Search Results (98)

Background and Objectives: Tear film instability and corneal surface irregularity are important sources of variability in keratometric and corneal topographic measurements, particularly affecting astigmatic magnitude and axis. Accurate preoperative biometry is crucial for optimal refractive outcomes in cataract surgery. Dry eye disease (DED) may compromise the reproducibility of keratometric parameters, leading to errors in intraocular lens (IOL) power calculation. This study aimed to evaluate the impact of DED on the reproducibility of keratometric measurements and to assess the effect of a four-week treatment with lipid-containing artificial tears on these parameters in cataract patients. Materials and Methods: This cross-sectional study included 116 patients scheduled for cataract surgery, of whom 65 (56.0%) had DED and 51 (44.0%) served as controls. All patients underwent two preoperative keratometric measurements 10–20 min apart (IOL1 and IOL2). The control group proceeded to surgery the next day, while surgery in the DED group was postponed. Patients with DED received preoperative therapy with lipid-containing artificial tears. Follow-up assessments occurred one month after therapy (keratometric measurement named IOL3) and eight weeks postoperatively. Clinical evaluation included slit-lamp examination, dry eye testing according to Dry eye Workshop II (DEWS II) criteria: Ocular surface Disease Index (OSDI), Tear Break-Up Time (TBUT), Schirmer I, Oxford staining, and meibomian gland assessment), ocular biometry, and postoperative spherical equivalent measurement using an auto ref-keratometer. Nonparametric statistical analyses were applied to evaluate associations between parameters. Results: In the DED group, corneal astigmatism showed a significant difference between IOL1 and IOL2 (Wilcoxon signed-rank test {Z = 2.43; p = 0.015}). Significant changes in predicted IOL power were observed between pretreatment and posttreatment values (t = 2.57; p = 0.013) and between IOL2 and IOL3 (t = 2.23; p = 0.029), indicating improved keratometric stability following tear film therapy. No additional significant correlations were identified. Conclusions: DED adversely affects the reproducibility of keratometric measurements and may compromise IOL power selection. Preoperative identification and treatment of DED, followed by repeated biometry after tear film stabilization, are strongly recommended to enhance refractive accuracy and optimize surgical outcomes in cataract patients. Full article

Dry Eye Disease (DED) is a highly characterised multifactorial disease resulting in the loss of tear film homeostasis and associated with a major impact on patient quality of life. DED affects up to half of the global population, with modern lifestyle factors playing a critical role in disease development, particularly excessive use of digital devices. The ultimate treatment goal is restoration of tear film homeostasis and breaking the ‘vicious circle’ of DED. Today, the use of tear substitutes represents the main option for the treatment of DED. These topical formulations aim to provide lubrication, reduce osmolarity, and improve tear clearance. However, they do not interact with the ocular surface epithelium nor modulate ocular inflammation, and do not fully restore natural tear function. T-LysYal is the first supramolecular ocular surface modulator for DED. Studies demonstrate that T-LysYal promotes tissue repair, improves tear breakup time, restores corneal epithelial cell damage, and modulates inflammation processes, significantly reducing the severity of DED symptoms in patients. In addition, T-LysYal provides stability that prolongs activity and favours cell adhesion. Through its 3D nanotube structure, movement of water in the eye is retained and improved, enhancing ocular hydrodynamics. This narrative review introduces T-LysYal for DED whilst highlighting both its in vitro activity and clinical profile against hyaluronic acid, a mainstay of disease management. Full article

Objectives: To compare the effects of two preoperative dry eye treatments—3% diquafosol sodium (DQS) and intense pulsed light with meibomian gland expression (IPL-MGX)—on refractive accuracy in cataract surgery and identify tear break-up time (TBUT) thresholds predictive of refractive success. Methods: In this prospective, paired-eye study, 62 patients (124 eyes) with meibomian gland dysfunction underwent bilateral cataract surgery with the same trifocal intraocular lens. One eye received DQS, while the fellow eye underwent four IPL-MGX sessions before biometry. Postoperative absolute prediction error (P-SE) was compared. TBUT and higher-order aberrations (HOAs) were evaluated. Logistic regression identified predictors of refractive accuracy, and receiver operating characteristic (ROC) analysis assessed the predictive value of TBUT for P-SE thresholds of <0.25 D and <0.50 D. Results: P-SE was significantly lower in IPL-MGX–treated eyes than in DQS-treated eyes (mean paired difference −0.11 D, p < 0.001). Success rates within <0.25 D and <0.50 D were higher with IPL-MGX (p < 0.01). TBUT and HOAs were predictors in univariate models, but only TBUT remained significant in the multivariable analysis (odds ratio, 4.90 per 1-s increase; 95% confidence interval, 1.92–12.51; p < 0.001). ROC analysis supported TBUT cutoffs of 7 s (<0.25 D) and 6 s (<0.50 D). Conclusions: IPL-MGX may improve refractive accuracy compared to DQS. TBUT appeared to be the most consistent predictor, and achieving ≥6 s was associated with higher likelihood of refractive success. Full article

Background: Type 2 diabetes mellitus (T2DM) is increasingly recognized as affecting not only the retina but also the ocular surface. Chronic hyperglycemia can disrupt meibomian gland function, reduce tear secretion, and impair corneal sensitivity, leading to tear film instability and symptoms of dry eye disease. However, previous studies have reported variable findings, and the extent of these alterations remains uncertain. Methods: Following PRISMA guidelines, this systematic review and meta-analysis evaluated observational studies that compared tear film parameters between adults with T2DM and non-diabetic controls. Eligible studies assessed one or more of the following: invasive or non-invasive tear break-up time, Schirmer test, tear meniscus height, or Ocular Surface Disease Index (OSDI). Results: Twenty-four studies involving approximately 3500 eyes were included. Most reported significantly reduced tear stability and secretion in diabetic participants compared with controls. Tear break-up times were consistently shorter in T2DM, indicating a less stable tear film. Schirmer test results demonstrated lower tear production correlated with diabetes duration and poor glycemic control. Tear meniscus height was modestly reduced in T2DM, reflecting decreased tear reservoir volume. Subjective symptoms, as measured by OSDI, were generally higher among patients with T2DM, suggesting greater ocular surface discomfort. Conclusions: T2DM is strongly associated with tear film instability, reduced tear secretion, and increased dry eye symptoms. These findings suggest that diabetic care should include routine ocular surface assessment and highlight the need for standardized, longitudinal investigations. Full article

Background and Objectives: Ankylosing spondylitis (AS) is a chronic inflammatory disorder frequently associated with acute anterior uveitis; however, it may also predispose individuals to dry eye disease. We aimed to evaluate dry eye in AS participants employing both conventional tests and conjunctival impression cytology (Nelson grading) to compare their sensitivity in detecting ocular surface changes. Materials and Methods: This prospective case–control study enrolled 24 patients with AS and 27 age- and sex-matched healthy controls. Dry eye was evaluated using the Schirmer I test (measuring tear production), fluorescein tear break-up time (BUT, assessing tear film stability), the Ocular Surface Disease Index (OSDI) questionnaire (evaluating symptoms), and conjunctival impression cytology (analyzing ocular surface changes). Intergroup differences were assessed using non-parametric statistical methods, and their correlations with clinical variables were examined. Results: Nelson conjunctival cytology scores were significantly higher in AS patients than control subjects (1.63 ± 0.92 vs. 0.74 ± 0.86; p = 0.001), indicating greater conjunctival goblet cell loss and squamous metaplasia. In contrast, Schirmer, BUT, and OSDI observations did not differ significantly between AS and control subjects (all p > 0.05). Within AS, the Nelson cytology grade did not correlate accompanied by tear test observations or disease activity indices, and symptom scores did not align accompanied by Schirmer or BUT values. Conclusions: AS patients demonstrated evidence of subclinical dry eye changes detectable by impression cytology even when standard tests were normal. Conjunctival cytology was more sensitive than Schirmer, BUT, or symptom assessment in identifying ocular surface involvement in AS. Integrating such ocular surface evaluation into AS management could allow earlier diagnosis of dry eye and prompt intervention to improve patient quality of life. Full article

Objectives: To compare the safety and efficacy of a prototype electronic heating device, Meiboleyes^®, with the BRUDER Moist Heat Eye Compress for the treatment of Meibomian Gland Dysfunction (MGD). Methods: Adults with evidence of active MGD (Ocular Surface Disease Index [OSDI] score ≥ 13, fluorescein tear break-up time [TBUT] < 10 s and meibomian gland secretion score ≤ 12 for 15 glands of the lower lid) were enrolled in this prospective, randomised, parallel group, investigator-masked dispensing study (Australian New Zealand Clinical Trials Registry–ACTRN12624000175572). Meibomian gland secretion (MGS) score and number of meibomian glands yielding liquid secretion (MGYLS), lipid layer thickness, TBUT, ocular physiology and subjective symptoms were measured at baseline, and 2 weeks and 6 weeks following treatment. Linear mixed model analysis was conducted to compare the two groups and changes over time. Results: Ten participants (average age 38.7 ± 14.5 years) in the Meiboleyes^® test group, and 10 participants (average age 38.9 ± 14.8 years) in the BRUDER control group completed the study. MGS and MGYLS significantly improved in both treatment groups from baseline to the 2-week and 6-week follow-up visits (p ≤ 0.006). Significant improvements in TBUT (5.5 ± 1.8 vs. 8.3 ± 2.1 s, p = 0.044), OSDI scores (45.2 ± 15.1 vs. 27.4 ± 12.9, p = 0.027) and visual analogue scale dryness (55.3 ± 27.2 vs. 28.0 ± 23.9, p = 0.023) were observed in the Meiboleyes^® group only after 6 weeks of treatment. No other significant differences were observed over time or between groups. Eight treatment-related adverse events were reported in the Meiboleyes^® group compared to seven in the BRUDER group. All resolved without sequalae. Conclusions: The prototype Meiboleyes^® device was safe and effective for use as an at-home treatment for MGD when used twice daily for six weeks. Improvements in meibomian gland function were comparable to the BRUDER Moist Heat Eye Compress, but significant improvements in tear film stability and subjective comfort after 6 weeks of treatment were observed in the Meiboleyes^® group only. Full article

Background: Platelets have conventionally been viewed as cellular fragments crucial for hemostasis; nonetheless, their extensive secretome of cytokines and growth factors has been increasingly acknowledged as a significant regulator of inflammation and tissue healing at the ocular surface. Aims: The objective of this narrative review is to synthesize existing knowledge of platelet biology with new findings about the therapeutic use of platelet-derived products in dry eye disease (DED). Methods: A qualitative review of the PubMed, Scopus, and Web of Science databases up to June 2025 identified preclinical, translational, and clinical studies assessing platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), platelet lysate, and autologous serum tears for dry eye disease (DED) and associated ocular surface disorders. Results: Platelet-derived formulations have exhibited reliable immunomodulatory and regenerative effects by diminishing inflammatory signaling, lowering cytokine expression, and facilitating epithelial and neurotrophic restoration. Clinical investigations have indicated enhancements in tear film stability, corneal staining, and patient-reported symptoms, especially in cases of moderate-to-severe or refractory illness. Nonetheless, methodological diversity, inconsistent preparation techniques, and restricted sample sizes have impeded comparability among experiments. Conclusions: Platelet-derived treatments constitute a biologically viable and clinically promising strategy for the management of dry eye disease (DED). Future research must emphasize the standardization of preparation protocols, the identification of predictive biomarkers such as transforming growth factor-β1 (TGF-β1), nerve growth factor (NGF), and matrix metalloproteinase-9 (MMP-9), as well as the design of multicenter randomized controlled trials to guarantee reproducible, GMP-compliant clinical applications. Full article

Background: The purpose of this study was to assess differences in clinical symptoms and signs of DED in non-adherent to treatment patients to describe long-term disease progression. Methods: 120 patients previously diagnosed with Dry Eye Disease (DED) were contacted to undergo a second eye examination. The final included participants were classified into three groups based on when the second examination was scheduled: 4 years (Group 1; n = 33), 6 years (Group 2; n = 18) or 8 years (Group 3; n = 37) since the diagnostic visit. All included participants were classified as ‘non-adherent to DED treatment’, defined as patients who reported not following their prescribed DED therapy. In both examinations, Ocular Surface Disease Index (OSDI) questionnaire, tear film osmolarity, inter-eye osmolarity (osmolarity |OD-OS|), Fluorescein Break-Up Time (FBUT), Maximum Blink Interval (MBI) and corneal staining were evaluated. Results: OSDI score improved after 4 years of DED diagnosis (Group 1, mean difference close to 12 points, p < 0.001) and after 8 years (Group 3, mean difference of 9 points, p < 0.001), but remained stable after 6 years (Group 2, p = 0.328). Osmolarity worsened only after 6 years of DED diagnosis (Group 2, mean difference of 13.2 mOsm/L, p = 0.011), while osmolarity |OD–OS| showed no change (all p ≥ 0.231). FBUT values were stable across all groups (all p ≥ 0.265). MBI increased after 4 and 8 years of DED diagnosis (Groups 1 and 3, p ≤ 0.003), but not after 6 years (Group 2, p = 0.391). Corneal staining worsened after 8 years of DED diagnosis (Group 3, 0.55 points, p = 0.011), with no changes at 4 or 6 years (Groups 1 and 2, both p ≥ 0.318). Conclusions: In non-adherent DED patients, osmolarity |OD-OS| and tear film stability remain stable during the natural course of the disease, while ocular surface damage increases. However, the subjective symptomatology and the nociceptive blink reflex due to ocular discomfort decreased since the diagnostic visit. Full article

Purpose: The purpose of this study was to investigate dry eye disease (DED) characteristics in patients with keratoconus (KC) using non-invasive methods. Methods: A total of 34 participants were included in the study. Corneal topography was conducted for each participant utilizing Pentacam, followed by grouping according to the results obtained. The patients with Kmax > 47.2 D (KC) were considered the keratoconus group (n = 17). Healthy control participants with Kmax < 47.2 D were considered the control group (n = 17). Non-invasive tear breakup time (NITBUT), tear meniscus height (TMH), (OSDI) questionnaire, meibography, and lipid layer evaluation were assessed across the groups. Results: Dry eye assessment revealed that the mean non-invasive tear breakup time (NITBUT) was significantly shorter in the keratoconus group (9.88 ± 3.25 s) compared to the control group (18.94 ± 4.26 s, p < 0.001). Tear meniscus height was also reduced in the keratoconus group (0.185 ± 0.053 mm) versus the control group (0.358 ± 0.076 mm, p < 0.001). OSDI scores were higher in the keratoconus group (21.41 ± 5.93) compared to the control group (7.52 ± 5.05, p < 0.001), reflecting greater subjective dry eye symptoms. Meibography showed more severe Meibomian gland dropout in the keratoconus group (2.11 ± 0.60 vs. 0.70 ± 0.34, p < 0.001). Lipid layer evaluation showed no significant difference between groups (p = 0.070). Conclusions: These findings suggested a significant correlation between keratoconus and dry eye disease, with keratoconus patients showing reduced tear film stability, decreased tear volume, and increased meibomian gland dysfunction. While lipid layer changes were not significant, the results emphasized the need for comprehensive evaluation of ocular surface parameters in keratoconus management. Full article

Background and Objectives: Dry eye disease (DED) is a multifactorial ocular surface disease that markedly diminishes quality of life. Although diabetes mellitus is well-known for its retinal consequences, anterior segment symptoms including dry eye disease are often overlooked. Chronic hyperglycemia causes metabolic, neurovascular, and immunological changes that undermine tear film stability, corneal innervation, and ocular surface integrity. This review seeks to consolidate existing knowledge regarding the concealed impacts of diabetes on ocular surface homeostasis, highlighting processes, diagnostic difficulties, and treatment prospects. Materials and Methods: A narrative review of the literature was performed by searching PubMed for publications from January 2020 to July 2025 using the terms “diabetic dry eye,” “hyperglycemia AND ocular surface,” “tear proteomics AND diabetes,” “corneal nerves AND diabetes,” and “neurotrophic keratitis.” Eligible studies were experimental research, clinical trials, and translational investigations concerning tear film function, corneal neuropathy, inflammatory indicators, or lacrimal gland dysfunction in diabetes. The exclusion criteria were non-English language, lack of primary data, and inadequate methodological description. Results: Hyperglycemia compromises lacrimal gland functionality, modifies lipid secretion from Meibomian glands, and diminishes corneal nerve density, resulting in neurotrophic deficits. Inflammatory cytokines and oxidative stress compromise epithelial integrity, but proteome alterations in tears serve as sensitive indicators of disease. Diagnosis is impeded by corneal hypoesthesia, resulting in a disconnection between symptoms and findings. Progress in imaging, proteomics, and artificial intelligence may facilitate earlier detection and improved risk assessment. Novel therapeutics, such as neurotrophic drugs, antioxidants, and customized anti-inflammatory approaches, show promise but remain under clinical evaluation. Conclusions: Diabetes-related dry eye disease is a multifaceted and underappreciated condition influenced by systemic metabolic dysfunction. The ocular surface may act as an initial indicator for systemic disease load. Narrative synthesis emphasizes the necessity for customized diagnostic instruments, individualized treatment approaches, and collaborative management. Reconceptualizing diabetic dry eye disease within the context of systemic metabolic care presents prospects for precision medicine strategies that enhance both ocular and systemic results. Full article

Background: Dry Eye Disease (DED) is a multifactorial ocular disorder characterized by tear film instability, inflammation, oxidative stress, and ocular surface damage. Current therapeutic options often provide only temporary relief and are limited by poor patient compliance and inadequate drug retention at the ocular surface. Aim: This review aims to critically analyze the therapeutic potential of polyphenols and their nanoencapsulated formulations for the management of DED, focusing on pharmacological mechanisms, formulation strategies, and translational implications. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science databases using combinations of the following keywords: “dry eye disease,” “polyphenols,” “antioxidants,” “nanocarriers,” “ocular delivery,” and “bioavailability.” Studies published in English from 2000 to 2024 were considered. Inclusion criteria encompassed experimental, preclinical, and clinical studies evaluating polyphenol-based formulations for ocular application, while reviews without original data or studies unrelated to DED were excluded. Results: The analysis identified EGCG, curcumin, resveratrol, and quercetin as the most extensively investigated polyphenols, exhibiting antioxidant, anti-inflammatory, and cytoprotective activities through modulation of cytokines, reactive oxygen species, and immune signaling pathways. Nanoformulations such as lipid nanoparticles, micelles, and cyclodextrin complexes improved solubility, stability, ocular retention, and bioavailability, leading to enhanced therapeutic efficacy in preclinical DED models. Conclusions and Future Perspectives: Polyphenol-loaded nanocarriers represent a promising approach for improving the management of DED by enhancing local drug delivery and sustained release. However, further clinical studies are needed to assess long-term safety, scalability, and regulatory feasibility. Future research should focus on optimizing formulation reproducibility and exploring personalized nanotherapeutic strategies to overcome interindividual variability in treatment response. Full article

Background: The increasing prevalence of high-fat diets is associated with a rise in metabolic and neurodegenerative diseases. The retina and retinal pigment epithelium are metabolically active tissues exposed to oxidative stress, making them particularly vulnerable to lipid excess. Materials and Methods: A systematic literature review was conducted covering years until 2025 inclusive. Results: High-fat diets lead to cholesterol accumulation and lipid metabolism disturbances in the retina, retinal pigment epithelium, and ocular vessels. They activate inflammatory and oxidative stress pathways, resulting in structural and functional damage. Omega-3 deficiency exacerbates inflammation, while supplementation improves the tear film stability, corneal epithelial function, intraocular pressure regulation, and exerts neuroprotective effects. Conclusions: High-fat diets represent a significant risk factor for ocular diseases by disrupting lipid metabolism, enhancing inflammation, and inducing oxidative stress. Omega-3 fatty acid supplementation reduces inflammation and supports ocular functions. Full article

Most people with obesity who have undergone gastric bypass surgery have dyslipidemia. Because tear film layers play a major role in the pathogenesis of evaporative dry eye, some studies suggest that dry eye syndrome (DES) and dyslipidemia could cooperate in the ocular system. This study aimed to investigate whether tear film conditions are correlated with blood lipid levels. We calculated a sample of 29 patients in this study. We measured the characteristics of the tear film via the Schirmer test and tear break-up time (BUT) test; three measurements were made, and the average value was subsequently recorded. High-density lipoprotein (HDL) correlated positively with BUT (p < 0.05), but cholesterol and triglycerides correlated negatively with Schirmer (p < 0.05 and p < 0.001, respectively). Our findings suggest that HDL levels significantly influence ocular tear film stability and that triglycerides and cholesterol influence the aqueous component of the tear film, which is conducive to the hypothesis that postgastric bypass surgery tear deficiencies could be mainly of evaporative origin and not watery. Bariatric patients may have a high likelihood of suffering dry eye by modifications in the lipid tear layer; however, the development of DES in bariatric patients remains unclear. Thus, high levels of cholesterol and triglycerides could be associated with aqueous-type dry eye (main gland production), and low HDL levels could be associated with evaporative-type dry eye (meibomian gland production). Full article

Dry eye disease (DED) is a multifactorial ocular surface disorder that significantly affects vision and quality of life. While artificial tears are the standard first-line therapy, their effectiveness is limited by the complex pathophysiology of DED. This study evaluated DayDrop^® Triple Action, a novel formulation combining hyaluronic acid (HA), ectoine, and carboxymethylcellulose (CMC), designed to enhance tear film stability and ocular surface protection. Physicochemical and rheological properties were assessed, including viscosity, pseudoplasticity, and viscoelastic behaviour under dynamic conditions, along with ectoine release over 24 h. An in vitro allergic conjunctivitis model using conjunctival fibroblasts exposed to a pro-allergic cytokine cocktail was employed to examine immunomodulatory effects. DayDrop^® Triple Action demonstrated high viscosity with pronounced pseudoplasticity and stable viscoelasticity, supporting improved mucoadhesion. The formulation provided sustained ectoine release and exhibited a positive immunomodulatory effect, likely linked to ectoine’s preferential hydration mechanism, which stabilizes membranes and reduces inflammatory signalling. These findings suggest that DayDrop^® Triple Action integrates viscoelastic optimization, osmoprotection, and targeted anti-inflammatory action, offering a promising non-pharmacological strategy for managing DED and allergic ocular surface disorders. Full article

Purpose: To investigate regional changes in tear film quality associated with orthokeratology (Ortho-K) lens wear using high-resolution spatial mapping and to evaluate the potential of artificial intelligence (AI) models in anticipating these changes. Methods: This study analysed tear film quality in 92 Ortho-K wearers divided into three groups based on lens wear duration (10–29 days, 30–90 days, and ≥91 days). Placido-based topographer measurement was used to generate regional tear film maps before and after treatment. A custom MATLAB pipeline enabled regional comparisons and statistical mapping. A feedforward neural network was trained to forecast local tear film quality using spatial data. Results: Single-value global mean metrics showed minimal changes in tear film quality across groups. However, regional mean mapping revealed significant mid-peripheral and peripheral deterioration over time, particularly in nasal and temporal corneal zones. These changes were often overlooked by global averaging and remained invisible through tear film breakup time (TBUT) measurements. The AI model predicted spatial tear quality with high accuracy (R ≥ 0.9 in testing), capturing nuanced regional variations. Conclusions: The regional analysis uncovers subtle, clinically relevant tear film disruptions caused by Ortho-K lens wear, particularly in peripheral areas. These insights challenge the adequacy of traditional single-value global mean assessments. The AI model demonstrates the potential for non-invasive, predictive evaluation of tear stability, supporting more personalised and effective Ortho-K care. Full article