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9 pages, 245 KB  
Article
Eyes of Fibromyalgia
by Arzu Dinç Yavaş, Akasya Şaipi and Sümeyye Akçay
Biomedicines 2026, 14(8), 1656; https://doi.org/10.3390/biomedicines14081656 - 23 Jul 2026
Viewed by 395
Abstract
Background/Objectives: Fibromyalgia (FM) is a multifactorial disorder characterized by chronic pain, fatigue, asthenia, and sleep disturbances. FM may have effects on the eyes, such as dry eye disease (DED) and retinal changes. The aim of this study is to evaluate these ocular [...] Read more.
Background/Objectives: Fibromyalgia (FM) is a multifactorial disorder characterized by chronic pain, fatigue, asthenia, and sleep disturbances. FM may have effects on the eyes, such as dry eye disease (DED) and retinal changes. The aim of this study is to evaluate these ocular changes in FM patients. Methods: It is a single-center prospective study. Forty-two female patients with FM (Group 1) and 37 healthy controls (Group 2) participated in the study. Study participants underwent screening tests for DED and the retinal nerve fiber layer (RNFL) thickness. Results: According to the Schirmer test, Group 1 had lower scores with a significant difference (8.2 ± 4.36 mm vs. 17.51 ± 2.41 mm). When the tear film breakup time (TBUT) test values were analyzed, there was a significant difference between groups; Group 1 had lower scores (4.95 ± 2.26 s vs. 9.86 ± 1.64 s). When the RNFL thickness values were analyzed by quadrants, our results in Group 1 FM patients were lower in the superior temporal quadrant (117.98 ± 13.98 µm vs. 124.35 ± 13.71 µm). Conclusions: These findings indicate that patients with fibromyalgia may have increased dry eye findings and localized RNFL thinning, suggesting that fibromyalgia may be associated with both anterior and posterior segment ocular alterations. However, these parameters should be interpreted as ocular manifestations rather than diagnostic markers. Further studies are needed to determine their clinical relevance and potential biomarker value. Full article
(This article belongs to the Special Issue Clinical and Translational Advances in Neuro-Ophthalmology)
12 pages, 598 KB  
Article
Beyond the Cornea: Early Changes in Scleral, Iris, and Corneal Parameters After Corneal Collagen Cross-Linking
by Tunahan Akyol, Osman Parca, Emine Seker Un, Ibrahim Toprak and Gokhan Pekel
J. Clin. Med. 2026, 15(12), 4428; https://doi.org/10.3390/jcm15124428 - 8 Jun 2026
Viewed by 333
Abstract
Background/Objectives: To evaluate early postoperative changes in scleral and iris thicknesses together with corneal layer thicknesses and tomographic parameters following corneal collagen cross-linking (CXL) in eyes with progressive keratoconus. Methods: This retrospective study included 94 eyes of 94 patients with progressive keratoconus who [...] Read more.
Background/Objectives: To evaluate early postoperative changes in scleral and iris thicknesses together with corneal layer thicknesses and tomographic parameters following corneal collagen cross-linking (CXL) in eyes with progressive keratoconus. Methods: This retrospective study included 94 eyes of 94 patients with progressive keratoconus who underwent standard epithelium-off CXL using the Dresden protocol. Corneal tomography (Pentacam) and anterior segment optical coherence tomography (AS-OCT) measurements were obtained preoperatively and at the early postoperative follow-up (3 months ± 2 weeks). Thickness measurements of the tear film, corneal epithelium, Bowman layer, stroma, Descemet–endothelium complex, sclera (1–3 mm from the limbus), and iris (1–2 mm from the pupillary margin) were analyzed. Pre- and post-CXL values were compared using paired statistical tests, and effect sizes were calculated. Results: In the early postoperative period, scleral thickness showed a significant increase at all measured distances from the limbus, with medium effect sizes, while iris thickness demonstrated a significant decrease at all measurement points with large effect sizes (p < 0.001). Tear film, epithelial, and stromal thicknesses decreased significantly after CXL, whereas Bowman layer and Descemet–endothelium complex thicknesses remained unchanged. Pachymetric measurements revealed significant thinning at the pupil center, corneal apex, and thinnest point. No significant changes were observed in Kmax or anterior chamber depth, indicating stabilization rather than progression in the early postoperative period. Conclusions: Corneal collagen cross-linking was associated with measurable early structural changes in corneal layers and extra-corneal anterior segment tissues during the postoperative period. The observed increase in scleral thickness and decrease in iris thickness suggest that structural alterations may occur in extra-corneal anterior segment tissues following CXL. These findings support the concept that CXL influences anterior segment biomechanics in a tissue-specific manner and that extra-corneal parameters may serve as complementary markers for early postoperative assessment. Full article
(This article belongs to the Special Issue Diagnosis and Management of Corneal Diseases)
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12 pages, 1298 KB  
Article
The Effects of Intraocular Pressure-Lowering Drops on the Tear Film Assessed by a Novel High-Resolution Tear Film Imager
by Alice Verticchio Vercellin, Samuel Potash, Kira Manusis, Paul A. Sidoti, Richard B. Rosen, Brent A. Siesky, Keren Wood, Lily A. Greenberg, Peter D’Amelia, Edan Kenig, Norman J. Kleiman, David J. Brenner, George J. Eckert, Lucia Tanga, Carmela Carnevale, Masako Chen, David Qi, Minwoo Kwon and Gal Antman
Diagnostics 2026, 16(10), 1482; https://doi.org/10.3390/diagnostics16101482 - 13 May 2026
Viewed by 524
Abstract
Background/Objectives: The aim of this study was to investigate the effects of intraocular pressure (IOP)-lowering drops on the sublayers of the human tear film as assessed by a novel nanometer-resolution Tear Film Imager (TFI, AdOM, Israel). Methods: In a prospective, cross-sectional study, 98 [...] Read more.
Background/Objectives: The aim of this study was to investigate the effects of intraocular pressure (IOP)-lowering drops on the sublayers of the human tear film as assessed by a novel nanometer-resolution Tear Film Imager (TFI, AdOM, Israel). Methods: In a prospective, cross-sectional study, 98 eyes from 56 adult human subjects were imaged using the TFI. The dataset included data from 18 eyes from 12 subjects treated with preserved IOP-lowering drops and 80 eyes from 44 control subjects not under ocular hypotensive therapy. Subjects in the IOP treatment group used a variety of IOP-lowering medications, including prostaglandin analogs, beta-blockers, carbonic anhydrase inhibitors, alpha agonists, and combination drops. A linear mixed effects model was used to assess the association between IOP-lowering therapy and tear film (TF) metrics, controlling for age and intra-individual correlation. The following parameters were measured: muco-aqueous layer thickness (MALT), muco-aqueous layer thinning rate (MALTR), lipid layer thickness (LLT), lipid map uniformity (LMU), inter-blink intervals (IBI), and lipid break-up time (LBUT). Results: Average ages significantly differed (p = 0.013) between the treatment group (66.5 years) and control group (average age 51.5 years), and thus results were adjusted for age accordingly. IOP was 17.1 mmHg in the treatment group and 16.1 mmHg in the control group. When analyzing the sublayers of the TF, MALTR had a significant association with IOP-lowering therapy after adjusting for age, with a difference of −52.68 nm/s; 95% confidence interval [−96.87, −8.48]; p-value = 0.020. Additionally, IBI was significantly associated with IOP-lowering therapy after log transformation (p = 0.049), with shorter IBI in the treatment group. All other metrics (MALT, LLT, LMU, and LBUT) were statistically insignificant (p > 0.05). Conclusions: These pilot results suggest that IOP-lowering drops may accelerate thinning of the TF, specifically the muco-aqueous layer. Longitudinal studies with significantly larger samples are needed to specify the differential impact of various ocular hypotensive therapies on the human TF and the clinical implications of these findings. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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14 pages, 2084 KB  
Article
Marine-Derived Neoagarotetraose Alleviates Dry Eye Disease by Suppressing Inflammation and Apoptosis in a Murine Model
by Nan Wu, Yating Du, Chaocheng Wu, Zhuhua Chan and Runying Zeng
Mar. Drugs 2026, 24(5), 175; https://doi.org/10.3390/md24050175 - 12 May 2026
Viewed by 944
Abstract
Dry eye disease (DED) is a complex ocular surface disorder characterized by tear film instability, chronic inflammation, and epithelial damage, for which current treatments remain limited. Marine-derived bioactive oligosaccharides have attracted increasing interest due to their diverse pharmacological activities and favorable safety profiles. [...] Read more.
Dry eye disease (DED) is a complex ocular surface disorder characterized by tear film instability, chronic inflammation, and epithelial damage, for which current treatments remain limited. Marine-derived bioactive oligosaccharides have attracted increasing interest due to their diverse pharmacological activities and favorable safety profiles. In this study, we investigated the therapeutic potential of neoagarotetraose (NA4), a marine oligosaccharide derived from red algal agar, in a murine model of DED. DED was induced in eight-week-old female C57BL/6 mice by topical instillation of 0.2% benzalkonium chloride for seven consecutive days. NA4 was administered topically at concentrations of 125, 250, and 500 mg/L. Therapeutic outcomes were evaluated by tear secretion, corneal fluorescein staining, histopathological analysis, immunofluorescence staining for Ki67, F4/80, IL-1β, IL-6, and TNF-α, TUNEL assay for apoptosis, and ELISA for cytokine levels. NA4 treatment significantly improved tear secretion and reduced corneal fluorescein staining scores. Histological analysis revealed that NA4 preserved corneal epithelial thickness and restored conjunctival goblet cell density. Immunofluorescence analysis revealed that NA4 reversed inflammation-associated epithelial hyperproliferation and attenuated macrophage infiltration. Moreover, NA4 markedly suppressed the expression and tissue levels of IL-1β, IL-6, and TNF-α, and attenuated corneal epithelial apoptosis, with the 500 mg/L NA4 group showing no significant difference in efficacy compared to the positive control 0.1% sodium hyaluronate. These findings demonstrate that NA4, a marine-derived oligosaccharide, exerts multi-targeted protective effects against DED by improving tear film stability, preserving ocular surface integrity, suppressing inflammation, and reducing apoptosis. Our study highlights the potential of marine oligosaccharides such as NA4 as promising candidates for ocular surface disease management and supports the further exploration of marine resources for ophthalmic therapeutic applications. Full article
(This article belongs to the Section Marine Pharmacology)
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13 pages, 1088 KB  
Article
Evaluating Dry Eye Disease Subtypes Based on Whole-Area Lipid Layer Thickness Assessment
by Hyunmin Ahn, Young Joon Choi, Ikhyun Jun, Tae-im Kim and Kyoung Yul Seo
J. Clin. Med. 2026, 15(9), 3553; https://doi.org/10.3390/jcm15093553 - 6 May 2026
Viewed by 504
Abstract
Background/Objectives: Lipid layer thickness (LLT) is widely used to assess tear film status in dry eye disease (DED), but single-point measurements may not adequately reflect spatial lipid distribution driven by tear film dynamics. This study evaluated whether the combined assessment of inferior and [...] Read more.
Background/Objectives: Lipid layer thickness (LLT) is widely used to assess tear film status in dry eye disease (DED), but single-point measurements may not adequately reflect spatial lipid distribution driven by tear film dynamics. This study evaluated whether the combined assessment of inferior and superior corneal LLT provides additional clinical relevance for interpreting DED subtypes. Methods: This cross-sectional study included 614 eyes of 614 patients with DED. Inferior corneal LLT (LLTinf) was measured using a tear interferometer, and superior corneal LLT (LLTsup) was graded using an LED-based slit-lamp assessment. DED parameters, including meibomian gland expressibility (MGE), meibum quality, tear meniscus height, Schirmer I test, and fluorescein tear break-up patterns, were analyzed. Results: Low LLTinf showed worse meibomian gland function, with higher MGE scores than in the high LLTinf group (1.9 ± 0.8 vs. 1.2 ± 0.9, p < 0.001). Higher LLTinf was associated with lower aqueous parameters, and aqueous deficiency was observed in 57.4% of the high LLTinf group increasing to 83.0% when LLTsup was low. Combined LLTinf–LLTsup assessment improved the prediction of aqueous deficiency compared with LLTinf alone (AUC, 0.719 vs. 0.559). Improvement for moderate-to-severe MGD was smaller (AUC 0.731 vs. 0.653). Conclusions: LLT reflects not only lipid secretion, but also aqueous-driven distribution. The combined assessment of LLTinf and LLTsup may improve the interpretation of LLT findings and provide additional insight into tear film dynamics in DED. However, its predictive performance remains moderate, suggesting that this approach is considered a complementary interpretive framework rather than a standalone diagnostic tool. Full article
(This article belongs to the Special Issue Meibomian Gland Dysfunction and Dry Eye Diseases)
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9 pages, 219 KB  
Article
Marginal Eyeliner Use and Meibomian Gland Function
by Mariam Alkawally, Rachelle J. Lin, Corina van de Pol, Alan Sasai, Andrew Loc Nguyen and Jerry R. Paugh
J. Clin. Med. 2026, 15(7), 2616; https://doi.org/10.3390/jcm15072616 - 29 Mar 2026
Viewed by 646
Abstract
Background/Objectives: To investigate whether chronic cosmetics use near or directly on the eyelid margin contributes to tear film instability and meibomian gland dysfunction. Methods: Subjects were enrolled in one of three groups: those who rarely wear makeup (No-M), those who wear it frequently [...] Read more.
Background/Objectives: To investigate whether chronic cosmetics use near or directly on the eyelid margin contributes to tear film instability and meibomian gland dysfunction. Methods: Subjects were enrolled in one of three groups: those who rarely wear makeup (No-M), those who wear it frequently but only outside the eyelid margin (Min-M), and those who wear it frequently and directly on the eyelid margin (W-M). Subjects were assessed for dry eye signs and symptoms by a masked examiner. Lipid layer thickness (LLT), tear meniscus height, meibomian gland excreta grade, number of glands secreting, corneal and conjunctival staining and tear breakup time were assessed. Results: 10 No-M, 18 Min-M, and 21 W-M subjects completed the study. Average fluorescein breakup time was 4.6 s in each group (p = 0.839, 1-way ANOVA). There were higher scores (worse findings) in the marginal eyeliner sample for symptoms (modified Schein, OSDI, SPEED), Oxford and total NEI staining and lower lid meibomian secretions. The W-M group demonstrated a statistically significant increase in the meibomian gland excreta grade (a worsening) compared to the No-M group (mean grades 1.2 and 0.55 respectively; Tukey test, adjusted p < 0.05, 95% CI 0.055–1.187). LLT, tear breakup time, eyelid marginal signs, and meibomian gland dropout had no differences among groups. Conclusions: Eyeliner wear both outside and on the eyelid margin demonstrated increased ocular staining and decreased gland excretion quality, compared to non-makeup users. The meibomian gland excreta decrement may lead to worsening meibomian gland function and potentially glandular atrophy over time. Full article
(This article belongs to the Special Issue Meibomian Gland Dysfunction and Dry Eye Diseases)
21 pages, 16353 KB  
Review
Anterior Segment Optical Coherence Tomography with Angiography for the Cornea and Ocular Surface
by Qiu Ying Wong, Ralene Sim and Marcus Ang
J. Clin. Med. 2026, 15(6), 2402; https://doi.org/10.3390/jcm15062402 - 21 Mar 2026
Cited by 1 | Viewed by 1127
Abstract
Background/Objectives: Anterior segment optical coherence tomography (AS-OCT) and optical coherence tomography angiography (AS-OCTA) have enhanced the evaluation of the cornea, ocular surface, and ocular surface diseases (OSD), offering high-resolution structural and anterior segment vascular imaging. This review summarizes recent advances in these [...] Read more.
Background/Objectives: Anterior segment optical coherence tomography (AS-OCT) and optical coherence tomography angiography (AS-OCTA) have enhanced the evaluation of the cornea, ocular surface, and ocular surface diseases (OSD), offering high-resolution structural and anterior segment vascular imaging. This review summarizes recent advances in these modalities and their clinical applications. Methods: A comprehensive literature search was conducted using PubMed, Web of Science, and Google Scholar with the terms OCT, OCTA, anterior segment, and ocular surface disease. Studies published in the past five years were included, emphasizing more recent developments such as ultra-high-resolution AS-OCT (UHR-AS-OCT) and swept-source AS-OCTA technologies. Results: UHR-AS-OCT provides non-invasive, sub-micron imaging of the cornea and the ocular surface, including tear film morphology and epithelial thickness to correlate with clinical tests such as tear break-up time, and fluorescein staining. Advances in AS-OCTA allow dye-free, depth-resolved imaging of corneal and conjunctival vasculature. These vascular biomarkers have shown promising utility in conditions such as limbal stem cell deficiency, chemical ocular injury, and ocular surface squamous neoplasia. Improvements in image acquisition, motion correction, and segmentation algorithms have enhanced accuracy and repeatability, supporting broader clinical translation. Conclusions: AS-OCT and AS-OCTA have become useful adjunctive imaging tools for the cornea and ocular surface evaluation. Their non-invasive, quantitative, and reproducible metrics may enable earlier diagnosis, objective staging, and longitudinal monitoring of OSD. Integration of OCT-based imaging with artificial intelligence and multimodal data, including tear proteomics and meibography, may optimize personalized treatment for ocular surface disorders. Full article
(This article belongs to the Special Issue Ocular Surface Disease: Epidemiology, Diagnosis and Management)
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13 pages, 807 KB  
Article
Tear Film Interferometry, Meibography, and Optical Coherence Tomography Angiography for Rosacea
by Matteo Capobianco, Marco Zeppieri, Federico Visalli, Francesco Pellegrini, Leandro Inferrera, Rosa Giglio, Irene Gattazzo, Francesco Cappellani, Fabiana D’Esposito and Caterina Gagliano
Diseases 2026, 14(3), 105; https://doi.org/10.3390/diseases14030105 - 12 Mar 2026
Viewed by 904
Abstract
Background/Objectives: Rosacea is a chronic inflammatory dermatosis that may involve the eye, causing surface and adnexal damage that can precede cutaneous signs. Detecting subclinical ocular changes is clinically important because early ocular surface dysfunction may be missed on routine examination yet progress to [...] Read more.
Background/Objectives: Rosacea is a chronic inflammatory dermatosis that may involve the eye, causing surface and adnexal damage that can precede cutaneous signs. Detecting subclinical ocular changes is clinically important because early ocular surface dysfunction may be missed on routine examination yet progress to corneal complications, allowing earlier preventive management when identified. We prospectively evaluated subclinical ocular alterations in cutaneous rosacea using a combined, fully non-invasive high-tech imaging workflow—tear film interferometry, infrared meibography, and exploratory retinal optical coherence tomography angiography (OCT-A)—including patients without clinically evident ocular involvement. Methods: Sixteen patients with cutaneous rosacea (mean age 44.3 ± 11.2 years; 4 males, 12 females) were enrolled and divided into: Group 1—rosacea with clinically evident ocular involvement (n = 11); Group 2—rosacea without clinical ocular involvement (n = 5). Six age-matched healthy subjects served as controls (Group 3). All underwent LipiView II® interferometry and meibography to quantify lipid-layer thickness (LLT, nm) and meibomian gland (MG) loss score (1 = normal–4 = severe), plus retinal OCT-A (Optovue Inc., Fremont, CA, USA). ANOVA with post hoc Tukey test assessed inter-group differences. Results: OCT-A showed no significant alterations in superficial or deep retinal plexuses across groups (p > 0.05). Conversely, LLT was significantly reduced in both rosacea groups vs. controls (OD: 45.5 ± 21.4 nm and 67.4 ± 10.1 nm vs. 92.7 ± 8.2 nm; OS: 40.4 ± 15.3 nm and 66.4 ± 10.1 nm vs. 96.0 ± 6.7 nm; p < 0.001). MG score was markedly higher (worse) in rosacea (OD: 3.63 ± 0.50 and 3.20 ± 0.83 vs. 1.83 ± 0.75; OS: 3.45 ± 0.68 and 3.40 ± 0.54 vs. 1.66 ± 0.81; p < 0.001). Ocular symptoms were reported by 85% of patients yet slit-lamp examination revealed surface alterations in 58% of asymptomatic cases. Conclusions: Tear film interferometry and meibography detect early ocular surface impairment in rosacea—even in the absence of clinical signs—while retinal microvasculature appears unaffected. Routine ophthalmologic screening of all rosacea patients could enable prompt treatment of subclinical dysfunction, potentially preventing corneal complications. Retinal OCTA metrics were not significantly different in this small pilot cohort, and these negative findings should be interpreted cautiously pending larger studies. Full article
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13 pages, 1237 KB  
Article
Intraoperative Use of a Topical Anesthetic Gel Versus Balanced Salt Solution During Cataract Surgery: Effects on Corneal Structure and Ocular Surface
by Pier Giuseppe Ruggeri, Alberto Carnicci, Matilde Buzzi, Fabrizio Giansanti and Rita Mencucci
J. Clin. Med. 2026, 15(5), 1992; https://doi.org/10.3390/jcm15051992 - 5 Mar 2026
Viewed by 786
Abstract
Background/Objectives: During cataract surgery, topical anesthesia is routinely achieved through the instillation of topical anesthetic eye drops, while different agents may be applied to the corneal surface during the procedure to support lubrication and protection. The impact of these intraoperative strategies on corneal [...] Read more.
Background/Objectives: During cataract surgery, topical anesthesia is routinely achieved through the instillation of topical anesthetic eye drops, while different agents may be applied to the corneal surface during the procedure to support lubrication and protection. The impact of these intraoperative strategies on corneal integrity and postoperative ocular surface recovery remains an area of clinical interest. This study aimed to compare the intraoperative and postoperative effects of applying a topical anesthetic gel (Ophtesic, Horus Pharma) on the corneal surface versus the use of balanced salt solution (BSS) during cataract surgery. Methods: In this longitudinal, observational prospective study, 24 eyes of 24 patients undergoing phacoemulsification received either topical anesthetic gel (n = 15) or BSS irrigation (n = 9). Central corneal thickness (CCT) and epithelial thickness were measured preoperatively and on postoperative days 1, 5, and 15 using anterior segment optical coherence tomography (AS-OCT). Basal epithelial cell (BEC) density was assessed by in vivo confocal microscopy (IVCM), while OSDI score, non-invasive breakup time (NI-BUT), and Schirmer test I values were evaluated preoperatively and on postoperative days 5 and 15. Patient and surgeon satisfaction were rated using a Likert-like scale. Results: Both groups showed increased CCT and epithelial thickness at day 1. In the gel group, CCT returned to baseline by day 15 (p = 0.361), and epithelial thickness normalized by day 5 (p = 0.066). In the BSS group, CCT remained elevated at day 15 (p < 0.05), and epithelial thickness decreased at day 5 (p < 0.05) before returning to baseline. BEC density normalized at day 15 in the gel group (p = 0.107) but remained altered in the BSS group (p < 0.05). NI-BUT Schirmer I, and OSDI showed a trend toward faster recovery in the gel group than in the BSS group. Conclusions: In this exploratory study, intraoperative application of a topical anesthetic gel appeared to support early normalization of corneal and tear film parameters while providing effective anesthesia. Further studies are warranted to confirm these observations and evaluate potential long-term benefits. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Clinical Treatment of Corneal Diseases)
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16 pages, 1084 KB  
Systematic Review
Lipid Layer Thickness in Soft Contact Lens Wearers With and Without Lenses In Situ—A Systematic Review and Meta-Analysis
by Maria Sobol and Jacek Pniewski
J. Clin. Med. 2026, 15(3), 1110; https://doi.org/10.3390/jcm15031110 - 30 Jan 2026
Viewed by 655
Abstract
Objectives: To systematically review and quantitatively synthesize lipid layer thickness (LLT) measurements in soft contact lens (CL) wearers obtained in the presence and absence of contact lenses in situ. Methods: A systematic literature search of PubMed, Scopus, and Web of Science databases was [...] Read more.
Objectives: To systematically review and quantitatively synthesize lipid layer thickness (LLT) measurements in soft contact lens (CL) wearers obtained in the presence and absence of contact lenses in situ. Methods: A systematic literature search of PubMed, Scopus, and Web of Science databases was conducted in accordance with PRISMA guidelines. Six studies meeting predefined inclusion criteria were included. Pooled mean LLT values were calculated using fixed-effects models, with heterogeneity, sensitivity analyses, and publication bias assessed. Results: In the absence of contact lenses, pooled LLT data from 86 healthy CL wearers yielded a mean LLT of 62.11 nm (95% CI: 47.33–76.90 nm). In the presence of contact lenses, pooled data from 330 subjects demonstrated a mean LLT of 69.52 nm (95% CI: 56.33–82.70 nm). Although LLT values were numerically higher with contact lens wear, the substantial overlap of confidence intervals indicated no consistent or statistically demonstrable difference between conditions. Conclusions: This meta-analysis provides the first quantitative synthesis of LLT in CL wearers and highlights the need for standardized methodologies to clarify the clinical relevance of LLT in contact lens-related tear film assessment. Full article
(This article belongs to the Special Issue Latest Advances in Ocular Surface Diseases)
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12 pages, 393 KB  
Article
Impact of Positive Airway Pressure and Mask Leakage on Dry Eye and Glaucoma Risk in Obstructive Sleep Apnea: A Cross-Sectional Analysis
by Wei-Xiang Wang, Ya-Ning Chuang, Chen-Ni Chang, Mei-Chen Yang and Elizabeth P. Shen
Biomedicines 2025, 13(12), 3077; https://doi.org/10.3390/biomedicines13123077 - 13 Dec 2025
Cited by 1 | Viewed by 1651
Abstract
Purpose: This study investigates the association between obstructive sleep apnea (OSA), dry eye disease (DED), and glaucoma, focusing on the impact of positive airway pressure (PAP) usage and air leakage. Methods: This retrospective cross-sectional study included 57 adults with polysomnography-confirmed OSA between 2010 [...] Read more.
Purpose: This study investigates the association between obstructive sleep apnea (OSA), dry eye disease (DED), and glaucoma, focusing on the impact of positive airway pressure (PAP) usage and air leakage. Methods: This retrospective cross-sectional study included 57 adults with polysomnography-confirmed OSA between 2010 and 2023. Participants were grouped into PAP users (PAP+, n = 40) and non-users (PAP−, n = 17). Ocular assessments included tear film break-up time, Schirmer’s test, Oxford staining, meibomian gland evaluation, intraocular pressure, cup-to-disc (C/D) ratio, and retinal nerve fiber layer thickness. PAP device data (usage duration and air leak rate) and OSA severity metrics were recorded. Group comparisons used chi-square and Student’s t-test, and regression analyses identified associations between PAP leakage and ocular parameters. Results: Among the 57 OSA patients, PAP users showed a trend toward a higher risk of glaucoma (OR = 0.83) and DED (OR = 0.69) compared to non-users, but neither trend was statistically significant. PAP users had significantly more severe OSA, including longer N1 sleep stage (p = 0.0005), higher apnea-hypopnea index (AHI, p = 0.0001), and poorer oxygenation. PAP leakage: 95% (mean = 25.84 L/min) exceeded the 24 L/min threshold specified in ResMed’s clinical guidelines, suggesting suboptimal therapy. Higher PAP leak was significantly associated with a lower Schirmer’s test value (p = 0.031) and a higher C/D ratio (p = 0.040) on regression analysis. However, no significant differences were found in ophthalmic parameters between PAP+ and PAP− groups. Conclusions: Suboptimal PAP therapy as mask leakage or nocturnal hemodynamic changes may worsen evaporative dry eye and affect intraocular pressure. Our findings highlight the association between PAP mask leakage and reduced tear production, and suggest that OSA-related optic nerve stress may persist unless both hypoxia and nocturnal IOP fluctuations are properly managed. However, due to the relatively small sample size and retrospective cross-sectional design, future prospective studies with larger cohorts are needed to confirm these associations. Full article
(This article belongs to the Special Issue Recent Research on Dry Eye)
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19 pages, 1127 KB  
Review
Ocular Manifestations of Celiac Disease: Current Evidence and Clinical Implications
by Monika Senterkiewicz, Anna Szaflarska-Popławska and Bartłomiej J. Kałużny
Nutrients 2025, 17(23), 3781; https://doi.org/10.3390/nu17233781 - 2 Dec 2025
Viewed by 2544
Abstract
Background: Celiac disease (CD) is a systemic autoimmune disorder triggered by gluten exposure in genetically predisposed individuals. Beyond gastrointestinal symptoms, CD is increasingly recognized to affect extraintestinal organs, including the eye. Methods: A PubMed, Cochrane, Web of Science, and Scopus databases search up [...] Read more.
Background: Celiac disease (CD) is a systemic autoimmune disorder triggered by gluten exposure in genetically predisposed individuals. Beyond gastrointestinal symptoms, CD is increasingly recognized to affect extraintestinal organs, including the eye. Methods: A PubMed, Cochrane, Web of Science, and Scopus databases search up to April 2025 was conducted to identify studies on ocular involvement in CD. Results: Large population-based cohorts have demonstrated an increased risk of cataract and uveitis in individuals with CD. Cross-sectional and case–control studies further report reduced tear break-up time and decreased Schirmer test values, indicating tear film instability and associated ocular surface abnormalities. Additional findings include reduced anterior chamber depth and volume, alterations in subfoveal and peripapillary choroidal thickness, thinning of the retinal nerve fiber layer, and microvascular changes such as reduced superficial and deep capillary plexus densities. Furthermore, deficiencies of vitamins A, D, B12, and iron have been consistently associated with structural and functional ocular alterations, underscoring the contribution of impaired nutrient absorption. Conclusions: Ocular involvement in CD likely reflects the interplay of immune dysregulation, nutritional deficiencies, and microvascular alterations. Ophthalmic referrals should be considered in CD patients presenting with ocular symptoms. Early recognition and regular monitoring may facilitate timely diagnosis, improve visual outcomes, and support normal ocular development. Full article
(This article belongs to the Section Nutritional Immunology)
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14 pages, 986 KB  
Article
A Randomised Pilot Trial to Demonstrate the Feasibility of a Prototype Electronic Heating Device in Patients with Meibomian Gland Dysfunction
by Jacqueline Tan, Tianni Jia, Sidra Qamar, Jennie Diec and Fiona Stapleton
Biomedicines 2025, 13(12), 2952; https://doi.org/10.3390/biomedicines13122952 - 30 Nov 2025
Viewed by 1756
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Recent Research on Dry Eye)
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22 pages, 1012 KB  
Review
From Tears to Toxins: Mapping Antibiotic Passage Through the Eye–Liver Axis
by Ivan Šoša
Antibiotics 2025, 14(11), 1069; https://doi.org/10.3390/antibiotics14111069 - 24 Oct 2025
Cited by 2 | Viewed by 1851
Abstract
Traditionally used to combat infections, systemic effects of antibiotics are increasingly recognized in the context of absorption through unconventional routes. One such as the ocular surface. This review tackles the bidirectional liver–eye axis, highlighting how trace antibiotic residues from environmental and therapeutic sources [...] Read more.
Traditionally used to combat infections, systemic effects of antibiotics are increasingly recognized in the context of absorption through unconventional routes. One such as the ocular surface. This review tackles the bidirectional liver–eye axis, highlighting how trace antibiotic residues from environmental and therapeutic sources affect the tear film, disturb ocular microbiota, and impact liver metabolism. It engages in anatomical pathways, microbial regulation, pharmacokinetics, and systemic immune responses. Additionally, this review discusses forensic uses and new therapeutic strategies, stressing the importance of integrated environmental monitoring and precision medicine to tackle nonmedicinal antibiotic exposure. Due to the absence of results from a systematic literature review, a narrative literature review was undertaken instead. More than 100 studies discussing mechanistic, clinical, and experimental insights were reviewed, with 98 of those studies being documented as source literature. The findings demonstrate that antibiotics may penetrate and be absorbed through the ocular surface, cause modifications of the hepatic first-pass metabolism, and change the activity of cytochrome P450. Correlations were documented between the various liver function biomarkers and the ocular tear film, as well as the thickness of the retinal pigment epithelium. The dysbiosis of eye microbiota may be an indicator of systemic inflammation associated with immune dysregulation. Restoring microbial homeostasis and addressing systemic dysregulation are novel therapeutic approaches, including the use of probiotics, nanoparticle scavengers, and CRISPR. The eye is a sensory organ and a metabolically active organ. Systemically, the eye can affect the liver through the ocular surface and the antibiotics through the liver–eye axis. To protect the systemic health of the individual and the lensed metabolically active eye, the eye and liver must be viewed as a sentinel of systemic balance. Novel therapies will be necessary with the added need for environmental monitoring. Full article
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9 pages, 854 KB  
Brief Report
The Effects of Age on the Human Tear Film Assessed with a Novel Imaging Device
by Alice Verticchio Vercellin, Lauren J. Isserow, Richard B. Rosen, Paul A. Sidoti, Brent A. Siesky, Keren Wood, Nathan Schanzer, Francesco Oddone, Carmela Carnevale, Tak Yee Tania Tai, Masako Chen, Kira Manusis, Katy Tai, David J. Brenner, Norman J. Kleiman, Samuel Potash, George J. Eckert and Gal Antman
Diagnostics 2025, 15(17), 2256; https://doi.org/10.3390/diagnostics15172256 - 6 Sep 2025
Cited by 3 | Viewed by 1592
Abstract
Purpose: We aimed to analyze the effects of age on human tear film (TF) using a novel nanometer resolution TF imaging device (Tear Film Imager, TFI, AdOM, Israel). Methods: 44 healthy adult subjects (≥18 years of age) without ocular or systemic diseases or [...] Read more.
Purpose: We aimed to analyze the effects of age on human tear film (TF) using a novel nanometer resolution TF imaging device (Tear Film Imager, TFI, AdOM, Israel). Methods: 44 healthy adult subjects (≥18 years of age) without ocular or systemic diseases or prior eye treatments with ages spanning seven decades were enrolled in this prospective cross-sectional study. Subjects underwent a comprehensive ophthalmic examination and completed the Ocular Surface Disease Index questionnaire (OSDI). All study participants underwent TF imaging using the TFI, including assessment of muco-aqueous layer thickness (MALT), lipid-layer thickness (LLT), inter-blink interval, and lipid map uniformity. Associations between TFI parameters and age were tested using linear regression (accounting for multiple eyes). Results: A total of 80 eyes (44 subjects) were imaged: 19 eyes from 10 subjects in the 3rd decade of life (aged 20–29); 10 eyes from 5 subjects in the 4th decade of life (aged 30–39); 5 eyes from 3 subjects in the 5th decade of life (40–49); 12 eyes from 7 subjects in the 6th decade of life (50–59), 19 eyes from 11 subjects in the 7th decade of life (60–69); 11 eyes from 6 subjects in the 8th decade of life (70–79); and 4 eyes from 2 subjects in the 9th decade of life (80–89). With increasing age, MALT significantly decreased (p = 0.024), and LLT significantly increased (p = 0.001). No statistically significant linear age effects were found for the other TFI parameters (p > 0.05) or the OSDI scores of study participants of different ages (p = 0.786). Conclusions: Quantitative TF biomarkers varied significantly with advancing age in healthy individuals, highlighting the importance of accounting for age in TF assessments. Full article
(This article belongs to the Section Clinical Diagnosis and Prognosis)
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