PURPOSE: To investigate the clinical usefulness of conjunctival brush cytology (CBC) in the diagnosis of dry eye syndrome. METHODS: Conjunctival impression cytology (CIC) was performed on the right eye and CBC was performed on the left eye in 24 patients with dry eye syndrome (9 patients with Sjogren's syndrome (SS) and 15 patients with non-Sjogren syndrome (Non-SS)) and 7 control subjects. The grade of squamous metaplasia was analyzed and the correlation between the grade and tear surface parameters was evaluated. RESULTS: The squamous metaplasia grade score in CIC and CBC were 2.44+/-0.73 and 1.56+/-1.01 in SS patients (p=0.047), 1.53+/-0.74 and 0.80+/-0.78 in Non-SS patients (p=0.017), and 0.43+/-0.54 and 0.14+/-0.38 (p=0.250) in control subjects, respectively. In SS patients, the score correlated significantly with the symptom score, basal tear secretion, break-up time (BUT) and keratoepitheliopathy score in CBC (p<0.05), but did not correlate with the tear surface parameters in CIC. In Non-SS patients, the score correlated significantly with the symptom score, basal tear secretion, BUT and keratoepitheliopathy score in CBC, and with the keratoepitheliopathy score in CIC (p<0.05). CONCLUSIONS: CBC is a more useful method than CIC in the diagnosis of dry eye syndrome.
Dry Eye Syndromes ; Eye ; Humans ; Metaplasia ; Sjogren's Syndrome ; Tears

PURPOSE: This study was performed to evaluate the level of I-TAC in tears of patients with dry eye syndrome and its correlation with the tear surface parameters. METHODS: I-TAC levels were measured by enzyme-linked immunosorbent assay (ELISA) in tear samples collected from 33 dry eye patients (16 patients with Sjogren syndrome and 17 patients with non-Sjogren syndrome) and 15 control subjects. The correlations between I-TAC levels and tear surface parameters including tear film break-up time (BUT), basal tear secretion, tear clearance rate (TCR), corneal sensation, keratoepitheliopathy and conjunctival goblet cell density were analyzed. RESULTS: The mean levels of I-TAC were 717+/-377 pg/ml in patients with dry eye and 444+/-119 pg/ml in control subjects (P=0.003). The mean levels in Sjogren syndrome patients (1261+/-324 pg/ml) were significantly higher than those of non-Sjogren syndrome patients (614+/-131 pg/ml, P=0.003). I-TAC levels correlated significantly with basal tear secretion (P=0.006), TCR (P=0.007), keratoepitheliopathy (P=0.022) and goblet cell density (P<0.001), but did not correlate with BUT (P=0.110) and corneal sensation (P=0.090). CONCLUSIONS: The level of I-TAC is elevated in tears of patients with dry eye syndrome including Sjogren syndrome. The level correlates with disease severity and tear surface parameters.
Dry Eye Syndromes ; Enzyme-Linked Immunosorbent Assay ; Eye ; Goblet Cells ; Humans ; Sensation ; Sjogren's Syndrome ; Tears

PURPOSE: To investigate the prevalence and clinical aspects of Sjogren syndrome in patients who were diagnosed with dry eye syndrome in Korea. METHODS: The medical records of patients who were diagnosed with dry eye syndrome in a dry eye clinic during a 2-year period (March 2008 to March 2010) and were followed up for more than 3 months were reviewed retrospectively. RESULTS: A total of 206 patients were included in the present study. Fifty-eight patients (28%) had Sjogren syndrome and 39 patients (19%) showed primary Sjogren syndrome. Sjogren syndrome patients showed poorer results than non-Sjogren syndrome patients in ocular surface disease index score (OSDI), tear break up time, Schirmer test score, and ocular surface staining score using the Oxford scheme (p < 0.05). Among the patients with primary Sjogren syndrome, 27 patients were SSA (anti-Ro antibodies) or SSB (anti-La antibodies) positive and 12 patients were sero-negative. There were no statistically significant differences in objective or subjective parameters between the sero-positive and sero-negative groups. CONCLUSIONS: Sjogren syndrome was observed in 28% of all dry eye patients, in two-thirds of severe dry eye patients. Sjogren syndrome patients showed more severe clinical aspects than dry eye patients with non-Sjogren syndrome. Diagnosing Sjogren syndrome through systemic evaluation is necessary in the patients with severe dry eye.
Autoantibodies ; Dry Eye Syndromes ; Eye ; Humans ; Medical Records ; Prevalence ; Sjogren's Syndrome ; Tears

PURPOSE: To evaluate the therapeutic effect of topical testosterone gel application to periocular area in dry eye. METHODS: Thirty-four eyes of 17 patients with refractory dry eye were included. Five patients had Sjogren's syndrome and 12 were non-Sjogren's syndrome patients. Testosterone gel was applied on the periocular area three times a day. Symptom score corneal sensitivity test (CST), tear film break-up time (BUT), basal tear secretion test (BST), fluorescein staining, tear clearance test (TCR), and conjunctival impression cytology were checked and evaluated before, one month after and two months after treatment. RESULTS: The mean symptom score before topical testosterone gel application was 3.44+/-0.70; it was 2.88+/-0.84 at 1 month after application and 2.03+/-1.09 at 2 months after application. The improvement of tear film parameters including BUT, tear clearance rate, fluorescein staining score, conjunctival metaplasia and goblet cell density was statistically significant (P<0.05) at one and two months after treatment but neither BST nor CST was improved with statistically significance. There was no difference in the therapeutic effect of topical testosterone gel between Sjogren's syndrome and non-Sjogren's dry eye patients. CONCLUSIONS: The function of tear film and the integrity of ocular surface improved after topical application of testosterone gel in dry eye patients. Topical testosterone gel application may be an effective adjuvant therapy for the treatment of dry eye.
Dry Eye Syndromes* ; Fluorescein ; Goblet Cells ; Humans ; Metaplasia ; Sjogren's Syndrome ; Tears ; Testosterone*

OBJECTIVE: To explore the effect of hypothyroidism (HT) on the ocular surface status of patients with primary Sjögren's syndrome-related dry eye (pSS-DED). METHODS: The cross-sectional study included 36 patients with pSS-DED who were treated at the dry eye clinic of Peking University Third Hospital from December 2020 to June 2021, of whom 12 were pSS-DED patients combined with HT. In the same period, 24 patients with simple dry eye disease (DED) were served as a control group. All the patients filled out the Ocular Surface Disease Index (OSDI) questionnaire, and performed tear film break-up time (BUT), Schirmer test, tear meniscus height, corneal/conjunctival fluorescein staining, meibomian gland secretion capacity, meibum evaluation and confocal microscope examination. RESULTS: (1) Compared with pSS-DED and simple DED patients, pSS-DED +HT patients had lower average BUT [(2.7±0.8) s], Schirmer test [(4.9±4.8) mm] and tear meniscus height [(0.13±0.03) mm], and the difference was statistically significant (F=12.43, P < 0.01; F=6.96, P < 0.01; F=3.31, P < 0.05). (2) Compared with DED and pSS-DED patients, the meibomian gland secretion capacity and meibomian trait scores of pSS-DED+HT patients were mainly distributed in the high division. There were statistically significant differences in the distribution of secretion capacity of meibomian glands (χ²=10.72, P < 0.05) and meibomian trait assessment scores (χ²=8.34, P < 0.05) among the three groups. (3) Serum total thyroxine and serum free thyroxine levels in the pSS-DED+HT patients showed positive correlation (P < 0.05, P < 0.05) with their BUT (r=0.60, 0.60), Schirmer's test (r=0.64, 0.66) and tear river height (r=0.61, 0.62), independent of lid gland secretory capacity; no significant correlation was found between thyroid-stimulating hormone, anti-thyroglobulin antibody and lid gland secretory capacity. Thyroid hormone, anti-thyroglobulin antibody, and thyroid peroxidase antibody were not found to be significantly correlated with ocular surface status. (4) Compared with pSS-DED, the fiber density of the subbasal nerve plexus in pSS-DED+HT group decreased (t=2.06, P < 0.05), and the curvature score increased (t=2.13, P < 0.05). CONCLUSION The ocular surface condition of pSS-DED patients with HT is worse than that of pSS-DED and DED patients. The main manifestations are that tear secretion, tear film stability, secretory function of the meibomian glands, meibum trait and fiber density of the subbasal nerve plexus decrease while the curvature increases. The mechanism might be related to the decrease in thyroid hormone production.
Cross-Sectional Studies ; Dry Eye Syndromes/etiology* ; Humans ; Hypothyroidism/complications* ; Sjogren's Syndrome/complications* ; Thyroxine

Bacteriologic factors, such as enzymes and toxins produced by microbes, are one of diverse etiologic factors in dry eye syndrome. We investigated the conjunctival bacterial flora in dry eye patients and compared the results between dry eye patients and normal persons. There were no differences in bacterial flora between the two groups.
Dry Eye Syndromes ; Humans

PURPOSE: To evaluate the diagnostic value of lacrimal punctal size in patients with dry eye. METHODS: We analyzed 55 patients (110 eyes) who underwent lacrimal punctal plug insertion in dry eye from June to November 2003. We performed BUT and Schirmer test, inquired about the symptoms of dry eye, and measured lower lacrimal punctal size by Punctal Gauging System(R). RESULTS: The mean number of symptoms of dry eye was 4.24 +/- 1.14, 4.57 +/- 1.22, 5.75 +/- 1.00, and 6.95 +/- 0.91 in lower lacrimal punctal size 0.5mm, 0.6mm, 0.7mm, and 0.8mm, and the mean BUT was 4.86 +/- 1.59 sec, 3.94 +/- 1.69 sec, 3.25 +/- 1.57 sec, and 3.53 +/- 0.96 sec, respectively. These differences were statistically significant (p<0.05). The mean result of Schirmer test was 5.76 +/- 3.37mm, 5.44 +/- 3.50mm, 3.50 +/- 2.22mm, and 3.79 +/- 2.99mm in lower lacrimal punctal size 0.5mm, 0.6mm, 0.7mm, and 0.8mm, respectively, but these differences were not statistically significant (p>0.05). CONCLUSIONS: These results suggest that an increase of lacrimal punctal size decreases the BUT results and causes discomfort for patients with dry eye symptoms. Thus, an increase of lacrimal punctal size is the causative factor of dry eye, and the measurement of lacrimal punctal size is thought to be helpful to diagnose dry eye and choose the size of lacrimal punctal plug.
Dry Eye Syndromes* ; Humans

Objective: The objectives of this study were to develop a cross-culturally adapted, Filipino version of the Ocular Surface Disease Index (OSDI) questionnaire and to assess its reliability. Methods: A Filipino-adapted version of the OSDI was developed following guidelines for language-specific questionnaires: forward translation into Filipino by 2 independent bilingual translators, back-translation into English by a language institution, and a final forward translation to Filipino resolved by a review committee. To check for equivalence, the English and Filipino versions of the OSDI were pretested on 16 patients in a dry eye clinic. The Filipino version was then administered to 36 participants, and a Cronbach alpha coefficient for reliability of the overall instrument and the alpha that would result if each item were removed were computed. Finally, the questionnaire was then retested on 11 dry eye patients to see if the coefficient would increase. Results: All reported no difficulty with the Filipino questionnaire, with 81.3% expressing preference in answering it. Most (81.3%) chose the same answer in at least half of the items in both languages, though the range of similar responses varied from 41.7% to 91.7%. Reliability testing of the Filipino questionnaire showed this to have fair internal consistency (α=0.5958). The value increased to moderate internal consistency (0.7576) when 3 items were removed. Conclusion A culturally-adapted OSDI in Filipino was successfully produced and was the preferred tool by most patient participants.
Dry Eye Syndromes

Objective: To determine the incidence of dry eye in patients undergoing clear cornea phacoemulsification and to investigate its effects on dry eye symptoms and tear function. Methods: This was a single-center, prospective, non-randomized study involving forty-nine (49) eyes from fortyfour (44) patients without preoperative dry eye, who underwent clear cornea phacoemulsification for age-related cataract. Main outcome measures were subjective grading of ocular discomfort, ocular surface disease index (OSDI), fluorescein tear break-up time (FTBUT), and Schirmer tests without anesthesia and with anesthesia. They were measured before surgery and 1 week, 1 month, and 3 months after surgery. Results: None of the patients qualified for the definition of dry eye disease before and after clear cornea phacoemulsification. Preoperative FTBUT (14.01 ± 0.56 seconds) decreased at 1 week (3.97 ± 0.21 seconds; p<0.001) and at 1 month (5.82 ± 0.32 seconds; p<0.001) after the surgery and gradually improved by 3 months (8.26 ± 0.54 seconds; p<0.001) after surgery. Preoperative Schirmer test without anesthesia (18.78 ± 1.17 mm) decreased at 1 week (14.02 ± 1.52 mm; p<0.001) and subsequently recovered by 3 months (16.31 ± 1.34 mm; p>0.05). Preoperative Schirmer test with anesthesia (14.24 ± 0.94 mm) decreased at 1 week (11.98 ± 1.00 mm; p=0.046) after surgery and went back to baseline levels by 3 months (13.80 ± 1.12 mm; p>0.05). Conclusion Patients without dry eye disease, who underwent clear cornea phacoemulsification, did not develop dry eye disease after the surgery. Temporary reduction in physiologic tear levels seen one week postsurgery gradually returned to near-normal baseline levels by the third postoperative month.
Dry Eye Syndromes ; Phacoemulsification

Objectives: To describe the population of dry eye disease (DED) patients seen at the Philippine General Hospital (PGH) Dry Eye Clinic, and to compare the diagnosis, type, and severity of DED using Oculus Keratograph® 5M (Oculus GmbH, Wetzlar, Germany) with clinical diagnosis. Methodology: This was a single-center comparative, cross-sectional study. Newly-diagnosed DED patients were recruited for the dry eye group. A subset of healthy volunteers without DED was also recruited for the control group. The clinical data for both groups were collected, and the Ocular Surface Disease Index (OSDI) questionnaire was administered. Standard clinical dry eye testing and Keratograph testing were subsequently done. The PGH Dry Eye Clinic definitions were used to classify the types of dry eye. Results: Eighty (80) eyes of 40 patients per group were examined. For the dry eye group, the mean age and OSDI scores were significantly higher, while the average tear break up time (TBUT) was significantly lower. There was no significant difference in average basal secretion test (BST) and Schirmer 1 measurements between the two groups. 73% had evaporative type dry eye, while 27% had mixed type. Majority of the DED patients were females of >50 years old with mild evaporative type. Foreign body sensation was the most common symptom. Overall, there was poor agreement between clinical and Keratograph assessments of diagnosis and severity among patients in the dry eye group, but there was acceptable agreement when assessment was done in the control group. Conclusions DED patients at the PGH have similar characteristics to reported DED of other Asian populations. Evaporative or short TBUT type dry eye is the most frequently seen. Further formal validity study is needed for Oculus Keratograph® 5M to increase the value of its data to be included in routine dry eye screening.
Dry Eye Syndromes ; Philippines