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Management of Ocular Surface Disease in Cataract and Refractive Surgery Patients

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Abstract

The integrity of the ocular surface is paramount for proper vision. The ocular surface is a delicate microenvironment susceptible to a variety of insults. Small changes can have a large impact on visual function. The pathophysiology of OSD is multifactorial; treatment of OSD therefore typically requires a multifaceted approach for effective management. Thorough evaluation of ocular surface and eyelid health is of critical importance in cataract and refractive surgery candidates. Relatively simple diagnostic techniques and treatments may effectively determine the difference between a satisfied and unsatisfied patient postoperatively. Comorbid OSD increases the risk of complications and can impair surgical outcomes. Thus, preoperative signs and symptoms of OSD must be managed aggressively. Cataract and refractive surgery should be delayed until the patient demonstrates objective evidence of improvement, with reliable and repeatable preoperative measurements. Patients should be encouraged to adhere to the prescribed treatment regimen, and certain cases can require several months of preoperative therapy. OSD may also influence intraoperative management of patients and guide selection of postoperative eye drop regimens and follow-up care. Meticulous attention to the health of the ocular surface is essential to optimize the surgical result, ensure patient satisfaction, and enhance vision-related quality of life.

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... Because of early refractive stabilisation, decreased astigmatism, and lower postoperative inflammation, phacoemulsification is being used more frequently in the management of cataracts [2]. Both patients and surgeons may frequently and unhappily experience alterations in the tear film following cataract surgery [6]. Patients who are affected may have red or watery eyes and a persistent feeling of a foreign body. ...
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The aim of this retrospective study was to evaluate the course of dry eye syndrome after phacoemulsification surgery. One hundred and ninety-two eyes of 96 patients (30 males, 66 females) with chronic dry eye syndrome and cataract, who had undergone phacoemulsification surgery were enrolled in this study. Their mean age was 68.46 ± 8.14 standard deviation (SD) (range 56-83) years . Thirty of them (31 %) were males and 66 (69 %) were females. Ocular Surface Disease Index (OSDI) questionnaire scores increased postoperatively, but arrived preoperative levels at the end of 3rd month following the surgery. Fluorescein staining patterns according to Oxford Schema got worse postoperatively, however after postoperative 3rd month they got better and resembled preoperative patterns. The mean postoperative 1st day, 1st week and 1st month Break-up Time (BUT) values were significantly lower than preoperative BUT value (P < 0.001, P < 0.001, P < 0.001), however 3rd month, 6th month, 1st year and 2nd year values were not significantly different from preoperative value (P = 0.441, P = 0.078, P = 0.145, P = 0.125). The mean postoperative 1st day, 1st week and 1st month Schirmer Test 1 (ST1) values were significantly lower than preoperative ST1 value (P < 0.001, P < 0.001, P < 0.001), however 3rd month, 6th month, 1st year and 2nd year values were not significantly different from preoperative value (P = 0.748, P = 0.439, P = 0.091, P = 0.214). Phacoemulsification surgery may aggravate the signs and symptoms of dry eye and affect dry eye test values in chronic dry eye patients in short-term. However, in long-term, signs and symptoms of dry eye decrease and dry eye test values return to preoperative values.
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In this article we review essentials of diagnosis and management of ocular surface disease in patients who undergo cataract surgery. It is clearly shown that dry eye disease worsens following the cataract surgery in patients with prior history of ocular surface disease, Also new cases of dry eye might appear. Current strategies for the timely diagnosis and proper management of dry eye syndrome in the face of cataract surgery patients is mainly emphasized. To achieve the best outcome in cataract surgery, a healthy ocular surface is crucial. While ocular surface preparation is indispensable in patients with established ocular surface disease, it is also helpful in those with minimal signs or symptoms of surface disease. The current approach begins with early diagnosis and drastic management of ocular surface disease before cataract surgery using a stepwise regimen customized to each patient and disease severity. These measures are continued throughout and after the surgery.
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To evaluate the incidence and severity pattern of dry eye after phacoemulsification. King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Prospective descriptive study. Samples were collected from ninety-two uncomplicated cataract patients who were 18 years old or older. Dry eye incidence and pattern were analyzed at days 0, 7, 30 and 90 after phacoemulsification using (1) Ocular Surface Disease Index (OSDI) questionnaire, (2) tear break up time (TBUT), (3) Oxford ocular surface staining system, and (4) Schirmer I test without anesthesia. Seven days after phacoemulsification, the incidence of dry eye was 9.8% (95% confidence interval; 3.6-16.0%). The severity of dry eye peaked seven days post-phacoemulsification and was measured by OSDI questionnaire and all three clinical tests. Within thirty days and 3 months post-surgery, both the symptoms and signs showed rapid and gradual improvements, respectively. However, dry eye post-phacoemulsification was not significantly associated with sex and systemic hypertension (P = 0.26, 0.17 and 0.73, respectively). The incidence of dry eye after phacoemulsification was 9.8%. Symptoms and signs of dry eye occurred as early as seven days post-phacoemulsification and the severity pattern improved over time. We recommend that ophthalmologists should evaluate patients both before and after phacoemulsification to prevent further damage to the ocular surface and able to manage the patient promptly and effectively so the patient will not have a poor quality of life and vision due to dry eye syndrome.
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The goals of the subcommittee were to review the current practice and published evidence of medical and surgical treatment options for meibomian gland dysfunction (MGD) and to identify areas with conflicting, or lack of, evidence, observations, concepts, or even mechanisms where further research is required. To achieve these goals, a comprehensive review of clinical textbooks and the scientific literature was performed and the quality of published evidence graded according to an agreed on standard, using objective criteria for clinical and basic research studies adapted from the American Academy of Ophthalmology Practice Guidelines1 (Table 1). It should be noted that, in many of the clinical textbooks and previous reports, terminology is often interchanged and the management of anterior and posterior blepharitis and/or meibomitis is often considered concurrently. Thus, a broad scope of documents was reviewed in this process. Consistency in terminology and global adoption of the term “meibomian gland dysfunction” would significantly aid clinical research and clinical care in MGD going forward.
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Article
purpose. To investigate the mechanisms governing corneal neovascularization and the appearance of goblet cells in a murine model of limbal insufficiency. methods. The spatial and time-dependent relationship between corneal neovascularization and goblet cell density was analyzed in corneal flatmounts. Immunohistochemical detection of the vascular endothelial growth factor (VEGF) receptor Flt-1 (VEGFR1) was performed in paraffin-embedded sections. A transgenic mouse that expresses the reporter gene lacZ targeted to the Flt-1 locus through homologous recombination was used to analyze corneal expression of Flt-1. The presence of soluble and membranous goblet cell Flt-1 mRNA and protein content was assessed with Northern and Western blot analyses, respectively. Finally, systemic adenoviral expression of a soluble Flt-1/Fc construct was used to study the effect of inhibition of VEGF bioactivity on the appearance of goblet cells and neovascularization. results. Corneal neovascularization preceded the appearance of goblet cells, although both processes overlapped temporally. Flt-1 was abundant in the conjunctiva-like epithelium covering the cornea, as well as in the goblet cells, invading leukocytes, and vasculature. A similar expression pattern was observed in the transgenic mice expressing the lacZ gene downstream from the Flt-1 promoter. Isolated human and rat goblet cells in culture expressed Flt-1 mRNA and protein, as did freshly isolated human conjunctiva. The systemic inhibition of VEGF bioactivity potently suppressed both corneal neovascularization (8.3% ± 8.1% vs. 41.1% ± 15.3% corneal area; P < 0.001) and corneal goblet cell density (1.6% ± 2.5% vs. 12.2% ± 2.4% corneal area; P < 0.001). conclusions. Two important features of corneal conjunctivalization, the appearance of goblet cells and neovascularization, are regulated by VEGF. Both processes are probably mediated, in part, through the Flt-1 receptor. Taken together, these data indicate that an anti-VEGF therapeutic approach may limit the visual loss associated with conjunctivalization of the corneal surface.
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Purpose To evaluate dry eye and meibomian gland dysfunction after cataract surgery. Design: Prospective observational case series Methods Fifty-eight eyes of 48 patients who underwent phacoemulsification were evaluated preoperatively, and at 1 month and 3 months postoperatively. Ocular symptom score, lid margin abnormalities, superficial punctate keratopathy (SPK), tear film break-up time (TBUT), Schirmer test, lower tear meniscus height , depth, and area using Fourier domain optical coherence tomography, meibum expressibility and images of the meibomian glands using meibography were measured. Results The ocular symptom scores were worse at 1 month and 3 months postoperatively (p < 0.001 and p < 0.001, respectively). Lid margin abnormalities were significantly increased (p < 0.001 and p < 0.001, respectively) and TBUT decreased postoperatively (p < 0.001 and p < 0.001, respectively). Meibum expressibility decreased at 3 months postoperatively (p = 0.016); however, meibography score, SPK, lower tear meniscus height , depth, and area and Schirmer test did not change significantly postoperatively (all p values > 0.05). Conclusion Meibomian gland function may be altered without accompanying structural changes after cataract surgery.
Article
Objectives To determine the clinical sensitivity, specificity, negative predictive value, and positive predictive value of a rapid point-of-care diagnostic test to detect elevated matrix metalloproteinase 9 levels (InflammaDry). Methods In a prospective, sequential, masked, multicenter clinical trial, InflammaDry was performed on 206 patients: 143 patients with clinical signs and symptoms of dysfunctional tear syndrome (dry eyes) and 63 healthy individuals serving as controls. Participants were assessed as healthy controls or for a clinical diagnosis of dry eye using the Ocular Surface Disease Index, Schirmer tear test, tear breakup time, and keratoconjunctival staining. Main Outcome Measures The sensitivity and specificity of InflammaDry were compared with clinical assessment. Results InflammaDry showed sensitivity of 85% (in 121 of 143 patients), specificity of 94% (59 of 63), negative predictive value of 73% (59 of 81), and positive predictive value of 97% (121 of 125). Conclusion Compared with clinical assessment, InflammaDry is sensitive and specific in diagnosing dry eye. Application to Clinical Practice Dry eye is often underdiagnosed resulting from poor communication between the clinical assessment of dry eye severity between clinicians and patients. This often leads to a lack of effective treatment. Matrix metalloproteinase 9 is an inflammatory biomarker that has been shown to be elevated in the tears of patients with dry eyes. The ability to accurately detect elevated matrix metalloproteinase 9 levels may lead to earlier diagnosis, more appropriate treatment, and better management of ocular surface disease. Preoperative and perioperative management of inflammation related to dry eyes may reduce dry eyes that develop after laser in situ keratomileusis, improve wound healing, and reduce flap complications. Recognition of inflammation may allow for targeted perioperative therapeutic management of care for patients who undergo cataract and refractive surgery and improve outcomes. Trial Registration clinicaltrials.gov Identifier: NCT01313351
Article
Purpose: Sterile corneal infiltrates can cause pain, blurred vision, and ocular discomfort in silicone hydrogel contact-lens users. The current study investigates the potential for the synthetic lymphocyte functional antigen-1 (LFA-1) antagonist lifitegrast (SAR 1118) to block corneal inflammation using a murine model. Methods: The role of LFA-1 (CD11a/CD18) was examined either in CD18(-/-) mice, by intraperitoneal injection of anti-CD11a, or by topical application of lifitegrast. Corneal inflammation was induced by epithelial abrasion and exposure to either tobramycin-killed Pseudomonas aeruginosa or Staphylococcus aureus in the presence of a 2-mm-diameter punch from a silicone hydrogel contact lens. After 24 h, corneal thickness and haze were examined by in vivo confocal microscopy, and neutrophil recruitment to the corneal stroma was detected by immunohistochemistry. Results: Neutrophil recruitment to the corneal stroma and development of stromal haze were significantly impaired in CD18(-/-) mice or after injection of anti-CD11a. Topical lifitegrast also inhibited P. aeruginosa- and S. aureus-induced inflammation, with the optimal application being a 1% solution applied either 2 or 3 times prior. Conclusion: As LFA-1-dependent neutrophil recruitment to the corneal stroma can be blocked by topical lifitegrast, this reagent could be used in combination with antibiotics to prevent leukocyte infiltration to the corneal stroma in association with contact-lens wear.
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To evaluate the safety and effectiveness of the LipiFlow System compared to the iHeat Warm Compress (WC) for adults with meibomian gland dysfunction (MGD). This was a non-significant risk, prospective, open-label, randomized, crossover multicenter clinical trial. One hundred thirty-nine subjects were randomized between LipiFlow (n=69) and WC control (n=70). Subjects in the LipiFlow group received a 12-minute LipiFlow treatment and were reexamined at 1 day, 2 weeks and 4 weeks. Control subjects received a 5-minute iHeat treatment with instructions to perform the same treatment daily for 2 weeks. At 2 weeks, they crossed over (LipiFlow Crossover) and received the LipiFlow treatment. Effectiveness parameters: meibomian gland (MG) assessment, tear break-up time (TBUT) and dry eye symptoms. Safety parameters: adverse events, ocular health exam, ocular surface staining, intraocular pressure, visual acuity and discomfort. LipiFlow resulted in significant improvement (P < 0.05) in MG secretion at 2 and 4 weeks (mean ± standard deviation at baseline = 6.3 ± 3.5; 2 weeks = 14.3 ± 8.7; 4 weeks = 16.7 ± 8.7); and TBUT at 2 and 4 weeks: (at baseline = 5.5 ± 2.9; 2 weeks = 6.9 ± 5.0; 4 weeks = 7.4 ± 5.5). There was no significant change in MG secretion or TBUT in the control group. LipiFlow resulted in a greater significant reduction in dry eye symptoms than the iHeat WC. The crossover group demonstrated similar significant improvement 2 weeks post-treatment with the LipiFlow. There was no significant difference between groups in the incidence of non-serious, device-related adverse events. The LipiFlow System was significantly more effective than iHeat WC. These results support its safety and effectiveness in the treatment of MGD and dry eye symptoms.
Article
To present the varying manifestations of and the treatment methods for corneal epitheliopathies because of focal limbal stem cell deficiency (LSCD) associated with soft contact lens (SCL) wear. The medical records of patients seen at 3 institutions who developed focal LSCD, based on clinical examination, that was attributed to SCL wear were reviewed. Information regarding the patients' demographics, contact lens wearing schedules, medical and surgical treatment modalities, and clinical and visual outcomes were recorded. Eighteen eyes of 10 SCL wearers were found to have varying degrees of corneal epitheliopathy secondary to focal LSCD. Nine of the 10 patients (90%) were women, and the mean age of all patients was 35.1 years (range, 20-58 years). The mean duration of SCL wear was 15.2 years (range, 4-30 years). Two patients wore the lenses for 20 hours per day. Mean follow-up time was 7.0 months (range, 0.25-24 months). Visual acuity at first examination was affected in 10 of the 18 eyes (55.6%) and ranged from 20/30 to hand motions. The focal LSCD was found superiorly in all involved eyes and inferiorly in only 5 of 18 eyes (27.8%). The epitheliopathy resolved or stabilized in 11 eyes (61.1%) with cessation of SCL wear and use of artificial tears. Five eyes required topical corticosteroid eyedrops, and 2 eyes required surgical intervention. One eye had a best spectacle-corrected visual acuity of less than 20/30 at last follow-up. Focal LSCD can be a result of SCL wear, presenting with varying manifestations. SCL wearers should be monitored routinely and counseled on this possible complication. Early identification of focal LSCD in SCL wearers with subsequent cessation of wear may prevent the need for surgical intervention.
Article
To evaluate the efficacy of cyclosporine 0.05% in alleviating dry-eye signs and improving visual quality after multifocal intraocular lens (IOL) implantation. Private practice and university medical center, New York, New York, USA. This randomized prospective contralaterally controlled double-masked trial comprised patients scheduled to have bilateral phacoemulsification with implantation of a refractive multifocal IOL (ReZoom). Patients received twice-daily cyclosporine 0.05% in 1 eye and an artificial tear in the other eye from 1 month before to 2 months after second-eye surgery. Outcomes were evaluated at baseline and 2 months after second-eye surgery. The study enrolled 28 eyes of 14 patients. At baseline, there were no statistically significant between-group differences in outcome measures. Two months postoperatively, the cyclosporine group had significantly lower mean uncorrected distance visual acuity than the artificial tear group (0.11 logMAR +/- 0.03 [SD] [20/25 Snellen equivalent] versus 0.19 +/- 0.05 logMAR [20/30]; P = .045) as well as significantly lower mean corrected distance visual acuity (0.0 +/- 0.02 logMAR [20/20] versus 0.1 +/- 0.02 logMAR [20/25]; P = .005) and corneal staining scores (0.210 +/- 0.07 versus 0.645 +/- 0.18; P = .034). Treatment with cyclosporine 0.05% also improved contrast sensitivity, conjunctival staining, and tear breakup time. Significantly more patients preferred the eye treated with cyclosporine 0.05% to the eye treated with artificial tears (57.1% versus 14.3%; P = .007). Cyclosporine 0.05% therapy reduced dry-eye signs and improved visual quality after multifocal IOL implantation. No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
Article
To determine (1) if the number of meibomian glands yielding liquid secretion (MGYLS) is correlated with dry eye symptoms and (2) the mean number of MGYLS in the nasal, central, and temporal regions of the lower eyelid in a random clinical sample. Subjects presenting for routine eye examinations were recruited (n = 133; 90 females, 43 males; mean age = 50.3 +/- 14.7 years). The sample included symptomatic and asymptomatic individuals using the Standard Patient Evaluation of Eye Dryness questionnaire. Meibomian gland evaluations were performed using a standardized technique and diagnostic instrument. The mean number of MGYLS in the lower eyelid correlated with dry eye symptoms, p = 0.0002. The mean numbers of MGYLS in each third of the lower eyelid were significantly different, p <or= 0.0001: temporal = 0.27 +/- 0.06, central = 2.14 +/- 0.13, and nasal = 3.10 +/- 0.15. The temporal third of the lower lid was 14 times as likely as the nasal third to have zero MGYLS; 86% of temporal versus 6% of nasal thirds had zero MGYLS. This is the first report to document the following: (1) a correlation between the number of MGYLS in the lower eyelid and dry eye symptoms; (2) the number of MGYLS varies significantly across the lower eyelid, with the highest number of MGYLS in the nasal third and the lowest number of MGYLS in the temporal third of the lower eyelid; and (3) instrumentation to standardize diagnostic meibomian gland expression is desirable if not mandatory for the evaluation of meibomian gland function.
Article
The source of infecting bacteria is often unknown in postoperative endophthalmitis. Using techniques of molecular epidemiology, the authors demonstrate that an organism isolated from the vitreous was genetically indistinguishable from an isolate recovered from the patient's eyelid, conjunctiva, or nose in 14 (82%) of 17 cases of endophthalmitis. In two cases of Staphylococcus epidermidis endophthalmitis, after cataract surgery was performed by the same surgeon on the same day, genetic analysis demonstrated that the infecting organisms from the two patients' vitreous were distinct, and, furthermore, that in each case the external isolates were indistinguishable from the vitreous isolate. The results implicate the patients' external tissues as the source of the infecting organism in those cases of acute postoperative endophthalmitis studied. Therefore, attention should be directed toward the external tissues and their microbial flora in the prophylaxis and prevention of postoperative bacterial endophthalmitis.
Article
Twenty-one eyes of 12 patients with contact lens-induced corneal warpage were followed prospectively using computer-assisted topographic analysis. Sixteen eyes had worn rigid contact lenses (13 eyes, polymethylmethacrylate; three eyes, gas-permeable), and five eyes had worn soft contact lenses. Initial corneal topographic patterns were characterized by the presence of central irregular astigmatism, loss of radial symmetry, and frequent reversal of the normal topographic pattern of progressive flattening of corneal contour from the center to the periphery. A correlation was noted between the initial corneal topography and the resting position of the contact lens on the cornea for nine of the 16 eyes with rigid contact lenses. Initial topography for each of these corneas showed relative flattening of the corneal contour underlying the resting position of a decentered contact lens. Superior-riding lenses produced a topography that simulated early keratoconus. After cessation of contact lens wear, 16 of 21 eyes had a change in corneal shape to a topography that was consistent with a normal pattern. Five corneas stabilized with an abnormal topographic pattern. A much longer time without contact lenses than had been previously reported, up to 5 months, was required for a return of a stable corneal topography in eyes with contact lens-induced corneal warpage caused by rigid lenses.
Article
A 21-year-old woman developed bilateral keratoconjunctivitis from contact lens wear, which progressed to diffuse corneal scarring and vascularization after the patient refused to discontinue wearing contact lenses. The visual disturbance became so severe that a penetrating keratoplasty had to be performed in one eye for visual rehabilitation. Examination of the penetrating keratoplasty specimen disclosed destruction of Bowman's membrane throughout the superior half of the cornea, which was replaced by a fibrous scar that was only midly chronically inflamed. Deep vascularization occurred within the stroma. This case represents an extreme expression of a recently characterized syndrome consisting of conjunctival and corneal changes in patients who may be allergic to contact lenses or the solutions used in conjunction with their care. In the milder end of the spectrum, there is superior epibulbar conjunctival injection with associated tarsal injection, and a mild superficial punctate keratopathy without filaments. Some earlier workers have termed this syndrome a variant of superior limbic keratoconjunctivitis in association with contact lens wear, but this leads to confusion with Theodore's classical superior limbic keratoconjunctivitis, to which the present entity bears no etiologic relationship; it also fails to show many of the findings of Theodore's disease. In mild cases, we would recommend the term contact lens-induced keratoconjunctivitis, and in the more severe cases, such as demonstrated by our patient, we would suggest the term contact lens-induced keratopathy.
Article
Giant papillary conjunctivitis is a syndrome found frequently as a complication of contact lenses. Many variables can affect the onset and severity of the presenting signs and symptoms. Rigid gas permeable contact lenses appear to result in less severe signs and symptoms, with a longer time before the development of giant papillary conjunctivitis. Nonionic, low-water-content soft contact lenses tend to produce less severe signs and symptoms than ionic, low-water-content soft contact lenses. Enzymatic treatment appears to lessen the severity of signs and symptoms. The association of an allergy appears to play a role in the onset of the severity of the signs and symptoms but does not appear to affect the final ability of the individual to wear contact lenses. Using multiple treatment options, such as changing the polymer to a glyceryl methyl methacrylate or a rigid lens, or utilizing a soft lens on a frequent-replacement basis, can result in a success rate of over 90%. In individuals who still have a return of symptoms, the use of topical mast cell stabilizers or a nonsteroidal anti-inflammatory drug as an adjunctive therapy offers the added possibility of keeping these patients in contact lenses.
Article
The purpose of this study was to examine the optical and visual impact of tear break-up. Optical quality of the eye was assessed during periods of nonblinking by quantifying vessel contrast in the fundus image and by monitoring the psychophysical contrast sensitivity and the spatial distribution of tear thickness changes by retroillumination. All measures were obtained from three eyes either with or without a soft contact lens. A noticeable decrease in retinal vessel contrast and contrast sensitivity were observed soon after a blink. Both of these measures of optical quality of the eye showed a similar pattern of image degradation both with and without a soft contact lens. Although trial-to-trial variability was considerable, sample means show that image contrast in the low spatial frequency range can drop to between 20% and 40% of initial values after 60 seconds of nonblinking. Retroillumination of the tear film showed local intensity fluctuations that progressively spread across the pupil with increasing time after the blink. Optical aberrations created by tear break-up contribute to the decline in image quality observed objectively and psychophysically. The decline in image quality that accompanies tear break-up may be a direct cause of the blurry vision complaints commonly encountered in dry-eye patients.
Article
Patients frequently experience dry eye symptoms after laser in situ keratomileusis (LASIK). The mechanisms that lead to these changes are not well understood. The purpose of this study was to investigate the effect of LASIK on tear function. Prospective, comparative, nonrandomized interventional trial. Fifty-eight consecutive patients (96 eyes) who underwent myopic LASIK treatment. The prospective study involved 58 consecutive patients (96 eyes) who underwent sequential or bilateral LASIK for the correction of myopia. Dry eye symptoms, standardized Schirmer test values, basal tear secretion test, and tear break-up time were measured before surgery and 1 day, 1 week, and 1 month after surgery. Schirmer test value, basal tear secretion value, and tear break-up time. Before surgery, 15.6% of patients (15/96) had dry eye symptoms. After surgery, 94.8% of patients (91/96), 85.4% of patients (82/96), and 59.4% of patients (57/96) experienced dry eye symptoms at 1 day, 1 week, and 1 month, respectively. Schirmer test value (13.32 +/- 10. 67 mm) increased at 1 day (14.48 +/- 10.57 mm; P = 0.25) and subsequently decreased at 1 week (11.18 +/- 9.81 mm; P = 0.05) and at 1 month (10.83 +/- 10.02 mm; P = 0.03). Basal tear secretion test value (8.49 +/- 8.48 mm) decreased at 1 day (6.80 +/- 6.48 mm; P = 0.05), at 1 week (5.97 +/- 6.88 mm; P = 0.005), and at 1 month (5.89 +/- 6.24 mm; P = 0.007). Tear break-up time (5.32 +/- 2.35 seconds) decreased 1 day (4.14 +/- 1.90 seconds; P < 0.001) and 1 week (4.49 +/- 1.70 seconds; P = 0.004) after surgery and recovered by 1 month after surgery (5.09 +/- 3.03 seconds; P = 0.52). Poor preoperative tear functions with a Schirmer test value less than 10 mm was a significant risk factor (72% vs. 46%; relative risk, 1.58 [1.10-2.26]) for experiencing dry eye symptoms at 1 month after surgery. Dry eye symptoms are common after myopic LASIK surgery. Laser in situ keratomileusis significantly altered the tear break-up time, Schirmer test values, and basal tear secretion. Patients with preexisting tear flow abnormality as demonstrated by Schirmer test values less than 10 mm are especially at risk of experiencing dry eye symptoms.
Article
To evaluate subclinical inflammation and mucus production of the conjunctiva in asymptomatic contact lens (CL) wearers, and to obtain an estimation of the chronologic variations in each group. Eighteen eyes fitted with rigid CL (RCL) and 28 eyes with soft CL (SCL) worn daily were compared with 10 eyes from five healthy non-CL wearers. Impression cytology (IC) specimens were collected after clinical examination and were analyzed by flow cytometry using antibodies directed to HLA DR and intercellular adhesion molecule type 1 (ICAM-1) (CD 54), as inflammatory markers, and to the peptidic core of the conjunctival mucin (M1/MUC5AC) for mucus and goblet cell detection. The percentage of positive cells was calculated, and levels of fluorescence expression were quantified and compared between each group. A significant increase of HLA DR and ICAM-1 was observed in the SCL group in comparison with the control group. The two inflammatory markers were highly positively correlated with each other. Mucin detection with M1/MUC5AC did not find a significant difference between each group in terms of percentage of positive cells, but analyses of mean levels of fluorescence showed a significant decrease in the two CL groups. Evolution in time was different for each group, with a regular low level of inflammation in the RCL group in the first 10 years in comparison with the SCL group. In the SCL group, inflammation seemed to be higher before 2 years and after 10 years of wear. Mucin expression was variable in time, but without significant difference at any time. This study confirms difference in expression of subclinical conjunctival inflammation in asymptomatic CL wearers, with lower levels for RCL than SCL wearers with daily or extended wear. The mucin system is also modified by this low but chronic aggression of the ocular surface, with a tendency to decrease with time in the RCL and SCL groups.
Article
Unlabelled: We present two cases of persons wearing hard contact lenses resulting in corneal modifications which could have falsified the indications for LASIK. Clinical cases: In the first case the use of hard contact lenses led to thickening of the cornea which might have led to an erroneous indication for LASIK and an excessive thinning of the cornea. In the second case, the shape of the cornea was modified and the rigid lens masked a subclinical keratoconus. Conclusion: Since corneal ectasia is the major complication of LASIK surgery due to excessive thinning of the cornea or LASIK surgery on an undiagnosed keratoconus, these two cases illustrate the importance of a pre-LASIK eye examination for patients wearing hard lenses several weeks after these contact lenses have been discontinued.
Article
To investigate the effects of artificial tears on corneal surface regularity and visual function in dry eyes. Nonrandomized, comparative trial. Forty patients (40 eyes) with dry eyes with (group 1, n = 15 eyes) or without (group 2, n = 25 eyes) punctate epithelial keratopathy and a normal control group of 20 individuals (20 eyes) with no ocular abnormalities (group 3). In both dry and normal eyes, the surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) were measured by computer-assisted videokeratography (TMS-1; Computed Anatomy, New York, NY). Spatial-contrast sensitivity and glare disability were also measured before and 1 minute after instillation of artificial tears. Differences in SRI, SAI, PVA, spatial-contrast sensitivity, and glare disability between groups, before instillation of tears, and within groups, after instillation of tears. Compared with group 3, eyes in group 1 had significantly worse SRI, SAI, PVA, and contrast sensitivity (incomplete glare disability data precluded analysis) before instillation of artificial tears. Differences in corneal surface regularity and visual function between groups 2 and 3 were not significant except for a significantly increased glare disability at low spatial frequency (1.5 cycles per degree [cpd]) in group 2. Significant improvement in SRI, SAI, PVA, and contrast sensitivity were observed after instillation of artificial tears in group 1. In groups 2 and 3, the only significant changes were improvement in glare disability at 1.5 cpd and worsening of the SRI, respectively. Tear film changes in dry eye patients may lead to irregularities on the corneal surfaces, causing glare disability. However, these changes may be too subtle in the early stages of dry eyes to be detected by corneal topography or contrast sensitivity measurements. Significant improvement in SRI, SAI, PVA, and contrast sensitivity were found after instillation of artificial tears in dry eyes with punctate epithelial keratopathy.
Article
To describe and to characterize the clinical findings and prognosis of patients with idiopathic limbal stem cell deficiency (LSCD). Retrospective case series. We reviewed records from seven patients whose LSCD had been diagnosed clinically and confirmed by impression cytology and in whom the cause of LSCD was never identified. A detailed history, clinical records, and results of slit-lamp biomicroscopy, photography, vital staining, and impression cytology were evaluated. Six of seven patients (86%) were women, indicating a female predominance. Two patients were from the same family, whereas one other had a positive family history. Severe photophobia was noted in all patients and reduced vision in three patients. The main clinical findings included superficial vascularization, worse in the superior followed by the inferior and nasal cornea. The limbal regions showed a loss of limbal palisades of Vogt, and the adjacent peripheral cornea revealed an irregular and hazy epithelium with positive late fluorescein staining and the presence of conjunctival goblet cells by impression cytology. LSCD was bilateral in all patients but asymmetric in four. During a mean follow-up of 6.1+/- 3.8 years, the visual acuity decreased in both eyes of one patient after cataract extraction and in both eyes of two other patients without surgery. The process of conjunctivalization advanced in four patients (57%) and remained stable in three (43%) without surgical intervention. Idiopathic LSCD is a rare and as yet poorly recognized clinical entity, and the findings reported herein may help explore how progressive loss of limbal stem cells occurs. Correct diagnosis of idiopathic LSCD is important so that the patient will not be subjected to unnecessary surgeries, which may actually severely worsen the clinical course.
Article
Fluid-ventilated, gas-permeable scleral lenses are a valuable front-line tool in the management of severe ocular surface disease. In addition to enhancing vision, they have the potential to reduce greatly the disabling ocular pain and photophobia associated with SJS, TEN, and ocular cicatricial pemphigoid. They are also useful in healing some PEDs that are refractory to all other treatment strategies and in reducing PED recurrence in stem cell-deficient and neurotrophic corneas. The therapeutic benefits of these lenses are provided by the oxygenated aqueous environment they create over the corneal epithelium. The oxygenated precorneal fluid compartment that is maintained at neutral pressure protects the epithelial surface from the desiccating effects of exposure to air and the friction generated by blinking and avoids the shearing forces generated during the blink-induced movement of soft lenses.
Article
To assess the visual effects of multifocal intraocular lenses (IOLs) compared with the current standard treatment of monofocal IOL implantation. Systematic literature review and meta-analysis of randomized controlled trials. The study was performed according to the Cochrane Collaboration methodology. Computer database and manual searches were made to identify all randomized trials comparing multifocal IOL implantation with a monofocal control group. Data were extracted using a standardized form and analyzed using Review Manager software. When study reporting allowed meaningful comparison, meta-analysis was performed. The chi-square test was used to examine heterogeneity between studies. Odds ratios were calculated for dichotomous outcomes and standardized mean differences for continuous variables. There is no single outcome measure that can be thought of as summarizing the efficacy of an IOL. A number of different outcomes had to be examined. The primary outcomes for this review were distance and near visual acuity (unaided and corrected) and spectacle dependence. The secondary outcomes for this review included depth of field, contrast sensitivity, glare, subjective assessment of quality of life or visual function, and surgical complications. Eight trials were identified. There was significant variability among the trials in the outcomes reported. Distance acuity was similar in multifocal and monofocal IOLs. Unaided near vision tended to improve with the multifocal IOL. This resulted in decreased spectacle dependence with use of the multifocal IOL. Adverse effects included reduced contrast sensitivity and the subjective experience of halos around lights. Multifocal IOLs are effective at improving near vision relative to monofocal IOLs. Whether that improvement outweighs the adverse effects of multifocal IOLs will vary between patients, with motivation to achieve spectacle independence likely to be the deciding factor.
Article
To investigate the functional and morphological toxicity of benzalkonium chloride (BAC) on corneal epithelial cells in vitro. Primary corneal epithelial cells were cultured from rabbit cornea. Corneal epithelial cells containing radioactive 51Cr were exposed for 5 min, 10 min, 30 min and 60 min to concentration of BAC 0.001%, 0.005%, 0.01%, 0.05% and 0.1%. Control cells were treated with phosphate buffer solution alone. 51Cr release from epithelial cells into the supernatant was used as an index of epithelial cell lysis. Cell detachment (index of cell dysfunction) was analysed by measuring 51Cr activity in the supernatant and wash fluid. Morphological cell damage was investigated with transmission electron microscopy. With the higher concentration and the longer duration of BAC exposure, corneal epithelial cell lysis was increased significantly (P < 0.05). Cells showed severe damage at BAC concentration over 0.05% during 5 min of exposure. Cell dysfunction appeared markedly at BAC concentrations of 0.005% for 30 min of exposure, but decreased with longer exposure times. There was an increase in significant cytoplasmic damage with longer BAC exposure times, although not with a minimal dose of 0.001%. Disrupted cytoplasmic membranes of corneal epithelial cells appeared at the higher BAC concentration of 0.1%, and at the longer exposure time of 30 min with BAC concentration of at least 0.001%. BAC can induce corneal epithelial dysfunction, which can damage the corneal epithelial barrier. This effect occurs when BAC is used frequently or for periods over 30 min, even when the BAC concentration is low (0.001%).
Article
To evaluate the effectiveness of the autologous serum eyedrops in the treatment of severe dry eye patients. Prospective randomized case-control study. Thirty-seven eyes of twenty severe dry eye patients without punctal occlusion were enrolled in this study. After 2 weeks of washout, they were randomly assigned to two groups. Group A patients used only preservative-free artificial tears, and group S patients used only autologous serum eyedrops. We evaluated the results of Schirmer test, fluorescein and rose bengal staining scores, tear film breakup time (BUT), and subjective symptom scores before and 2 weeks after treatment. Mean BUT and fluorescein and rose bengal staining scores, as well as subjective symptom scores, showed significant improvement in the patients assigned to autologous serum eyedrops compared with subjects assigned to preservative-free artificial tears after 2 weeks of treatment. Autologous serum eyedrops were found effective in the treatment of severe dry eye disease, as evidenced by improvement of tear stability and ocular surface vital staining scores.
Article
To evaluate and relate the clinical (including corneal sensitivity and tear function) and cytological (presence of goblet cells and cytokeratin 3- and 19-positive cells) features of limbal stem cell deficiency (LSCD). Twenty-nine patients (44 eyes) with a clinical diagnosis of LSCD participated in this study. Corneal signs (epithelial alterations, superficial neovascularisation and stromal scarring) and cytological findings (presence of goblet cells and cytokeratins 3 and 19) were evaluated and scored (from 0 to 3) from each of the five corneal sectors. Corneal sensitivity (Cochet-Bonnet aesthesiometer) and tear function (Schirmer test and BUT) were also assessed. Cytological scores were correlated statistically with both corneal signs and sensitivity values. Cytokeratin 19-positive cells were found in 82% of corneal impression cytology samples, while goblet cells were identified in only 59% of these same samples. Cytokeratin 3-positive cells were present in 61% of LSCD eyes and in all unaffected eyes. Corneal sensitivity was significantly decreased in affected eyes compared with contralateral, healthy eyes (1.6+/-1.7 cm versus 5.7+/-0.3 cm). Tear function tests did not show significant changes. In LSCD eyes, goblet cells and cytokeratin 19-positive cells on the corneal surface were significantly correlated to corneal epithelial alterations and to corneal superficial neovascularisation (p<0.001). Corneal cytokeratin 3-positive cells were inversely related to epithelial alterations (p=0.003). Corneal sensitivity was decreased in corneal sectors with epithelial alterations (p<0.001), neovascularisation (p<0.001) and stromal abnormalities (p=0.049), and was indirectly related to the presence of goblet cells (p=0.005) and cytokeratin 19-positive cells (p<0.001). This study confirmed the importance of cytological tests in the diagnosis of LSCD. Furthermore, the absence of goblet cells may not exclude corneal conjunctivalisation as demonstrated by cytokeratin 19 immunostaining. Lastly, corneal conjunctivalisation was associated with zone-specific impairment in corneal sensitivity.
Article
The hormonal status and in particular sex steroids play a role in the ocular surface homeostasis and function, during the whole life and in both sexes, accomplished by estrogenic and androgenic receptors located on corneal and conjunctival epithelia and Meibomian gland. The ocular surface is an integrated unit and any dysfunction results in a scarce or unstable preocular tear film which produces dry eye, a chronic inflammatory condition with increasing incidence as people get older but always more frequent among females. In post-menopausal women endocrine changes join the aging effects in the pathogenesis of dry eye, but still it remains controversial whether estrogen or androgen deficiency or their imbalance impair ocular surface function. Another questionable issue concerns the efficacy of hormonal replacement therapy in the amelioration of dry eye symptoms and recovery of tear function, since the scientific literature stands in between a therapeutic or a promoting effect of eye dryness. Therapy of dry eye is usually based upon topical administration of tear substitutes; estrogen or androgen-based eye drops represents a promising innovative treatment based upon important scientific rationale.
Article
To examine tear film, contact lens, medical, and patient-related factors associated with self-reported contact lens-related dry eye. Four hundred fifteen contact lens wearers were recruited and enrolled in this phase of a larger cross-sectional study. A variety of tear film (e.g., interferometry, osmolality, phenol red thread, meibography, fluorescein, and lissamine green staining), contact lens (i.e., water content, refractive index, material), and patient-related (e.g., gender, sociodemographic, education, income, and medical health) factors were examined in relation to dry eye status. Univariate and multivariate logistic regression models were used to examine the relation between these tear film, contact lens, and patient-related factors associated with dry eye status. Of the 415 enrolled, the data from 360 were used in the analyses. The average age was 31.1 +/- 11.5 years, 245 (68%) participants were female, and 55.3% were classified as having-contact lens-related dry eye via self-report. Overall, 327 (90.8%) were hydrogel lens wearers and 33 (9.2%) were gas-permeable lens wearers. Several factors were shown to be related to dry eye status in multivariate modeling, including female gender (P = 0.007), lenses with higher nominal water content (P = 0.002), rapid prelens tear film thinning time (P = 0.008), frequent usage of over-the-counter pain medication (P = 0.02), limbal injection (P = 0.03), and increased tear film osmolality (P = 0.05). Contact lens-related dry eye may be explained mechanistically by increased tear film thinning times (evaporation or dewetting) resulting in increased tear film osmolality. Other contributing factors include the use of high-water-content lenses, which have traditionally been reported to be associated with less patient comfort than lower-water-content lenses, potentially due to spoilation and deposition. As found in other studies of dry eye, women are more likely to report contact lens-related dry eye than are men.
Article
We investigated the effects of corticosteroid and doxycycline on expression of matrix metalloproteinase (MMP)-9 and inflammatory cytokines and activation of mitogen-activated protein kinase (MAPK) signaling pathways, c-jun N-terminal kinases (JNK), extracellular-regulated kinases (ERK) and p38, in experimental murine dry eye. Experimental dry eye (EDE) was created in C57BL6 mice, with or without or topical treatment consisting of 1% methylprednisolone, 0.025% doxycycline or balanced salt solution four times per day. MMP-9 expression in the cornea epithelia was evaluated by laser scanning confocal microscopy. Gelatinase activity in the cornea was evaluated by in situ zymography and MMP-9 activity in tear washings was evaluated by gelatin zymography. Total and phosphorylated MAPKs (JNK1/2, ERK1/2, p38) were detected by Luminex immunobead assay. Levels of MMP-9, interleukin (IL)-1alpha, IL-1beta and tumor necrosis factor (TNF)-alpha RNA transcripts were evaluated by real-time PCR. MMP-9 immunoreactivity was localized to the apical corneal epithelial cell membranes in normal control eyes. Desiccating stress significantly increased production of MMP-9 by the corneal epithelium and increased its activity in the corneal epithelium and tear fluid. Dryness also increased expression of IL-1alpha, IL-1beta and TNF-alpha mRNA and stimulated phosphorylation of JNK1/2, ERK1/2 and p38 MAPKs in the corneal epithelium. Both methylprednisolone and doxycycline reduced expression and activity of MMP-9, decreased levels of inflammatory cytokines transcripts and reduced activation of MAPKs in the corneal epithelium in response to EDE. Desiccating stress stimulates expression of MMP-9, IL-1alpha, IL-1beta and TNF-alpha mRNA , as well as activates MAPK signaling pathways in the corneal epithelium. Both corticosteroid and doxycycline suppressed this molecular stress response.
Article
To evaluate contrast sensitivity and disability glare in patients with dry eye using the Contrast Glaretester 1000. Contrast sensitivity and disability glare were determined in 33 eyes of 33 patients with dry eye and 30 eyes of 30 healthy control subjects for six target sizes with a visual angle of 6.3-0.7 degrees using the Contrast Glaretester 1000, whose working mechanism is similar to that of the conventional perimetry instrument. Contrast sensitivity was significantly worse in dry eye group when viewing all target sizes (reduction of 0.10-0.25 log contrast units, p < 0.01) except at 6.3 degrees. In the presence of glare, differences in log contrast sensitivity between the groups (0.10-0.25 units) were significant (p < 0.01) for all target sizes, with the dry eye group showing worse results. The reduction in contrast sensitivity induced by glare (disability glare) was significantly worse in the dry eye group versus the control group but only for the 2.5-degree size target, where 0.14 log contrast units were lost. Contrast sensitivity with and without glare was significantly reduced in patients with dry eye compared with control subjects, but the number of log contrast units lost with glare (disability glare) was similar in the two groups, except for the 2.5-degree size target.
Article
To evaluate the effect of hormone replacement therapy (HRT) on dry eye in post-menopausal women. Forty post-menopausal women with dry eye (20 patients, group 1) and without dry eye (20 patients, group 2), and planning to receive HRT (estrogen plus progesterone), were recruited as the study groups. Forty age-matched untreated women were enrolled as controls (group 3 with dry eye, 5 patients; group 4 without dry eye, 35 patients). Patients having at least one of the symptoms (dryness, itching, photophobia, foreign body sensation, and tearing) together with two of the tests with positive results for dry eye (tear film break-up time (BUT), fluorescein staining of the cornea, analysis of the meibomian gland, and Schirmer I test) in both eyes were considered dry eye positive. Hormonal assay for follicle stimulating hormone, luteinizing hormone, estradiol, and free testosterone was performed. Dry eye statuses in the groups were evaluated statistically. Four patients with incomplete follow-up data were excluded. HRT use increased estradiol levels in the groups. Mean ages of patients (50.2+/-4.8 and 50.7+/-3.9 years, and 50.0+/-4.6 and 53.0+/-3.9 years) were similar (p=0.67). Duration of menopause in groups 1 and 2 (3.2+/-2.2 and 1.4+/-1.2 years; p=0.01), and in groups 3 and 4 (3.0+/-1.6 and 1.7+/-1.3 years; p=0.014) were different. At the third month examinations, all of the patients in group 1, and 11 patients (61.1%) in group 2 had dry eye (p=0.003). Duration of menopause and use of HRT may increase the incidence of dry eye in post-menopausal woman.
Article
To examine the profile of clear corneal cataract incisions in the living eye using optical coherence tomography (OCT). Private practice, Eugene, Oregon, USA. The Zeiss Visante OCT anterior segment imaging system was used to study the profile of clear corneal cataract incisions, all in senior citizens. The OCT images of the operative eye were taken on the first postoperative day approximately 24 hours after surgery. The OCT images of clear corneal incisions were compared with an OCT image of a control eye, incisions without stromal hydration, and previous drawings of clear corneal incisions. In the images, the clear corneal incisions had an arcuate configuration rather than a straight line configuration, as previously indicated. This architecture appears to add greater stability as a result of a tongue-and-groove-like fit of the floor to the roof of the incision as well as an incision that is longer than the chord length that had previously been measured. Other findings include that stromal swelling, which facilitates sealing of these incisions by the endothelial pump, lasted for at least 24 hours. Results indicate an incision in the plane of the cornea with a chord length of at least 2.0 mm provides advantageous architecture for adequate self-sealing. Proper clear corneal incision construction resulted in an incision architecture that seemed to have increased stability and added safety, contributing to an absence of endophthalmitis for more than 10 years and 9000 cases in a single practice.
Article
To report clinical outcome of treating ocular demodecosis by lid scrub with tea tree oil (TTO). Retrospective review of clinical results in 11 patients with ocular Demodex who received weekly lid scrub with 50% TTO combined with daily lid hygiene with tea tree shampoo. These 11 patients also had meibomian gland dysfunction (n = 7) manifesting abnormal lipid film with slow lipid film spread, intermittent trichiasis (n = 5), and subjective lash loss (n = 4), suggesting damage to the meibomian glands and lash follicles. In addition, conjunctival inflammation (n = 8) was associated with conjunctivitis (n = 5), conjunctivochalasis (n = 3), findings suspicious for pemphigoid (n = 2), and recurrent pterygium (n = 2). After TTO lid scrub, the Demodex count dropped to 0 for 2 consecutive visits in less than 4 weeks in 8 of 11 patients. Ten of the 11 patients showed different degrees of symptomatic relief and notable reduction of inflammatory signs. Significant visual improvement in 6 of 22 eyes was associated with a stable lipid tear film caused by significant reduction of lipid spread time. Lid scrub with 50% TTO caused notable irritation in 3 patients. Demodex potentially causes ocular surface inflammation, meibomian gland dysfunction, and lash abnormalities. Lid scrub with TTO can effectively eradicate ocular Demodex and result in subjective and objective improvements. This preliminary positive result warrants future prospective investigation of Demodex pathogenicity.
Article
This paper reviews recent studies of the role of the tear film in the optical quality of the eye. Recent investigations focus on the dynamics of the tear film after a blink and its important role in the optical quality of the eye. The results in this review were used in an attempt to understand the optical and visual impact of tear-film breakup in normal eyes and dry eyes. It was noted that patients with dry-eye syndrome have large optical aberrations compared with those in normal eyes, which may be the cause of blurry vision associated with the syndrome. In addition, instillation of artificial tears reduces optical aberrations and thus improves the optical quality of vision in these patients.
Article
To study dry eye and analyze pathogenic factors in patients after cataract surgery. A total of 37 patients (50 eyes) were studied by using a 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ25) and Ocular Surface Disease Index (OSDI) 3 days before and 1 week, 1 month, and 3 months after cataract surgery. Slit-lamp microscope examination, cornea and conjunctiva fluorescein staining, tear breakup time (BUT), Schirmer test I (STI), and impression cytology (IC) were carried out at the same time. Cytologic specimens for IC were obtained from the upper lid-covered region, explosive region, and lower lid-covered region of the globe conjunctiva. The average density of goblet cells on these 3 regions was measured, and the pathogenic factors of dry eye after cataract surgery were analyzed. After cataract surgery, the incidence of dry eye increased dramatically; NEI-VFQ25 and OSDI indicated that most patients developed this symptom after surgery. The lacrimal river line became narrow, and BUT and STI decreased in patients after cataract surgery. IC suggested the presence of serious squamous metaplasia in the epithelial layer of the globe conjunctiva, especially the lower lid region. Dry eye can develop or deteriorate after cataract surgery if not treated in time. Misuse of eyedrops is one of the major pathogenic factors that causes dry eye after cataract surgery. Eyedrops should be carefully administered before and after cataract surgery to avoid or reduce the occurrence of dry eye postoperatively.
Article
Dry eye is the most common reason for contact lens (CL) discontinuation, and the patient with pre-existing dry eye presents particular challenges to the CL fitter. Poor tear film quality/stability, oxygen deprivation, lens deposits, and adverse reactions to CL solutions all contribute to dry eye, and lid disease, allergies, environmental factors, and medications can further hamper successful CL wear by the patient with dry eye. Health and comfort of the ocular surface is affected by the water content, ionicity, oxygen permeability, and modulus of elasticity of the lens, as well as by surface characteristics, such as protein, lipid, and mucin deposition; protein adsorption; and wettability. The choice of CL cleaning solutions with regard to action, cytotoxicity, and biocompatibility are as important as the choice of the CL itself. With appropriate management of the lid, meibomian gland, and ocular surface conditions that produce dry eye, careful selection of lenses and solutions, and vigilant follow-up, successful CL wear should be achievable for the dry eye patient.
Cataract and dry eye: prospective health assessment of cataract patients ocular surface study. American Society of Cataract and Refractive Surgery annual meeting
  • W Trattler
  • C Reilly
  • D Goldberg