Search

OBJECTIVES To investigate the correlation between the clinical grading of the severity of meibomian gland dysfunction (MGD) and meibomian gland area (MGA) loss detected using Sirius meibography in the upper and lower eyelids and to correlate these parameters with dry eye signs and symptoms. METHODS One hundred thirty eyes of 130 volunteer patients were enrolled. Meibomian gland dysfunction was defined as the presence of signs consistent with meibomian gland terminal duct obstruction and categorized between grades 1 and 4. Upper and lower MGA loss percentages were evaluated using Sirius meibography by two blinded examiners. Patients were categorized into two groups (positive and negative for MGD) based on their Ocular Surface Disease Index (OSDI) scores (≥15 and

PURPOSE: To investigate the hypothesis that ocular surface epithelial thickness is correlated with tear osmolarity, conjunctivochalasis (CCh) and dry eye clinical tests. DESIGN: A case control study METHODS: A total of 50 patients with different types of dry eye disease (DED) and 15 age- and sex-matched control subjects were enrolled in this study. We performed a detailed diagnostic assessment of tear film and ocular surface parameters, including Ocular Surface Disease Index questionnaire, visual analog scale questionnaire, topographic surface regularity and surface asymmetry indices, tear film break-up time, corneal and conjunctival dye staining, Schirmer I test, and tear osmolarity. The corneal and bulbar conjunctival epithelial thickness (CET) were obtained using the latest version of spectral domain optical coherence tomography (SD-OCT). RESULTS: Patients with aqueous deficient DED (ADDED) had lower bulbar CET values particularly in the temporal region than that of normal subjects and patients with evaporative type DED (EDED); however, the difference did not quite reach a statistically significant level. Patients with DED and CCh had lower bulbar CET values in temporal (38.52 ± 9.58 μm) and inferior regions (50.79 ±9.10 μm) compared to those with DED without CCh (47.39 ±11.71 μm, 60.38 ± 14.36 μm, respectively, P

Objective: To investigate the effects of chronic obstructive pulmonary disease (COPD) in dry eye status in males and whether the hypoandrogenic status has any concomitant impact.Methods: Eighty patients with stable COPD and individually matched healthy volunteers on the basis of body mass index (BMI), age, and sex were enrolled. Ocular surface testing included ocular surface disease index (OSDI) questionnaire, evaluation of meibomian gland dysfunction (MGD), tear fluorescein break-up time (TF-BUT), ocular surface staining with lissamine green (LG), Schirmer test with topical anesthesia and Sirius meibographic analysis of meibomian gland area (MGA) loss. Bioavailable testosterone and free testosterone (fT) were measured through the measured total testosterone (TT), albumin, and sex hormone binding globulin (SHBG) concentrations.Results: Patients with COPD had lower levels of circulating androgens, decreased TF-BUT and Schirmer score and increased LG staining score, MGD grade and MG area loss compared to healthy controls (pConclusion: Males with COPD had worse tear film parameters, and this finding was more notable in patients with lower androgen levels. Hypoandrogenic status in patients with COPD attributes to dry eye status of the patients independent of their FEV1 and FEV1/FVC status.

Neurotrophic keratitis (NK), a potentially sight-threatening corneal disease, still does not have a specific treatment. The reduction or complete loss of corneal sensation, the most important factor in its pathogenesis, is one of the most important factors that complicate the treatment of corneal wound healing. In addition, the visual outcome may be adversely affected because of aggressive stromal fibrosis in severe NK cases. Basically, the current management of NK aims to accelerate wound healing and prevent the progression. However, new therapeutic agents, particularly developed depending on cell type-specific healing mechanisms are required for better visual outcomes. In recent years, several studies have started to use new promising areas of translational research, including gene therapy, stem cell therapy, miRNA, and bioengineering. Evidence has emerged that future treatment strategies for NK will be designed by the results of these studies. In this review, it is aimed to summarize scientific data of new treatment modalities for NK.

The management of nonhealing corneal ulcers, particularly in patients with neurotrophic corneas, remains a challenging problem today. Some patients may fail to respond to conventional therapy, making new alternative agents necessary to treat these resistant cases. In this article, we aim to present six challenging cases of refractory corneal ulcers that revealed healing response to the adjuvant treatment with coenzyme Q10 (CoQ10) eye drops and to review the literature examining of new therapeutic agents.Our study was designed as a descriptive case series demonstrating the use of novel coenzyme Q10 eye drops in refractory corneal ulcers. In our case series, CoQ10 eye drops were added to the existing therapies as an adjuvant agent in six cases: three cases with neurotrophic corneal ulcers, two cases with postinfectious corneal ulcers (one unknown etiology+one Acanthamoeba keratitis), and 1 case with Stevens-Johnson syndrome. All cases were monitored regularly and corneal images were taken at all visits.All nonhealing corneas with conventional therapy revealed recovery after the addition of CoQ10 eye drops. Except for two cases that responded to the CoQ10 eye drops more rapidly (within 1 to 2 weeks), complete corneal healing was observed in four cases between weeks 4 and 8. No adverse events were reported in these cases throughout the follow-up period.Coenzyme Q10 eye drops can be considered as an important adjuvant therapeutic agent promoting corneal epithelial wound healing in challenging cases.

OBJECTIVE To evaluate the comfort and visual performance of soft HydroCone (Toris K) silicone hydrogel lenses in keratoconus patients. METHODS Fifty eyes of 50 keratoconic patients who were fitted with the Toris K lens were included in the study. All patients were evaluated at baseline and after 2 weeks of lens wear. Uncorrected and best-corrected visual acuities were measured. Corneal topography, ocular aberrations, and point spread function (PSF) were obtained using NIDEK-OPD Scan. Comfort level and visual performance in daytime and nighttime conditions were scored from 0 to 5 after 2 weeks of lens wear. RESULTS Best-corrected visual acuity was significantly better with the Toris K lens (P

To describe the clinical findings of a patient with tyrosinemia type I with noncompliance to a protein-restricted diet, treated with 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione (NTBC). Clinical findings at the initial examination and after strict compliance to a protein-restricted diet after 4 weeks follow-up are described in a patient with tyrosinemia type I on NTBC treatment, who had been treated with presumed herpetic keratitis. A 10-year-old girl diagnosed with hereditary tyrosinemia type I and on NTBC treatment presented with photophobia and ocular discomfort in both eyes. An ophthalmologic examination demonstrated bilateral dendritiform epithelial lesions in the central cornea, staining faintly with fluorescein. These lesions were subsequently intermittently treated with topical antivirals for presumed herpes simplex virus keratitis and lubricant eye drops for 9 months without resolution; however, when strict compliance with a protein-restricted diet was instituted, nearly a complete resolution of the lesions was noted at the 4-week follow-up. Although type II tyrosinemia is known to have corneal involvement, the natural course of tyrosinemia type I has not been shown to have corneal involvement. Corneal involvement in type I tyrosinemia may be an indicator of dietary noncompliance and may show complete resolution with a strict compliance to protein-restricted diet only.

This study investigated the relationship between clinical severity and percentage of conjunctival antigen-presenting cells (APCs) in Sj&ouml, gren&rsquo, s syndrome (SS)-associated keratoconjunctivitis sicca (KCS). KCS clinical severity was based on symptom severity, tear volume, tear break-up time, and ocular surface dye staining. Conjunctival goblet cell density (GCD) was measured in periodic acid Schiff (PAS)-stained membranes. Conjunctival cells obtained by impression cytology were used for flow cytometry to measure percentages of CD45+HLA-DR+ APCs and mature CD11c+CD86+ dendritic cells (DCs). Compared to normal conjunctiva, the percentages of HLA-DR+ and CD11c+CD86+ cells were higher in the conjunctiva of the KCS group (p &lt, 0.05). The percentage of CD45+HLA-DR+ cells positively correlated with clinical severity (r = 0.71, p &lt, 0.05) and negatively correlated with GCD (r = &minus, 0.61, p &lt, 0.05). Clinical severity also negatively correlated with GCD (r = &minus, 0.54, p &lt, 0.05). These findings indicate that a higher percentage of APCs and mature DCs in the conjunctiva is associated with more severe KCS in SS. These APCs may contribute to the generation of the pathogenic Th1 cells that cause goblet cell loss in KCS.

OBJECTIVES The aim of this study was to compare different measurement tools and parameters, including a new computer-assisted image processing technique for the quantitative analysis of the percentage of pterygium on the corneal surface, horizontal/vertical lengths obtained using slitlamp beam and surgical compass. METHODS A total of 21 pterygia of 17 patients were included in the study. The pterygia were measured by three different methods: a slitlamp beam, a surgical compass, and a new computer-assisted image processing method. Refractive indices and higher-order aberrations were analyzed in all cases. RESULTS The new computer-assisted image processing technique revealed excellent intraclass correlation coefficients for intraobserver and interobserver reliability (0.999 and 0.995, respectively). However, horizontal and vertical lengths revealed more deviation between the measurements obtained with slitlamp beam and surgical compass. Although uncorrected visual acuity did not show any significant correlation between horizontal and vertical lengths of pterygia measured by either slitlamp beam or surgical compass, it was correlated with the digital pterygium ratio (rho, 0.462; P=0.035). All ocular aberration (total, higher-order, coma, trefoil, quatrefoil, spherical, and higher-order astigmatism) Root-mean-square values more strongly correlated with higher percentage values of pterygium that covers the cornea, measured by the new computer-assisted image processing technique. CONCLUSION The percentage of pterygium covering the corneal surface seems to be more associated with the pterygium-related visual disturbances than with horizontal and vertical lengths measured by conventional techniques. Moreover, the new computer-assisted image processing technique can accurately and reliably measure the percentage extension of pterygium on cornea.

Dysfunction of one or more components of the lacrimal functional unit results in an unstable tear film that can trigger eye irritation or cause ocular surface disease. There are distinct differences in the pattern of cornea and conjunctival disease and inflammation between aqueous deficient and aqueous sufficient tear dysfunction. There are accurate commercially available methods to measure tear volume. Diagnostic classification based on tear volume can guide therapy and identify patients with higher risk of developing disabling ocular surface disease or irritation.

The aim of the study was to investigate the effects of the Allergan Intranasal Tear Neurostimulator (ITN) on conjunctival goblet cell (GC) degranulation.A randomized, double-masked, placebo-controlled crossover trial.A total of 15 subjects (5 normal and 10 dry eye) were enrolled in a 3-visit study consisting of 1 screening and 2 separate randomized-masked ITN treatments (sham extranasal or intranasal). Tear meniscus height (TMH) was measured by anterior segment optical coherence tomography before and after applications. Impression cytology (IC) was taken from the bulbar conjunctiva of the right eye for periodic acid-Schiff staining and from the left eye for MUC5AC mucin immunostaining at baseline and after each treatment. The ratio of degranulated to nondegranulated GCs was measured as a marker of secretion.In all participants, both inferior bulbar (IB) and temporal bulbar (TB) cytology specimens stained for MUC5AC revealed a significantly higher ratio of degranulated to nondegranulated GCs after the ITN (IB: 2.28 ± 1.27 and TB: 1.81 ± 1.01) compared to baseline (IB: 0.56 ± 0.55, P = .015) (TB: 0.56 ± 0.32, P = .003) and extranasal sham application (IB: 0.37 ± 0.29, P = .001) (TB: 0.39 ± 0.33, P = .001). When the same analysis was repeated in the dry eye or control groups, the ratio was significantly higher after ITN than the baseline ratio and ratio after extranasal application in both groups (P.05). Moreover, although control subjects had a higher ratio of degranulated to nondegranulated GCs at baseline (0.75 ± 0.52) compared with the dry eye group (0.41 ± 0.27), the ratio became slightly higher in dry eye (2.04 ± 1.12 vs 1.99 ± 1.21 in control) after the ITN application. There was no significant difference between the IB or TB conjunctiva locations in terms of the effectiveness of the ITN application on conjunctival goblet cell secretory response.These preliminary results document that the Allergan ITN can stimulate degranulation of goblet cells in the conjunctiva, which is a promising new approach for the management of dry eye.

The aim was to assess corneal endothelial characteristics and central corneal thickness (CCT) in a population of Turkish cataract patients and to define the impact of age and gender on these parameters.Five hundred and seventeen cataract patients were examined with noncontact specular microscope preoperatively. The eye planned to be operated was selected for analysis. The parameters measured were endothelial cell density (ECD), cell area (CA), coefficient of variation (CV) of the CA, percentage of hexagonal cells (PHCs), and CCT.The mean values in ECD, CA, CV, PHC, and CCT in all eyes were 2,258 ± 474 cells per square millimeter, 468 ± 130 μm(2), 39%±7%, 49%±12%, and 500 ± 37 μm, respectively. Regression analysis revealed a statistically significant decrease in ECD (R=-0.169, P0.0001), increase in CA (R=0.186, P0.0001), and decrease in the CCT (R=-0.122, P=0.006) with increase in age. The changes in the CV (R=0.008, P=0.861) and PHC (R=-0,060, P=0.177) were not found to be dependent on age. The parameters showed no sex differences. The number of eyes with ECD below 1,000 and 2,000 cells per square millimeter was 5 (0.97%) and 130 (25.1%), respectively.The data from our study emphasize that age, but not gender, is the main determinant of ECD.

PURPOSE To investigate the effect of different sizes of pterygium on ocular aberrations along with corneal refractive changes, keratometry, and corneal topography. METHODS Forty eyes of 34 patients who had different sizes of primary nasal pterygium and 40 eyes of 22 age- and sex-matched healthy subjects without a clinical diagnosis of pterygium or pinguecula were enrolled in this study. All patients underwent a measurement of uncorrected and best spectacle-corrected visual acuities, corneal topography, and ocular aberrations. The pterygia sizes were measured with a slit lamp by using a slit beam of light. RESULTS All indices (topographic/refractive spherical and astigmatic values and topographic/refractive spherical equivalent) were higher in the pterygia group than in the control group. Both horizontal length (Rho: 0.64 and P < 0.001) and width of pterygia (Rho: 0.68 and P < 0.01) were found to be correlated with corneal astigmatism. When the root mean square values of ocular aberrations were compared among the groups (control, small, medium, and large size pterygia), differences were found to be statistically significant regarding all parameters including total (P < 0.001), tilt (P < 0.001), higher order aberrations (P < 0.001), total coma (P < 0.001), total trefoil (P < 0.001), total tetrafoil (P < 0.001), total spherical aberrations (P = 0.004), and higher order astigmatism (P < 0.001). Moreover, the root mean square values of ocular aberrations seem to strongly correlate with both horizontal length and width of pterygia. CONCLUSIONS Pterygia, particularly with larger sizes, seem to be correlated with increased ocular aberrations. Moreover, increase of ocular aberrations may become one of the indications for surgical treatment if this association is supported by further investigations.

PURPOSE To describe the use of the Boston ocular surface prosthesis (BOSP) to successfully treat a persistent corneal epithelial defect (PCED) after herpes zoster ophthalmicus that was minimally responsive to conventional therapies. METHODS A case report. RESULTS A 44-year-old man who developed a PCED in the right eye after herpes zoster ophthalmicus was treated with conventional therapies, including topical difluprednate opthalmic emulsion, 0.05% cyclosporine ophthalmic emulsion, topical autologous plasma, and oral doxycycline. Silicone plugs were inserted in the right upper and lower puncta. An 18-mm therapeutic hydrogel contact lens was placed in the right eye. After 4 weeks of this treatment, double layer amniotic membrane transplantation and temporary lateral tarsoraphy were performed. Ten days after the procedure, the amniotic membrane had dissolved and the tarsorrhaphy was opened. Because only partial healing of the corneal epithelial defect was observed, the patient was fit with the BOSP that he wore all waking hours. A soft contact lens was worn overnight after the BOSP was removed. Rapid reepithelization was observed within the week after starting the BOSP. The epithelial defect completely healed after 3 weeks, and the uncorrected visual acuity in the right eye improved to 20/50. CONCLUSIONS The BOSP should be considered as an important treatment option for management of PCEDs in eyes with altered corneal sensitivity.

To report on a case of idiopathic orbital myositis with scleritis that was effectively controlled with topical 0.05% cyclosporine A and to provide a review of the literature on the treatment of ocular myositis with scleritis.A case report.A 35-year-old woman presented with a longstanding history of intractable periorbital pain, redness on her left eye, and diplopia during ocular movement. Her medical history revealed that she had the same symptoms for 5 years and had used numerous prescribed medications for migraine and ocular myositis. During this period, her symptoms and signs had been lessened on systemic steroid treatment, which recurred or worsened after discontinuing or tapering the therapy. Magnetic resonance imaging scans demonstrated an isolated enlargement of the left medial rectus muscle. Laboratory examination results showed no evidence of dysthyroid ophthalmopathy or another systemic disease. Because of adverse affects of systemic corticosteroid and cyclosporine treatments, topical cyclosporine A (0.05%) and dexamethasone were administered four times daily. The patient continued to use topical 0.05% cyclosporine A for 6 months. Using only topical cyclosporine A, she currently has no recurrences of disease on the last examination after 6 months of treatment. Moreover, magnetic resonance imaging revealed a completely normal extraocular muscle configuration.Topical 0.05% cyclosporine A may be a safe and effective long-term treatment of ocular myositis and scleritis. It should be considered as a steroid-sparing agent, particularly in recurrent disease and in those patients who experience adverse effects of systemic medications.

Dry eye disease or keratoconjunctivitis sicca (KCS) is a common disorder which refers to a spectrum of ocular surface diseases with multiple etiologies.1 KCS is associated with symptoms of ocular discomfort such as burning, sense of dryness, foreign body sensation, ocular pain, and is sometimes associated with photophobia, blurred vision, visual fatigue, and sight-threatening corneal complications in severe cases.2,3 Epidemiologic studies have stated that more than 6% of the population complains of dry eye symptoms, and this ratio increases to 15% over the age of 65.4–6 Most of the studies have also found an increasing prevalence with aging and greater prevalence among women due to the hormonal status.4,6,7 Pathogenesis of KCS has not been completely clarified. Even though KCS has been thought of classically and basically as a condition of tear deficiency, whether caused by decreased lacrimation or excessive evaporation, it is a complex disorder. Many clinicopathological entities involving tear film, lacrimal glands, eyelids, and a wide spectrum of ocular surface cells, including epithelial, inflammatory, immune, and goblet cells may play a role in its pathogenesis.2,8 Over the past years, as a result of numerous studies, new concepts of pathogenesis have shown that KCS seems to be caused by inflammation mediated by T-cell lymphocytes.9–11 This finding has also been augmented by the studies investigating the role of antiinflammatory therapies. For instance, the treatment of KCS gained a new dimension with the approval of topical 0.05% cyclosporine A (Restasis) (Allergan, Inc., package insert for Restasis) by the US Food and Drug Administration. Consequently, because of the increasing importance of the role of inflammation and the use of cyclosporine eye drops, the goal of this review article is to provide the readers with an overview of the role of inflammation and also to discuss antiinflammatory therapies such as topical cyclosporine in KCS.

PURPOSE: To investigate the hypothesis that a new matrix therapy agent (ReGeneraTing Agent, [RGTA]) would speed up the corneal reepithelialization, improve stromal healing, and reduce ocular symptoms after epi-off corneal cross-linking (CXL). METHODS: Sixty eyes of 60 patients with progressive keratoconus were enrolled in the study. Epi-off accelerated CXL was performed in all patients. Sixty eyes were randomized into two groups according to use of RGTA eye drops prior to contact lens fitting at the end. Identical medical agents were started postoperatively for the two groups. All participants were monitored on 3 consecutive days after the CXL. Ocular pain, burning, stinging, tearing, photophobia, conjunctival hyperemia, and corneal healing status were evaluated. RESULTS: By day 2, 25 eyes (83.3%) with RGTA revealed complete healing compared to 4 eyes (13.3%) that revealed complete healing in the control group ( P < .001). All eyes had complete corneal epithelial defect closure by day 3 in both groups. Ocular pain scores were lower in the RGTA group on days 0, 1, and 2 (all P < .05). Burning scores were lower on days 1 and 2; stinging scores on days 2 and 3; tearing scores on days 2 and 3; and photophobia on days 1 and 2 ( P < .05) in the RGTA group compared to the control group. CONCLUSIONS: RGTA ophthalmic solution facilitates corneal healing by reconstructing the extracellular matrix in the wound area, leading to an earlier relief of symptoms for patients. [ J Refract Surg. 2017;33(3):163–170.]

To evaluate the clinical findings and multifocal electroretinography results of cases with solar maculopathy due to eclipse watching. Eight eyes of six patients (ages ranged 12–42) who presented to our clinic after the solar eclipse of 29 March 2006 were evaluated in the study. All patients underwent a full ophthalmologic examination and multifocal electroretinography (mfERG). Visual acuities at the initial examination were between 20/32 and 20/20; and at final examination between 20/25 and 20/20 respectively. Fundoscopic examination disclosed macular pigmentary changes in almost all patients. Fundus Fluorescein Angiography revealed a window defect in six eyes. The initial findings of the mfERG at the first visit showed a decrease in the P1 and N1 amplitudes of the central responses. The following mfERG recordings showed a recovery in central P1 and N1 amplitudes. Decrease in P1 and N1 amplitudes of central macular region can be detected by mfERG in patients with solar maculopathy. Follow-up mfERG test results may recover with the increase of visual acuity.

To investigate the hypothesis that increased interferon-γ (IFN-γ) expression is associated with conjunctival goblet cell loss in subjects with tear dysfunction.Goblet cell density (GCD) was measured in impression cytology from the temporal bulbar conjunctiva, and gene expression was measured in cytology samples from the nasal bulbar conjunctiva obtained from 68 subjects, including normal control, meibomian gland disease (MGD), non-Sjögren syndrome (non-SSATD)-, and Sjögren syndrome (SSATD)-associated aqueous tear deficiency. Gene expression was evaluated by real-time PCR. Tear meniscus height (TMH) was measured by optical coherence tomography. Fluorescein and lissamine green dye staining evaluated corneal and conjunctival disease, respectively. Between-group mean differences and correlation coefficients were calculated.Compared to control, IFN-γ expression was significantly higher in both ATD groups, and its receptor was higher in SSATD. Expression of IL-13 and its receptor was similar in all groups. Goblet cell density was lower in the SSATD group; expression of MUC5AC mucin was lower and cornified envelope precursor small proline-rich region (SPRR)-2G higher in both ATD groups. Interferon-γ transcript number was inversely correlated with GCD (r = -0.37, P0.04) and TMH (r = -0.37, P = 0.02), and directly correlated with lissamine green staining (r = 0.51, P0.001) and SPRR-2G expression (r = 0.32, P0.05).Interferon-γ expression in the conjunctiva was higher in aqueous deficiency and correlated with goblet cell loss and severity of conjunctival disease. These results support findings of animal and culture studies showing that IFN-γ reduces conjunctival goblet cell number and mucin production.

Juvenile nasopharyngeal angiofibroma (JNA) is one of the most common benign nasal cavity tumors of adolescence. It exhibits a strong tendency to bleed and despite being microscopically benign, its behavior is locally aggressive. Preoperative embolization is helpful to minimize intraoperative bleeding. However, embolization procedure may have some important thromboembolic complications such as central retinal artery occlusion. In this article, a young male with juvenile nasopharyngeal angiofibroma, who lost his vision in the left eye following embolization was presented and the possible therapeutic options in such a complication were discussed.

Background To investigate the expression levels of vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor 1 (VEGFR-1) and VEGFR-2 in pterygium and to clarify the prognostic significance of these expressions in pterygia. Methods A total of 40 surgically excised pterygia and 9 normal conjunctivae were immunohistochemically studied applying the streptavidin–biotin method in paraffin-embedded tissue sections. Monoclonal antibodies were targeted against VEGF, VEGFR-1 and VEGFR-2 proteins. At the sixth postoperative month, the recurrence rate was graded on a scale of 1–4. Results The mean percentage of VEGF-positive epithelial cells was comparable in pterygium and normal conjunctivae. However, the pterygium group presented higher expression levels of VEGF in pterygia endothelial cells (p=0.05). In terms of VEGFR-1 expression in epithelial cells, no statistically significant difference was found between two groups (p=0.658). However, normal conjunctivae exhibited higher expression levels of VEGFR-1 in endothelial cells (p=0.002). Epithelial cells in pterygium presented higher combined scores of VEGFR-2 (87.5% and 22.2%, respectively) (p=0.013). While higher expression levels of VEGFR-2 were documented in pterygia endothelial cells, no VEGFR-2 immunoreactivity was observed in the endothelial cells of normal conjunctivae (p

Purpose To present a case of acute idiopathic endotheliitis occurred early after corneal collagen cross-linking (CXL) for progressive keratoconus, and to discuss possible risk factors, causes, and other similar complications in the literature. Methods A 24-year-old woman with bilateral keratoconus underwent a corneal de-epithelization and subsequently CXL in the right eye, which was performed with the application of 0.1% riboflavin with 20% dextran, and exposure to ultraviolet-A light (370 nm, 2.9-3.1 mW/cm) for 30 minutes. A bandage contact lens was placed until complete re-epithelialization. Postoperatively, the patient received 0.5% topical moxifloxacin (3 times a day) and preservative free artificial tears (6 times a day). Results Postoperatively, the patient presented with significant hyperemia and photophobia on day 3. On biomicroscopy, ring-shaped endothelial infiltrates and localized corneal edema were observed in the inferior paracentral location of the cornea. Idiopathic endotheliitis was diagnosed, the therapeutic contact lens was removed, and 1% prednisolone acetate suspension was started every hour in addition to hypertonic ophthalmic solution every 3 hours. After this intensive corticosteroid treatment, the infiltrates improved and completely resolved after 1 week. Conclusions We reported a successfully treated acute idiopathic endotheliitis occurring early after routine CXL. This very rare complication is hypothesized to occur as a result of the phototoxic effect of ultraviolet-A transmission on the corneal endothelium, or as an inflammatory response to surgical trauma or solutions used throughout the procedure.

Purpose. To describe the clinical findings of a patient who initially underwent surgery for a pterygium and who was finally diagnosed with invasive squamous cell carcinoma. and to determine the necessity and importance of pathologic investigation in all cases of a presumed pterygium. Methods. A case report. Results. A 63-year-old man was referred for severe pain, redness. and purulent secretion in his right eye. A year earlier. he had under-one excision of a pterygium in his right eye by a bare sclera technique without any adjunctive antimetabolite in a private eye clinic. Furthermore, 6 months after this operation, he had undergone autologous conjunctival graft surgery because of dehiscence of the Surgical site. His visual acuity was Only light perception in the right eye. Slitlamp biomicroscopy showed severe nasal corneoscleral melting, purulent secretion, conjunctival hyperemia, corneal edema. hypopyon, intracamaral hemorrhage. and lid swelling. Ultrasonography showed a right hypoechoic mass invading the nasal part of the globe and a totally detached retina. Orbital magnetic resonance imaging showed a large (2 cm in diameter), irregular, lobulated mass invading the globe in the medial part of the right orbit. Results of a biopsy were consistent with squamous cell carcinoma. Because of the extensive intraocular involvement at the time of the diagnosis, subtotal orbital exenteration was performed. Conclusions. All pterygia Should be evaluated meticulously with regard to possible underlying causes, Such as carcinoma in situ or squamous Cell carcinoma, and all excised lesions should also be evaluated pathologically to prevent Such serious adverse Outcomes that are mentioned in this case report.

Purpose To evaluate relationships between tear meniscus dimensions and parameters of ocular surface disease in a variety of tear dysfunction conditions. Design Single-institution prospective observational study. Methods This study from the Baylor College of Medicine included 128 eyes of 64 subjects. Cross-sectional lower tear meniscus height and tear meniscus area were measured using optical coherence tomography and were compared with tear break-up time (TBUT), corneal staining, conjunctival staining, and an irritation symptom questionnaire (Ocular Surface Disease Index). Study groups included meibomian gland disease (MGD), aqueous tear deficiency (ATD), Sjogren syndrome, non–Sjogren syndrome ATD, and control subjects. Statistical analyses were performed using the Pearson correlation and Student's t test. Results When compared with mean tear meniscus height in controls (345 μm), mean tear meniscus height was lower in all tear dysfunction (234 μm; P = .0057), ATD (210 μm; P = .0016), and Sjogren syndrome groups (171 μm; P = .0054). For tear meniscus height ≤210 μm, relative risk ratio for developing corneal staining ≥10 was 4.65. Tear meniscus height correlated with corneal staining for all subjects ( R = −0.32; P = .0008), MGD ( R = +0.40; P = .059), and ATD ( R = −0.36; P = .04). Tear meniscus area showed similar trends in MGD ( R = +0.55; P = .006) and ATD ( R = −0.40; P = .018). Tear meniscus height correlated with TBUT for all subjects ( R = +0.39; P R = +0.37; P = .018). Conclusions In tear dysfunction conditions, lower tear volume correlates with worse corneal epithelial disease in ATD and Sjogren syndrome, conditions with lacrimal gland dysfunction. In contrast, higher tear volume is associated with corneal epithelial disease in MGD. These findings may improve the ability to identify patients at risk for corneal epithelial disease.

To evaluate the impact of aging on conjunctivochalasis in an objective manner using anterior segment optical coherence tomography.Prospective clinical trial.Sixty eyes of 30 healthy volunteers (15 men, 15 women; age range, 24-75 years) without any ophthalmic diseases were recruited for the study. Subjects were organized into 3 sex-matched groups, each including 10 subjects according to their ages: 20-39 years (Group 1), 40-59 years (Group 2), 60-75 years (Group 3). Cross-sectional area of conjunctivochalasis was measured at 3 locations (temporal, central, and nasal) using Fourier-domain optical coherence tomography. Tear meniscus height was also measured in all images where a typical triangular-shaped tear meniscus was obtained.In terms of the cross-sectional area of conjunctivochalasis, there were statistically significant differences among 3 groups at temporal and nasal locations (P .001). At the central location, whereas there were no subjects in Groups 1 and 2, solely 3 eyes revealed conjunctivochalasis in Group 3. The severity of conjunctivochalasis affecting the temporal and nasal bulbar conjunctiva was strongly correlated with age (η(2) = 0.81, P .001 and η(2) = 0.78, P.001). Lower central tear meniscus height was compared among the groups and a significant increase with age was observed (P.001).Fourier-domain optical coherence tomography provides an objective and quantitative approach for assessing the stages of conjunctivochalasis. The current study objectively confirms that conjunctivochalasis can be observed even in younger, healthy eyes; its severity increases with age; and it may alter tear distribution along the lower lid.

Aims The aim of this study was to show the prevalence of obstructive sleep apnoea (OSA) in non-arteritic anterior ischaemic optic neuropathy (NAION). Methods 20 patients diagnosed with NAION were included in the study. 20 age and sex matched subjects with similar risk factors for NAION, such as diabetes mellitus (DM) and hypertension (HT), constituted the control group. All cases underwent polysomnography for investigation of the presence of OSA. Cases with an Apnoea–Hypopnoea Index >5 were accepted as having OSA. Results Mean ages of the patients and controls were 60.90±8.14 and 61.15±7.23 years, respectively. There were no significant differences between the patient and control groups in terms of age, gender, body mass index, smoking/alcohol consumption or systemic diseases. In the patient group, 85% were diagnosed with OSA compared with 65% in the control group (p>0.05). Conclusions We found a high prevalence of OSA in patients with NAION but it was also high in the control group (p>0.05). This may be due to the fact that the two groups were matched for the same risk factors for NAION. The study indicates that OSA is not a risk factor for NAION in itself but is the contributing factor as it has effects on the vascular endothelium in DM, HT and atherosclerosis.

Background The authors aimed at investigating ophthalmological changes at high altitude and correlating this with blood oxidation/antioxidation parameters. Methods There were 40 volunteers who participated in the study. Initial ophthalmological examinations were performed at 3543 ft (1080 m) and repeated on the following day after the participants climbed to an altitude of 9186 ft (2800 m) on Mt. Erciyes, Turkey. Venous blood samples were taken at both altitudes to evaluate total oxidative system (TOS) and antioxidative system (TAS) levels. Results IOP-right eyes at 3543 ft (1080 m) was 13.23 +/- 0.43 mmHg and significantly increased to 14.45 +/- 0.56 mmHg at 9186 ft (2800 m). LOP-left eyes at 3543 ft (1080 m) was 13.50 +/- 0.44 mmHg and increased to 14.13 +/- 0.54 mmHg at 9186 ft (2800 m) (P = n.s.). Central corneal thickness (CCT) of the right eyes was 540.98 +/- 4.34 microm at 3543 ft (1080 m) and significantly increased to 549.73 +/- 4.59 microm at 9186 ft (2800 m). CCT of the left eyes was 542.13 +/- 29.01 microm at 3543 ft (1080 m) and significantly increased to 547.23 +/- 4.59 microm at 9186 ft (2800 m). Spherical equivalent refraction of right or left eyes did not show any significant changes. TOS at 3543 ft (1080 m) was 5.33 +/- 0.76 micromol H2O2 equiv/L and significantly increased to 7.55 +/- 0.82 micromol H2O2 equiv/L at 9186 ft (2800 m). TAS at 3543 ft (1080 m) was 2.45 +/- 0.12 micromol H2O2 equiv/L and decreased to 2.22 +/- 0.08 micromol H2O2 equiv/L (P = n.s.) at 9186 ft (2800 m). There was a positive correlation between TAS and LOP at 9186 ft (2800 m). Conclusion Increased CCT can be related to stromal edema caused by hypoxia's effect on corneal endothelial function. Although TOS increased at high altitude, TAS did not show any parallel increase. Since this was nonacclimatized climbing, the antioxidant system could not have reached sufficient levels to counterbalance the observed oxidant stress.

Orbital apex syndrome is a rare manifestation of Herpes Zoster Ophthalmicus. Herein we report on a case of orbital apex syndrome secondary to Herpes Zoster Ophthalmicus. A 75 year-old male complained of vision loss, conjunctival hyperemia and proptosis on the left eye, was referred to our clinic. Visual acuity was 5/10 Snellen lines and he had conjunctival hyperemia, chemosis, minimal nuclear cataract and proptosis on the left eye. A diagnosis of orbital pseudotumor was demonstrated firstly. The patient received oral and topical corticosteroids, antiinflammatory and antibiotic agents. On day 2, vesiculopustular lesions were observed, Herpes Zoster Ophthalmicus was diagnosed and corticosteroid treatment stopped, oral acyclovir treatment initiated. Two days later, total ophthalmoplegia, ptosis and significant visual loss were observed on the left. The diagnosis of orbital apex syndrome was considered and the patient commenced on an intravenous acyclovir treatment. After the improvement of acute symptoms, a tapering dose of oral cortisone treatment initiated to accelarate the recovery of ophthalmoplegia. At 5-month follow-up, ptosis and ocular motility showed improvement. VA did not significantly improve because of cataract and choroidal detachment on the left. We conclude that ophthalmoplegia secondary to Herpes Zoster Ophthalmicus responds favourably to intravenous acyclovir and steroids.

PURPOSE To investigate the effects of pterygium excision with conjunctival autograft plus corneal polishing on ocular higher-order aberrations (HOAs) and to monitor the changes throughout the first postoperative year. METHODS A total of 18 eyes of 16 patients with primary pterygium who had an indication for surgical excision were included in the study. All patients underwent a detailed ophthalmologic examination preoperatively and at the third and twelfth postoperative months. Pterygium excision with conjunctival autograft plus corneal polishing was performed by the same surgeon (K.G.). Corneal topography and ocular HOAs were measured by NIDEK optical path difference scanning system ARK-10000 refractive power/corneal analyzer. RESULTS Root mean square values of total aberrations and total HOAs were found to be significantly decreased both at 3 and 12 months after an uneventful pterygium surgery. Although solely root mean square values of coma and trefoil revealed a statistically significant reduction in the third postoperative month (P=0.043 and P=0.018, respectively), after 1 year, all parameters (total coma: P

Objective To evaluate the efficacy of onabotulinumtoxinA injection for the treatment of refractory filamentary keratitis. Methods A retrospective review of treatment response of 33 eyes of 17 patients with filamentary keratitis resistant to conventional medical therapy who were treated with onabotulinumtoxinA injection was performed. Ocular surface findings, symptom improvement, and the number and location of filaments before and after the injections were recorded. All eyelids were injected subcutaneously with onabotulinumtoxinA (10 U/0.1 mL). All treatments were performed in accordance with an individualized treatment plan using precise localizing treatment maps, with adjustments to dosage based on treatment response. Results Objective and subjective improvement was noted after the initial onabotulinumtoxinA injection in all patients. Filaments completely resolved after the onabotulinumtoxinA injection in 29 eyes (88%). In 20 of these eyes, filaments and punctate fluorescein staining resolved, whereas in 9 eyes, filaments resolved but punctate fluorescein staining persisted. Three eyes (9%) had partial improvement: 2 residual microfilaments were noted in one eye and 1 in the other eye. In 1 eye, filaments resolved after initial and subsequent injections but recurred within 8 weeks of each injection. Although 14 treated eyes (42%) showed sustained improvement after 1 onabotulinumtoxinA injection, additional injections were necessary in 19 eyes (58%) during the follow-up period because of the recurrence of symptoms and filaments on the cornea. Conclusions OnabotulinumtoxinA injection should be considered an effective option for treating refractory filamentary keratitis. Because of the likelihood of recurrence, serial onabotulinumtoxinA injections may be necessary in some cases.

PURPOSE. To evaluate tear film stability in patients with tear dysfunction and an asymptomatic control group by using the novel, noninvasive Tear Stability Analysis System (TSAS). METHODS. In this prospective case‐control study, 45 patients with dysfunctional tear syndrome (DTS) were stratified into three groups (1, 2, and 3/4) based on clinical severity, with higher scores indicating more severe symptoms; 25 asymptomatic control subjects were evaluated. TSAS measurements were performed with the RT-7000 Auto Refractor-Keratometer (Tomey Corporation, Nagoya, Japan). Images of ring mires projected onto the cornea every second for 6 seconds were captured and analyzed. Focal changes in brightness were calculated as numerical ring breakup (RBU) values, and the elapsed time when the cumulative values (RBU sum) exceeded a threshold was defined as the ring breakup time (RBUT). RESULTS. RBUTs in the DTS groups were all significantly lower than those in the control subjects, with the lowest values found in DTS 3/4. RBUT was significantly shorter in DTS 3/4 than in DTS 1 (P 0.001). The change in RBU sum over a 6-second period in the DTS groups combined or between the individual groups was statistically significant (P 0.001), as was the difference between the 1- and 6-second values. For distinguishing between asymptomatic controls and DTS, the sensitivity and specificity of a 5.0-second RBUT cutoff were 82.0% and 60.0%, respectively. CONCLUSIONS. The TSAS may be a useful, noninvasive instrument for evaluating tear stability and for classifying DTS severity. (Invest Ophthalmol Vis Sci. 2011;52:456‐461) DOI

Purpose To evaluate cross-sectional conjunctivochalasis area (CChA) and tear meniscus area (TMA) using Fourier-Domain-RTVue-100 optical coherence tomography (OCT) before and after conjunctival cauterization and to evaluate inter- and intraobserver reliability. Methods A total of twelve eyes of 7 patients with conjunctivochalasis aged 56 to 87 were evaluated. After topical anesthesia, conjunctival cauterization was performed on the inferior bulbar conjunctiva. All patients underwent anterior segment OCT (AS-OCT) imaging prior to and 4 weeks after the procedure. Cross-sectional TMA and CChA at 3 locations (nasal, center and temporal areas) were measured in all patients. Results Non-significant increases (p= 0.177) in TMA as a whole (3 locations combined) were observed at following cauterization. CChA measurements significantly decreased in all 3 locations after cauterization (p< 0.001). Mean CChA decreased from 0.247 ± 0.24 mm2 to 0.054 ± 0.79 mm2. For two measurements of TMA by examiner 1, intraclass correlation coefficients (ICC) ranged from 0.998 to 0.999. Among two examiners, Cronbach’s alpha reliability coefficients were as high as 0.993 and 0.997 before and after conjunctival cauterization. Regarding the CChA measurements, ICC values were similar to those of TMA, but Cronbach’s alpha reliability coefficients were slightly less. Conclusion This study indicates the AS-OCT is a useful and reproducible instrument to measure cross-sectional area of conjunctiva prolapsing into the tear meniscus of patients with conjunctivochalasis. The method can monitor effectiveness of thermo reduction of conjunctivochalasis.

To evaluate cross-sectional areas of conjunctivochalasis and tear meniscus using Fourier-Domain RTVue-100 optical coherence tomography (OCT) before and after conjunctival cauterization and to evaluate inter- and intraobserver reliability.Prospective, nonrandomized, consecutive case study.A total of 12 eyes of 7 patients with conjunctivochalasis (aged 56 to 87) were evaluated. After topical anesthesia, conjunctival cauterization was performed on the inferior bulbar conjunctiva. All patients underwent anterior segment OCT (AS-OCT) imaging prior to and 4 weeks after the procedure. Cross-sectional tear meniscus and conjunctivochalasis areas at 3 locations (nasal, center, and temporal areas) were measured in all patients.Nonsignificant increases (P = .177) in cross-sectional tear meniscus area as a whole (3 locations combined) were observed following cauterization. Cross-sectional conjunctivochalasis area measurements significantly decreased in all 3 locations after cauterization (P.001). Mean cross-sectional conjunctivochalasis area decreased from 0.247 ± 0.24 mm(2) to 0.054 ± 0.79 mm(2). For 2 measurements of cross-sectional tear meniscus area by examiner 1, intraclass correlation coefficients ranged from 0.998 to 0.999. Among 2 examiners, Cronbach's alpha reliability coefficients were as high as 0.993 and 0.997 before and after conjunctival cauterization. Regarding the cross-sectional conjunctivochalasis area measurements, intraclass correlation coefficient values were similar to those of the cross-sectional tear meniscus area, but Cronbach's alpha reliability coefficients were slightly less.This study indicates the AS-OCT is a useful and reproducible instrument to measure the cross-sectional area of conjunctiva prolapsing into the tear meniscus of patients with conjunctivochalasis. The method can monitor effectiveness of thermoreduction of conjunctivochalasis.

PURPOSE: The purpose of this study was to explore changes in ocular surface and tear function parameters in chronic hepatitis C at different stages of hepatic fibrosis. METHODS: Fifty-four patients with biopsy-proven chronic hepatitis C and 54 age- and sex-matched healthy control subjects without systemic hepatitis C infection were examined with the Ocular Surface Disease Index questionnaire, Schirmer with and without anesthesia, tear film breakup time, and scoring of ocular surface Lissamine green staining using modified Oxford and van Bijsterveld scoring systems and corneal fluorescein staining. RESULTS: Patients with chronic hepatitis C scored significantly worse than the control subjects on all parameters: modified Oxford scores of Lissamine green staining (5.5/3.0; P

PURPOSE Pattern electroretinography (PERG) is a specific test for the analysis of functions of the central retina. In this study, we investigated the PERG recordings in subjects with myopia. SUBJECTS AND METHODS This study was performed on 1 eye of 80 subjects with varying degrees of myopia. Four groups were formed according to the refraction values: group 1: between 0.00 and -0.75 diopter (D); group 2: between -1.00 and -3.00 D; group 3: between -3.25 and -6.00 D; and group 4: between -6.25 and -10.00 D. Amplitudes and latencies of transient PERG P50 and N95 waves were recorded in all subjects. RESULTS P50 and N95 wave amplitudes were lower in higher myopes (groups 3 and 4) when compared with lower myopes (groups 1 and 2; P

Purpose: To review and integrate recent advances in identifying the role of inflammation in the pathogenesis of dry eye conditions and the biological rationale and practical clinical aspects of newer, antiinflammatory theories. Methods: A comprehensive literature survey. Results and conclusion: Keratoconjunctivitis Sicca (KCS) is a multifactorial and complex disorder in which ocular surface inflammations play a central role. Identification of specific CD4-T-Cell pathways and the recent recognition of targeting of alpha-fodrin suggest a case for novel new therapeutic aspects such as anti-CD4 monoclonal antibodies, systemic linoleic and gamma-linolenic acids, and omega-6 essential fatty acids. Replacement of tear volume with nonpreserved wetting agents and standard typical antiinflammatory corticosteroid and/or cyclosporine A continues to be central current conventional therapy for KCS.

Purpose To evaluate the changes in pattern electroretinography (PERG) 1 month after photodynamic therapy alone and photodynamic therapy in combination with intravitreal bevacizumab for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods This is a prospective series of 45 eyes with subfoveal CNV secondary to AMD. Twenty eyes were treated with photodynamic therapy (PDT) with verteporfin and 1.25 mg of intravitreal bevacizumab, and 25 patients were treated with PDT alone. Visual acuities and serial PERG recordings were performed both before and 1 month after therapy. Results Following the 1-month therapy period, visual acuity improved in 56% of patients in the PDT group and 76% of patients in the combination group. No significant ocular or systemic adverse effects were observed in either group. According to the PERG results, the mean P50 amplitude was 1.5 +/- A 0.9 mu V before PDT and improved to 2.1 +/- A 1.1 mu V at 1 month after PDT. The mean P50 amplitudes in the combination therapy group before and after therapy were 1.6 +/- A 0.8 mu V and 2.7 +/- A 1.2 mu V, respectively, and the difference was statistically significant between the groups. Conclusions In this small series of eyes with limited follow-up, the combined treatment of PDT with verteporfin and intravitreal bevacizumab seems to be associated with improvement in VA and pattern electroretinographic results when compared to those in the PDT group.

The purpose of this study is to describe clinical and electrophysiological findings of three patients with unilateral extensive peripapillary myelinated nerve fibers. Three patients with unilateral extensive peripapillary myelinated nerve fibers were examined. A complete ophthalmologic examination including uncorrected and best spectacle corrected visual acuities (UCVA, BSCVA) on Snellen charts, dilated fundoscopy, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), perimetry and electrophysiological tests was performed. ERG results of both eyes were normal in all cases. FFA showed hypofluorescence at the myelinated nerve fibers (MNF) area in the affected eyes. We found a visual field defect resembling arcuat scotom at perimetry of the affected eyes. In OCT, there was hyper-reflectivity in reply to MNF. In all cases, pattern ERG results of the affected eyes showed decreased amplitudes and increased latencies of P50 and N95 waves. P100 amplitudes of PVER and FVER were decreased, and latencies were increased in all affected eyes. Extensive peripapillary myelinated nerve fibers may cause changes in PERG and VER.

Purpose This study aimed to investigate the role of protein peroxidation by detecting the serum levels of advanced oxidation protein products (AOPP), a novel marker for the degree of oxidative damage to proteins, and total thiol as a marker of antioxidant status in diabetic patients with or without diabetic retinopathy (DR) and to compare the results with those of control subjects. Methods The study groups consisted of two separate subgroups: 1) 37 patients (14 male, 23 female) with noninsulin-dependent diabetes mellitus (NIDDM) showing diabetic retinopathy (DR) and 2) 20 patients with NIDDM and without any signs of DR (9 male, 11 female); 26 healthy non-diabetic control subjects (15 male, 11 female) were selected from the patients attending our department for refractive disorders. Venous blood samples of all participants were collected in the morning after an overnight fast, and serum samples stored at −70°C until assay for AOPP, and total thiol. Results AOPP levels were significantly higher in diabetic patients with (210.9±73.0 μmol/L) or without DR (222.7±94.4 μmol/L) when compared to those of controls (152.4±72.04 μmol/L) (p=0.004). Even though the difference was not statistically significant (p=0.095), total thiol levels in cases with DR (278.7±139.1 μmol/L) were lower than those without DR (334.0±129.4 μmol/L) and controls (353.2±145.6 μmol/L). Correlation tests did not reveal any association between these parameters and age, sex, or duration of DM. Conclusions The present study suggests that increased protein oxidation may contribute to the pathogenesis of DR.

In the present study, viscous solutions of cysteamine hydrochloride (CH) were prepared by using 0.5%, 1.0%, 1.5% or 3.0% of hydroxypropylmethylcellulose (HPMC) and were evaluated for their in-vitro characteristics and stability. Osmolalities, pH and viscosity of the formulations were determined. The influence of benzalkonium chloride and autoclave sterilization on solution characteristics was also investigated. For stability assessment, the viscous solutions were stored at +4 and +25 degrees C over 12 months. In-vitro characteristics and CH contents of the stored solutions were monitored. Irritation tests for the formulations were evaluated on rabbit eyes. Dialysis sac technique was used to perform in vitro release study of the solutions containing 1.0% and 1.5% HPMC. All of the viscous solutions tested showed non-newtonian (dilatant) flow behavior. Osmolality values were ranked between 351.2+/-6.2 and 355.1+/-7.9 mOsm kg(-1), and pH values were between 3.97+/-0.1 and 3.98+/-0.2 for all the solutions. Furthermore, no significant changes in dilatant behavior, osmolality or pH values of the pure HPMC solutions were observed. After addition of the excipients or CH-excipients, increased viscosity values were noted in these formulations. Neither benzalkonium chloride nor autoclave sterilization had any influence on viscosity, pH or osmolality values of the solution containing 1.5% HPMC. Stability studies showed that a faster decrease in the concentration of CH was observed in the formulations stored at 25 degrees C compared to those kept at 4 degrees C; no changes were determined in osmolality values of the solutions at all storage conditions. Increased pH and decreased viscosity values were noted in HPMC solutions containing CH and excipients, while no changes in these values were observed for pure HPMC solutions kept at 4 and 25 degrees C. In vitro release tests revealed that 81.2% and 85.3% of CH were released from the viscous solutions containing 1.5% and 1% HPMC, respectively, in 8h. No irritation was observed when the viscous solutions were tested on rabbit and human eyes.