Superfície Ocular

NOVEMBRO/DEZEMBRO 2010

Maskin SL.
Intraductal meibomian gland probing relieves symptoms of obstructive meibomian gland dysfunction.
Cornea 2010; 29 (10): 1145-1152.

PURPOSE: To perform a retrospective evaluation of a new treatment for obstructive meibomian gland dysfunction (O-MGD) using invasive orifice penetration and intraductal probing.
SETTING: Office-based ophthalmology private practice.
METHODS: Medical charts of 25 consecutive patients with O-MGD (based on presence of lid margin or tarsal hyperemia, lid margin telangiectasia, thickening or irregularity, and meiboman gland orifice metaplasia) plus lid tenderness or symptoms of lid margin congestion were reviewed to evaluate the effect of probing on tenderness and congestion.
RESULTS: Twenty-four of 25 patients (96%) had immediate postprobing relief, whereas all 25 patients (100%) had relief of symptoms by 4 weeks after procedure. Twenty patients (80%) only required 1 reatment and had an average of 11.5-month follow-up. Five patients (20%) had retreatment at an average of 4.6 months. All patients had symptom relief at time of last follow-up. Of 56 symptomatic and treated lids, 42 (75%) were upper lids. Patients frequently reported improvement in newly recognized but previously subclinical symptoms.
CONCLUSIONS: Invasive orifice penetration and intraductal probing seems to provide lasting rapid symptom relief for patients with O-MGD. Probing findings in this study frequently included (1) mild resistance upon orifice penetration, (2) proximal duct gritty tactile and aural sensation suggestive of keratinized cellular debris, and (3) focal variable resistance deeper within the duct, which may be relieved with the probe, suggestive of fibrovascular tissue. Taken together, these findings may offer probing characteristics that may allow for a grading system for duct obstruction. The postprobing improvement of symptoms not previously appreciated supports the notion that meibomian gland disease exists subclinically.

Maskin SL.
Intraductal meibomian gland probing relieves symptoms of obstructive meibomian gland dysfunction.
Cornea 2010; 29 (10): 1145-1152.

Kojima T, Matsumoto Y, Dogru M, Tsubota K
The Application of in vivo laser scanning confocal microscopy as a tool of conjunctival in vivo cytology in the diagnosis of dry eye ocular surface disease
Mol Vis 2010; 16: 2457-2464.

Purpose: To evaluate the applicability of in vivo laser scanning confocal microscopy as a tool of conjunctival cytology in a prospective case-control study.
Methods: Nineteen right eyes of 19 Sjogren’s syndrome dry eye patients (19 females; mean age: 55.8±15 years), and 18 right eyes of 18 normal healthy control subjects (12 females and 6 males; mean age: 50.8±14 years) were evaluated in this study. The eyes were analyzed by the Heidelberg retina tomography (HRTII)/Rostock cornea module (RCM). Ocular surface and tear function tests including vital stainings (fluorescein and Rose Bengal), Schirmer test, tear film break up time (BUT), and conjunctival impression cytology were performed. After obtaining the confocal microscopy images, the mean individual epithelial cell area (MIECA), and nucleocytoplasmic (N/C) ratio were analyzed. The correlation between confocal microscopy and impression cytology parameters was also investigated.
Results: The BUT, Schirmer test values, vital staining scores and squamous metaplasia grades in impression cytology were significantly worse in dry eye patients compared to controls (p<0.0001). The MIECA and the mean N/C ratios were worse in dry eye subjects compared to controls both in impression cytology and in vivo confocal microscopy (p<0.0001) with no significant differences between these parameters when the two examination techniques were compared. The MIECA and N/C ratio in conjunctival impression cytology showed significant correlation with the corresponding confocal
microscopy parameters (MIECA, r2:0.557 ; N/C, r2:0.765).
Conclusions: Laser scanning confocal microscopy seems to be an efficient non-invasive tool in the evaluation of phenotypic alterations of the conjunctival epithelium in dry eye disease. N/C ratio and MIECA appear to be two promising and new parameters of in vivo confocal cytology in the assessment of the ocular surface in dry eye disease.

Sullivan BD, Whitmer D, Nichols KK, Tomlinson A, Foulks GN, Geerling G, Pepose JS, Kosheleff V, Porreco A, Lemp MA.
An objective approach to dry eye disease severity.
Invest Ophthalmol Vis Sci. 2010 Jul 14. [Epub ahead of print]

Abstract
Purpose: A prospective, multi-site clinical study (10 sites in the E.U. and U.S.) evaluated the clinical utility of commonly used tests and tear osmolarity for assessing dry eye disease severity. Methods: 314 consecutive subjects between the ages of 18-82 years were recruited from the general patient population, 299 of which qualified with complete datasets. TearLab osmolarity, Schirmers without anesthesia, tear film breakup time (TBUT), corneal staining, meibomian dysfunction assessment, and conjunctival staining were performed bilaterally. A symptom questionnaire (OSDI), was also recorded for each patient. Distributions of clinical signs and symptoms against a continuous, composite severity index were evaluated. Results: Osmolarity was found to have the highest correlation coefficient to disease severity (r2=0.55), followed by conjunctival staining (r2=0.47), corneal staining (r2=0.43), OSDI (r2=0.41), meibomian grading (r2=0.37), TBUT (r2=0.30), and Schirmers (r2=0.17). Comparison of standard threshold-based classification with the composite severity index revealed significant overlap between the disease severities of prospectively defined "Normal" and "Dry Eye" groups. Fully 63% of the subjects were found to be poorly classified by combinations of clinical thresholds. Conclusions: Tear film osmolarity was found to be the single best marker of disease severity across normal, mild/moderate and severe categories. Other tests were found to be informative in more severe forms of disease, thus clinical judgment remains an important element in clinical assessment of severity. The study also indicates that the initiation and progression of dry eye is multifactorial, and supports the rationale for redefining severity of dry eye based on a continuum of clinical signs.

Kimball SH, King-Smith PE, Nichols JJ.
Evidence for the Major Contribution of Evaporation to Tear Film Thinning between Blinks.
Invest Ophthalmol Vis Sci. 2010; 51 (12): 6294-7.

Abstract

Purpose. To determine the contribution of evaporation to the thinning of the precorneal tear film between blinks. Methods. The rate of tear film thinning after a blink was measured using spectral interferometry from the right eyes of 37 subjects. Data were obtained under two different conditions: free air and air-tight goggles. Results. The mean (±SD) tear film thinning rates for subjects was 3.22 ± 4.27 μm/min in free air and -0.16 ± 1.78 μm/min (i.e., a slight but not significant thickening) for the same subjects wearing air-tight goggles; this reduction in thinning rates was significant (P < 0.0001). Conclusions. The large reduction in thinning rate caused by wearing goggles indicates that evaporation is the major cause of thinning between blinks. The mean thinning rate in free air is greater than reported evaporation rates; it is argued that the preocular chambers used in evaporimeters restrict movement of air over the tear film and reduce evaporation compared to our free air condition.

SETEMBRO/OUTUBRO 2010

Springs CL.
Novel hydroxypropyl-guar gellable lubricant eye drops for treatment of dry eye.
Adv Ther. 2010 Aug 26. [Epub ahead of print]

Abstract
OBJECTIVE|: The objective of this review is to evaluate the safety and efficacy of polyethylene glycol 400/propylene glycol/hydroxypropyl-guar (Systane(R) Ultra [PEG/PG with HP-guar], Alcon Laboratories, Inc., Fort Worth, TX, USA) lubricant eye drops in reducing the signs and symptoms of dry-eye disease. METHODS|: A systematic literature search utilizing MEDLINE was conducted to identify peer-reviewed articles related to dry-eye disease and PEG/PG with HP-guar lubricant eye drops. The search covered the period prior to October 2009. Additionally, a manual search based on citations in the published literature was conducted. RESULTS|: The PEG/PG with HP-guar artificial tears shows in-vitro viscoelastic properties with pH optimization. The pH of the solution adjusts to the pH of the ocular surface upon instillation, which results in tear film elasticity and viscosity similar to that of subjects without dry-eye disease. The reviewed literature demonstrated that this delivery system showed a reduction in corneal and conjunctival staining in dryeye disease, an improvement in tear film stability, a low coefficient of friction in an in-vitro model, and improved maintenance of best-corrected visual acuity over time. CONCLUSION|: A few small-sized studies with short-term follow-up demonstrated that PEG/PG with HP-guar is a safe and effective lubricant eye drops for the treatment of dry-eye disease. Larger studies with longer duration are warranted to assess the long-term safety and efficacy of this formulation in patients with dry.eye disease.

Pietrini D
Laser de surface et myopie moyenne à forte : quand faut-il utiliser la mitomycine ?
Réalités ophtalmol 2010; 175: 55-58.

Barbaro V, Ferrari S, Fasolo A, Pedrotti E, Marchini G, Sbabo A, Nettis N, Ponzin D, Di Iorio E.
Evaluation of ocular surface disorders: a new diagnostic tool based on impression cytology and confocal laser scanning microscopy.
Br J Ophthalmol 2010; 94 (7): 926-932.

AIM: To provide a new tool for the evaluation of altered ocular surfaces by using a combination of impression cytology, laser scanning confocal microscopy and advanced image analysis.
METHODS: The expression of keratin 3 (K3), keratin 12 (K12), keratin 19 (K19) and mucin 1 (MUC1) was analysed by immunofluorescence on both histological sections of nine corneoscleral but-tons from normal donors comprising conjunctiva, limbus and cornea and impression cytology speci-mens from six healthy normal subjects (12 eyes) and 12 patients with chronic ocular surface disorders. Levels of fluorescence expression of the different markers were quantified through quantitative fluo-rescence immunohistochemistry (Q-FIHC).
RESULTS: Impression cytology specimens from normal and diseased ocular surfaces showed distinct expression patterns for K12 and MUC1. Healthy corneas expressed only K12 (but not MUC1), while conjunctivalised corneas from patients with limbal stem cell deficiency (LSCD) were characterised by the presence of MUC1 and the disappearance of K12. Similar clear-cut results were not seen with the K3/K19 markers, which showed lack of specificity and overlapping signals in cornea and conjunctiva impression cytology specimens.
CONCLUSIONS: The ability of K12 and of the antibody against MUC1 to discriminate clearly bet-ween limbus/cornea and conjunctiva in impression cytology specimens could become a valuable dia-gnostic tool for ophthalmologists in order to evaluate alterations of the ocular surface and the grading of LSCD.

Mencucci R, Paladini I, Brahimi B, Menchini U, Dua HS, Romagnoli P.
Alcohol delamination in the treatment of recurrent corneal erosion: an electron microscopic stu-dy.
Br J Ophthalmol 2010; 94 (7): 933-939.

AIM: To investigate by electron microscopy the plane of separation of the epithelial sheet from its substratum in the procedure of alcohol delamination (ALD) in patients with recurrent corneal erosion syndrome.
METHODS: Ten cases of recurrent corneal erosions (RCE) secondary to trauma and seven cases rela-ted to map-dot-fingerprint dystrophy (MDFP) were treated with ALD. The epithelial sheets obtained from these patients were examined by transmission electron microscopy. Similarly sheets obtained from 20 patients undergoing photorefractive keratectomy (10 by mechanical removal and 10 by ALD) were also examined as control group. Five further corneal buttons obtained at keratoplasty were treated with ALD and the epithelial sheet and corresponding stroma were both examined.
RESULTS: In all specimens, whether removed mechanically or by ALD, the intercellular surfaces did not show any disruption and desmosomes were preserved. In patients with traumatic RCE and in cor-neal buttons obtained at keratoplasty, tissue separation occurred along the lamina lucida, whereas in patients with MDFP the whole basal lamina was removed along with the epithelium. Focal areas of basal cell degeneration and epithelial detachment from the basal lamina were also noted.
CONCLUSIONS: ALD enables efficient removal of the epithelium with an almost complete preser-vation of the lamina densa in traumatic RCE. In RCE due to MDFP the epithelium separates from the stroma below the basal lamina and may reflect the pathology of the condition.

Kernt M, Hirneiss C, Neubauer AS, Kampik A.
Minocycline is cytoprotective in human corneal endothelial cells and induces anti-apoptotic B-cell CLL/lymphoma 2 (Bcl-2) and X-linked inhibitor of apoptosis (XIAP).
Br J Ophthalmol 2010; 94 (7): 940-946.

INTRODUCTION: Loss of corneal endothelial cells (CECs) is one major factor limiting transplant clarity and survival after keratoplasty. Amongst other factors, apoptosis due to cellular stress is respon-sible for these problems. This study investigates the possible anti-apoptotic and cytoprotective effects of minocycline on a human corneal endothelial cell line (HCEC-SV40) cultured under oxidative stress and with transforming growth factor beta (TGF-beta).
METHODS: CECs were treated with 1-150 microM minocycline. Cell viability and the median inhi-bitory concentration (IC(50)) were evaluated after 48 h and after H(2)O(2) treatment (tetrazolium dye reduction assay and live-dead assay). Expression of B-cell CLL/lymphoma 2 (Bcl-2) and X-linked inhibitor of apoptosis (XIAP) and their mRNA were assessed by reverse transcriptase (RT)-PCR and western blot analysis after treatment with minocycline alone and consecutive incubation with 200 mi-croM H(2)O(2) and TGF-beta2. A quantitative detection of histone-associated DNA fragmentation by ELISA was performed.
RESULTS: Minocycline concentrations from 1-50 microM showed no toxic effects on CECs. Pre-treatment with 10-40 microM minocycline led to an increase in viability after H(2)O(2) treatment. In addition, minocycline pre-treatment attenuated the increase of histone-associated DNA fragmentation after treatment with H(2)O(2) and TGF-beta2 significantly. When CECs were treated with minocy-cline and then consecutively with H(2)O(2) or TGF-beta2, RT-PCR and western blot analysis yielded an overexpression of Bcl-2 and XIAP.
CONCLUSION: In this study minocycline prevented apoptotic cell death in cultured CECs in vitro. Our results suggest that minocycline might offer cytoprotective properties that might help to prevent loss of corneal endothelial cells in vivo.

Neeley C, Ishiwata M.
Regenereting Damaged Ocular Surfaces
Eye News 17 (2): 19-22.

Sánchez MA, Arriola-Villalobos P, Torralbo-Jiménez P, Girón N, de la Heras B, Herrero Vanrell R, Alvarez-Barrientos A, Benítez-del-Castillo JM.
The effect of preservative-free HP-Guar on dry eye after phacoemulsification: a flow cytometric study.
Eye (Lond) 2010; 24 (8): 1331-1337.

PURPOSE: To assess the effect of hydroxypropyl (HP)-Guar added to regular post-phacoemulsification treatment in dry eye signs and symptoms, and its influence on the expression of various inflammatory markers by flow cytometry (FCM) in impression cytology specimens.
METHODS: This prospective, interventional, single-centre study included 48 eyes of 48 patients with age-related cataract. After phacoemulsification, patients were randomised to the usual treatment group (UT), with 21 patients who received tobramycin and dexamethasone eye drops (Tobradex, Alcon Cusí, Spain), and the HP-Guar group, with 27 patients who received the UT plus preservative-free artificial tears (Systane UD, Alcon Cusí, Spain). Corneal and conjunctival staining with fluorescein and lissa-mine green, tear film break-up time (TBUT), Schirmer's I test with anaesthesia (Jones test), tear clea-rance, and ocular surface disease index (OSDI) were assessed preoperatively and 1 month after surge-ry. Besides, conjunctival impression cytology was performed in order to investigate inflammatory markers (CD3, CD11b, and HLA-DR) using FCM.
RESULTS: HP-Guar group shows statistical better results compared with the UT group in TBUT (6.4+/-0.7 vs 9+/-2.5, P=0.0004), OSDI (11.5+/-8.2 vs 3.3+/-2.5, P=0.0002), ocular symptoms subscale (7.3+/-6.1 vs 1.7+/-1.8, P=0.0004), vision-related function subscale (2.2+/-1.8 vs 0.4+/-0.6, P=0.0002), CD3 (2.5+/-1.4 vs 1.1+/-1.1, P=0.011), and HLA-DR (6.8+/-4.5 vs 1.8+/-1.7, P=0.0002).
CONCLUSION: The addition of HP-Guar to regular treatment after cataract surgery reduces ocular surface inflammation and dry eye signs and symptoms.

Foulks GN, Borchman D.
Meibomian gland dysfunction: the past, present, and future.
Eye Contact Lens 2010; 36 (5): 249-253.

OBJECTIVE: To recount the historic evaluation of meibomian gland dysfunction (MGD) and describe new techniques to monitor disease and therapy.
METHODS: A review of the literature regarding the description of MGD and the role of ab-normalities of meibomian gland secretion in health and disease.
RESULTS: Meibomian gland dysfunction is a common clinical condition and is a major cause of evaporative dry eye with associated discomfort, visual disturbance, and contact lens intolerance. De-spite the early description of the anatomy and physiology of the meibomian gland, recognition of the importance of the MGD and particularly therapeutic options to treat it has been limited.
CONCLUSIONS: Improved methods of spectroscopic and chemical analysis of the mei-bomian gland secretion in health and disease are providing a better understanding of the physical and chemical ab-normalities of the meibomian gland secretions and are allowing bet-ter evaluation of medical therapies.

Ashwin PT, McDonnell PJ.
Collagen cross-linkage: a comprehensive review and directions for future research.
Br J Ophthalmol 2010; 94 (8): 965-970.

Individuals with keratoconus form a significant proportion of patients for a practitioner specialising in corneal diseases. Yet it is a disease where the pathogenesis is poorly understood, and until recently, there has been no treatment apart from transplantation that could be offered that was curative or even capable of slowing the progression of the disease. Collagen cross-linking treatment using riboflavin and UV light has been developed to address this need, and the initial results are promising. The purpose of this review is to critically evaluate this treatment in light of the scientific basis for cross-linking, to highlight the strengths and limitations of the evidence in terms of efficacy and long-term safety, and finally to identify areas for future research in this area with a significant potential to change the way we treat our keratoconus patients. In addition, we hope that our unbiased review for the first time would bring together, in a concise fashion, scientific information for a practitioner contemplating on offering this treatment and to help inform their patients of its potential risks and benefits.

Yuki K, Shiba D, Ota Y, Ozeki N, Murat D, Tsubota K.
A new method to prevent loss of mitomycin C soaked sponges under the conjunctiva during tra-beculectomy.
Br J Ophthalmol 2010; 94 (8): 1111-1112.

Nishida T.
Translational research in corneal epithelial wound healing.
Eye Contact Lens 2010; 36 (5): 300-304.

PURPOSE: To review both the roles of fibronectin and the sensory neurotransmitter sub-stance P in corneal epithelial wound healing and the clinical application of these agents to treat persistent corneal epithelial defects.
RESULTS: Fibronectin is expressed at the site of corneal epithelial defects, serves as a provi-sional matrix for the migration of epithelial cells, and stimulates epithelial wound healing in vitro and in ani-mal models. Eyedrops containing autologous plasma fibronectin are also effec-tive for the treatment of persistent epithelial defects of the cornea in patients. Substance P and insulin-like growth factor-1 syn-ergistically stimulate corneal epithelial wound healing in vitro and in animal models. Furthermore, the administration of eyedrops containing both a subs-tance P-derived peptide (FGLM-amide) and insulin-like growth factor-1-derived peptide (SSSR) is effective for the treatment of persistent epithelial de-fects in individuals with neuro-trophic keratopathy.
CONCLUSIONS: Basic research on the mechanism of corneal epithelial wound healing has the poten-tial to lead to the development of new modes of treatment for persistent corneal epi-thelial defects. Clinical experience with eyedrops containing fibronectin or both FGLM-amide and SSSR has high-lighted the importance of the basement membrane and neural stimuli in maintenance of the integrity of the normal corneal epithelium.

Fonn D, Peterson R, Woods C.
Corneal staining as a response to contact lens wear.
Eye Contact Lens 2010; 36 (5): 318-321.

OBJECTIVE: To review the effects of contact lenses on the corneal surface.
METHODS: A review of the literature and in-house research of corneal staining and its va-rious forms of presentation.
RESULTS: Corneal staining manifests in many different forms. The severity of staining or insult of the cornea is usually determined by the extent (area of coverage), density, and depth. The cause of staining is multifactorial, and its location is often linked to the type of lens that is being worn, the solution used to clean/disinfect the lens, the state of hydration of the soft lens, and the state of the cornea that has been affected by the lens.
CONCLUSIONS: Sodium fluorescein dye effectively highlights corneal integrity changes referred to as corneal staining. This review describes the manifestations, the cause, the me-chanisms, and the methods of remediation of corneal staining.

Moorthy S, Jhanji V, Constantinou M, Beltz J, Graue-Hernandez EO, Vajpayee RB.
Clinical experience with N-butyl cyanoacrylate tissue adhesive in corneal perforations secondary to herpetic keratitis.
Cornea 2010; 29 (9): 971-5.

Abstract
PURPOSE: To evaluate the success of cyanoacrylate tissue adhesive in the management of corneal perforations associated with herpetic keratitis.

METHODS: Case records of 46 patients with microbiologically proven herpetic keratitis associated with corneal perforations that were treated with corneal gluing were analyzed retrospectively in a terti-ary care hospital. N-Butyl cyanoacrylate tissue adhesive and bandage contact lens were applied in ad-dition to antiviral therapy. The main outcome measure was preservation of the structural integrity of the globe.

RESULTS: Glue application could heal corneal perforations in only 17 eyes (37%). Therapeutic kera-toplasty had to be performed in 26 eyes (57%) because of failure of the glue. Fourteen eyes (31%) re-quired multiple applications of tissue adhesive, and 2 eyes had to be eviscerated. Location of perfora-tion, additional anterior chamber intervention, and use of prophylactic acyclovir therapy had no statis-tically significant effect on the overall final outcome.

CONCLUSION: Corneal perforations associated with herpetic keratitis may not heal with glue appli-cation alone, and corneal transplantation surgery may be required to maintain the ocular structural in-tegrity.

Arita R, Itoh K, Maeda S, Maeda K, Furuta A, Tomidokoro A, Amano S.
Proposed diagnostic criteria for seborrheic meibomian gland dysfunction.
Cornea 2010; 29 (9): 980-4.

PURPOSE: To compare clinical findings between patients with seborrheic meibomian gland dysfunc-tion (MGD) and normal controls and to propose diagnostic criteria for seborrheic MGD.

METHODS: Thirty eyes of 30 patients [13 men and 17 women; age (mean +/- SD) 73.9 +/- 9.9 years] diagnosed with seborrheic MGD and 60 eyes of 60 healthy volunteers (22 men and 38 women; age: 71.0 +/- 9.3 years) as a control group were included in this study. Ocular symptoms were scored from 0 to 14 according to the number of symptoms present. Lid margin abnormality was scored from 0 to 4 depending on the number of abnormalities present. Meibomian gland changes were scored from 0 to 6 on the basis of noncontact meibography (meiboscore). Superficial punctate keratopathy was scored from 0 to 3. Tear film production was evaluated by Schirmer test. Receiver operating characteristic curves with calculations of the area under the curve were used to describe the accuracy of each pa-rameter to differentiate patients with seborrheic MGD from normal eyes.

RESULTS: Ocular symptom score and lid margin abnormality score were significantly higher in the seborrheic MGD group than in the control group (P < 0.0001 for both scores). Area under the curve values indicated that the lid margin abnormality score had the highest diagnostic power as a single parameter followed by the ocular symptom score. When the diagnosis for seborrheic MGD was made on the basis of the 2 scores (ocular symptom score and lid margin abnormality score) being abnormal, the sensitivity was 100% and the specificity was 98.3%.

CONCLUSIONS: On the basis of these findings, we recommend that physicians use ocular symptom score and lid margin abnormality score in the diagnosis of seborrheic MGD. Seborrheic MGD should be considered very likely when both of the 2 scores are abnormal.

Tomlinson A, McCann LC, Pearce EI.
Comparison of human tear film osmolarity measured by electrical impedance and freezing point depression techniques.
Cornea 2010; 29 (9): 1036-41.

Abstract
PURPOSE: Tear hyperosmolarity is diagnostic of dry eye disease (DED), yet difficulty in measure-ment has limited its utility; development of new instruments could facilitate its clinical application. This study compares the new OcuSense TearLab osmometer (OcuSense, Inc, San Diego, CA), based on electrical impedance "lab-on-a-chip" nanoliter technology, with the freezing point depression Clifton Osmometer (Clifton Technical Physics, Hartford, NY).

METHODS: Thirty-six subjects were recruited: 15 DED (9 women, 6 men age: 41 +/- 16 years) and 21 controls (12 women, 9 men age: 35 +/- 12 years); criteria for DED were noninvasive tear breakup time <10 seconds, Schirmer I test <5 mm, and positive symptoms. Samples were collected from the inferior tear meniscus for testing with both osmometers.

RESULTS: Osmolarity values measured with OcuSense TearLab were 308 +/- 6 and 321 +/- 16 mOsm/L for controls and dry eye, respectively, and those measured with Clifton were 310 +/- 7 and 323 +/- 14 mOsm/L for controls and dry eye, respectively; these values were significantly different. Significant correlation was found between OcuSense and Clifton measurements (r = 0.904; P = 0.006). Bland-Altman analysis revealed agreement between techniques; the majority of points fell within the 95% confidence limits, and actual values differed by less than 1%. A cutoff value of >316 mOsm/L, derived from the distribution of osmolarity values, was used to diagnose DED with an effectiveness of 73% sensitivity, 90% specificity, and 85% positive predictive value for the OcuSense and 73% sensi-tivity, 71% specificity, and 65% positive predictive value for the Clifton in the study samples.

CONCLUSIONS: Tear film osmolarity measured with the OcuSense TearLab system correlates well with the Clifton Osmometer. The new instrument has the potential to provide clinicians with a readily available clinically applicable measure, which could become the gold standard in DED.

Versura P, Profazio V, Campos EC.
Performance of tear osmolarity compared to previous diagnostic tests for dry eye diseases.
Curr Eye Res 2010; 35 (7): 553-64.

Abstract
PURPOSE: Tear osmolarity is considered a key point in dry eye disease (DED) and its measurement is the gold standard in dry eye diagnosis. Tear osmolarity was evaluated in dry eye (DE) patients vs. a control group to assess its diagnostic performance compared to clinical and laboratory tests performed in either clinical or research settings.

METHODS: Tear osmolarity was measured with the TearLab Osmolarity System (OcuSense) in 25 normal subjects and 105 DE patients (severity score 1-4, Dry Eye Workshop (DEWS)). The following tests were also performed: Ocular Surface Disease Index (OSDI) symptoms questionnaire, Schirmer I test, Tear Film Break Up Time (TFBUT), ferning test, lissamine green staining, tear clearance, corneal esthesiometry, and conjunctival cytology by scraping and imprint. Statistical evaluation was performed by unpaired Student's t and Mann-Whitney tests, the Spearman's rho and the Pearson's r correlation coefficients (significance p < 0.05); all variables were also analyzed for sensitivity, specificity, Receiver Operating Characteristics (ROC) curves, likelihood ratio LR+, and positive predictive value (PPV).

RESULTS: Tear osmolarity normal values were 296.5 +/- 9.8 mOsm/L, increasing values were shown stepwise DE severity (mild to moderate to severe dry eye, respectively: 298.1 +/- 10.6 vs. 306.7 +/- 9.5 vs. 314.4 +/- 10.1, p < 0.05). A progressive worsening occurred in all the parameters with DED severity increase. Tear osmolarity exhibited the larger correlation strength vs. tear clearance, TFBUT and clinical score, strength increased with DED severity, mainly to inflammatory score and corneal sensi-tivity. Tear osmolarity 305 mOsm/L was selected as cut-off value for dry eye, 309 mOsm/L for mod-erate dry eye, 318 mOsm/L for severe dry eye (Area-Under-the-Curve was 0.737, 0.759, and 0.711, respectively).

CONCLUSIONS: Tear osmolarity can now be considered a test suitable to be performed in a clinical setting. It showed a good performance in dry eye diagnosis, higher than the other tests considered, mainly in severe dry eye. Tear osmolarity values should be interpreted as an indicator of DED evolu-tionary process to severity.

Arita R, Itoh K, Maeda S, Maeda K, Furuta A, Tomidokoro A, Amano S.
Meibomian gland duct distortion in patients with perennial allergic conjunctivitis.
Cornea 2010; 29 (8): 858-60.

Abstract
PURPOSE: To observe morphologic changes of meibomian glands in patients with and without peren-nial allergic conjunctivitis (AC) and to assess the relation between morphologic changes of the mei-bomian glands of both eyelids and tear film parameters.

METHODS: In this study, 55 eyes of 55 patients with perennial AC and 47 eyes of 47 healthy volun-teers as controls were included. The following tests were performed: a slit-lamp examination, meas-urement of tear film breakup time, grading of meibomian gland morphologic changes (meibography score) assessed with a noncontact meibography, meibomian gland duct distortion in meibography, tear production by the Schirmer I test, and grading of meibum expression.

RESULTS: The frequency of meibomian gland duct distortion was significantly greater in patients with AC (45%) than that in controls (8.5%; P < 0.0001). The meibum (P = 0.049) and superficial punctate keratopathy scores (P = 0.0076) were significantly higher in patients with AC than those in controls. There was no significant difference in meibography score, breakup time, or Schirmer value between the 2 groups. The meibomian expression score was significantly higher in patients with AC with meibomian gland duct distortion than in patients with AC without meibomian gland duct distor-tion (P = 0.0012).

CONCLUSION: Perennial AC is associated with increased meibomian gland duct distortion.

Gumus K, Cavanagh DH.
The role of inflammation and antiinflammation therapies in keratoconjunctivitis sicca.
Clin Ophthalmol 2009; 3: 57-67.

Abstract
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.

Nettune GR, Pflugfelder SC.
Post-LASIK Tear Dysfunction and Dysesthesia.
Ocul Surf. 2010; 8 (3): 135-45.

ABSTRACT Symptoms of tear dysfunction after laser in situ keratomileusis (LASIK) occur in nearly all patients and resolve in the vast majority. Although dry eye complaints are a leading cause of patient discomfort and dissatisfaction after LASIK, the symptoms are not uniform, and the disease is not a single entity. Post-LASIK tear dysfunction syndrome or dry eye is a term used to describe a spectrum of disease encompassing transient or persistent post-operative neurotrophic disease, tear instability, true aqueous tear deficiency, and neuropathic pain states. Neural changes in the cornea and neuropathic causes of ocular surface discomfort may play a separate or synergistic role in the development of symptoms in some patients. Most cases of early post-operative dry eye symptoms resolve with ap-propriate management, which includes optimizing ocular surface health before and after surgery. Se-vere symptoms or symptoms persisting after 9 months rarely respond satisfactorily to traditional treat-ment modalities and require aggressive management. This review covers current theories of post-LASIK dry eye disease, pathophysiology, risk factors, and management options for this disease spec-trum of post-LASIK tear dysfunction and neuropathic pain.

Gupta N, Sachdev R, Tandon R.
Sutureless patch graft for sterile corneal melts.
Cornea 2010; 29 (8): 921-3.

Abstract
An innovative technique to seal large paracentral corneal melts is being presented. Two patients with sterile corneal melts sized 3-5 mm in diameter were treated with a full-thickness patch graft punched using a dermatological trephine and secured with the fibrin-aprotinin biological tissue adhesive, sup-planting the need for sutures. The defect was adequately sealed, and successful tectonic support with postoperative best-corrected visual acuity of 6/24 was achieved in both cases, circumventing the need for an emergency full-thickness penetrating keratoplasty.

Korb DR, Blackie CA.
Restoration of meibomian gland functionality with novel thermodynamic treatment device-a case report.
Cornea 2010; 29 (8): 930-3.

Abstract
A new and previously unpublished thermodynamic treatment device, which for the first time applies heat directly to both inner eyelid surfaces with a precision-controlled resistive heater while pulsating pressure is simultaneously applied to the outer eyelids using an inflatable air bladder, was used to re-store meibomian gland functionality for a subject with severe evaporative dry eye. The subject, a 39-year-old white woman of light complexion with severe symptoms and corroborating objective signs of dry eye, had been unsuccessfully treated for 3 years by 7 practitioners. Using a new standardized mei-bomian gland expression device, a diagnosis of nonobvious meibomian gland dysfunction, where none of the approximately 24 meibomian glands of the right lower eyelid and 1 meibomian gland of the left lower eyelid were functional, was made. The patient underwent a single 12-minute treatment per eye with the treatment device. The treatment restored the functionality of 8 glands in each eye, doubled the fluorescein break-up time (FBUT) from 5 to 10 seconds, and decreased the symptom scores by approximately 80% for the entire follow-up period of 3 months

JUNHO/JULHO/AGOSTO 2010

Jonisch J, Steiner A, Udell IJ.
Preservative-free low-dose dexamethasone for the treatment of chronic ocular surface disease refractory to standard therapy.
Cornea 2010; 29 (7): 723-726.

PURPOSE: To evaluate the short-term safety and efficacy of topical preservative-free dexamethasone 0.01% for the treatment of ocular surface disease and/or tearing refractory to conventional treatments. METHODS: Retrospective chart review of all patients who received topical unpreserved dexametha-sone 0.01% (Leiters Pharmacy, San Jose, CA). Follow-up visits were reviewed for subjective responses to the formulation and intraocular pressure. Responses were graded as significant/complete resolution of symptoms (50%-100% improvement), mild (25%-50% improvement), or no improvement. RESULTS: Thirty-one patients received topical unpreserved dexamethasone 0.01% for the treatment of ocular surface disease. Follow up ranged from 4 to 60 months (average, 11.5 weeks). Twenty patients (65%) reported moderate or complete resolution of ocular symptoms. Seven patients (22%) had mild improvement in their symptoms. Four patients (13%) had no change in ocular symptoms. No patient in our series developed an elevation of intraocular pressure greater than 5 mm Hg above baseline intraocular pressure. No patient developed intraocular pressure greater than 22 mm Hg. CONCLUSIONS: Topical nonpreserved 0.01% dexamethasone could be an effective therapy for re-calcitrant chronic ocular surface disease.

Luchs J
Azithromycin in DuraSite® for the treatment of blepharitis
Clin Ophthalmol 2010; 4: 681-688.

Abstract: Blepharitis is a common inflammatory disease of the eyelid. Posterior blepharitis affects the posterior lamella of the eyelid and involves inflammation of the meibomian glands, whereas anterior blepharitis affects the anterior lamella of the eyelid and the eyelashes; either version can be inflammatory or infectious in nature. Each of these conditions can incite or propagate the other; anterior blepharitis, if not treated, can lead to meibomian gland disease, and vice versa. Blepharitis is typically chronic, and can be associated with a variety of systemic diseases such as dermatitis, as well as ocular diseases such as dry eye, conjunctivitis, or keratitis. The standard treatment regimen historically consists of lid hygiene with warm compresses and eyelid scrubs, although these treatment modalities may have limited efficacy for many patients, especially those with more severe disease. Adjunctive treatment includes systemic and topical antibiotics, topical corticosteroids, and tear replacement therapy. Topical antibiotics are recommended to decrease the bacterial load, and topical corticosteroids may help in cases of severe inflammation. Azithromycin ophthalmic solution 1% in DuraSite® (AzaSite®; Inspire Pharmaceuticals, Durham, North Carolina, USA) has been proposed as a novel treatment for posterior blepharitis, based on its well-known anti-infective profile, its antiinflammatory properties, its excellent tissue penetration, and its regulatory approval for the treatment of bacterial conjunctivitis. This review focuses on an off-label indication for topical azithromycin 1% in DuraSite for the treatment of blepharitis.

Montés-Micó R, Cerviño A, Ferrer-Blasco T, García-Lázaro S, Ortí-Navarro S.

Optical quality after instillation of eyedrops in dry-eye syndrome.
J Cataract Refract Surg 2010; 36 (6): 935-940.

PURPOSE: To study the effect of eyedrop instillation on the optical quality of the air-tear film inter-face at the anterior cornea in cases of dry eye. SETTING: University of Valencia, Valencia, Spain. METHODS: Corneal aberrations (total, spherical-like, and coma-like) were determined from corneal elevation maps and purpose-designed software in cases of dry eye before, immediately after, and 10 minutes after lubricating eyedrop instillation (Blink Intensive Tears). All data were decomposed using Zernike polynomials to yield the root-mean-square wavefront deviations for pupil diameters of 3.0 mm and 5.5 mm. Outcome measures included comparison with clinical tear breakup time (TBUT). RE-SULTS: Wavefront higher-order aberrations (HOAs) decreased significantly, by a factor of 2.5 on ave-rage, after artificial tear instillation with both pupil diameters (P<.01). The reduction was maintained 10 minutes after eyedrops instillation (P>.2). The mean TBUT was 3.6 seconds +/- 1.7 (SD). Eyedrop instillation increased the TBUT values significantly (by approximately 60%) from baseline (P<.01). CONCLUSIONS: This method of air-tear film interface analysis facilitated evaluation of optical quali-ty improvement after eyedrop instillation in patients with dry eye. After eyedrops were given, the in-creasingly regular tear film decreased HOAs, improving optical quality. (c) 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Walker PM, Lane KJ, Ousler GW 3rd, Abelson MB.
Diurnal variation of visual function and the signs and symptoms of dry eye.
Cornea 2010; 29 (6): 607-612.

PURPOSE: Subjects with dry eye often complain of disturbances in visual function and worsening of symptoms in the evening. To clinically substantiate these reports of diurnal variations, the present study tested subjects with dry eye on a series of visual function and ocular physiology measures. ME-THODS: Twenty-one subjects with dry eye were enrolled and underwent ophthalmic examinations, including best spectacle-corrected visual acuity, visual function decay as measured by the interblink interval visual acuity decay test without ocular anesthetic, reading rate test, slit-lamp biomicroscopy, and tear film breakup time. Keratitis, conjunctival redness, and corneal sensitivity were also assessed. Examinations occurred once during the morning and for a second time in the evening. Subjects also completed a modified version of the Ocular Surface Disease Index at both study visits. RESULTS: Subjects with dry eye showed impaired visual function in the evening, as compared to that in the mor-ning; they maintained their best spectacle-corrected visual acuity for a shorter time between blinks (P < 0.01) and had longer readings times (P < 0.05) in the evening as compared with that in the morning. These findings were qualified by Ocular Surface Disease Index results showing greater subjective vi-sual impairment in the evening. Subjects also demonstrated a significant increase in keratitis and con-junctival redness from morning to evening testing. Less ocular discomfort was reported in the evening than in the morning; this effect significantly correlated with corneal sensitivity in the evening. CON-CLUSIONS: Subjects with dry eye experience significant diurnal variations of visual function and ocular surface physiology. These daily rhythms should be considered when designing clinical trials and when quantifying disease severity.

Craig JP, Purslow C, Murphy PJ, Wolffsohn JS.
Effect of a liposomal spray on the pre-ocular tear film.
Cont Lens Anterior Eye. 2010; 33 (2): 83-7.

Abstract
PURPOSE: With the potential to address evaporative dry eye, a novel spray has been developed in which phospholipid liposomes are delivered to the tear film via the surface of the closed eyelid. This study evaluated the short-term effects of liposomal spray application on the lipid and stability characte-ristics of the pre-ocular tear film in normal eyes. METHODS: Twenty-two subjects (12M, 10F) aged 35.1+/-7.1 years participated in this prospective, randomised, double-masked investigation in which the liposomal spray was applied to one eye, and an equal volume of saline spray (control) applied to the contralateral eye. Lipid layer grade (LLG), non-invasive tear film stability (NIBUT) and tear meniscus height (TMH) were evaluated at baseline, and at 30, 60, 90 and 135min post-application. Subjective reports of comfort were also compared. RESULTS: Treated and control eyes were not significantly different at baseline (p>0.05). Post-application, LLG increased significantly, at 30 and 60min, only in the treated eyes (p=0.005). NIBUT also increased significantly in the treated eyes only (p<0.001), at 30, 60 and 90min. TMH did not alter significantly (p>0.05). Comfort improved relative to baseline in 46% of treated and 18% of control eyes, at 30min post-application. Of those expressing a preference in comfort between the eyes, 68% preferred the liposomal spray. CONCLUSIONS: Consistent with subjective reports of improved comfort, statistically and clinically significant improvements in lipid layer thickness and tear film stability are observed in normal eyes for > or =1h after a single application of a phospholipid liposomal spray. 2010. Published by Elsevier Ltd. All rights reserved.

Brémond-Gignac D, Milazzo S.
Une blépharite.
Réflexions Ophtalmol 2010; 15 (135): 41-43.

Résumé
La blépharite est une inflammation du bord libre des paupières. Les signes cliniques se traduisent par des croûtes palpébrales, une hyperhémie des bords libres, une tuméfaction palpébrale, un prurit ou des chalazions récidivants. Il faut distinguer les blépharites antérieures de la partie cutanée du rebord pal-pébral, les blépharites postérieures de la partie muqueuses du rebord palpébral et les formes mixtes. Les étiologies sont nombreuses mais les blépharites sont souvent causées par un dysfonctionnement des glandes de Meibomius. Les différentes formes cliniques sont : les blépharites infectieuses, les blé-pharites séborrhéiques s’accompagnant d’une dermatite séborrhéique, les blépharites dans le cadre d’une rosacée cutanée ou oculaire pure.

Mortemousque B.
Allergie versus sécheresse oculaire
Réalités Ophtalmol 2010; 173: 43-48.

Kawasaki R, Yasuda M, Song SJ, Chen SJ, Jonas JB, Wang JJ, Mitchell P, Wong TY.
The prevalence of age-related macular degeneration in Asians: a systematic review and meta-analysis.
Ophthalmology 2010; 117 (5): 921-927.

OBJECTIVE: To determine the prevalence of age-related macular degeneration (AMD) in Asian po-pulations and to compare this with prevalence in white populations. DESIGN: A clear understanding of AMD prevalence in Asians is essential to meet future demands for eye health care. METHODS: We searched published literature reporting AMD prevalence in Asian populations. We limited studies examined to those using standardized grading systems (either the Wisconsin Age-Related Maculopa-thy Grading System or the international classification proposed by the International ARM Epidemiolo-gical Study Group). We used metaanalytical methods to calculate age-specific pooled prevalence of AMD using inverse-variance weighting in a random effect model. We also calculated pooled estimates of age-standardized prevalence. A metaregression model was used to examine gender differences and differences between Asian and white populations. RESULTS: We identified 9 studies reporting AMD prevalence from 4 Asian populations. Pooled prevalence estimates of early and late AMD in Asian populations aged 40 to 79 years were 6.8% (95% confidence interval [CI], 4.6%-8.9%) and 0.56% (95% CI, 0.30%-0.81%), respectively; corresponding prevalence estimates in white populations were 8.8% (95% CI, 3.8%-13.8%) and 0.59% (95% CI, 0.35%-0.84%), respectively. Reliable prevalence estimates of AMD in Asian persons aged > or =80 years were not available owing to small subject numbers in this age category. CONCLUSIONS: Among persons aged 40 to 79 years, the age-specific prevalence of late AMD in Asians was comparable with that reported from white populations, but early AMD signs were less common among Asians. Further studies in Asian populations are warranted to investigate whether certain specific AMD phenotypes or subtypes, such as polypoidal choroidal vascu-lopathy, are more common. Copyright 2010 American Academy of Ophthalmology. Published by El-sevier Inc. All rights reserved.

Chalmers RL, Begley CG, Caffery B.
Validation of the 5-Item Dry Eye Questionnaire (DEQ-5): Discrimination across self-assessed severity and aqueous tear deficient dry eye diagnoses.
Cont Lens Anterior Eye 2010; 33 (2): 55-60.

Abstract

PURPOSE: To validate a subset of Dry Eye Questionnaire (DEQ) items that discriminate across self-assessed severity and various diagnoses of dry eye (DE). METHODS: Subjects (n=260) in 2 studies received a clinical DE diagnosis, completed the 6-page DEQ and self-assessment of DE severity (SA-Sev). SA-Sev ratings were: 46 Severe, 107 Moderate, 77 Mild, and 46 None. Dry eye diagnoses were: 48 asymptomatic controls (C), 155 non-SS KCS, and 57 Sjögren Syndrome (SS). All DEQ items were correlated to SA-Sev by Spearman. Groups of highly correlated DEQ items were tested to discriminate SA-Sev; and the subset tested to distinguish across DE diagnosis. RESULTS: The DEQ-5 comprises: frequency of watery eyes (r=0.48), discomfort (r=0.41), and dryness (r=0.35), and late day (PM) intensity of discomfort and dryness (r=0.42, 0.36) all significantly correlated to SA-Sev (p<0.01). Mean DEQ-5 scores by SA-Sev: Severe 14.9+/-2.3, Moderate 11.4+/-3.3, Mild 8.6+/-3.1 and None 2.7+/-3.2 (ANOVA, p<0.0001) and by DE diagnosis: C 2.7+/-2.9, non-SS KCS10.5+/-4.5 and SS14.0+/-3.4, differing significantly overall (Z=-8.6, p=0.000) and between diagnoses (X(2)=116.3, p=0.000). Watery eyes were reported primarily by non-SS KCS. Proposed screening criteria for the DEQ-5 are >6 for DE and >12 for suspected SS. CONCLUSIONS: The DEQ-5, the sum of scores for frequency and PM intensity of dryness and discomfort plus frequency of watery eyes, effectively discriminated across self-assessed severity ratings and between patients with DE diagnoses. These results indicate that DEQ-5 scores >6 suggest DE and scores >12 may indicate further testing to rule out SS-DE. 2009 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Zhivov A, Kraak R, Bergter H, Kundt G, Beck R, Guthoff RF
Influence of benzalkonium chloride on langerhans cells in corneal epithelium and development of dry eye in healthy volunteers.
Curr Eye Res 2010; 35 (8): 762-9.

Abstract
Purpose: To investigate the influence of benzalkonium chloride (BAC) on corneal Langerhans cells (LCs) and on the development of dry eye. Methods: A randomized double-blind clinical trial was performed in 20 healthy volunteers. One eye of each subject was treated with a 0.01% BAC solution (and the fellow eye with a placebo solution) three times daily for 12 weeks. The distribution and density of LCs in the central and peripheral corneal epithelium were evaluated by in-vivo confocal laser-scanning microscopy (CLSM). The subjects were monitored for dry eye (subjective discomfort, slit-lamp biomicroscopy, tear film break-up time, Schirmer's test). Results: In the BAC group, compared with placebo, a marked increase in LC density was found in the central cornea at Week 6 and in the central and peripheral cornea at Week 12. LC density then decreased again in both zones after the end of treatment, falling toward (or even below) baseline levels. Significant changes in the LC count relative to baseline were found at Week 12 in the central and peripheral cornea in the BAC group as well as in the peripheral cornea in the placebo group. LC density in the BAC group increased more rapidly in the central than in the peripheral cornea. During therapy the BAC group showed no signs of dry eye. Conclusion: 12-week application of a 0.01% BAC solution in healthy volunteers induces a significant increase in LCs in the central cornea at Week 12 without dry-eye changes. The return of LC counts toward (or even below) baseline levels just four weeks after the end of BAC administration demonstrates the rapid normalization of the inflammatory environment.

Walker PM, Lane KJ, Ousler GW 3rd, Abelson MB.
Diurnal variation of visual function and the signs and symptoms of dry eye.
Cornea 2010; 29 (6): 607-612.

Stahl U, Willcox M, Stapleton F.
Role of hypo-osmotic saline drops in ocular comfort during contact lens wear.
Cont Lens Anterior Eye 2010; 33 (2): 68-75.

Abstract
PURPOSE: To determine whether hypo-osmotic saline drops can improve contact lens associated dis-comfort and dryness by decreasing contact lens osmolality. METHODS: Fifteen symptomatic subjects wore Lotrafilcon A lenses bilaterally for 6h on two different days. According to randomisation, hypo-osmotic (280mmol/kg) or hyper-osmotic (380mmol/kg) saline drops were applied four times during each day and ocular symptoms, tear film and contact lens parameters, and contact lens osmolality were assessed. RESULTS: Sixty percent of the subjects preferred the hypo-osmotic saline drops, compared to 33%, who preferred the hyper-osmotic ones. Subjects experienced significantly less dryness and lens awareness with hypo-osmotic saline drops compared to hyper-osmotic ones (p<0.05). Using the hypo-osmotic drops, there was a trend for decreased contact lens osmolality from 379 to 343mmol/kg (p=0.06). There were no differences in lipid layer, non-invasive tear film break-up time, lens surface wettability, lens water content after wear, lens movement on eye or ocular staining and indentation between saline drops (all p>0.05). Interestingly, the difference in contact lens osmolality between drops did not reflect the osmolality difference between the two saline drops. CONCLUSION: Hypo-osmotic saline drops were preferred by a greater number of subjects and contact lens osmolality tended to be lower with the use of hypo-osmotic saline. Hypo-osmotic drops have the potential to decrease contact lens osmolality which in turn may help improve ocular comfort. This has possible impact on the practitioners' choice of the lens rewetting drop recommended and the design of future lens rewetting drops. 2010 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved

Foulks GN, Borchman D, Yappert M, Kim SH, McKay JW.
Topical azithromycin therapy for meibomian gland dysfunction: clinical response and lipid alte-rations.
Cornea 2010; 29 (7): 781-8.

Abstract
PURPOSE: Meibomian gland dysfunction (MGD) is a common clinical problem that is often associated with evaporative dry eye disease. Alterations of the lipids of the meibomian glands have been identified in several studies of MGD. This prospective, observational, open-label clinical trial documents the improvement in both clinical signs and symptoms of disease and spectroscopic behavior of the meibomian gland lipids after therapy with topical azithromycin ophthalmic solution. METHODS: Subjects with symptomatic MGD were recruited. Signs of MGD were evaluated with a slit lamp. Symptoms of MGD were measured by the response of subjects to a questionnaire. Meibum lipid, lipid-lipid interaction strength, and conformation and phase transition parameters were measured using Fourier transform infrared spectroscopy. RESULTS: In subjects with clinical evidence of MGD, changes in ordering of the lipids and resultant alteration of phase transition temperature were identified. Topical therapy with azithromycin relieved signs and symptoms and restored the lipid properties of the meibomian gland secretion toward normal. CONCLUSIONS: Improvement in phase transition temperature of the meibomian gland lipid with the determined percent trans rotomer composition of the lipid strongly suggests that the ordering of the lipid molecules is altered in the disease state (MGD) and that azithromycin can improve that abnormal condition toward normal in a manner that correlates with clinical response to therapy.

Yuan Y, Wang J, Chen Q, Tao A, Shen M, Shousha MA.
Reduced tear meniscus dynamics in dry eye patients with aqueous tear deficiency.
Am J Ophthalmol 2010; 149 (6): 932-938.

PURPOSE: To measure the tear meniscus dynamics in aqueous tear deficiency dry eye patients using optical coherence tomography. DESIGN: Clinical research study of a laboratory technique. METHODS: Twenty-five aqueous tear deficiency dry eye patients and 30 healthy subjects were recruited. Upper and lower tear menisci of 1 randomly selected eye of each participant were imaged during normal and delayed blinking using optical coherence tomography. Measured parameters included upper tear meniscus height and volume, lower tear meniscus height and volume, the blink outcome defined as the meniscus volume change during blink action, and open eye outcome defined as the meniscus volume change during the open eye period. RESULTS: During normal blinking, both tear meniscus height and volume before blink in dry eye patients were significantly smaller than those in healthy subjects, except for the upper tear meniscus volume. During normal blinking, the blink outcome and open eye outcome of lower tear meniscus were significantly smaller in dry eye patients compared with healthy subjects. During delayed blinking, the upper and lower tear menisci heights and volumes significantly increased in both groups. However, dry eye patients had smaller increases than healthy subjects. During delayed blinking, the open eye outcomes of upper and lower tear menisci were smaller in dry eye patients than healthy subjects. CONCLUSIONS: Dry eye patients seem to have reduced tear meniscus dynamics during normal blinking and smaller increases of meniscus volume during delayed blinking. Analysis of tear meniscus dynamics may provide more insight in the altered tear system in dry eye patients. Copyright 2010 Elsevier Inc. All rights reserved.

Doan S.
Vers une nouvelle approche de la surface oculaire.
Réflexions Ophtalmol 2010; 15 (136): 52-55.

Une meilleure compréhension pour une meilleure prise en charge des syndromes secs oculaires.
Quels traitements en cas d’hyperosmolarité ?
-    Diminuer l’osmolarité lacrymale,
-    Protéger de l’hyperosmolarité lacrymale.
Thérapie de l’œil sec, une voie unique ?
En quoi la surface oculaire est-elle cruciale en chirurgie réfractive ?
-    Quel est l’impact de la chirurgie sur la surface oculaire ?
-    Quelles mesures prendre en cas d’anomalie préexistante de la surface oculaire ?

Chauvin MC.
Les autres nouveautés SFO 2010
Cahiers Ophtalmol 2010; 141: 65.

Saad A, Azar D, Melki S, Gatinel D.
Complications du Lasik : étiologie, prise en charge et prévention.
Endophtalmies. Encycl Med Chir (Paris, France), Ophtalmologie 2010; 21-206-A-35: 1-18.

ABRIL/MAIO 2010

Ibrahim OM, Matsumoto Y, Dogru M, Adan ES, Wakamatsu TH, Goto T, Negishi K, Tsubota K.
The efficacy, sensitivity, and specificity of in vivo laser confocal microscopy in the diagnosis of meibomian gland dysfunction.
Ophthalmology 2010; 117 (4): 665-672.

PURPOSE: To evaluate the efficacy, sensitivity and specificity of confocal microscopy (CM) parame-ters: meibomian gland (MG) acinar longest diameter (MGALD), MG acinar shortest diameter (MGASD), inflammatory cell density (ICD), and MG acinar unit density (MGAUD) in the diagnosis of MG dysfunction (MGD). DESIGN: Prospective, controlled, single-center study. PARTICIPANTS: Twenty MGD patients (9 males, 11 females; mean age, 63.5+/-16.5 years) and 26 age- and gender-matched control subjects (13 males, 13 females; mean age, 53.2+/-15.7 years) were recruited. METH-ODS: All subjects underwent slit-lamp examinations, tear film break-up time (BUT) measurements, assessment of tear evaporation rate from the ocular surface (TEROS), vital stainings, Schirmer test, meibography, MG expressibility, and CM of the MG. Data were compared between the 2 groups using the Mann-Whitney and chi-square tests. MAIN OUTCOME MEASURES: The correlation between the clinical findings of tear functions, vital staining scores, and the 4 CM parameters were tested by Spearman's correlation coefficient by rank test. Receiver operating characteristic curve technique was used to evaluate the sensitivity, specificity, and cutoff values of CM parameters. RESULTS: The mean tear film BUT, vital staining scores, TEROS values, MG expressibility, and MG dropout grades by meibography were significantly worse in MGD patients compared with controls (P<0.001). The mean values of the MGALD, MGASD, ICD, and MGAUD in MGD patients were significantly worse than those observed in the controls with CM. All CM parameters showed a strong, significant correlation with tear functions, ocular surface vital stainings, MG expressibility, and MG dropout grades. The cut-off values for MGALD, MGASD, ICD, and MGAUD in the diagnosis of MGD were 65 microm, 25 microm, 300 cells/mm2, and 70 glands/mm2, respectively. The sensitivity and specificity values of these parameters under these cutoff values were 90% and 81% for MGALD, 86% and 96% for MGASD, 100% and 100% for ICD, 81% and 81% for MGAUD. CONCLUSIONS: Confocal micros-copy has the potential to diagnose the simple MGD with high sensitivity and specificity. The CM-based diagnostic parameters correlated significantly and strongly with the status of the ocular surface disease. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Korb DR, Herman JP, Blackie CA, Scaffidi RC, Greiner JV, Exford JM, Finnemore VM.
Prevalence of Lid Wiper Epitheliopathy in Subjects With Dry Eye Signs and Symptoms.
Cornea 2010; 29 (4): 377-383.

Abstract
PURPOSE:: The purpose of this study was to investigate the prevalence of lid wiper epitheliopathy (LWE) in patients diagnosed with dry eye disease (DED). METHODS:: Patients were recruited for two groups. Inclusion criteria for the DED group (n = 50) was: a score greater than 10 with the Stan-dard Patient Evaluation of Eye Dryness questionnaire, fluorescein break-up time 5 seconds or less, corneal and conjunctival staining with fluorescein, lissamine green Grade 1 or greater (scale 0-3), and Schirmer test with anesthesia 5 mm or less. For the asymptomatic group (n = 50), inclusion criteria were: no dry eye symptoms, fluorescein break-up time 10 seconds or greater, no corneal or conjunctival staining, and Schirmer test 10 mm or greater. Sequential instillations (n = 2, 5 minutes apart) of a mixture of 2% fluorescein and 1% lissamine green solution were used to stain the lid wipers of all pa-tients. LWE was graded (scale 0-3) using the horizontal lid length and the average sagittal lid widths of the stained wiper. RESULTS:: In symptomatic patients, 88% had LWE, of which 22% was Grade 1, 46% Grade 2, and 20% Grade 3. In asymptomatic patients, 16% had LWE, of which 14% was Grade 1, 2% was Grade 2, and 0% Grade 3. The difference in prevalence of lid wiper staining between groups was significant (P < 0.0001). CONCLUSIONS:: The prevalence of LWE was six times greater for the DED group and the prevalence of LWE Grade 2 or greater was 16 times greater for the DED group than for the control group. These data further establish LWE as a diagnostic sign of dry eye dis-ease.

McDonald M, D'Aversa G, Perry HD, Wittpenn JR, Donnenfeld ED, Nelinson DS
Hydroxypropyl cellulose ophthalmic inserts (lacrisert) reduce the signs and symptoms of dry eye syndrome and improve patient quality of life.
Trans Am Ophthalmol Soc 2009; 107: 214-221.

Purpose: A multicenter, 2-visit, open-label, 4-week study was conducted to determine the acceptability of hydroxypropyl cellulose ophthalmic inserts in adult patients with a history of dry eye syndrome (DES).
Methods: At visit 1, patients (N = 520) were evaluated, screened by slit-lamp biomicroscopy, and completed the Ocular Surface Disease Index (OSDI), a validated measure of quality of life. Patients were trained in the proper placement and use of hydroxypropyl cellulose ophthalmic inserts and were contacted by telephone on day 3 of the study. At week 4, patients were given a clinical evaluation and completed a second questionnaire. Answers determined changes in symptoms and quality of life. Ad-verse events were monitored throughout the study.
Results: Four hundred eighteen patients completed the study and reported significant improvements in discomfort, burning, dryness, grittiness, stinging, and light sensitivity (P = .05) after 4 weeks use of hydroxypropyl cellulose ophthalmic inserts. Significant improvements in clinical signs (keratitis, con-junctival staining, and tear volume) were reported. Contact lens wearers reported significant improve-ments similar to nonwearers, with a strong trend toward improvement in light sensitivity. Mean OSDI total scores, measuring quality of life, significantly improved by 21.3% (from 41.8 ± 22.38 to 32.9 ± 21.97, P ≤ .0215). The most commonly reported adverse event leading to discontinuation was blurred vision, observed in 8.7% of patients (n = 45). Compliance during the study was good; 41.5% of sub-jects were fully compliant. Of the 58.5% of subjects who missed doses, the majority (69.4%) missed only one to five.
Conclusions: Hydroxypropyl cellulose ophthalmic inserts significantly reduced symptoms and clinical signs of moderate to severe DES. They also significantly improved DES in patients wearing contact lenses. Patients experienced a statistically significant improvement in quality of life, as measured by the OSDI, of 21.3%.

Vogel R, Crockett RS, Oden N, Laliberte TW, Molina L; Sodium Hyaluronate Ophthalmic Solution Study Group.
Demonstration of efficacy in the treatment of dry eye disease with 0.18% sodium hyaluronate ophthalmic solution (vismed, rejena).
Am J Ophthalmol 2010; 149 (4): 594-601.

Abstract
PURPOSE: To evaluate the efficacy and safety of 0.18% sodium hyaluronate ophthalmic solution (Re-jena, Vismed) compared with its vehicle for the treatment of signs and symptoms of dry eye disease. DESIGN: Randomized, placebo-controlled clinical trial. METHODS: A total of 444 subjects with dry eye disease were randomized 1:1 to active study drug (n = 221) or vehicle control (n = 223) in this multicenter, double-masked trial. Subjects instilled 1 to 2 drops, 3 to 6 times daily for 14 days, with evaluations at Days 7 and 14. The study's 2 primary efficacy endpoints were change from baseline at Day 7 in lissamine green staining scores (objective) and in global symptom frequency scores (subjec-tive). Results were analyzed using Wilcoxon rank sum test and Student t test in the intent-to-treat (ITT) population with last observation carried forward (LOCF). RESULTS: At Day 7, the differences between the active and vehicle groups in change from baseline for lissamine green staining score (P = .050, Wilcoxon; P = .029, t test) and global symptom frequency score (P = .050, Wilcoxon; P = .017, t test) were both statistically significant. There were no clinically relevant safety findings related to the use of Rejena. CONCLUSIONS: This study demonstrated the clinical efficacy of Rejena in the treat-ment of dry eye disease in both a primary objective endpoint and a primary subjective endpoint when compared to its vehicle. The study results also supported the well-known safety profile of Rejena. Copyright 2010 Elsevier Inc. All rights reserved.

Tao A, Shen M, Wang J, Chen Q, Lu F.
Upper and lower tear menisci after laser in situ keratomileusis.
Eye Contact Lens 2010; 36 (2): 81-5.

Abstract
OBJECTIVES: To determine upper and lower tear menisci using optical coherence tomography (OCT) in volunteers after laser in situ keratomileusis (LASIK) for myopia. METHODS: Thirty-five eyes of 35 nonsurgical volunteers were evaluated. Twenty-eight eyes of 28 volunteers who underwent LASIK served as the study group. The height, area, and volume of the upper and lower tear menisci were ob-tained in the study group, using OCT before surgery, 1 week, 1 month, and 20 months after surgery. At each visit, Schirmer test (type I, without anesthesia), tear break-up time, and corneal fluorescein staining score were evaluated. OCT imaging was conducted in the nonsurgical group with the same settings. RESULTS: The lower tear meniscus volume at baseline were significantly smaller in the study group compared with the nonsurgical group (t test, P < 0.01). The upper tear meniscus volume de-creased from 0.44 +/- 0.11 microL to 0.37 +/- 0.08 microL at 1 month after surgery (P < 0.05). The lower tear meniscus volume (0.54 +/- 0.15 microL) reduced to 0.44 +/- 0.10 microL at 1 month after surgery (posthoc, P < 0.05). For the subgroup analysis, tear menisci, Schirmer test, and tear break-up time after LASIK decreased during the first 1 month (P < 0.05) and recovered by 20 months after sur-gery (t test, P > 0.05). CONCLUSIONS: The upper and lower tear menisci decreased up to 1 month after LASIK and recovered by 20 months. OCT is a useful tool for evaluating the tear system in a non-invasive manner.

Koppen C, Gobin L, Tassignon MJ.
The absorption characteristics of the human cornea in ultraviolet-a crosslinking.
Eye Contact Lens 2010; 36 (2): 77-80.

Abstract
OBJECTIVES: With respect to the safety of ultraviolet-A (UVA) crosslinking for the corneal endothe-lium, an absorption coefficient is used that has been calculated in riboflavin soaked porcine corneas. We aim to validate this value for clinical use by measuring the absorption coefficient for UVA 365 nm in postmortem human corneas after instilling riboflavin on the corneal surface. METHODS: Corneal thickness was measured in nine pairs of human donor eyes of which one eye was subjected to manual removal of the epithelium, whereas the epithelium of the fellow eye was left intact. Both eyes were instilled with riboflavin 0.1% in dextran 20% on the intact globe. After 20 min, the corneas were rinsed, and a corneoscleral button was trephined. The transmission of the cornea for UVA 365 nm was measured by transillumination, which allows calculation of the absorption coefficient. RESULTS: Measurement of average corneal thickness was 658.5 +/- 51.5 microm when the epithelium was re-moved, and 758.3 +/- 98.8 microm without epithelial removal. The average transmittance for UVA 365 nm was 12.89 +/- 4.10% with epithelial debridement and 28.52 +/- 4.39% without (P<0.05). The resul-tant average absorption coefficient is 32 +/- 5 cm when the epithelium is removed and 17 +/- 2 cm when it is left intact (P<0.05). CONCLUSIONS: Our results show an absorption coefficient for human corneas that is much lower than the values reported in the literature. This finding may be relevant when considering endothelial safety of the clinical crosslinking treatment.

Doan S.
Les lunettes à chambre humide.
Réflexions ophtalmol 2010; 15 (133): 26-27.

Le traitement du syndrome sec oculaire repose sur les substituts lacrymaux. Dans les formes y répon-dant partiellement, ou dans le but de prolonger leur effet, les moyens mécaniques visant à retenir les larmes sur la surface oculaire peuvent être utiles. L’occlusion des points lacrymaux est le premier trai-tement auquel on pense. Les lunettes à chambre humide représentent un moyen moins utilisé, mais qui peut s’avérer très efficace.

Stead RE, Stuart A, Keller J, Subramaniam S.
Reducing the rate of cataract surgery cancellation due to blepharitis.
Eye (Lond) 2010; 24 (4): 742.

MARÇO 2010

Labetoulle M.
Conduite diagnostique et thérapeutique dans la sécheresse oculaire.
Réflexions ophtalmol 2010; 15 (132): 43-45.

FEVEREIRO 2010

Benelli U, Nardi M, Posarelli C, Albert TG;
Tear osmolarity measurement using the TearLab Osmolarity System in the assessment of dry eye treatment effectiveness.
Cont Lens Anterior Eye. 2010 Feb 11. [Epub ahead of print]

PURPOSE: To evaluate the efficacy of three commercially available lubricant eye drops for the treat-ment of mild, dry, irritated eyes. METHODS: Randomized, investigator-masked evaluation of 60 pa-tients in which 20 patients used carboxymethylcellulose sodium (CMC), 0.5% (Cellufresh((R)), Aller-gan Inc., Irvine, CA) (group 1); 20 patients used a drop containing polyethylene glycol 400, 2.5% and sodium hyaluronate (Blink((R)) Intensive Tears, Abbott Medical Optics Inc., Santa Ana, CA) (group 2); and 20 patients used HP Guar 0.18% (Systane((R)), Alcon Laboratories Inc., Ft. Worth, TX) (group 3). Study visits were at baseline and 1 month. Tests performed at both visits included Schirmer, tear-film break-up time (TBUT), visual acuity, fluorescein staining, tear osmolarity and wavefront aber-rometry. Osmolarity testing was performed prior to instillation of the lubricant eye drops and then a final time 5min after instillation of the drop at both day 1 and day 30. Tear osmolarity was performed only in the right eye and only one time before and after instillation of lubricant eye drops. RESULTS: At day 1 the mean reduction in osmolarity 5min after instillation of the lubricant eye drop was, -5.0+/-1.9 in group 1, -9.0+/-4.2 in group 2 and -5.0+/-2.2 in group 3. At day 30 the mean reduction in osmo-larity 5min after instillation of the lubricant eye drop was, -5.6+/-2.3mOsm/L in group 1; -9.9+/-2.8mOsm/L in group 2 and -4.5+/-1.8mOsm/L in group 3. The differences were statistically significant between groups 1 and 2, and 2 and 3. There was a reduction of osmolarity from day 1 to day 30 but the differences were not statistically significant. We feel that after a 30-day treatment with the lubricant eye drops, the lower osmolarity values could indicate that the tear film is progressing towards a more normal osmolarity value. A future study could examine the tear osmolarity value after 60 or 90 days of usage. LogMAR best-corrected visual acuity (BCVA) results showed an improvement in group 2 compared with baseline with no change in BCVA in groups 1 and 3. There was no statistically significant change from day 1 to 1 month in TBUT, while the Schirmer test showed an improvement in all groups at 1 month. CONCLUSIONS: Assessment of tear osmolarity provides the most objective, measurable test for determining improvement in dry eye patients. The instillation of any artificial tear or lubricant eye drop should decrease the tear-film osmolarity. The results found that polyethylene glycol 400, 0.25% and sodium hyaluronate (Blink((R)) Intensive Tears) significantly improved tear osmolarity compared with carboxymethylcellulose sodium (CMC), 0.5% (Cellufresh((R))) and HP Guar 0.18% (Systane((R))) after instillation.

Iovieno A, Lambiase A, Micera A, Stampachiacchiere B, Sgrulletta R, Bonini S.
In vivo characterization of doxycycline effects on tear metalloproteinases in patients with chronic blepharitis. Eur J Ophthalmol 2009; 19 (5): 708-716.

PURPOSE: Matrix metalloproteinases (MMPs) have a role in the pathogenesis of rosacea-associated chronic blepharitis. Doxycycline is largely used as a treatment for recalcitrant chronic blepharitis. It has been shown in vitro that doxycycline inhibits MMPs activation. The aim of this study was to inves-tigate in vivo the effect of doxycycline in modulating MMPs in patients with chronic idiopathic ble-pharitis. METHODS: Eight patients (6 male, 2 female; mean age 45.7+/-17.5 years) were included in the study. Doxycycline (100 mg) was administered orally, twice a day, for 2 weeks and once a day for an additional 2 weeks. Clinical signs and symptoms were evaluated and scored (0-3) at baseline and after 4 weeks. Total sign (TSS) and total symptom (TSyS) scores were calculated. Tear samples and conjunctival impression cytologies were collected at baseline and after 4 weeks of treatment to evalu-ate MMP-9 and TIMP-1 expression and activity. RESULTS: An improvement in TSS (4.5+/-1.1 vs 2.7+/-1.5) and TSyS (6.6+/-1.3 vs. 3.1+/-1.9) was observed after 4 weeks, with significant amelioration of hyperemia, marginal blepharitis, and superficial punctuate keratopathy. Zymography revealed a de-crease of MMP-9 activity after 4 weeks. MMP-9 mRNA and protein levels did not change, while an upregulation of TIMP-1 expression was observed. CONCLUSIONS: This study suggests that 4-week treatment with doxycycline significantly improved symptoms and signs in patients with chronic ble-pharitis in association with a decrease in MMP-9 activity. Upregulation of TIMP-1 is proposed as a possible mechanism of MMP-9 inactivation.

Sanchez MA, Torralbo-Jimenez P, Giron N, de la Heras B, Herrero Vanrell R, Arriola-Villalobos P, Diaz-Valle D, Alvarez-Barrientos A, Benitez-Del-Castillo JM.
Comparative analysis of carmellose 0.5% versus hyaluronate 0.15% in dry eye: a flow cytometric study. Cornea 2010; 29 (2): 167-171.

PURPOSE: To compare the effects of Viscofresh 0.5% (carmellose sodium 0. 5%) versus Lubristil (sodium hyaluronate 0.15%) in dry eye syndrome and to study the influence of these two treatments on the expression of various inflammatory markers by flow cytometry in impression cytology specimens. METHODS: In this randomized, masked-observer, parallel group, single-center study, 15 patients with dry eye syndrome were randomized to sodium carmellose 0.5% or sodium hyaluronate 0.15% 1-month treatment after a 1-week washout period. Corneal staining with flurescein, breakup time, Schirmer 1 test with anesthesia (Jones test), and tear clearance were assessed. Besides, conjunctival impression cytology was performed to investigate inflammatory markers (CD3, CD11b, and HLA-DR) using flow cytometry. RESULTS: Carmellose group shows statistical improvement compared with the hyaluronate group in breakup time, corneal staining, and HLA-DR. The two other inflammatory markers had also a tendency for a decreased expression in both groups, with no statistical significance. There were neither visual acuity loss nor other complications related to treatment. CONCLUSION: Both artificial tears improve dry eye signs and symptoms and inflammatory markers expression, with significant better results in carmellose group.

JANEIRO 2010

Blackie CA, Korb DR.
The diurnal secretory characteristics of individual meibomian glands.
Cornea 2010; 29 (1): 34-38.

PURPOSE: To investigate the diurnal secretory characteristics of individual meibomian glands (MGs). METHODS: Ten subjects (4 females and 6 males) with healthy eyelid appearance and without dry eye symptoms were recruited (mean age = 23.8 +/- 1.8 years). Both right and left lower eyelids were marked in 3 places to locate 5 consecutive MGs in each third (temporal, central, and nasal) of the lower eyelid. A total of 15 MGs per eye were diagnostically expressed for 10 seconds on both right and left lower eyelids every 3 hours for 4 consecutive measurements over a 9-hour period. RESULTS: Thirty-four percent of all tested MGs yielded liquid secretion at all measurements. Sixty-nine percent of the tested nasal MGs yielded liquid secretion at all measurements in contrast to 31% of the central MGs and only 22% of the temporal MGs. The mean numbers of MGs secreting liquid oil were significantly higher in the nasal section relative to the central and temporal sections at all measurements (p < 0.001, all measurements). CONCLUSIONS: (1) A single MG is capable of secreting oil on demand over the course of a working day ( approximately 9 hours); (2) nasal MGs were the most likely to secrete upon demand over the course of day compared with the temporal and to a lesser degree the central MGs; and (3) secretory characteristics of individual MGs examined as a function of their location in the lower eyelid does not change diurnally.

Asbell PA, Spiegel S.
Ophthalmologist perceptions regarding treatment of moderate-to-severe dry eye: results of a physician survey.
Eye Contact Lens 2010; 36 (1): 33-8.

PURPOSE: To understand ophthalmologists' current perceptions and treatment of patients with mod-erate-to-severe dry eye disease (DED). SETTING: Online survey. METHODS: The online survey was sent to 7,882 ophthalmologists, including 51 corneal specialists, throughout the United States from October 9 to 21, 2008. The response rate was 3.1% (n = 245), typical for this type of survey. Only oph-thalmologists who treated four or more moderate-to-severe DED patients per month (235 of 245 [96%]) were asked to complete the survey. RESULTS: Ninety-four percent of respondents agreed that more treatment options are needed for moderate-to-severe DED. Corneal specialists were more likely to strongly agree (63%) than general ophthalmologists (54%). Only 33% overall felt that current thera-pies were extremely or very effective for moderate DED and only 5% for severe disease. Ninety-two percent agreed that multiple therapeutic agents are needed to manage moderate-to-severe DED. The respondents prescribed or recommended a mean of 3.2 different treatments (standard deviation = 1.2) for moderate DED patients over the course of a year and 4.9 (standard deviation = 2.2) for patients with severe DED. The most highly ranked goals for treatment of moderate-to-severe DED patients were maintaining and protecting the ocular surface (ranked 1 or 2 x 74%) and lubricating and hydrat-ing the ocular surface (ranked 1 or 2 x 67%). Corneal specialists ranked maintaining and protecting the ocular surface even more highly (ranked 1 or 2 x 82%). CONCLUSIONS: Results reflected the diffi-culty of treating moderate-to-severe DED, the importance of using multiple treatment approaches, the limitations of current treatment options, and the need for additional treatment options.

Kading D
A two-week clinical evaluation of the safety of Systane® Ultra in contact lens-wearing patients
Clinical Ophthalmology 2010:4 27-32.

Objective: To evaluate the safety of Systane® Ultra Lubricant Eye Drops (test solution) in contact
lens wearers. A currently marketed contact lens rewetting drop was the control solution.
Participants: This investigator- and patient-masked, single-site, randomized, and prospective
study involved 45 successful contact lens wearers.
Methods: Eligible subjects' baseline biomicroscopy findings, visual acuity, and corneal staining
score were recorded. Subjects received either the test or control solution with masked labeling.
Subjects were instructed to instill their assigned solution in both eyes: 15 minutes prior
to lens insertion, at least one drop during lens wear and another drop immediately following
lens removal. After 14 days, biomicroscopy results, visual acuity, and corneal staining score
were recorded.
Results: No adverse events were documented for either the test or the control solution. For
subjects using Systane® Ultra, no statistically significant change was detected in visual acuity
(= 0.7667) or corneal staining score (P = 1.000). For subjects using the control solution,
the change in visual acuity (P = 0.0011, mean difference = 1.70 ± 3.22 standard deviation)
was not clinically relevant and there was no significant change in corneal staining score
(P = 0.5413).
Conclusions: This clinical study provided evidence of safety and compatibility of Systane®
Ultra Lubricant Eye Drops in contact lens wearers.

Roncone M, Bartlett H, Eperjesi F.
Essential fatty acids for dry eye: A review.
Cont Lens Anterior Eye. 2009 Dec 21. [Epub ahead of print]

PURPOSE: Dry eye is a common complaint often encountered in optometric practice. However, it is a difficult condition to treat as clinical signs do not always correlate with patient symptoms. Essential fatty acids (EFA), particularly omega-3 EFA, may be effective in dealing with the underlying causes. METHODS: A literature review was carried out on the PubMed, ScienceDirect and Ovid databases. Searches included keywords such as 'dry eye', 'essential fatty acids' and 'nutrition' to find articles relat-ing to the treatment of dry eye syndrome (DES) with omega-3 EFAs. RESULTS: Omega-3 and -6 EFAs need to be consumed together within a reasonable ratio to be effective. Currently, typical diets in developed countries lack omega-3 EFA and this results in an overexposure to omega-6. Omega-3 supplementation has an anti-inflammatory effect, inhibiting creation of omega-6 prostaglandin precursors. Omega-3 EFAs also demonstrate anti-inflammatory action in the lacrimal gland preventing apoptosis of the secretory epithelial cells. Supplementation clears meibomitis, allowing a thinner, more elastic lipid layer to protect the tear film and cornea. CONCLUSION: Dietary supplementation of omega-3 EFA has already proven to be effective in coronary heart disease and arthritis. Safety is not a concern as it works synergistically with omega-6 in the body. Evidence suggests that supplementation with omega-3 EFA may be beneficial in the treatment and prevention of DES. Copyright © 2009 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Mian SI, Li AY, Dutta S, Musch DC, Shtein RM.
Dry eyes and corneal sensation after laser in situ keratomileusis with femtosecond laser flap creation Effect of hinge position, hinge angle, and flap thickness.
J Cataract Refract Surg 2009; 35 (12): 2092-2098.

PURPOSE: To determine whether corneal sensation and dry-eye signs and symptoms after myopic laser in situ keratomileusis (LASIK) surgery with a femtosecond laser are affected by varying hinge position, hinge angle, or flap thickness. SETTING: University-based academic practice, Ann Arbor, Michigan, USA. METHODS: This prospective randomized contralateral-eye study evaluated eyes after bilateral myopic LASIK with a femtosecond laser (IntraLase). Superior and temporal hinge positions, 45-degree and 90-degree hinge angles, and 100 microm and 130 microm corneal flap thicknesses were compared. Postoperative follow-up at 1 week and 1, 3, 6, and 12 months included central Cochet-Bonnet esthesiometry, the Ocular Surface Disease Index questionnaire, a Schirmer test with anesthesia, tear breakup time (TBUT), corneal fluorescein staining, and conjunctival lissamine green staining. RESULTS: The study evaluated 190 consecutive eyes (95 patients). Corneal sensation was reduced at all postoperative visits, with improvement over 12 months (P<.001). There was no difference in corneal sensation between the different hinge positions, angles, or flap thicknesses at any time point. The overall ocular surface disease index score was increased at 1 week, 1 month, and 3 months (P<.0001, P<.0001, and P = .046, respectively). The percentage of patients with a TBUT longer than 10 seconds was significantly lower at 1 week and 1 month (P<.0001). CONCLUSIONS: Dry-eye syndrome after myopic LASIK with a femtosecond laser was mild and improved after 3 months. Corneal flap hinge position, hinge angle, and thickness had no effect on corneal sensation or dry-eye syndrome.

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