The Immunological Basis of Dry Eye Disease and Current Topical Treatment Options.

Homeostasis of the lacrimal functional unit is needed to ensure a well-regulated ocular immune response comprising innate and adaptive phases. When the ocular immune system is excessively stimulated and/or immunoregulatory mechanisms are disrupted, the balance between innate and adaptive phases is dysregulated and chronic ocular surface inflammation can result, leading to chronic dry eye disease (DED). According to the Tear Film and Ocular Surface Society Dry Eye Workshop II definition, DED is a multifactorial disorder of the ocular surface characterized by impairment and loss of tear homeostasis (hyperosmolarity), ocular discomfort or pain, and neurosensory abnormalities. Dysregulated ocular immune responses result in ocular surface damage, which is a further contributing factor to DED pathology. Several therapeutics are available to break the vicious circle of DED and prevent chronic disease and progression, including immunosuppressive agents (steroids) and immunomodulators (cyclosporine and lifitegrast). Given the chronic inflammatory nature of DED, each of these agents is commonly used in clinical practice. In this study, we review the immunopathology of DED and the molecular and cellular actions of current topical DED therapeutics to inform clinical decision making

Pain Sensitivity Associated With the Length of the Maximum Interblink Period.

Pain sensitivity has been identified as a factor that affects how individuals answer dry eye questionnaires, but it is unknown how it affects ocular discomfort. This study used the time that individuals could refrain from blinking as an indicator of ocular discomfort and set out to determine whether it was related to pain sensitivity, while adjusting for ocular surface conditions.Subjects first completed the Pain Sensitivity Questionnaire to quantify pain sensitivity levels. Exposed interpalpebral area, tear meniscus height, tear-film lipid layer thickness, ocular surface cooling, and noninvasive tear breakup were assessed. Subjects were then asked to refrain from blinking until the initial onset of discomfort, which was termed "the maximum interblink period" (MIBP), while ocular surface cooling rate was simultaneously measured. Subjects were seen for four visits over a course of 2 days.Forty-two subjects (36 females, 6 males) completed the study, with a mean (SD) age of 23.2 (3.8) years. A longer MIBP was associated with decreased pain sensitivity (P = 0.04), lower ocular surface cooling rate (P < 0.001), and Asian ethnicity (P = 0.005). Based on the results from the mixed-effect model, it is estimated that individuals would be able to refrain from blinking for an additional 4 seconds if they had the lowest (0.6) compared to the highest (6.1) pain sensitivity in the study cohort.The Pain Sensitivity Questionnaire was associated with the MIBP length even after adjusting for ocular surface conditions, which suggests that pain sensitivity plays a role in influencing how ocular discomfort is perceived

One month use of Systane® improves ocular surface parameters in subjects with moderate symptoms of ocular dryness

Piera Versura, Vincenzo Profazio, Emilio C CamposDepartment of Surgery and Anesthesiology, Section of Ophthalmology, Alma Mater Studiorum University at Bologna, Bologna, ItalyThe data in this paper were first presented at the 9th International Ocular Inflammation Society (IOIS) Annual Meeting, September 17–20, 2007, Paris, France, and the European Association for Vision and Eye Research (EVER) Congress, October 3–6, 2007, Portoroz, SloveniaObjective: To evaluate the efficacy of Systane® Lubricating Eye Drops in improving the symptoms of moderate ocular dryness.Methods: Fifty subjects with moderate symptoms of ocular dryness were enrolled in this open label study. The mean age of subjects was 57.6 ± 15.4 years. To be eligible, subjects’ tear film break-up time (TFBUT) had to be <10 seconds, and subjects had to have at least one ocular discomfort symptom in addition to dryness. Saline was used for a wash-out period of 3–5 days. Subjects were re-examined, and those continuing to meet the inclusion criteria were dispensed Systane® and re-examined again after 28 days. At each visit, slitlamp examination was conducted, and ocular discomfort symptoms and TFBUT were evaluated. Subjects rated their overall satisfaction at baseline and on the last visit.Results: No significant changes in TFBUT or ocular discomfort symptoms were observed after saline use, compared with screening visit. After 28 days of Systane® use there was statistically significant improvement of TFBUT (p = 0.0001) compared with baseline. Subjects experienced significant symptomatic relief for all 6 ocular discomfort symptoms at the endpoint visit.Conclusion: Systane® effectively relieved the symptoms associated with moderate ocular dryness, with measurable improvement in objective TFBUT, subjective symptoms, and overall satisfaction.Keywords: Systane, lubricant eye drops, TFBUT, ocular dryness, ocular symptom

Short term effect of virtual reality on tear film stability and ocular discomfort

Virtual reality (VR) has been integrated and used with smartphones as one of the digital entertainments such as in gaming and movie streaming. With emergent of various VR brands in the market, it concerns the public on the possible side effects of VR on the ocular performance specifically on tear film stability and ocular discomfort. The purpose of this study was to compare the change on non-invasive keratograph tear break-up time (NIKBUT), tear meniscus height (TMH) before and after the use of VR for 30 minutes, and to measure the ocular discomfort after the use of VR quantitatively. Thirty-two subjects were recruited in this study and all the subjects were divided randomly into two groups; VR and laptop (used as a control) groups. Each subject needed to watch a movie for 30 minutes using the respective devices. The changes of tear film stability and ocular discomfort before and after the use of the devices were then compared and the results showed that there was no significant difference (p>0.05) after 30 minutes of the use. Comparison of the ocular parameters between the devices on post-watching activities was also not significant (p>0.05). Use of VR did not give any signs of dryness to the eyes and it can be used without any discomfort even after 30 minutes usage of the devices

Estudo experimental do comportamento ocular em trabalhadores administrativos como um indicador de conforto visual em situação de risco de encadeamento

The daylight impact on the visual environment is fundamental on visual display terminal work (VDT). Visual performance and visual comfort should be considered for equal. The study (n=16) was performed at the experimental lighting laboratory. Office work with VDT was evaluated using STROOP task in two orientations: (with/without solar presence in the visual field). Our hypothesis states the existence of a relationship between ocular behavior and visual comfort of workers. An eye-tracker was employed in order to record the ocular gestural parameters: blinks, direction of gaze, eye aperture (Degree of eye?s openness) and pupil size, which were correlated with the vertical illuminance at the eye. Visual comfort was assessed with Glare Sensation Vote. Results indicate a strong negative linear correlation between eye illuminance and the degree of eye?s openness in the direct sunlight scenario (p=-0.636; s=0.008) and in diffuse light scenario (p=-0.661; s=0.005), that could be the main predictor of visual discomfort. This experiment allowed us to explore eye behavior patterns that could be visual comfort indices under glare risk situations.O impacto a luz do dia no ambiente visual é fundamental para o trabalho no Ecrã de Visualização de Dados (EDV). Desempenho visual e conforto visual devem ser considerados em igual. O estudo (n = 16) foi realizado no laboratório experimental de iluminação. O trabalho de escritório com EDV foi avaliado utilizando a tarefa de Stroop em duas orientações: (com / sem presença solar no campo visual). A nossa hipótese afirma a existência de uma relação entre o comportamento ocular e conforto visual dos trabalhadores. Um “eye-tracker” foi desenvolvido para gravar os parâmetros gestuais oculares: pestanejar, direção do olhar, abertura dos olhos (Grau de abertura do olho) e tamanho da pupila, que foram correlacionados com a iluminância vertical no olho. Conforto visual foi avaliado com a escala de sensação de encadeamento. Os resultados indicam uma correlação linear negativa forte entre a luminosidade dos olhos e do grau de abertura de olho no cenário de luz solar direta (p = -0,636; s = 0,008) e no cenário de luz difusa (p = -0,661; s = 0,005), que poderia ser o principal preditor de desconforto visual. Esta experiência permitiu-nos explorar padrões de comportamento do olho que poderiam ser os índices de conforto visual em situação de risco de encadeamento.Fil: Yamin Garretón, Julieta Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Ciencias Humanas, Sociales y Ambientales; ArgentinaFil: Rodriguez, Roberto Germán. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Ciencias Humanas, Sociales y Ambientales; ArgentinaFil: Pattini, Andrea Elvira. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Ciencias Humanas, Sociales y Ambientales; Argentin

Latanoprost with high precision, piezo-print microdose delivery for IOP lowering: clinical results of the PG21 study of 0.4 µg daily microdose.

Background:Topical high-precision piezo-print delivery of microdoses of latanoprost achieved significant IOP reduction consistent with the eyedropper effect but with a 75% reduced exposure to drugs and preservatives. Prostaglandin analogs are a mainstay glaucoma therapy. However, conventional eyedroppers deliver 30-50 µL drops that greatly exceed the physiologic 7-µL ocular tear film capacity. Eyedropper overdosing floods the eye with excess drug compounds and preservatives, resulting in ocular surface toxicity, periorbitopathy, and other well-characterized ocular side effects. Piezoelectric high-precision microdosing provides targeted delivery that can reduce exposure to both drug and preservatives compared to conventional eyedropper delivery, with the potential to deliver similar biologic effect. Methods:Both eyes (N=60) of 30 healthy volunteers received single 8-µL microdoses of 0.005% latanoprost (0.4 µg; µRx-latanoprost) on the morning of Days 1 and 2 using a high-precision, piezo-print horizontal delivery system. Diurnal IOP was measured before and 2 days after microdosing. Main efficacy outcomes were diurnal IOP change after µRx-latanoprost microdosing and accurate microdosing success rates, and the primary safety outcome was adverse event (AE) incidence. Results:µRx-latanoprost reduced baseline IOP by 26% and 30% at 1 and 2 days postadministration, respectively. Successful topical dosing was achieved in 100% of technician-assisted deliveries. All patients successfully self-administered microdoses after receiving training. Microdose administration was well tolerated and did not result in any AEs. Conclusion:Microdosing of 0.4 µg of µRx-latanoprost achieved significant IOP reduction. Lower ocular exposure with topical prostaglandin analog microdosing can enable new therapeutic opportunities for optimizing glaucoma treatment. Microdosing may also be beneficial in reducing ocular side effects associated with excessive drug product and preservatives often used to treat chronic ocular diseases such as glaucoma

Intracameral lidocaine as supplement to classic topical anesthesia for relieving ocular pain in cataract surgery

● AIM: To evaluate safety, efficacy, and patient adherence of intracameral lidocaine as supplement of classic topical anesthetic drops in cataract surgery. ● METHODS: A prospective and controlled trial including a large cohort of 1650 individuals suffering with bilateral cataract not complicated, in program by phacoemulsification surgery, were randomly assigned to 2 different groups for the type of anesthesia received, 0.4% oxybuprocaine hydrochloride (INN) drops, and INN drops associated to intracameral 1% lidocaine hydrochloride monohydrate. At the end of surgery, tables were assigned to each patient indicating the degree of pain (0-3) felt during the operation. ● RESULTS: Thirty-two percent of patients in group 1 declared to have not felt any pain against the 77% of patients in group 2. Fifty-nine percent of patients in group 1 complained about only a slight discomfort against 20% of group 2 patients. Only a small percentage of patients in group 1 (5%) admitted severe pain, while no patient in group 2 admitted severe pain. Four patients of group 2 reported an episode of transient amaurosis, lasting several hours after surgery. ● CONCLUSION: Intracameral administration of lidocaine is a simple and secure method able to increase the analgesia during the cataract surgery, eliminating the discomfort and increasing also the cooperation of the patients during the steps of manipulation

Ocular and Visual Activities-related Complaints among Healthy Smokers: a Cross-sectional Study

Smoking and the harmful compound in smoke has been associated with many deleterious effects on the eye. Yet, the ocular and visual-related complaints that may arise due to physiological changes are inadequately explored. This study aimed to investigate the effect of smoking behaviour on ocular symptoms. A self-administered questionnaire describing the ocular surface discomfort and visual-related activities was distributed to healthy smokers. Majority of smokers reported severe dry eye symptoms and often complained of glare disability. A comparison of reported symptoms between groups showed older-aged, dual smokers, longer duration of smoking, and current-daily smokers obtained significantly higher scores (p<0.005). Keywords: smoking; ocular complaint; ocular discomfort; dry eye eISSN: 2398-4287 © 2023. The Authors. Published for AMER & cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), and cE-Bs (Centre for Environment-Behaviour Studies), College of Built Environment, Universiti Teknologi MARA, Malaysia DOI:

A rational pharmacovigilance safety appraisal of topical pefloxacin 0.3% ophthalmological drops in bacterial conjunctivitis, in global multi-centre tertiary care hospitals

Background: Pefloxacin is a newer broad-spectrum bactericidal fluoroquinolone antibiotic, with superior antibacterial activity in vivo against pathogenic ocular gram-negative and anaerobic microorganisms and better pharmacokinetic properties. The objective of this clinical research study was the rational pharmacovigilance safety appraisal of topical pefloxacin 0.3% ophthalmological drops in bacterial conjunctivitis, in global multi-centre tertiary care hospitals.Methods: The 43 bacterial conjunctivitis patients were prescribed topical pefloxacin 0.3% ophthalmological drops, 2 drops in each eye after every 3 hours for 2 days, and 2 drops in each eye after every 6 hours for next 5 days. The pharmacovigilance safety appraisal was performed by monitoring the occurrence of adverse drug reactions, like, transient ocular burning or discomfort, ocular irritation, redness, stinging, pruritis, photophobia, ocular watering and dryness, and recording in Adverse Event Case Report Forms, on days 0, 3, 5, 7, 10, 15, 30, and on further follow-ups.Results: In this study, the safety assessment showed that only 1 patient had ocular discomfort in the eye. The occurrence of adverse effects was statistically non-significant. Thus, 0.3% pefloxacin ophthalmological drops treatment was safe and tolerable, among all 43 patients.Conclusions: Therefore, pefloxacin is a safe ocular antibiotic for treating bacterial conjunctivitis, with adequate drug tolerability exhibited by the patients