (P<0.05). After treatment, the improvement in SIt, TBUT, serum inflammatory factors, and tear cytokine levels in the DQS group and the CsA group was significantly better than that in the conventional group (P<0.05). However, these indexes were comparable in the DQS and the CsA group (P>0.05). Conclusions: Compared to the conventional treatment alone, the addition of 3% DQS or 0.05% CsA eye drops (II) to the conventional treatment both are effective and might more effectively alleviate DE in patients undergoing CS. [ABSTRACT FROM AUTHOR]

Purpose: Run-Mu-Ling granules (RMLG), a traditional Chinese medicinal formula, are used to treat dry eye (DE); however, the underlying mechanism remains poorly understood. This study aimed to elucidate the potential molecular mechanisms by which RMLG alleviates ocular surface inflammation in DE. Methods: We established an in-vivo DE rat model and in-vitro human corneal epithelial cell line (HCEC) injury models. Corneal damage severity was evaluated using various tests, including corneal fluorescein staining, tear break-up time, and phenol red tear test. Hematoxylin and eosin staining was used to examine histopathological changes in corneal tissues. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling detected corneal cell damage in rats. Transmission electron microscopy was used to observe the microstructures of corneal tissue. Immunofluorescence and Western blotting analyses were used to assess NLRP3, GSDMD, ASC, caspase-1, IL-18, IL-1β, and TNF-α expression levels in corneal tissues and HCEC. Cell viability was determined using CCK-8 and colony formation assays, and pyroptosis was examined using Annexin V-PI staining. Results: RMLG significantly improved tear film stability, promoted tear secretion, attenuated corneal tissue damage, enhanced HCEC activity, and suppressed pyroptosis. It also inhibited the activation of the NLRP3/GSDMD signaling pathway in corneal tissues and HCEC, reducing the release of downstream pro-inflammatory cytokines. Conclusion: This study suggests that NLRP3/GSDMD-mediated pyroptosis plays a crucial role in the pathogenesis of DE and that inhibition of this pathway is a key mechanism by which RMLG alleviates ocular surface inflammation in DE. These findings suggest that RMLG could be a promising therapeutic option for DE, offering new insights into its molecular action and potential clinical application. [ABSTRACT FROM AUTHOR]

With the development of science and technology, electronic devices have become an inevitable part of our daily life and work. There has been an increase of interest in the use of various video display terminals(VDT). The ocular surface is the first barrier of the visual system to resist the damage of the external environment. In recent years, the number of patients with dry eye has consistently increased with the excessive use of VDT. Blue light produced by VDT, with wavelengths ranging from 400 to 500 nm, has a high energy in visible light. Therefore, blue light may also be an important risk factor for dry eye. In particular, the outbreak of COVID-19 has left people worldwide suffering from increased blue light, which promotes further research into dry eye caused by blue light emitted from VDT. In this review, we summarize the recent studies on the role of blue light produced by VDT in dry eye to provide reference for future related research.

AIM: To assess the stability of the tear film and the characteristics of corneal nerves in patients with Parkinson's disease(PD).METHODS: This cross-sectional observational study included 72 PD patients and 50 healthy controls. Disease severity was determined using the Hoehn-Yahr(H-Y)scale, dividing patients into mild and moderate PD groups. Dry eye symptoms were evaluated via the ocular surface disease index(OSDI)questionnaire, while tear secretion was quantified using the Schirmer I test. Ocular surface damage was assessed through staining scores, and comprehensive ocular examinations were performed utilizing the LipiView ocular surface interferometer and an ocular surface analyzer. Corneal nerve parameters were examined using corneal confocal microscopy in conjunction with automated analysis software ACCMetrics, with correlations drawn between these parameters, PD course, and severity.RESULTS: PD patients exhibited significantly elevated OSDI scores, indicative of more pronounced dry eye symptoms compared to the control group(F=70.290, P

Andrea Bedei,1 Pedro Rocha Cabrera,2 Luis Oliveira,3 Laura Castellini,1 Giulia De Grazia,4 Stefano Remiddi4 1Ophthalmology Department Casa di Cura San Camillo, Forte dei Marmi, Italy; 2Ophthalmology Department Hospital San Juan de Dios Tenerife, Santa Cruz de Tenerife, Spain; 3Ophthalmology Department Hospital Santo Antonio, Porto, Portugal; 4Department of Research and Development, MD Italy, Albano Laziale, ItalyCorrespondence: Stefano Remiddi, MD Italy srl, Department of Research and Development, Via Cancelliera, 12, Albano Laziale, Rome, 00041, Italy, Email stefano.remiddi@md-italy.itPurpose: To assess the efficacy, adherence, and tolerability of a new artificial tear based on arabinogalactan, hyaluronic acid, and trehalose in a population with dry eye disease (DED).Methods: A retrospective, real-world, post-marketing study identified 96 adult patients (aged 18– 80 years) with signs and symptoms of dry eye. These patients received fixed combination therapy with eye drops containing arabinogalactan, hyaluronic acid, and trehalose at various dosing schedules. The data for this study were collected from April 2022 to June 2023. Patients underwent evaluation at baseline (T0) and after a follow-up period of two–three months (T1) using a patient-reported questionnaire.Results: In 96 adult patients (71 women and 25 men) with dry eye due to various conditions, the results indicated a 98% positive response to therapy. This response included improvements in vision (13%), comfort (39%), redness (13%), itching (16%), photophobia (4%), and tearing (14%). Additionally, 61% of the patients experienced 1– 2 hours of comfort following instillation.Conclusion: This real-life post-marketing study demonstrated clinical improvement of signs and symptoms in patients with dry eye disease using a new artificial tear medical device based on arabinogalactan, hyaluronic acid, and trehalose.Keywords: dry eye, real-world study, arabinogalactan, hyaluronic acid, trehalose, post-marketing study

AIM: To investigate the effect of intense pulsed light(IPL)combined with Yuyin Runmu formula fumigation and meibomian gland massage on the treatment of patients with meibomian gland dysfunction(MGD)-related dry eye.METHODS: Prospectively selected 198 cases(396 eyes)of MGD-related dry eye patients admitted to our hospital from November 2021 to November 2023, and they were randomly divided into 99 cases(198 eyes)in control group treated with fumigation of Yuyin Runmu formula and meibomian gland massage, and 99 cases(198 eyes)in observation group treated with combined IPL on the basis of the control group. The efficacy of the two groups was compared, as well as the changes in the levels of ocular indexes [tear film break-up time(BUT), Schirmer I test(SⅠt)], visual quality [objective scattering index(OSI), Strehl ratio(SR), and modulation transfer function(MTF)], lipid layer thickness(LLT)of the tear film, and changes in tear fluid levels of inflammatory factors [tumour necrosis factor-α(TNF-α)and transforming growth factor-beta 1(TGF-β1)].RESULTS: All the patients completely received the treatment and follow-up. The levels of BUT, SⅠt, SR, MTF, and LLT increased and the levels of OSI, TNF-α, and TGF-β1 decreased in the two groups at 2 mo after treatment(all P

AIM:To analyze differential proteins associated with the pathogenesis of dry eye(DE)using bioinformatics methods, in order to reveal their potential molecular mechanisms.METHODS: Articles published in PubMed and EMBASE databases from the inception of the database to August 31, 2023, that used proteomic methods to detect protein expression in clinical samples of dry eye were searched. Differential proteins were selected and further analyzed using the STRING database and Cytoscape software for hub gene screening and module analysis. Protein-protein interaction(PPI)analysis, gene ontology(GO)functional annotation, and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis were performed.RESULTS: A total of 21 articles were included, identifying 74 differentially expressed proteins. The most frequently occurring differential proteins were calgranulin A(SA1008), lipocalin-1(LCN1), lysozyme C(LYZ), mammaglobin-B(SCGB2A1), proline-rich protein 4(PRR4), transferrin(TF), and calgranulinB(S100A9). The top 10 hub genes were serum albumin(ALB), tumor necrosis factor(TNF), interleukin 6(IL6), IL1B, IL8, matrix metalloproteinase 9(MMP9), alpha-1-antitrypsin(SERPINA1), IL10, complement component 3(C3), and lactotransferrin(LTF). Module analysis suggested MMP9 and PRR4 as seed genes. KEGG analysis showed that differential proteins were mainly enriched in the IL17 signaling pathway(61.9%).CONCLUSION: The results reveal potential molecular targets and pathways for DE and confirm the association between the pathogenesis of DE and inflammation. Further in-depth research is needed to confirm the significance of these biomarkers in clinical practice.

AIM: To analyze the clinical outcomes of cyclosporine combined with lacrimal plug in the treatment of dry eye in patients with primary Sjögren's syndrome.METHODS: The clinical data of 60 patients(120 eyes)who were admitted to the ophthalmology department and rheumatology and immunology department of Baoding No.1 Central Hospital and were diagonosed with siogren's syndrome dry eye after multidisciplinary consultation from June 2022 to September 2023 were retrospectively analyzed. All the patients received regular treatment of primary Sjögren's syndrome, and they were divided into three groups according to treatment methods: A, B and C, with 20 cases(40 eyes)in each group. The group A received 0.3% sodium hyaluronate eyedrops, the group B received 0.3% sodium hyaluronate eyedrops plus 0.05% cyclosporine eyedrops, and the group C received 0.3% sodium hyaluronate eyedrops plus 0.05% cyclosporine eyedrops combined with binocular lacrimal plugs. The ocular surface disease index(OSDI)score, conjunctival hyperemia score, tear film breakup time(BUT), tear meniscus height(TMH), corneal fluorescein staining(FL)score and tear secretion of the three groups of patients were compared before and at 4, 8 and 12 wk after treatment. The contents of inflammatory factors such as interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)in tears were detected before and at 12 wk after treatment.RESULTS: At 4, 8 and 12 wk after treatment, the scores of OSDI, conjunctival hyperemia score and FL in the three groups of patients were lower than those before treatment, and the BUT, TMH and tear secretion were higher than those before treatment(all P0.05).CONCLUSION: The combined use of cyclosporine and lacrimal plug is safe and effective in improving the clinical symptoms of patients with moderate and severe dry eye, promoting the function of tear film and cornea, increasing tears secretion, and reducing the level of tear inflammatory factors.

Obesity is a risk factor and pathological basis for various chronic non-communicable diseases and is an important risk factor leading to human mortality and disability. The harm of obesity to the body includes not only various systemic diseases but also some ocular diseases. Currently, the higher pursuit of life and visual quality has led to increased attention to the etiology and prevention of ocular diseases, and the impact of obesity on ocular diseases has been gradually discovered. This article reviews the impact of obesity on certain ocular diseases to deepen the understanding of obesity's impact on ocular diseases and provide a reference for the prevention and treatment of ocular diseases.

Objective: To evaluate newly diagnosed vernal keratoconjunctivitis patients for their symptomatology, refractive errors and presence of dry eye disease along with its severity. Methods: A cross-sectional study was conducted after approval from the institutional ethics committee, among 100 patients of vernal keratoconjunctivitis, according to the inclusion and exclusion criteria. After obtaining informed consent, visual acuity and refraction, tear film break-up time, corneal fluorescein staining and Schirmer test (I and II) were performed. An ocular surface disease index questionnaire was filled out for symptomatic evaluation and was also graded on the basis of their ocular findings. The results were analysed by SPSS software. Results: In our study, the most common symptoms experienced were itching (87%) and redness (79%). Dry eye symptoms were present in 43% of patients with an ocular surface disease index (OSDI) mean score of 11.3 ± 4.67. Out of 100 patients, 45 patients had mild findings and 55 patients had moderate findings of VKC. The mean value of tear film break-up time (TBUT) was 8.15 ± 4.47 (P: 0.539), that of corneal fluorescein staining was 4.18 ± 3.4 (P: 0.885) and those of Schirmer’s test I and II were 13.4 ± 5.9 mm (P: 0.288) and 12.95 ± 5.8 mm (P: 0.615), respectively. Myopia was found to be the most common refractive error (35%) followed by hypermetropia (30%) and astigmatism (10%). Conclusion: The results concluded that patients of VKC showed a mild-to-moderate disease and are associated with dry eye having the values of TBUT, corneal staining and Schirmer test, proving the association. Refractive errors are not present in all patients of VKC but have a positive association with increasing severity of the disease.

AIM: To study the effect of intense pulsed light(IPL)combined with meibomian gland massage on postoperative dry eye in cataract patients with meibomian gland dysfunction(MGD).METHODS: A retrospective analysis was conducted on the general data of 100 patients(100 eyes)with cataract and postoperative dry eye syndrome accompanied by MGD treated in our hospital from June 2022 to June 2023. They were divided into a control group(n=50)and an observation group(n=50)according to different treatment methods, and received meibomian gland massage and meibomian gland massage combined with IPL treatment, respectively. The tear film break-up time(BUT), Schirmer I test(S I t), meibomian gland secretion score, ocular surface disease index(OSDI), ocular staining score(OSS), and treatment efficacy of the two groups of patients were compared before treatment and at 1 wk and 1 and 3 mo after treatment.RESULTS: The BUT and SIt in both groups after treatment were higher than those before treatment, while the secretion of meibomian gland, OSS score, and OSDI score were lower than those before treatment(all P

Sjogrens disease, well-described in people, is rarely identified in veterinary species. In people, Sjogrens disease is one of the most common systemic autoimmune disorders with an incidence of 0.5% in the female population. The hallmark histopathologic finding of primary Sjogrens disease is lymphomononuclear cell infiltrates aggregating as periductal infiltrate in salivary glands. Sjogrens-like disease has been reported in a domestic shorthair cat and golden retriever dog. However, both lacked positive antinuclear antibody (ANA) titers and the dog showed no clinical evidence of dry eye disease. The following case report describes the clinical and immunohistochemical findings suggestive of Sjogrens disease in a 3-year-old spayed female German shepherd cross that was presented for medically refractory absolute dry eye, xerostomia confirmed with oral atropine response tests, and bilateral mandibular salivary gland enlargement. Routine topical lacrostimulants, anti-inflammatories, heterologous serum, ocular lubrication, and oral pilocarpine failed to improve clinical signs or tear production. The ANA titer at 1:160 was interpreted as positive, while the complete blood count and serum biochemistry panels were unremarkable. Head and neck ultrasound revealed bilateral moderately enlarged mandibular salivary glands with a hypoechoic, mottled echotexture consistent with sialoadenitis and regional lymphadenomegaly; thoracic radiography and abdominal ultrasonography were normal. In vivo confocal microscopy and spectral-domain optical coherence tomography of the cornea confirmed lipid keratopathy presumably secondary to corneal desiccation and steroid administration. Salivary gland histopathological and immunohistochemical analyses supported an immune-mediated etiology. Approximately 60% of the salivary section contained inflammatory cells replacing the glandular structures with a focus score of 12. Immunohistochemical markers CD3, CD204, CD79a, and CD20 were evaluated. The inflammatory infiltrate was a mixture of T-cells and macrophages with rare individual immunoreactive B-cells. CD3 and CD4+ T-cells were confirmed using immunohistochemistry and quantitative PCR, respectively. Clinical signs including ocular discharge and mandibular salivary gland enlargement markedly improved following oral immunomodulatory therapy with prednisone (1 mg/kg/d, tapered over 2 months) and long-term leflunomide (2 mg/kg/d). Ocular discomfort improved dramatically decreasing the need for topical lubricants; however, tear production failed to improve likely due to extensive lacrimal gland atrophy. The aim of this report is to increase awareness of Sjogrens disease in dogs and interpret the pathology involved.

Objective To analyze influencing factors of asthenopia among mental laborers, and construct a predictive model. Methods This cross-sectional study included mental laborers. Basic information, lifestyle habits, and ocular health were collected. Ocular health was assessed using the Ocular Surface Disease Index (OSDI), the Allergic Conjunctivitis 12-item (AC-12), and the Asthenopia Survey Questionnaire 17-Item (ASQ-17). Univariate and multivariate Logistic regression analyses were conducted to identify factors associated with asthenopia and to construct a predictive model. The performance of the predictive model was comprehensively evaluated and validated using the receiver operating characteristic (ROC) curve and area under curve (AUC), calibration curve, decision curve analysis, and Bootstrap resampling method. Results 221 mental laborers were included, with 102 (46.15%) having asthenopia. Multivariate Logistic regression analysis showed that dry eye [OR=1.16, 95%CI(1.10, 1.21)] and allergic conjunctivitis [OR=1.17, 95%CI(1.06, 1.28)] were risk factors for asthenopia, while appropriate sleep duration with 8~

Bruno Barbosa Ribeiro,1 João Heitor Marques,1,2 Pedro Manuel Baptista,1,2 Paulo JM Sousa,1 Saúl Pires,1 Pedro Menéres,1,2 Irene Barbosa1,2 1Department of Ophthalmology, Unidade Local de Saúde Santo António, Porto, Portugal; 2School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, PortugalCorrespondence: Bruno Barbosa Ribeiro, Unidade Local de Saúde Santo António – Department of Ophthalmology, Largo Do Prof. Abel Salazar, Oporto, 4099-001, Portugal, Tel +351 222 077 500, Email brunot.barbosaribeiro@gmail.comPurpose: To study corneal epithelial thickness in patients with Dry Eye Disease (DED), according to symptomatology.Patients and Methods: Cross-sectional study in the outpatient clinic of the Ophthalmology Department of a tertiary hospital in Oporto, Portugal. Adult patients with a clinical diagnosis of dry eye disease were eligible for participation. Each patient underwent corneal epithelial thickness mapping with swept-source optical coherence tomography (SS-OCT, Heidelberg Anterion®) and automated ocular surface analysis (IDRA® Ocular Surface Analyzer SBM Sistemi, Italy). Schirmer’s test, tear film osmolarity (by TearLab® Osmolarity System) and Dry-Eye Related Questionnaire (OSDI-12) were also evaluated. Patients were classified accordingly the severity of symptoms in the OSDI-12 in group 1 (mild disease) and group 2 (moderate to severe disease).Results: We enrolled 200 eyes (of 100 subjects): 65 in group 1 and 135 in group 2. Median OSDI and Schirmer’s test in group 1 was 7 vs 46 points, p< 0.001 and 15 vs 11 mm, p=0.007 in group 2. Eyes from group 2 showed higher mean epithelial thickness (48.4 vs 47.1 μm, p=0.027) and lower mean stromal thickness (522.0 vs 546.6 μm, p< 0.001) in comparison with group 1. OSDI score was positively correlated with the mean epithelial thickness (r=0.188, p=0.008) and epithelial variability index (r=0.277, p=0.004) and negatively correlated with the mean stromal thickness (r=− 0.313, p< 0.001). Patients in group 2 showed higher epithelial variability index (4.5 vs 3.2, p< 0.001).Conclusion: Our study suggests that patients with more severe DED symptoms have thicker corneal epithelia and thinner stroma, which may act as a compensatory response. Epithelial variability index is positively correlated with the OSDI score and may reflect DED severity. This is the first study to report stromal thinning in patients with DED, thereby proving novel information regarding the matter. More studies are needed to confirm these results.Plain Language Summary: We have conducted original research regarding the effects of Dry Eye Disease on corneal epithelial and stromal thickness, as evaluated by Swept-Source Optical Coherence Tomography (Heidelberg Anterion®). Our study is pioneer in showing that patients with more severe symptoms have thicker epithelia with an apparent compensatory stromal thinning. Besides, corneal epithelium seems to have higher variability index in these patients, which appears to correlate with Dry Eye symptom severity. Our results may be helpful to reveal the role of dry eye disease in corneal structural changes.Keywords: dry eye, cornea, epithelium, thickness, anterion

AIM: To investigate the efficacy and mechanisms of indirect intense pulsed light (IPL) irradiation on meibomian gland dysfunction (MGD). METHODS: A total of 60 MGD patients was included in this prospective randomized controlled trial. Patients were randomly assigned 1:1 into two groups (3-mm group and 10-mm group) in which IPL was applied at distances from the lower eyelid margin of 3 and 10 mm, respectively. Both groups received three times treatment with 3-week interval. Meibomian gland yield secretion score (MGYSS), standard patient evaluation of eye dryness (SPEED) questionnaire, tear break-up time (TBUT), corneal fluorescein staining (CFS), and in vivo confocal microscopy were performed at baseline and after every treatment. RESULTS: After three IPL treatments, both groups had significant improvement in MGYSS (both P

Background: Diabetes, as the most common disease caused by metabolic disorders, is associated with several compli-cations, including ocular complications. The aim of this cross-sectional study was to determine the fre-quency of meibomian gland dysfunction and dry eye in patients with diabetes. Materials and Methods: In this descriptive-analytical cross-sectional study, patients with type 2 diabetes referred to the eye clinic of Farshchian Hospital (Sina) from December 2019 to October 2020 were included. Data were collected on the patients’ demographic characteristics, duration of diabetes, and HbA1c using a pre-designed checklist. The severity of dry eye was assessed by the tear breakup time (TBUT) test, while meibomian gland disorder and ocular complications were evaluated by a slit lamp. Results: In this study, 267 patients with type 2 diabetes participated. The mean age of the patients was 59.8 years, and 44.2% of them were male. Mild, moderate, and severe dry eye were observed in 34.1%, 18.0% and 5.2% of the patients, respectively. Grades 1, 2, and 3 of meibomian gland dysfunction were observed in 32.6%, 15.7%, and 5.2% of the patients respectively. Patients with poor glycemic control had higher se-verity of dry eye (p

Dry eye, the most common ocular surface disease, can cause ocular surface tissue damage and discomfort symptoms and seriously affect people's quality of life. The etiology of dry eye is diverse, and its pathogenesis is complex. The oxidative stress reaction is considered to be among the important factors in the pathogenesis of dry eye. Therefore, activating the antioxidant system has a potential therapeutic effect on dry eye. Nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway is considered the most important antioxidant pathway in the body. The activation of the Nrf2 signaling pathway and its interaction with other pathways are important mechanisms to prevent the occurrence and development of dry eye. This review describes the structure and function of Nrf2, summarizes the changes in the oxidative stress response in dry eye, focuses on the potential mechanism of the Nrf2 signaling pathway in the treatment of dry eye, and, finally, summarizes the drugs that activate the Nrf2 signaling pathway in the treatment of dry eye.

AIM: To investigate the mechanism of action of Qingxuan Runmu Yin(QRY)in the treatment of dry eye(DE)based on transcriptomics and network pharmacology, and to validate the efficacy and key targets of QRY through a animal model of DE.METHODS:RNA-sequencing(RNA-seq)technology was used to detect differentially expressed genes(DEGs)between mice in the DE group and mice in the normal control group, the active ingredients and potential targets of QRY were screened through database, and gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis were carried out after overlapping the results and obtaining key targets. Additionally, “drug-component-target signaling pathways” network was built and the protein-protein interaction(PPI)was analyzed. Mice were examined for Schirmer I test(SⅠt), tear film breakup time(BUT), and corneal fluorescein staining(FL)every 7 d from the beginning of the animal experiments. Hematoxylin-eosin staining(HE)was performed to observe pathologic changes in mouse corneal tissues. Enzyme linked immunosorbent assay(ELISA), Western blot and quantitative real-time polymerase chain reaction(qRT-PCR)were performed to verify the mRNA and protein expression levels of the core targets in mouse corneal tissues.RESULTS:Totally 2 234 DEGs, 233 active ingredients and 457 related targets of QRY were collected, with a total of 64 key targets obtained. GO function and KEGG pathway results showed that QRY was closely related to inflammatory mediators, and 19 core targets such as interleukin-1β(IL-1β)were screened by PPI network construction; SⅠt, BUT and FL results in the QRY group were statistically significantly different compared with the model group(all P

Abstract Background Dry eye disease (DED) is a prevalent condition affecting over 16 million patients in the USA. DED and the symptoms of ocular discomfort are debilitating and a significant burden on patients. If left untreated, DED can progress to cause severe pathology. Treatment is often initiated by patients without consulting a healthcare professional. This study investigated the safety and efficacy of a novel lipid-containing eye drop (BTC), which might better mimic the components of natural tears. Methods This was a multicenter, randomized, double-masked, active control, two arm, parallel group study of eye drops in adult subjects with self-reported DED. Subjects were randomly assigned to BTC or control (commercially available non-lipid eye drops; NLED) arm and were followed for 30 days. Assessments using visual analog scale and patient-reported outcomes (PRO) questionnaires, non-invasive tear break up time, slit-lamp examination, and subject-reported ocular symptoms were conducted at baseline and at days 7 and 30. The primary endpoint was change in overall ocular comfort score from baseline to day 30. Results 158 subjects were randomized, of whom 130 completed the study per protocol (PP). Mean (SD) age was 47.8 (14.14) years. The mean (95% CI) change in overall comfort scores at the 30-day follow-up in the PP population was 21.4 (15.1, 27.7) for the test drop and 10.0 (3.9, 16.1) for the comparator. The mean (95% CI) treatment difference was 11.3 (2.6, 20.1); this met the pre-defined requirements for non-inferiority. There was no significant difference in the proportion of eyes with reported ocular symptoms between the groups. At day 7, the OR (95% CI) was 0.967 (0.528, 1.770) and at day 30 was 1.160 (0.610, 2.203). There were no Grade 3 or higher corneal edema, corneal neovascularization, corneal staining, conjunctival injection, tarsal abnormalities or any other biomicroscopy findings, and no corneal infiltrates observed during the study. Conclusions The investigational lipid eye drop BTC was noninferior to the commercially available non-lipid comparator in all parameters measured and has the potential to provide an effective therapy for subjects with symptoms of dry eye who would benefit from a lipid-based artificial tear. Trial Registration NCT03995355 ( http://www.clinicaltrials.gov ), registered June 24, 2019.

Abstract Meibomian Gland Dysfunction (MGD) and Dry Eye Disease (DED) comprise two of the most significant eye diseases, impacting millions of sufferers worldwide. Several etiological factors influence the early symptoms of DED. Early diagnosis and treatment of erectile dysfunction may significantly improve the Quality of Life (QoL) for people. The current study introduces the ESAE-ODNN, an improved stacked autoencoder-aided optimised deep neural network, as a new way to predict DED using feature selection (FS), feature extraction (FE), and classification. The approach described here is novel because it merges chaotic maps into FS, employs SLSTM-STSA for improved classification accuracy (CA), and optimizes with the adaptive quantum rotation of the Enhanced Quantum Bacterial Foraging Optimisation Algorithm (EQBFOA). The present study enhances prediction functions by extracting MGD-related features and complicated relationships from the DED dataset. To ensure essential feature identification, the ESAE minimizes irrelevant and redundant features. To predict the DED, the ESAE first applies FE and then implements an ODNN classifier. This method fine-tunes the ODNN framework to enhance the effectiveness of the classification. The proposed ESAE-ODNN classification system efficiently assists in the early diagnosis of DED. Combining advanced Deep Learning (DL) methods with optimization can help us understand MGD features better and sort the data with the best accuracy (96.34%). The experimental evaluation with relevant performance metrics indicates that the proposed method is efficient in diverse aspects: accurate identification, reduced complexity, and fine-tuned performance. The ESAE-ODNN’s robustness in handling intricate feature indications and high-dimensional data outperforms the existing state-of-the-art techniques.

Purpose To evaluate the prevalence of dry eye, meibomian gland dysfunction (MGD), and conjunctivochalasis in patients with obstructive sleep apnea (OSA). Methods We included 37 patients diagnosed with OSA according to polysomnography. The control group comprised 31 subjects. The study participants underwent a complete ophthalmic examination and ocular surface assessment. Meibography was done using infrared imaging. Furthermore, tear meniscus height was measured using anterior segment optical coherence tomography. Results The mean age of the OSA and control groups were 50.3 ± 9.0 and 50.3 ± 8.0, respectively (P = 0.77). The mean scale for meibomian gland expression, meibomian gland plugging, and lid margin telangiectasia was similar in both groups. The meiboscores of the upper and lower eyelids were similar in both groups (upper meiboscores of 0.67 ± 0.48 and 0.37 ± 0.49 in OSA and control group, P = 0.180 and lower meiboscores of were 0.47 ± 0.57 and 0.22 ± 0.42 in OSA and control group, P = 0.179). The mean tear break-up time (TBUT) was significantly lower in the OSA group (8.17 ± 3.70 compared to 11.47 ± 4.52, P < 0.001). Upper and lower tear meniscus height were 186.14 ± 40.11 μm and 199.59 ± 37.22 μm and 237.25 ± 82.86 μm and 218.59 ± 68.8 μm in OSA and control group, respectively (P = 0.221, P = 0.166). The mean conjunctivochalasis grading score was 0.92 ± 0.72 and 0.81 ± 0.65 in the OSA and control groups, respectively (P = 0.143). Conclusions Despite decreased TBUT in patients with OSA, other dry eye parameters are not altered in these patients. Moreover, the frequency of MGD and conjunctivochalasis is not higher in OSA patients.

Caffeine, commonly found in coffee and tea, affects various aspects of eye health as it blocks adenosine receptors, impacting tear production, intraocular pressure, macular perfusion, and choroidal thickness. However, its connection with eye conditions like glaucoma and cataracts remains uncertain due to conflicting research findings. Some studies suggest potential benefits for cataracts, while others warn against frequent caffeine intake in glaucoma and surgical scenarios due to possible increases in intraocular pressure. Conflicting evidence also exists regarding its effects on dry eye, macular degeneration, myopia/hyperopia, diabetic retinopathy, retinopathy of prematurity, and central serous retinopathy. Caffeine does not seem to be a risk factor for dry eye, although studies have shown that caffeine may offer protection against wet age-related macular degeneration, and the metabolite 7-methylxanthine could be a more promising treatment for myopia. Moreover, caffeine can potentially cause tremors and might hinder surgical performance, especially in less experienced surgeons. Recommendations from experts vary, highlighting the need for further research to fully understand how caffeine affects the eye. Individuals genetically predisposed to glaucoma should be cautious due to the possibility of clinically significant elevations in intraocular pressure with caffeine consumption. For delicate procedures like microsurgery, where tremors can be detrimental, caution should be exercised with caffeine. This review underscores the importance of additional studies to provide clearer insights and prudent recommendations regarding caffeine’s impact on eye health.

Objective: To explore the metabolic differences between dry eye patients with Qi-Yin deficiency and heat stagnation in liver meridian patterns, and clarify their metabolic characteristics. Methods: Patients with dry eye who were treated in the Ophthalmology Ward and Outpatient Department of the First Hospital of Hunan University of Chinese Medicine from October 1, 2020, to October 30, 2021 were enrolled as the research participants in the study. They were assigned to two groups based on traditional Chinese medicine (TCM) syndrome types: heat stagnation in liver meridian pattern group and Qi-Yin deficiency pattern group. Healthy volunteers who underwent health check-ups in the Health Management Department were included as healthy group following the random number table method. The tears of the patients and the healthy volunteer participants were tested by high-performance liquid chromatography-mass spectrometry (LC-MS). The differential metabolites were screened out by multivariate statistical analysis, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment was performed on the differential metabolites. Finally, the association analysis of differential proteins and metabolites was conducted to verify and supplement the metabolites. Results: A total of 32 dry eye patients were enrolled, including 16 cases with heat stagnation in liver meridian pattern and 16 cases with Qi-Yin deficiency pattern. Fourteen healthy volunteers were included as healthy group. There were no significant differences in baseline characteristics among the three groups (P > 0.05). A total of 412 biomarkers were determined in Qi-Yin deficiency pattern group, mainly including lipids, lipid-like molecules, organic acids and their derivatives, organic heterocyclic compounds, and nucleosides and their analogues. For heat stagnation in liver meridian pattern group, 112 metabolites were determined, mainly including organic acids and their derivatives, lipids, and lipid-like molecules. The KEGG enrichment results of pathways and the relative content analysis of differential markers demonstrate that purine metabolism and caffeine metabolism pathways are common metabolic characteristics of all dry eyes. Among them, deoxyinosine monophosphate (dIMP) and 2-(formamido)-N1-(5-phospha-D-ribosyl) acetamidine can serve as their biomarkers. The main characteristics of Qi-Yin deficiency syndrome pattern were the significant enhancement of metabolic pathways such as lysine degradation, ovarian steroidogenesis, cholesterol metabolism, pyrimidine metabolism, and bile secretion (P < 0.05). Dry eye associated with the heat stagnation in liver meridian pattern is mainly characterized by inhibition of the valine, leucine, and isoleucine biosynthesis pathways (P < 0.05). Conclusion: Metabolomics can be used as an effective basis for TCM syndrome classification. Different patterns of dry eye syndrome exhibit typical characteristics in the types and concentrations of metabolites, which correspond to the syndrome classification in TCM. This study initially confirms the rationality of TCM syndrome classification and provides significant reference for the mechanism of dry eye and drug development.

AIM: To psychometrically validate the Chinese version of the dry eye-related quality-of-life score questionnaire (DEQS-CHN) among Chinese patients with dry eye. METHODS: This study involved 231 participants, including 191 with dry eye disease (DED) comprising the dry eye disease group, and 40 healthy participants forming the control group. Participants were required to complete the DEQS-CHN, and Chinese dry eye questionnaire and undergo clinical tests including the fluorescein breakup time (FBUT), corneal fluorescein staining (CFS), and Schirmer I test. To assess the internal consistency and retest reliability, Cronbach's α and the intraclass correlation coefficient (ICC) were employed. Content validity was assessed by item-level content validity index (ICV) and an average scale-level content validity index (S-CVI/Ave). Construct validity was assessed by confirmatory factor analysis. The concurrent validity was assessed by calculating correlations between DEQS-CHN and Chinese dry eye questionnaire. Discriminative validity was evaluated through non-parametric tests, with receiver operating characteristic (ROC) curve serving as conclusive indicators of the questionnaire's distinguishing capability. RESULTS: The Cronbach's α coefficients for frequency and degree of ocular symptoms, impact on daily life, and summary score were 0.736, 0.704, 0.811, 0.818, 0.861, and 0.860, respectively, and the ICC were 0.611, 0.677, 0.715, 0.769, 0.711, and 0.779, respectively. All I-CVI scores ranged from 0.833 to 1.000, with an S-CVI/Ave of 0.956. Confirmatory factor analysis results exhibited a well-fitting model consistent with the original questionnaire CONCLUSION: The DEQS-CHN has been demonstrated as a valid and reliable instrument for assessing the impact of dry eye disease on the quality of life among Chinese individuals with DED.

AIM: To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China. METHODS: A total of 265 patients clinically diagnosed with dry eye received a convenience survey questionnaire at West China Hospital of Sichuan University. All participants completed the rating scale of health self-management skill for adults (AHSMSRS), Huaxi Emotional-Distress Index (HEI), e-health literacy scale (e-HEALS) and Brief Illness Perception Questionnaire (Brief-IPQ). A generalized linear model was employed to establish a multivariate linear model with demographic data, psychological state, e-HEALS, and illness perception as independent variables and health self-management skill score as the dependent variable. RESULTS: The mean score for health self-management skill was 165.58±15.79. Multivariate analysis revealed that advanced age, better illness perception and improved psychological state were associated with better health self-management ability among dry eye patients. Furthermore, the health self-management ability of patients with a disease duration less than 1y was found to be higher compared to those with a disease duration exceeding 1y. CONCLUSION: The health self-management ability of dry eye patients in west China is relatively high. Age, duration of disease, illness perception and psychological state are the influencing factors on the health self-management ability of dry eye patients.

Abstract Background To compare and evaluate objective and subjective clinical parameters between 0.05% cyclosporine nanoemulsion (CsN) and 0.15% hyaluronic acid (HA) administration in patients with mild-to-moderate dry eyes. Methods In this prospective, randomized, double-masked, single-center, and placebo-controlled parallel study, patients with mild-to-moderate dry eyes were randomly allocated to be treated with 0.05% CsN or 0.15% HA twice daily. Patients were followed-up at 4, 8, and 12 weeks. Objective and subjective parameters were evaluated during each visit. Results A total of 35 patients were enrolled in this study. Compared with baseline, tear film break-up time and fluorescein staining scores at 4, 8, and 12 weeks significantly improved in the CsN group. However, the Schirmer I test showed no statistically significant change until week 12. Using the Symptom Assessment in Dry Eye (SANDE) score, both groups gradually showed significant improvement compared with baseline values. However, the Dry Eye-Related Quality-of-life Score Questionnaire (DEQS) showed no statistically significant change during the treatment period. Conclusions Both 0.05% CsN and 0.15% HA administration twice a day effectively improved the objective signs and subjective symptoms of patients with mild-to-moderate dry eyes. However, patients treated with 0.05% CsN experienced greater and faster improvement.

Abstract Topical eye drop approaches to treat ocular inflammation in dry eyes often face limitations such as low efficiency and short duration of drug delivery. Nanofibers serve to overcome the limitation of the short duration of action of topical eye drops used against ocular inflammation in dry eyes. Several attempts to develop suitable nanofibers have been made; however, there is no ideal solution. Here, we developed polycaprolactone (PCL) nanofibers loaded with dexamethasone acetate (DEX), prepared by electrospinning, as a potential ocular drug delivery platform for corneal injury treatment. Thirty-nine Sprague Dawley rats (7 weeks old males) were divided into four treatment groups after alkaline burns of the cornea; negative control (no treatment group); dexamethasone eyedrops (DEX group); PCL fiber (PCL group); dexamethasone loaded PCL (PCL + DEX group). We evaluated therapeutic efficacy of PCL + DEX by examining the epithelial wound healing effect, the extent of corneal opacity and neovascularization. Additionally, various inflammatory factors, including IL-1β, were investigated through immunochemistry, western blot analysis, and quantitative real-time RT-PCR (qRT-PCR). PCL + DEX group showed histologically alleviated signs of corneal inflammation compared with DEX group, which showed a decrease in IL-1β and MMP9 in the corneal stroma. The quantitative expression on day 1 after alkaline burn of pro-inflammatory markers, including IL-1β and IL-6, in the PCL + DEX group was significantly lower than that in the DEX group. Notably, PCL + DEX treatment significantly suppressed neovascularization, and enhanced the anti-inflammatory function of DEX during the acute phase of ocular inflammation. Collectively, these findings suggest that PCL + DEX may be a promising approach to effective drug delivery in corneal burn injuries.

Abstract To evaluate changes in dry eye-related parameters after posterior chamber phakic refractive lens (PC-PRL) implantation. This prospective study included 21 highly myopic patients (39 eyes) who underwent PC-PRL implantation at Lanzhou Huaxia Eye Hospital between January 2021 and June 2022, with a 3-month postoperative follow-up. In addition to routine preoperative examinations, dry eye assessments were conducted preoperatively and at 1 week, 1 month, and 3 months postoperatively. These assessments included the Ocular Surface Disease Index (OSDI) questionnaire score, non-invasive first tear break-up time (NIF-BUT), non-invasive average tear break-up time (NIA-BUT), tear meniscus height (TMH), meibomian gland loss (MGL) rate, and Schirmer I test (SIt). Repeated measures ANOVA was used to compare the differences in parameters across different time points, with pairwise comparisons conducted using the LSD-t test. After grouping, the Student's t-test was applied to compare normally distributed data, while the Mann–Whitney U test was used for non-normally distributed data. Categorical data were analyzed using the chi-square test. A total of 21 patients (39 eyes) were included, comprising 10 males (19 eyes) and 11 females (20 eyes), aged 19 to 49 years (33.76 ± 7.87). All patients completed the 3-month follow-up. Significant differences in OSDI scores were observed pre- and post-surgery (P = 0.008), with a peak at one week post-surgery (P 0.05). Significant differences in dry eye parameters were observed between the dry eye and control groups before and after surgery (P

Guo-Hong Zhao,1 Jin-Da Wang,1 Mei-Rui Liu,2,3 Li-Jun Zhang,4 Yan Sun,5 Kai Cao6 1Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Pulmonary Rehabilitation, Emergency General Hospital, Beijing, People’s Republic of China; 3School of Public Health, North China University of Science and Technology, Tangshan, Hebei, People’s Republic of China; 4Department of Obstetrics and Gynecology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, People’s Republic of China; 5Department of Ophthalmology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, People’s Republic of China; 6Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Kai Cao, Email crcteam@163.comObjective: To explore the distribution and influence factors of non-invasive tear film break-up time (NIBUT) in children.Methods: This is a hospital-based cross-sectional study. Spherical equivalent error (SER) was measured with cycloplegia. NIBUT was measured by an ocular surface integrated analyzer.Results: A total of 1269 children (1269 eyes) were included in this study. Participants’ median age was 11 (range 6– 18) years. 47.1% (598/1269) of participants were boys. The median NIBUT of myopic children and non-myopic children were 9.9 seconds (s) (Inter-quartile range, IQR: 6.4 to 16.1) and 10.9 s (IQR: 8.8 to 17.9), respectively, which was statistically significant (p = 0.004). In myopic children, 49.9% (573/1148) were able to achieve NIBUT of 10 s or more, compared to 67.8% (82/121) in non-myopic children, which was statistically significant (p < 0.001). There were 41 (3.57%) children in the myopic group and none (0%) in the non-myopic group with dry eye disease (p = 0.028). There was a positive correlation between NIBUT and age: NIBUT = 9.256 + 0.352&ast;Age. 71.8% (824/1148) of myopic children used electronic products almost every day, compared to 37.2% (45/121) of non-myopic children, which was statistically significant (p < 0.001).Conclusion: The NIBUT of myopic children was significantly shorter than that of non-myopic children. Children with myopia are more likely to have dry eyes. NIBUT increases with age. High frequency of electronic product use may be an important cause to NIBUT shortening in children.Keywords: Tear film break-up time, dry eye, Myopia, ocular surface, children

Hiroko Otake,1,&ast; Ko Kobayashi,2,&ast; Reita Kadowaki,1 Taiyo Kosaka,1 Mizuki Itahashi,1 Masanobu Tsubaki,1 Masaru Matsuda,2 Norio Iwakiri,2 Eiji Harata,2 Noriaki Nagai1 1Faculty of Pharmacy, Kindai University, Osaka, Japan; 2Life Science Division, NOF CORPORATION, Kanagawa, Japan&ast;These authors contributed equally to this workCorrespondence: Noriaki Nagai, Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka, 577-8502, Japan, Tel +81 6 4307 3638, Fax +81 6 6730 1394, Email nagai_n@phar.kindai.ac.jpPurpose: We aimed to prepare a β-cyclodextrin (β-CD) polymer using radical polymerization with co-monomers, 6-deoxy-6-(2-methacryloyloxyethylsuccinamide)-β-cyclodextrin (CD-MSAm) and N,N,N-trimethyl-N-(2-hydroxy-3-metacryloyloxopropyl)-ammonium chloride (QA) to design cyclodextrins suitable for use in ophthalmology. In addition, we evaluated their solubility and inclusion properties with rebamipide (REB), a poorly soluble drug, and investigated the usefulness of the β-CD polymer and REB (REB@CDQA) combination in treating dry eye.Methods: The β-CD polymer (CD-MSAm-co-QA, CDQA) based on CD-MSAm/QA was prepared via radical polymerization, and the usefulness of REB@CDQA in treating dry eye was evaluated using a rabbit treated with N-acetylcysteine (dry eye model).Results: The solubility of the CDQA powder was higher than that of the β-CD powder, and 80 nm colloids were observed in the CDQA solution. No corneal toxicity was observed in human corneal epithelial cells or rat corneas treated with 0.2% CDQA solution. The levels of REB dissolved in the CDQA solution were higher than those of the β-CD solution. Moreover, the application of the CDQA solution enhanced REB retention in the cornea and attenuated the transcorneal penetration of REB. In addition, instillation of REB@CDQA enhanced the volume of the lacrimal fluid and normalized the reduced mucin levels in the dry eye model. The extent of tear film breakup was attenuated by REB@CDQA instillation.Conclusion: The CDQA solution enhanced the solubility of REB, and the combination of CDQA and REB enhanced the drug content in the corneal tissue. Moreover, the therapeutic effect on dry eye was higher than that of REB suspensions without CDQA. Keywords: β-cyclodextrin, polymer, cationic group, rebamipide, dry eye