Characterization of Ocular Surface Symptoms From Optometric Practices in North America

Begley, Carolyn G.; Chalmers, Robin L.; Mitchell, G. Lynn; Nichols, Kelly K.; Caffery, Barbara; Simpson, Trefford; Dutoit, Renee; Portello, Joan K.; Davis, Leverett

doi:10.1097/00003226-200108000-00011

Cited by 265 publications

(164 citation statements)

References 23 publications

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“…24 Less than half of the subjects had been diagnosed with dry eye, but half thought they had dry eye, which is a gestalt question associated with greater dry eye symptoms. 35 Pixel-Based Analysis of Fluorescence Changes After a Blink Figure 1 shows the change in normalized median PI over time for each subject. The median PI decreased for all subjects and in all trials, regardless of whether subjects were in the BU or BUmin group.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Tear Film Fluorescence and Discomfort During Tear Film Instability and Thinning

Begley

Simpson

Liu

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. The purpose of this study was to test the association between tear film fluorescence changes during tear break-up (TBU) or thinning and the concurrent ocular sensory response.METHODS. Sixteen subjects kept one eye open as long as possible (MBI), indicated their discomfort level continuously, and rated ocular sensations of irritation, stinging, burning, pricking, and cooling using visual analog scales (VAS). Fluorescence of the tear film was quantified by a pixel-based analysis of the median pixel intensity (PI), TBU, and percentage of dark pixels (DarkPix) over time. A cutoff of 5% TBU was used to divide subjects into either break-up (BU) or minimal break-up (BUmin) groups. RESULTS.Tear film fluorescence decreased (median PI) and the percentage of TBU and DarkPix increased in all trials, with the rate significantly greater in the BU than the BUmin group (Mann-Whitney U test, P < 0.05). The rate of increasing discomfort during trials was highly correlated with the rate of decrease in median PI and developing TBU (Spearman's, r ‡ 0.70). Significant correlations were found between corneal fluorescence, MBI, and sensory measures.CONCLUSIONS. Concentration quenching of fluorescein dye with tear film thinning best explains decreasing tear film fluorescence during trials. This was highly correlated with increasing ocular discomfort, suggesting that both tear film thinning and TBU stimulate underlying corneal nerves, although TBU produced more rapid stimulation. Slow increases in tear film hyperosmolarity may cause the gradual increase in discomfort during slow tear film thinning, whereas the sharp increases in discomfort during TBU suggest a more complex stimulus.Keywords: tear film instability, tear film break-up, tear film thinning, evaporation, fluorescein concentration quenching, corneal sensory nerves, nociception D ry eye is a common condition, affecting millions in the United States and elsewhere, 1-5 affecting quality of life, [6][7][8] and potentially engendering high health care costs now and in the future. 9 However, despite its prevalence and impact, the underlying etiology of the condition and the basis of dry eye symptoms remain subject to speculation. 10,11The recent international Dry Eye Workshop report identified the core mechanisms of dry eye as tear film hyperosmolarity and instability, which are thought to generate dry eye symptoms through repeated stress to the ocular surface, inflammation, and activation of corneal sensory nociceptors. 10In support of this hypothesis, tear hyperosmolarity has been shown to stress the surface and trigger ocular surface inflammation, 12,13 and recent reports have associated tear film hyperosmolarity with dry eye symptoms. 14 However, while tear film osmolarity is likely to fluctuate markedly or spike 15 in the interblink interval due to evaporation or other factors, [16][17][18] it cannot be measured directly over the cornea with current techniques of sampling the tears from the inferior meniscus. 19 Thus, changing conditions within the tear film during ins...

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Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Tear Film Fluorescence and Discomfort During Tear Film Instability and Thinning

Begley

Simpson

Liu

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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“…[3][4][5][6][7] Similar studies conducted in several countries around the world including Germany, 8 Australia, 9,10 Japan, [11][12][13][14] India, 15 Thailand, 16 and Indonesia 17 have resulted in similar prevalence estimates. As summarized in the DEWS report, the prevalence of dry eye is most likely in the range of 5-30% of the population aged Z50 years.…”

Section: Introductionmentioning

confidence: 91%

Neuropathic ocular pain: an important yet underevaluated feature of dry eye

Galor

Levitt

Felix

et al. 2014

Eye

185

187

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Dry eye has gained recognition as a public health problem given its prevalence, morbidity, and cost implications. Dry eye can have a variety of symptoms including blurred vision, irritation, and ocular pain. Within dry eyeassociated ocular pain, some patients report transient pain whereas others complain of chronic pain. In this review, we will summarize the evidence that chronicity is more likely to occur in patients with dysfunction in their ocular sensory apparatus (ie, neuropathic ocular pain). Clinical evidence of dysfunction includes the presence of spontaneous dysesthesias, allodynia, hyperalgesia, and corneal nerve morphologic and functional abnormalities. Both peripheral and central sensitizations likely play a role in generating the noted clinical characteristics. We will further discuss how evaluating for neuropathic ocular pain may affect the treatment of dry eye-associated chronic pain.

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“…Blepharitis is more common in the ever-growing older age group [4] with close to half of the sufferers requiring treatment [6] . Patients with dry eye and blepharitis (DEB) have their daily activities disrupted [7] and work productivity lowered [8] due to recurrent blurred vision and ocular discomfort. Moderateto-severe dry eye damages the ocular surface epithelium [9] and produces ocular surface inflammation [10] .…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Topical Atorvastatin for the Treatment of Dry Eye Associated with Blepharitis: A Pilot Study

Ooi¹,

Wakefield

Billson

et al. 2015

Ophthalmic Res

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Aims: To elucidate if topically applied atorvastatin safely decreases corneal fluorescein staining in dry eyes associated with blepharitis. Methods: Ten dry eye and blepharitis (DEB) patients were enroled in a prospective pilot study. All patients were treated with topical atorvastatin (50 μM) 8 times a day for 4 weeks and allowed to continue with their existing dry eye treatment. The patients were examined weekly for 4 weeks. The primary outcome measure was corneal fluorescein staining. Secondary outcome measures were tear film break-up time (BUT), Schirmer I testing, blepharitis score and bulbar conjunctival injection. The subjective efficacy was evaluated with global symptom and facial analogue scores. Results: An improvement in corneal fluorescein staining in the treated eye by >1 point from baseline to completion of the trial at week 4 was found in 9 of 10 patients (p < 0.01). Topical atorvastatin significantly improved the tear film BUT (p < 0.01), blepharitis score (p < 0.05) and bulbar conjunctival injection (p < 0.05). The global symptom score and facial analogue score also improved (p < 0.05). There were no side effects. Conclusion: Topical atorvastatin is a potential therapy for DEB patients. Larger comparative clinical studies are required to establish the efficacy and safety of topical atorvastatin.

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Characterization of Ocular Surface Symptoms From Optometric Practices in North America

Cited by 265 publications

References 23 publications

Quantitative Analysis of Tear Film Fluorescence and Discomfort During Tear Film Instability and Thinning

Quantitative Analysis of Tear Film Fluorescence and Discomfort During Tear Film Instability and Thinning

Neuropathic ocular pain: an important yet underevaluated feature of dry eye

Efficacy and Safety of Topical Atorvastatin for the Treatment of Dry Eye Associated with Blepharitis: A Pilot Study

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