Microstructural proofs of dry eye changes

PURPOSE: To evaluate and to demonstrate the morphological changes of the Meibomian glands in patients with evaporative `dry eye` compared to normal subjects by in vivo laser scanning confocal microscopy and to correlate these changes to the clinical observations and tear functions.DESIGN: Prospective over controlled case seriesMETHODS: The study was based on trans-tarsal images (optical slices) of 30 normal and 19 diseased lids (patients with subjective complaints and objective symptoms of evaporative `dry eye`). Each participant was examined by in vivo laser scanning confocal microscopy (HRTII Rostock corneal module). The results were compared to histological findings of normal or pathologically changed Meibomian glands.RESULTS: Patients with evaporative `dry eye` presented with destructive changes of the Meibomian glands as follows: occlusion of the lumen, impaired morphology of the acines, lack of normal structure and infiltration with inflammatory cells. Reported ocular surface and tear function abnormalities were correlated to the Meibomian glands dysfunction. In all cases the lid hygiene and anti-inflammatory treatment demonstrated tendency to restoration of the structure.CONCLUSION: In vivo laser scanning confocal microscopy can effectively demonstrate the morphological changes of the Meibomian glands in patients with evaporative dry eye symptoms. This new noninvasive technology is useful as a supplementary diagnostic tool for in vivo assessment of the histopathology of many ocular surface disorders and monitoring of the therapeutic effect in patients with Meibomian glands dysfunction. Glandular acinar density and acinar unit diameter seemed to be promising new parameters of Meibomian glands in vivo confocal microscopy. The examination has the potential to change the evaporative dry eye treatment approach

Advances, limitations and future perspectives in the diagnosis and management of dry eye in Sjogren's syndrome

Primary Sjogren's syndrome is a complex systemic autoimmune disorder that primarily affects exocrine glands such as the lacrimal glands. Dry eye disease is one of the most prevalent complications of Sjogren's syndrome, affecting most patients. It significantly impairs quality of life and management is often difficult and unsatisfactory, in part due to weak correlation between symptoms and signs and poor recognition of the three main subtypes aqueous-deficient, evaporative and neuropathic dry eye. This review provides an overview of key aspects of dry eye disease, such as its multifactorial aetiology and recent insights into pathophysiology. The uses and pitfalls of commonly-used diagnostic tests for dry eye are reviewed, as well as the increasing number of new imaging technologies and biomarkers to refine diagnosis. There are many current and emerging treatment options for dry eye in Sjogren's syndrome, but high-level evidence of efficacy is mostly lacking, as are evidence-based treatment algorithms. All these aspects make the management of dry eye in Sjogren's syndrome challenging

Advances, limitations and future perspectives in the diagnosis and management of dry eye in Sjogren's syndrome

Primary Sjogren's syndrome is a complex systemic autoimmune disorder that primarily affects exocrine glands such as the lacrimal glands. Dry eye disease is one of the most prevalent complications of Sjogren's syndrome, affecting most patients. It significantly impairs quality of life and management is often difficult and unsatisfactory, in part due to weak correlation between symptoms and signs and poor recognition of the three main subtypes aqueous-deficient, evaporative and neuropathic dry eye. This review provides an overview of key aspects of dry eye disease, such as its multifactorial aetiology and recent insights into pathophysiology. The uses and pitfalls of commonly-used diagnostic tests for dry eye are reviewed, as well as the increasing number of new imaging technologies and biomarkers to refine diagnosis. There are many current and emerging treatment options for dry eye in Sjogren's syndrome, but high-level evidence of efficacy is mostly lacking, as are evidence-based treatment algorithms. All these aspects make the management of dry eye in Sjogren's syndrome challenging

Sjögren’s Syndrome as an Ocular Problem: Signs and Symptoms, Diagnosis, Treatment

Sjögren’s syndrome (SS) is an autoimmune disease of exocrine glands, which is characterized by dry mouth and dry eye, though ocular disturbances, such as dry eye disease, may be the first sign of the problem. In pathogenesis of SS, activated T-cells and B-cells infiltrate the lacrimal glands and autoimmune process leading to cell destruction. This process causes hyposecretion of tears and aqueous-deficient dry eye disease. Evaporative dry eye disease is connected with Meibomian gland dysfunction (MGD) and/or goblet cell loss. There are many questionnaires and tests to dry eye disease diagnosing, but there is no “gold standard.” Correlation of data from symptom questionnaires and results of ocular staining score, Schirmer test I (without anesthesia), and break-up-time make it easier to diagnose. The treatment of SS includes both local (tear drops and moistures) and systemic (nonsteroidal anti-inflammatory drugs—NSAIDs, glucocorticoids, and disease-modifying antirheumatic drugs—biologics) therapies, but it is individual. We would like to present recent data on the ocular involvement and perspective of dry eye disease diagnosis and treatment in patients with SS

A mass and solute balance model for tear volume & osmolarity in the normal and the dry eye

Tear hyperosmolarity is thought to play a key role in the mechanism of dry eye, a common symptomatic condition accompanied by visual disturbance, tear film instability, inflammation and damage to the ocular surface. We have constructed a model for the mass and solute balance of the tears, with parameter estimation based on extensive data from the literature which permits the influence of tear evaporation, lacrimal flux and blink rate on tear osmolarity to be explored. In particular the nature of compensatory events has been estimated in aqueous-deficient (ADDE) and evaporative (EDE) dry eye.\ud \ud The model reproduces observed osmolarities of the tear meniscus for the healthy eye and predicts a higher concentration in the tear film than meniscus in normal and dry eye states. The differential is small in the normal eye, but is significantly increased in dry eye, especially for the simultaneous presence of high meniscus concentration and low meniscus radius. This may influence the interpretation of osmolarity values obtained from meniscus samples since they need not fully reflect potential damage to the ocular surface caused by tear film hyperosmolarity.\ud \ud Interrogation of the model suggests that increases in blink rate may play a limited role in compensating for a rise in tear osmolarity in ADDE but that an increase in lacrimal flux, together with an increase in blink rate, may delay the development of hyperosmolarity in EDE. Nonetheless, it is predicted that tear osmolarity may rise to much higher levels in EDE than ADDE before the onset of tear film breakup, in the absence of events at the ocular surface which would independently compromise tear film stability. Differences in the predicted responses of the pre-ocular tears in ADDE compared to EDE or hybrid disease to defined conditions suggest that no single, empirically-accessible variable can act as a surrogate for tear film concentration and the potential for ocular surface damage. This emphasises the need to measure and integrate multiple diagnostic indicators to determine outcomes and prognosis. Modelling predictions in addition show that further studies concerning the possibility of a high lacrimal flux phenotype in EDE are likely to be profitable

Clinical observation on treating evaporative dry eye with the tonifying kidney pill combining with mingmuwuzi

AIM: To observe the clinical effect of the tonifying kidney pills with mingmuwuzi treating evaporative dry eyes.METHODS: This study adopted the positive drug control, prospective study, random number remainder grouping method to 65 cases of outpatient patients diagnosed with evaporative dry eyes which were divided into the treatment group 32 cases(64 eyes)and the control group 33 cases(66 eyes). The treatment group took the decoction of kidney pills with mingmuwuzi, combined with sodium hyaluronate eye drops. The control group simply use sodium hyaluronate eye drops, both group were set to 4wk for a course of treatment. To observe the symptoms and signs of two groups before and after the treatment, the change of the evaluation index and curative effect were evaluated.RESULTS: The effectiveness of the treatment group was 87.5%, the control group was 78.8%, the difference was statistically significant(z=-3.149, PCONCLUSION: The treatment of the kidney pills with mingmuwuzi combined with sodium hyaluronate eye drops to evaporative dry eyes is more effective than the simple use of sodium hyaluronate eye drops

Experimental investigation on performance of fabrics for indirect evaporative cooling applications

© 2016 Indirect evaporative cooling, by using water evaporation to absorb heat to lower the air temperature without adding moisture, is an extremely low energy and environmentally friendly cooling principle. The properties of the wet channel surface in an indirect evaporating cooler, i.e. its moisture wicking ability, diffusivity and evaporation ability, can greatly affect cooling efficiency and performance. Irregular fibres help to divert moisture and enlarge the wetted area, thus promoting evaporation. A range of fabrics (textiles) weaved from various fibres were experimentally tested and compared to Kraft paper, which has been conventionally used as a wet surface medium in evaporative coolers. It was found that most of the textile fabrics have superior properties in moisture wicking ability, diffusivity and evaporation ability. Compared with Kraft paper, the wicking ability of some fabrics was found to be 171%–182% higher, the diffusion ability 298%–396% higher and evaporation ability 77%–93% higher. A general assessment concerning both the moisture transfer and mechanical properties found that two of the fabrics were most suitable for indirective evaporative cooling applications

Redesigning the Management and Treatment Algorithm For Dry Eye Clinicians

Dry eye disease multifactorial aetiologies and complexity makes a single treatment not functional enough to manage different subtypes. Instead, a tailored-managed-therapy plan is needed to lead to an effective treatment of signs and symptoms. An organisation tool to manage dry eye disease was created in 2017 by Tear Film & Ocular Surface Society Dry Eye WorkShop II, yet no differentiation between disease subtype (evaporative dry eye or aqueous dry eye) or severity, was made as a cause of lack of level 1 studies. This thesis sought to compile a series of experimental studies to provide; Additional scientific evidence of management strategies (Chapter 1:), by the means of; identifying therapeutic effects from all different treatment stages (Chapter 2:), assessing if further modifications of this guideline are needed (Chapter 3:) and to disseminate the current prescribing patterns of therapies across the globe (Chapter 4:). Accordingly, this thesis has found that: • Dry eye is being managed worldwide similarly to TFOS DEWS II recommendations, with exception of home-made facecloths. Products prescribed for evaporative dry eye and aqueous dry eye are different. North American and Asia/Middle Eastern regions tend to use a more pharmacological approach at lower levels of dry eye disease severity. • Between liposomal drops, liposomal sprays and emulsion-drops, the decrease in symptomatology was similar, no statistically significant changes happened to homeostatic markers during a 2-week treatment. • Only lipid-based artificial tear provides relief for patients with the evaporative subtype of dry eye, and both lipid-based and a non-lipid based artificial tears, show a 1-month symptomatology decrease for both dry eye subtypes, with signs taking 3-4 months to show a statistically significant improvement. • The use of an automatic massaging-mask provides improvement in symptomatology (subjectively improving severity) after 2 weeks of mask-treatment twice a day. • Eyelid warming therapy, improves Meibomian gland expression quality, regardless of its dropout extent. Debridement helps removing orifice obstruction in patients with Meibomian gland dropout, yet forcible expression provides nonadditional benefit on partial MGs