Dry Eye (dry + eye)

Distribution by Scientific Domains

Terms modified by Dry Eye

  • dry eye disease
  • dry eye patient
  • dry eye syndrome

  • Selected Abstracts


    Tissue-engineered tear secretory system: Functional lacrimal gland acinar cells cultured on matrix protein-coated substrata

    JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 1 2007
    Shivaram Selvam
    Abstract Dry eye is a general term that refers to a myriad of ophthalmic disorders resulting in the inadequate wetting of the corneal surface by the tear film. Dry eyes are typically treated by the application of artificial tears. However, patients with lacrimal insufficiencies such as Stevens-Johnson syndrome, chemical and thermal injuries, or ocular cicatricial pemphigoid have very limited options because of the short duration and action of lubricating agents. As a therapeutic strategy, we are working to develop a bioengineered tear secretory system for such patients. This article describes the growth and physiological properties of purified rabbit lacrimal gland acinar cells (pLGACs) on several matrix protein-coated polymers such as silicone, collagen I, copolymers of poly- D,L -lactide- co -glycolide (PLGA; 85:15 and 50:50), poly- L -lactic acid (PLLA), and Thermanox® plastic cell culture coverslips. Monolayers of acinar cells were established on all of the polymeric substrata. An assay of ,-hexosaminidase activity in the supernatant medium showed significant increases in protein secretion, following stimulation with 100 ,M carbachol on matrix protein-coated and uncoated polymers such as silicone, PLGA 85:15, and PLLA. Our study demonstrates that PLLA supported the morphological and physiological properties of purified rabbit lacrimal gland epithelial cells more successfully than the others. © 2006 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2007 [source]


    3221: Pathophysiology of dry eye syndrome

    ACTA OPHTHALMOLOGICA, Issue 2010
    J HORWATH-WINTER
    Dry eye or dysfunctional tear syndrome is a highly prevalent disease worldwide. It is related to a pathological condition of anyone of the parts of the "ocular surface system" that involves the cornea, conjunctiva, lacrimal gland, accessory lacrimal glands, nasolacrimal duct and the lids with the meibomian glands. These are linked as a functional system by innervation, the endocrine and immune system. Endogenous or exogenous caused alterations in one or several components of the ocular surface system or its secretions result in changes of the tear film or ocular surface provoking inflammation. With time, inflammatory reactions may lead to corneal neuropathy compromising the reflex response of the lacrimal glands. Additionally a self-perpetuating vicious circle with loss of function and damage can be initiated also by an immune-modulated inflammation. [source]


    4133: Dry eye and human tear lipid compositional, conformational and functional relationships using spectroscopy

    ACTA OPHTHALMOLOGICA, Issue 2010
    D BORCHMAN
    Purpose Knowledge of the relationships among composition, conformation and function of tear film lipids could facilitate the development of therapies to alleviate symptoms related to meibomian gland dysfunction (MGD) and to diagnose the disease. Toward this goal, we used spectroscopic approaches to assess tear lipid composition and conformation relationships with age, sex and meibomian gland dysfunction. Methods Spectra of meibum from 41 patients diagnosed with MGD (Md) and 27 normal donors (Mn) were acquired. Results 1H-NMR spectra showed cholesterol esters were found to decrease by 21% with MGD. The number of double bonds/ester increased with age and MGD which indirectly relates to tear film stability. With age, the amount of CH2 groups increased twice as much as the C=C moieties and the C=C/CH2 and CH3/CH2 ratios were related to lipid order and indirectly related to meibum delivery. With the use of MALDI-TOF MS, we quantified and identified lipid components in Mn and Md such as cholesterol, hydrocarbons and wax esters with a sensitivity of 9 pmoles for each analyte. Sixty-nine of the 189 resolved peaks were unique to Md spectra compared to Mn spectra and were not due to waxes. Extra peaks in Md spectra may arise from increased lipid synthesis, bacteria or cellular debris. Conclusion It is reasonable that as the lipids become more ordered and more viscous with Md, less lipid flows out of the meibomian gland orifice and more casual lipid is present on the lid margin. The age- and disease-related changes in the physical and chemical characteristics of meibum lipids suggest that the C=C/CH2 and CH3/CH2 ratios may be more important than quantity in relation to tear film stability. [source]


    Recent developments of dry eye in children

    ACTA OPHTHALMOLOGICA, Issue 2009
    D BREMOND-GIGNAC
    Purpose Dry eye syndrome in children is a rare disease sometimes difficult to diagnose. The research of the etiology can contribute to adjust the treatment. Methods Two features of dry eye syndrome in children can be distinguished. Dry eye integrated in general disease with evidence of diagnosis and etiology and asymptomatic dry eye which needs a careful check up to recognize the primary etiology. Keratitis sicca usually does not lead to children complaint and simple signs as rubbing or blinking are often observed. Clinical and practical cases are described. Results Review of literature confirms common conditions with adult dry eye but also the specificity of the pediatric dry eye. Dry eye in children is also commonly an inflammatory condition of the ocular surface. New treatment with their indications are listed including tear-like topical therapies and anti-inflammatory or immunosuppressive drugs for ocular surface with specificities in children. Conclusion Dry eye syndrome in children must be recognized and diagnosed. In addition to classical tear-like treatment, specific therapy should be adapted to the etiology. [source]


    Unmet needs in the treatment of glaucoma related to compliance, tolerability and concomitant dry eye

    ACTA OPHTHALMOLOGICA, Issue 2008
    G HOLLO
    Purpose Compliance to long-term topical treatment of glaucoma can be less than optimal. This may decrease the efficacy of the treatment. This presentation summarises the unmet needs in the current topical treatment of glaucoma related to compliance, tolerability and concomitant dry eye and discusses the expectations for future therapies. Results Glaucoma is a life long conditions and its management is multifactorial. However, compliance to topical glaucoma treatment can be less than optimal. Forgetfulness and topical side effects have been identified as important reasons for non-compliance. Topical side effects decrease the quality of life of the patient, which impacts on compliance. Dry eye and glaucoma are often concomitant diseases. Therefore, it is advisable to consider the management of both diseases together for the optimal care for these patients. Preservative free preparations may have benefits for the long term treatment of glaucoma patients, especially those with dry/sensitive eyes. Conclusion Compliance remains a key issue in the management of glaucoma. Glaucoma and dry eye as concomitant diseases present specific challenges for the optimal care of the patient. [source]


    Tissue-engineered tear secretory system: Functional lacrimal gland acinar cells cultured on matrix protein-coated substrata

    JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 1 2007
    Shivaram Selvam
    Abstract Dry eye is a general term that refers to a myriad of ophthalmic disorders resulting in the inadequate wetting of the corneal surface by the tear film. Dry eyes are typically treated by the application of artificial tears. However, patients with lacrimal insufficiencies such as Stevens-Johnson syndrome, chemical and thermal injuries, or ocular cicatricial pemphigoid have very limited options because of the short duration and action of lubricating agents. As a therapeutic strategy, we are working to develop a bioengineered tear secretory system for such patients. This article describes the growth and physiological properties of purified rabbit lacrimal gland acinar cells (pLGACs) on several matrix protein-coated polymers such as silicone, collagen I, copolymers of poly- D,L -lactide- co -glycolide (PLGA; 85:15 and 50:50), poly- L -lactic acid (PLLA), and Thermanox® plastic cell culture coverslips. Monolayers of acinar cells were established on all of the polymeric substrata. An assay of ,-hexosaminidase activity in the supernatant medium showed significant increases in protein secretion, following stimulation with 100 ,M carbachol on matrix protein-coated and uncoated polymers such as silicone, PLGA 85:15, and PLLA. Our study demonstrates that PLLA supported the morphological and physiological properties of purified rabbit lacrimal gland epithelial cells more successfully than the others. © 2006 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2007 [source]


    Decreased Tear Expression with an Abnormal Schirmer's Test Following Botulinum Toxin Type A for the Treatment of Lateral Canthal Rhytides

    DERMATOLOGIC SURGERY, Issue 2 2002
    Seth L. Matarasso MD
    background. Inactivation of muscles of facial expression by chemodenervation with botulinum toxin remains an off-label indication. Nevertheless, it continues to be a safe and effective technique to improve dynamic rhytides and is the treatment of choice for the hypertrophic lateral fibers of the orbicularis oculi muscle that can cause the superimposed crow's feet. objective. Although infrequent and self-limiting, the complication of unexpected muscle weakness from toxin diffusion or erroneous placement is documented. methods. However, injection into the pretarsal portion of the orbicularis oculi muscle resulting in unilateral ocular irritation and diminished tear expression as evidenced by a dry eye and an abnormal Schirmer's test has rarely been reported. Direct injection into the pretarsal fibers of the muscle as opposed to diffusion of the toxin into the muscle fibers or the lacrimal gland was consistent with the onset of action of the toxin and the prolonged duration of the ocular symptoms. results. Treatment consisted of ocular lubrication until the effects of the toxin dissipated and muscle tone returned. Subsequent treatment did not result in a result in a recurrence of adverse sequelae. conclusions. Facial muscles are small, not isolated, and often have fibers that interdigitate. An important factor in the administration of botulinum toxin is the identification of the muscles responsible for the corresponding rhytide. Precise knowledge of muscular anatomy and function will aid in minimizing this and other potential complications. [source]


    Effects of solifenacin on overactive bladder symptoms, symptom bother and other patient-reported outcomes: results from VIBRANT , a double-blind, placebo-controlled trial

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2009
    M. D. Vardy
    Summary Aim:, The aim of this study was to evaluate the efficacy of solifenacin on symptom bother using the Overactive Bladder Questionnaire (OAB-q). Methods:, In VIBRANT, a double-blind, US-based trial, patients with OAB for , 3 months received flexibly dosed solifenacin or placebo for 12 weeks. At baseline and 4-week intervals, patients completed the OAB-q [symptom bother and health-related quality of life (HRQL) scales] and 3-day bladder diaries; other patient-reported outcome measures were also assessed at baseline and week 12. The primary efficacy end-point was the change from baseline to end of treatment (EOT) on the OAB-q Symptom Bother scale. Adverse events (AEs) were monitored. Results:, At EOT, solifenacin (n = 377) vs. placebo (n = 374) significantly improved mean symptom bother (,29.9 vs. ,20.4, p < 0.0001), HRQL total (25.3 vs. 16.7, p < 0.0001) and all HRQL domain scores (Ps < 0.0001). Solifenacin vs. placebo significantly improved daily episodes of urgency, incontinence and frequency but not nocturia. Significant separation from placebo was evident as early as week 4. Overall, significantly more solifenacin vs. placebo patients reported treatment benefit (84% vs. 63%), satisfaction (80% vs. 59%) and willingness to continue (79% vs. 60%; Ps< 0.0001). Treatment-related AEs in solifenacin vs. placebo patients were dry mouth (13% vs. 2%), constipation (8% vs. 2%) and dry eye (2% vs. 0.3%). Conclusions:, As early as week 4 and through EOT, flexibly dosed solifenacin significantly improved OAB symptom bother and HRQL as well as the symptoms of urgency, frequency and incontinence compared with placebo. Significantly more solifenacin patients reported treatment benefit and satisfaction at week 12 compared with placebo. [source]


    A survey of the scope of therapeutic practice by UK optometrists and their attitudes to an extended prescribing role

    OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2008
    Justin J. Needle
    Abstract Purpose:, Recent changes in medicines legislation in the UK have broadened the opportunities for optometrists to use and supply therapeutic drugs. We set out to investigate the current therapeutic practice of UK optometrists and to elicit their views on an extended prescribing role. Methods:, Members of the College of Optometrists were invited via email to take part in an online survey. The survey questions covered four areas: mode of practice, proximity and relationship to other providers of eye care, scope of current therapeutic practice and future plans regarding prescriber training. Results:, Of the 1288 responses received (response rate 24%), over 90% were from optometrists working in community practice. Common, non-sight-threatening conditions were managed frequently or occasionally by between 69 and 96% of respondents. Blepharitis and dry eye were the most common (managed routinely by >70%). In terms of therapeutic agents used, large numbers of optometrists reported that they commonly supplied or recommended over-the-counter (non-prescription) drugs, particularly lubricants and anti-allergic agents. However, fewer respondents supplied antibiotics (only 14% supplying chloramphenicol or fusidic acid frequently). Overall, relatively few respondents (14%) expressed no interest in undertaking further training for extended prescribing, although several barriers were identified, including cost and time taken for training, lack of remuneration and fear of litigation. Conclusion:, Significant numbers of community optometrists are currently managing a range of common ocular conditions using a limited formulary. Enabling optometrists to train as independent prescribers will further develop this role, allowing greater use of their skills and providing patients with quicker access to medicines. [source]


    The relation between tear film tests in patients with dry eye disease

    OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 6 2003
    Kelly K. Nichols
    Abstract Purpose:, The purpose of this report was to investigate the relation between dry eye diagnostic tests. Methods:, Dry eye patients were enrolled to complete a clinical examination, including the following dry eye tests: a meibomian gland evaluation, tear meniscus height, fluorescein tear breakup time, fluorescein staining of the cornea, the Schirmer 1 test, the phenol red thread test, and rose bengal staining of the conjunctiva. Statistical analyses, including correlation coefficients, the Wilcoxon sign rank test, chi-square test, and logistic regression were used to address the relation between these clinical tests of dry eye. Results:, There was a strong relation between the Schirmer test and fluorescein staining in all four statistical analyses. Similarly, there was also a strong relation between the phenol red thread test and both fluorescein and rose bengal staining. Finally, the results of the Schirmer test were associated with the tear breakup time test in three of four analyses. Conclusions:, The results indicate that tests of aqueous deficiency (volume or production) are associated with ocular surface desiccation. This important relation should be recognized when choosing dry eye tests as outcomes in clinical trials and epidemiological studies. [source]


    3445: Evaluation, diagnosis and grading of severity of MGD

    ACTA OPHTHALMOLOGICA, Issue 2010
    AJ BRON
    Purpose To evaluate current diagnostic tests and make future recommendations. Methods An evidence-based review of procedures. Results MGD is a common symptomatic disorder leading to associated ocular surface disease including evaporative dry eye. A two stage diagnostic approach is recommended including an assessment of meibomian function based on lid morphology, gland mass, expressibility, lipid layer appearance and tear evaporation. A diagnosis of dry eye is based on measures of tear production and clearance, tear osmolarity, tear film stability and the presence of ocular surface changes revealed by tissue staining and inflammatory biomarkers. Quantification of MGD depends on grading meibum quality and expressibility. Newer, quantitative methods will make grading more accurate in the future and include quantitative meibomian expression, non-invasive meibography, confocal microscopy, video-interferometry and the use of inflammatory biomarkers. Meibomian gland dropout can be to monitor and stratify MGD in clinical trials. Conclusion A provisional severity rating of MGD and MGD-related disease has been proposed as a guide to the selection of treatment and the monitoring of disease progression. [source]


    3222: New developments in dry eye treatment

    ACTA OPHTHALMOLOGICA, Issue 2010
    JM BENITEZ-DEL-CASTILLO
    Purpose This study summarizes the management and therapeutic options for treating dry eye disease. Goals of this review is to identify appropriate therapeutic methods for the management of dry eye disease and recommend a sequence or strategy for their application, based on evidence-based review of the literature. Methods To achieve this a comprehensive review of clinical textbooks and scientific literature was performed and the quality of published evidence graded according to an agreed standard, using objective criteria for clinical and basic research studies. Results There have been tremendous advances in the treatment of dry eye and ocular surface disease in the last decades related to the increase in knowledge regarding the pathophysiology of dry eye. This has led to a paradigm shift in dry eye management from simply lubricating and hydrating the ocular surface with arti,cial tears to strategies that stimulate natural production of tear constituents, maintain ocular surface epithelial barrier function, and inhibit the in,ammatory factors that adversely impact the ability of ocular surface and glandular epithelia to produce tears. Conclusion The authors will present current and future treatment options for dry eye disease. [source]


    3223: Dry eye syndrome and omega-3 fatty acids

    ACTA OPHTHALMOLOGICA, Issue 2010
    T KAERCHER
    Purpose Dry eye disease is characterized by an inflammatory component of the ocular surface. Pathways to modulate inflammation include corticoids and cyclosporine. Omega-3 fatty acids like eicosapentaenoic acid and docosahexaenoic acid represent an alternate pharmacologic way to influence the inflammatory cascade. Methods Clinical studies. Results An epidemiologic study in 32.470 healthy women showed that those with a higher intake of omega-3 fatty acids had a 68% decreased prevalence of dry eye syndrome. Hyposecretory dry eye was tested after intake of omega-3 fatty acids for 45 days. Symptoms, signs and inflammatory markers like HLA-DR improved. Hyperevaporative dry eye improved after a long-term supplementation with omega-3 fatty acids with respect to symptoms, break-up time and meibom score. Patients with refractive surgery (PRK) improved after omega-3 fatty acids intake; this was derived from the OSDI-score, Schirmer I test and tear clearance. In 102 contact-lens wearers the symptoms and signs of dry eye improved after 12 weeks therapy with omega-3 fatty acids. Conclusion Nutricionals with omega-3 fatty acids show evidence-based effects on the inflammatory component of ocular surface disease and tear film disorder. Their beneficial effect was tested for hypovolemic and hyperevaporative dry eye. Patients after refractive surgery and contact lens wearers improved after supplementation, too. In contrast to the available anti-inflammatory therapy the supplementation is apt for a long-term application. [source]


    3224: Chitosan in the treatment of dry eye

    ACTA OPHTHALMOLOGICA, Issue 2010
    L SCHMETTERER
    Purpose To demonstrate the safety and efficacy of a new eye drop formulation containing a novel thiolated biopolymer, namely chitosan-N-acetylcysteine, in a number of pre-clinical tests. It is postulated that interaction between thiol groups of the topically applied chitosan-N-acetylcysteine and cysteine-rich mucin (MUC5AC) increases polymer residence time on the ocular surface and tear film stability. Methods The efficacy of isotonic and buffered chitosan-N-acetylcysteine eye drops was evaluated in two different dry eye mouse models. The dosage dependent ocular residence time and biodistribution were investigated in a rabbit model using microPET technology. Long-term irritation and delayed-type hypersensitivity tests with chitosan-N-acteylcysteine eye drop formulation were conducted in rabbits. Results In both dry eye studies mice treated with chitosan-N-acetylcysteine showed decreased expression of ocular surface mRNA of IL-,, IL-10, IL-12,, and TNF, indicating that the formulation may have protective ocular surface properties. The residence time of chitosan-N-acetylcysteine eye drops on the ocular surface of rabbits was increased (detection up to 22h). Results of a long-term ocular irritation study in rabbits demonstrate that the novel formulation is well tolerated and non-irritant to the eye. Conclusion Based on the promising pre-clinical study results both in terms of efficacy and safety a clinical phase 1 trial is scheduled in the near future. Commercial interest [source]


    2433: A revolutionary hypothesis to explain Marx's line and progressive disease at the lid margin

    ACTA OPHTHALMOLOGICA, Issue 2010
    AJ BRON
    Purpose The conjunctiva of the lid margin is protected from direct exposure to the atmosphere, by the tear meniscus. We examine the pathophysiological consequences of evaporation from this compartment. Methods A consideration of empirical data. Results The concave meniscus thins progressively to the point where it is pinned at the mucocutaneous junction (MCJ). We predict that, as a result, over the interblink period, evaporation generates a solute gradient which peaks behind the MCJ and is amplified over multiple cycles of the blink. We hypothesise that this creates a hyperosmolar state here which: i. stresses epithelial cells behind the MCJ, ii. stimulates a high cell turnover and iii. leads to immaturity of the surface cells and their glycocalyx. This is considered to explain an increased permeability to dyes at this site (rose bengal, lissamine green and fluorescein) and the stainability with dyes which is termed Marx's line. This gradient mechanism could also concentrate proteins, such as inflammatory mediators, at this location. Conclusion Since Marx's line lies directly behind the terminal Meibomian ducts and acini, chronic stress in this region is further invoked to explain forward migration of Marx's line and the MCJ which occurs with age and the induction of primary Meibomian gland dysfunction. Arguments are put forward to explain how this mechanism might be accentuated in dry eye and how the globe might be protected from this gradient effect in the region of the ,black line', where the tear film is segregated from the meniscus after the blink. Factors pro and con the hypothesis are discussed. [source]


    3233: Effectiveness of a new lubricant for dry eye after photoablation using an osmolarity measurement

    ACTA OPHTHALMOLOGICA, Issue 2010
    B COCHENER
    Purpose LASIK has been shown to lead to corneal hypoesthesia, which can trigger a decrease in the reflex arc regulating tears secretion. The goal of this study was to evaluate the benefits of a new lubricant after LASIK compared to a classical treatment by measuring tear osmolarity. Methods Twenty patients scheduled to undergo LASIK were enrolled in the study and randomized into two groups. A baseline osmolarity measurement was taken (TearLab Osmolarity System, TearLab Corp) and then randomized into one of two groups. Patients in the first group received two artificial tears (Refresh and Celluvisc, Allergan) following surgery while the 2nd group received a PEG 400 and hylauronic acid (HA) artificial tear (Blink, Abbott Medical Optics) following treatment. These patients were assessed at 1 month postoperative for changes in osmolarity. Results Normal values of osmolarity with Tear Lab range between 275 and 308 mOsm/L; above this, we consider that the eye is dry. The single tear treatment had the same efficiency as our standard two-drop therapy. No side effects were noted in any patients. Most patients found it easier to have only one kind of lubricant instead of a combination of two, which lead to a better observance. The use of the tear osmolarity system provided a quick, reliable test for detecting patient with a risk of postoperative dry eye and for assessing the effectiveness of the therapy. Conclusion The new lubricant, Blink, is another choice in the therapeutic panel for treatment of dry eye disease. It is well tolerated and as efficient as the combination of Refresh and Celluvisc. New osmolarity measurement is an easy, fast and non-invasive well tolerated test for detecting infraclinical dryness especially before refractive surgery. [source]


    Recent developments of dry eye in children

    ACTA OPHTHALMOLOGICA, Issue 2009
    D BREMOND-GIGNAC
    Purpose Dry eye syndrome in children is a rare disease sometimes difficult to diagnose. The research of the etiology can contribute to adjust the treatment. Methods Two features of dry eye syndrome in children can be distinguished. Dry eye integrated in general disease with evidence of diagnosis and etiology and asymptomatic dry eye which needs a careful check up to recognize the primary etiology. Keratitis sicca usually does not lead to children complaint and simple signs as rubbing or blinking are often observed. Clinical and practical cases are described. Results Review of literature confirms common conditions with adult dry eye but also the specificity of the pediatric dry eye. Dry eye in children is also commonly an inflammatory condition of the ocular surface. New treatment with their indications are listed including tear-like topical therapies and anti-inflammatory or immunosuppressive drugs for ocular surface with specificities in children. Conclusion Dry eye syndrome in children must be recognized and diagnosed. In addition to classical tear-like treatment, specific therapy should be adapted to the etiology. [source]


    In vivo confocal microscopic evaluation of inflammatory changes in the ocular surface

    ACTA OPHTHALMOLOGICA, Issue 2009
    A LABBE
    Purpose The ocular surface constitutes a complex physiopathological and anatomical entity assuring the barrier between the outside world and the fragile ocular structures. Ophthalmic instruments such as the slit lamp, which magnifies approximately 40 times, cannot provide details of the corneal structures at the cellular level. Methods In vivo confocal microscopy using the HRT Rostock Cornea module® (HRT / RCM) provides better resolution and therefore outlines distinctively in vivo inflammatory changes occurring in the ocular surface. Results In vivo confocal microscopy is capable of providing corneal, conjunctival and limbal cellular details in different ocular surface diseases such as dry eye, infectious keratitis, toxic keratitis, corneal intraepithelial neoplasia or vernal keratoconjunctivitis. Conclusion In correlation with ex vivo impression cytology analysis, in vivo confocal microscopy constitutes an interesting aid in the diagnosis and management of complex ocular surface conditions. [source]


    History of and necessity for KPros

    ACTA OPHTHALMOLOGICA, Issue 2009
    C LIU
    The history of keratoprostheses goes back over 200 years. There was a resurgence in interest in the second half of the twentieth century as it was recognised that keratoplasty could not solve all types of corneal blindness. Many devices have been described but few have survived. Corneal transplantation is complicated by graft rejection and astigmatism. There is also a problem with adequate supply, and there is a risk of transmission of infection. There is a desire for an artificial cornea which surpasses cadaveric transplantation. There is much ongoing work, but the majority of clinical work on keratoprostheses are for corneal blindness not amenable to cadaveric grafts. These can be separated into two main groups. The wet blinking eye which have had multiple graft failures, and the dry eye with a keratinised ocular surface which may also have a deficiency in lid cover. The approaches to these are quite different. [source]


    Keratinisation status and cytokeratins of the human Meibomian gland epithelium

    ACTA OPHTHALMOLOGICA, Issue 2009
    E KNOP
    Purpose The Meibomian gland (MG) is an indispensable component of the functional anatomy of the ocular surface. Increasing evidence points to a high impact of hyper-keratinisation as a major cause of obstructive MG dysfunction (MGD) and evaporative dry eye. Information of normal keratinisation status and cytokeratin composition of the human MG is limited. Methods Conjunctival whole-mount specimens including the lid margin from ten body donors of older age were embedded in paraffin. Serial sections were stained by H&E and Masson-Goldner stain and by immunohistochemistry with an antibody panel to cytokeratins. Results In conventional stains, the MG shows distinct similarities with the pilo-sebaceous unit of the cilia. The keratinised skin epithelium extended into the terminal part of the MG excretory duct similar to the hair follicle. Preliminary IHC results showed that the epithelium was positive there for the skin keratin CK10. Along the central duct the keratinisation CK10 expression was gradually lost similar to keratinisation marker involucrin. However, filaggrin, a marker for incipient stages of keratinisation and located in keratohyalin granules continued in the superficial layer of the duct epithelium all along the Meibomian central ductal system. CK14 a marker for basal undifferentiated cells showed a homogenous expression all along the basal cell layer of the MG ducts and the acini. Conclusion The MG shares similarities with the cilia in embryology, in structure and in the cytokeratin composition. It can hence be regarded as a "hair without a hair shaft". All parts of the MG ducts have signs of incipient keratinisation and preserve a commitment to keratinisation. Upregulation in MGD explain hyper-keratinisation as a typical event in obstructive MGD. [source]


    Compartmental factors influencing tear film osmolarity

    ACTA OPHTHALMOLOGICA, Issue 2008
    AJ BRON
    Purpose To illustrate how compartmental factors could influence the distribution of tear osmolarity at the ocular surface in normals and dry eye. Methods Mathematical modelling using parameters in the literature. Results Tear film hyperosmolarity is a final common pathway causing ocular surface damage in dry eye. Modelling predicts that tear osmolarity is higher in the tear film than the meniscus, which may influence the distribution of ocular surface damage and the initiation of symptoms caused by hyperosmolarity. Once tear film break up occurs within the blink interval it is likely that this differential is amplified locally. The model allows the effect of compartmental factors on tear osmolarity to be addressed, including: regional differences in air flow and surface temperature, variations in ambient temperature and humidity, imperfect tear mixing, differential corneal and conjunctival exposure and individual differences in reflex tear flow, evaporation rate and blink interval. We hypothesise that interactions between these factors determine the dry eye phenotype in an individual. Additional considerations suggest that events at the ocular surface differ in aqueous-deficient and evaporative dry eye. Conclusion Hyperosmolarity at the ocular surface is affected by multiple factors, each of which may make different contributions to distribution and severity of surface damage in a given individual. This may determine the phenotype, frequency and severity of dry eye in a population. [source]


    Unmet needs in the treatment of glaucoma related to compliance, tolerability and concomitant dry eye

    ACTA OPHTHALMOLOGICA, Issue 2008
    G HOLLO
    Purpose Compliance to long-term topical treatment of glaucoma can be less than optimal. This may decrease the efficacy of the treatment. This presentation summarises the unmet needs in the current topical treatment of glaucoma related to compliance, tolerability and concomitant dry eye and discusses the expectations for future therapies. Results Glaucoma is a life long conditions and its management is multifactorial. However, compliance to topical glaucoma treatment can be less than optimal. Forgetfulness and topical side effects have been identified as important reasons for non-compliance. Topical side effects decrease the quality of life of the patient, which impacts on compliance. Dry eye and glaucoma are often concomitant diseases. Therefore, it is advisable to consider the management of both diseases together for the optimal care for these patients. Preservative free preparations may have benefits for the long term treatment of glaucoma patients, especially those with dry/sensitive eyes. Conclusion Compliance remains a key issue in the management of glaucoma. Glaucoma and dry eye as concomitant diseases present specific challenges for the optimal care of the patient. [source]


    Occurrence of lacrimal gland tissue outside the lacrimal fossa: comparison of clinical and histopathological findings

    ACTA OPHTHALMOLOGICA, Issue 1 2005
    Ghassan Ayish Alyahya
    Abstract. Purpose:,To analyse clinical referral diagnoses and the location of lesions with histologically verified lacrimal gland tissue occurring outside the fossa of the lacrimal gland. Methods:,Sections of lesions excised from areas outside the fossa of the lacrimal gland containing lacrimal gland tissue on histological examination were collected from the files of the Eye Pathology Institute, Copenhagen, Denmark. Specimens spanned a period of 50 years. Sections were re-examined and referral data on location and clinical diagnosis were compared with histological findings. Results:,A total of 120 lesions were collected. Of these, 59 (49%) consisted of prolapsed lacrimal gland. The remaining 61 (51%) lesions contained ectopic lacrimal gland tissue, either as part of a complex choristoma in 38 (32%) cases, or as solitary ectopic lacrimal gland tissue in 23 (19%) cases. The majority (97; 81%) of lesions had been located at the temporal epibulbar conjunctiva and included mainly prolapsed lacrimal gland and complex choristoma. The clinical referral diagnoses covered a wide spectrum of lesions. The most frequent clinical diagnoses were non-specific tumour (35%), non-specific cyst (18%) and dermoid (11%). Of the 61 lesions containing ectopic lacrimal gland tissue, only two had been preoperatively diagnosed as such and only two of the 59 lesions with prolapsed lacrimal gland had been correctly diagnosed. Conclusions:,Prolapsed palpebral lobe of the lacrimal gland was the most common lesion and, as expected, the prime location was the temporal conjunctiva. Despite this location, the referring clinical diagnosis was often wrong or non-specific. Surgeons seem to have been unaware of the various clinical manifestations of extrafossal glandular tissue, particularly when excising lesions in the upper temporal region of the conjunctiva. Surgical intervention in this location may jeopardize the excretory ducts of the lacrimal gland and may consequently lead to dry eye and thus should be avoided when the typical clinical appearance of prolapsed lacrimal gland is encountered. [source]


    Efficacy of topical cyclosporine A in the treatment of severe trachomatous dry eye: comment

    CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 1 2010
    Patrick MK Tam MRCS
    No abstract is available for this article. [source]


    A natural solution to dry eye?

    CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2008
    Jennifer P Craig PhD
    No abstract is available for this article. [source]


    Modulation of tear film protein secretion with phosphodiesterase inhibitors

    CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2000
    Victoria Evans BOptom
    ABSTRACT A double-blind randomized clinical study was conducted to determine whether nicardipine hydrochloride was a useful treatment for dry eye. We examined its effect on the tear film, ocular surface and ocular comfort. Nicardipine hydrochloride, 3-isobutyl-1-methylxanthine and pilocarpine hydrochloride were dissolved in an artificial tear vehicle and applied topically to one eye of 12 subjects on separate days. Ocular physiology, ocular comfort and tear volume were assessed. The trial was repeated with nicardipine in an aqueous gel vehicle. Tears were collected and assessed for protein concentration and protein profile, using electrophoresis and mass spectrometry. Nicardipine induced conjunctival redness and symptoms of dryness and irritation. There was no change in total tear protein concentration or volume. An increase in a 68 kDa protein was observed, this was probably due to conjunctival vessel dilation and leakage of albumin. The adverse symptomatology and increased conjunctival redness experienced with nicardipine make it an undesirable treatment for dry eye. [source]


    Dynamic wavefront aberrations and visual acuity in normal and dry eyes

    CLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 3 2009
    Yan Wang MD
    Purpose:, The aim was to study the dynamic properties of wavefront aberrations and visual acuity in normal and dry eyes. Methods:, Thirty dry-eye patients and 27 normal subjects participated in this study. Multi-file mode of a Hartmann-Shack wavefront sensor was used to measure dynamic wavefront aberrations for a period of 45 seconds. Dynamic measurements of visual acuity (VA) were made for 150 seconds using a multi-functional VA tester. Standard deviation of the measurements (RMS or VA) over the testing period was used to estimate instability of the dynamic wavefront aberration and VA. Results:, For most subjects, both wavefront aberration and VA changed over time and the instability varied substantially among individuals. Blink-dependent fluctuation in wavefront aberration or VA was observed for some dry-eye subjects. On average, the dry-eye group had greater instability than the normal group in either the higher order wavefront aberrations (t = 2.09, p = 0.03, for OD; t = 3.76, p = 0.001, for OS) or the VA (t = 2.09, p = 0.02, for OD; t = 204, p = 0.03, for OS). Instability of VA in the dry-eye group was significantly correlated with blink rate (r = 0.28, p = 0.02). Conclusion:, Dynamic changes in wavefront aberrations and VA are highly individual dependent, while the dry eye tends to be less stable than the normal eye. The results suggest that tear-film fluctuation might play a role in determining dynamic wavefront aberration and VA, however, contributions from other factors should not be overlooked. For dry eye, dynamic change in VA depends on blink rate. [source]


    Salivary flow and its relationship to oral signs and symptoms in patients with dry eyes

    ORAL DISEASES, Issue 2 2004
    M Koseki
    Objectives:, The aim of this study was to investigate oral symptoms and clinical parameters in dry eye patients. Subjective reports of the sensation of a dry mouth, salivary flow rates, and clinical parameters of oral disease related to three different types of dry eye patients were examined. Subjects and methods:, There were 224 individuals, including dry eye patients and control subjects. The dry eye patients were classified into three types: patients with Sjögren's syndrome (SS-DE), patients without SS-DE (non-SS-DE), and patients with Stevens,Johnson syndrome (SJS-DE). Salivary flow rates were measured using two kinds of sialometry. Subjective and objective oral symptoms and signs were also examined. Results and conclusion:, Over half of the dry eye patients complained of a dry mouth. The flow rates of their stimulated whole saliva and parotid saliva were significantly lower than those of the control groups (P < 0.05, P < 0.01). The sensation of a dry mouth and changes in oral soft tissues, dental caries, and oral Candida frequently occurred in dry eye patients. [source]


    Clinical decision paths in KPro Surgery

    ACTA OPHTHALMOLOGICA, Issue 2009
    G GRABNER
    Purpose To analyse the currently available methods for treating very severe anterior segment disease, such as stem cell transplantation with amniotic membrane transplantation, lamellar and penetrating keratoplasty techniques, and the different Kpro´s currently available, in regard to the initial clinical findings, the potential complications encountered and the surgical requirements needed for the different techniques. Factors considered are: uni- or bilaterality, limbal stem cell status, dry eye status and availability of healthy teeth. Methods A systematic analysis of surgical options available for different stages of a variety of anterior segment diseases and currently published results of VA and complications Results With a systematic approach it becomes clear that some popular reconstructive surgical techniques should be avoided in cases where a very low chance of success is to be expected (e.g. amniotic membrane and stem cell transplantation and /or PKP in very dry eyes ,> these would have to be treated with OOKP). Conclusion Following a simple the clinical decision path the anterior segment surgeon will be presented with standardized guidelines for treating those patients where conventional surgical procedures have to be avoided and replaced by rather rarely performed KPro techniques. [source]


    Skin burn, bilateral iridocyclitis and amnesia following a lightning injury

    ACTA OPHTHALMOLOGICA, Issue 5 2004
    Lone K. Sommer
    Abstract. Purpose:,To describe a case of lightning injury restricted to the eyes and facial skin. Methods:,Case history describing the clinical examination of a 54-year-old woman. Results:,Following a lightning stroke the patient suffered from a sharply demarcated facial skin burn and bilateral iridocyclitis with raised intraocular pressure. Initially she had amnesia regarding the incident. She recovered on symptomatic treatment, with dry eyes as the only sequela. Conclusion:,We suggest that a lightning current travelled over the outside of the patient's body facilitated by her wet raincoat, a so-called flash-over. Thereby, she was spared from more severe injury, and only the exposed areas of the face and eyes were affected. [source]