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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaClinico San Carlos, Madrid, Spain; 2 Ophthalmology, 2UniversityClinic Hospital, Düsseldorf, Germany.Purpose: To evaluate the thickness of the lipid layer of the tear filmin healthy subjects with a new interferometry device (Lipiview®)before and after instillation of various commercially available tearsubstitutes with lipid composition.Methods: Ten healthy subjects (20 eyes) were included in arandomized, double-masked study to participate in a three-day visitevaluation. Before, subjects completed a dry eye questionnaire(ocular surface disease index-OSDI-) to evaluate symptoms of dryeye. Only normal individuals, defined as a Schirmer test resultwithout anaesthesia above 10 mm/5min and Tear Break Up Time(TBUT) above 7s were included. A semiautomated interferometre(Lipiview® system), was used to measure the precorneal tear lipidlayer thickness followed by measurement of the non-invasive breakup time (NITBUT) with Oculus Keratograph® 5M. Then one of threelipid emulsion eye drops/spray (which main components containedwere lipid carbomer, rizin oil and lecithin soy respectively) wasapplied while the fellow eye received sodium hyaluronate, sodiumcarboxymethylcellulose or saline spray solution for negative control.In randomised sequence and after one week of wash-out betweenmeasurements, the 2nd and again one week later a 3rd emulsion wasalso studied. Measurements were performed at baseline and at 15, 30,60, and 120 minutes after instillation of the drops or application ofthe spray.Results: Tear lipid layer thickness significantly increased in allsubjects after lipid emulsion instillation. The emulsion with lipidcarbomer showed a significant increase at 15 and 30 time points frombaseline (p=0.012 and p=0.01). The emulsion with rizin oil alsosignificantly raised lipid layer thickness for 15 and 30 minutes(p=0.009 and p=0.002) and showed good correlation with NIBUT(p=0.001), as this parameter also increased from baseline at the sametime points. Lecithin soy spray significantly increased the lipidconcentration at 30 minutes only (p=0.006).Conclusions: Lipid emulsion eye drops significantly increase thelipid layer thickness of the tear film measured with Lipiview® inhealthy subjects. This effect lasts for only 30 minutes afterinstillation. The lipid layer thickness correlated well with the NIBUT.Commercial Relationships: Lara Borrego, None; Federico Saenz-Frances, None; David Finis, Oculus (R); Jose M. Benitez-del-Castillo, None; Gerd Geerling, Alcon (C), Allergan (C), TheaPharma (C), Novagali (C), Bausch & Lomb (C), Tearlab Inc. (C)Program Number: 6016 Poster Board Number: A0079Presentation Time: 10:30 AM - 12:15 PMBenzalkonium chloride-induced rat dry eye model mimicshyperosmolarity in tear volume deficient dry eye diseaseDavi L. Marques 1 , Monica Alves 1, 2 , Carolina Modulo 1 , LeonardoMalki 1 , Peter Reinach 1 , Eduardo M. Rocha 1 . 1 Universidade de SãoPaulo, Ribeirão Preto, Brazil; 2 Pontific Catholic University ofCampinas, Campinas, Brazil.Purpose: Chronic use of antiglaucomatous eye drops withbenzalkonium chloride (BAK) leads to ocular surface disease andtear film hyperosmolarity. In rodent BAK dry eye disease (DED)models, it is unclear if BAK induces hyperosmolarity. We show inrats that the BAK DED model also entails development of tear filmhyperosmolarity since tear volume collection is sufficient to monitorosmolarity changes.Methods: Unanesthesized male rats (n=10) were treated twice dailywith PBS containing 0.2% BAK in the right eye, whereas the left eyeserved as a control. After 7 days, tear film osmolarity was measuredwith the TearLab Osmolarity System (Ocusense). Phenol Red Threadtest (PRT) evaluated tear fluid rates in 15 sec whereas vital stainingmonitored ocular surface integrity. Observers evaluated stainingmagnitude by assigning arbitrary values of from 1-to 18. Lightmicroscopy evaluated corneal epithelial thickness.Results: Tear flows were 7.6 ± 2.01 mm in controls and 3.40 ± 0.67mm in BAK treated eyes (p=0.03). Lissamine staining was 1.0 ± 0.77in control and 8.40 ± 1.36 in BAK group (p=0.01); and fluoresceinwas 2.20 ±0.96 in control and 9.80 ±1.49 in BAK group. Controlosmolarity was 284.0 ± 3.29 mOsm and with BAK 306 ±4.09 mOsm(p=0.01). Corneal epithelial thickness decreased by day 7 relative tothat in the control group. Seven days after suspending BAKapplication, all changes recovered to their control values.Conclusions: The rat BAK DED model is novel since increases intear film osmolarity were measurable. This model is relevant sincethese rises mimic those identified in tear volume deficient patientsafflicted with DED.Commercial Relationships: Davi L. Marques, None; MonicaAlves, None; Carolina Modulo, None; Leonardo Malki, None;Peter Reinach, None; Eduardo M. Rocha, NoneSupport: Fundação de Amparo à Pesquisa do Estado de São Paulo -FAPESPProgram Number: 6017 Poster Board Number: A0080Presentation Time: 10:30 AM - 12:15 PMDebridement of the Lower Lid Margin and Line of Marx iseffective in increasing meibomian gland function and patientcomfortCaroline A. Blackie 1, 2 , Donald R. Korb 1, 2 . 1 TearScience, Morrisville,NC; 2 Korb Associates, Boston, MA.Purpose: The purpose of this study was to evaluate whethermechanical debridement of the Line of Marx (LOM) and the lowerlid margin would improve meibomian gland function and reduce dryeye symptoms.Methods: 16 symptomatic subjects undergoing treatment forevaporative dry eye (age range: 26-81 yrs, mean: 55.9 +/- 15.0 yrs)who also evidenced anteroplacement and a thickened LOM, wereenrolled and consented according to the tenets of the Declaration ofHelsinki. Exclusion criteria included active ocularinfection/inflammation, ocular surgery within the previous 6 months,lid abnormalities other than those related to meibomian glanddysfunction and/or normal age related lid margin changes. Prior todebridement the LOM was stained with lissamine green (OdysseyMedical, TN). The entire width of the keratinized lower lid marginwas debrided, followed by debridement of the stained LOM using astainless steel, foreign body, golf club spud (Akorn Ophthalmics, IL).Meibomian gland function and symptoms were assessed pre andapproximately 1-month post lid margin debridement. No new oradditional treatment was permitted during the 1-month postdebridement period. Using standardized diagnostic expression withthe meibomian gland evaluator, meibomian gland function wasevaluated along the full length of the lower lid margin. Symptomswere evaluated with the SPEED questionnaire (maximum score =28). Only data for the right eye is reported.Results: There was a significant decrease in symptoms and increasein the number of functional meibomian glands as a result of thedebridement of the lid margin and LOM. Symptoms: baseline meanpre-debridement = 13.4 +/- 4.6 and 1 month post-debridement = 10.5+/- 3.7 (p < 0.0001, paired t-test). Number of functional meibomianglands: baseline mean pre-debridement = 2.5 +/- 1.2 and 1 monthpost-debridement = 3.7 +/- 1.4 (p = 0.0007, paired t-test).Conclusions: The results indicate that debridement of the lower lidmargin and LOM provides significant symptom relief and improvesmeibomian gland function. Thus, lid margin debridement should begiven further consideration in the context of age related lid margin©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Corneachanges, and for the prevention and management of meibomian glanddysfunction and dry eye symptoms.Commercial Relationships: Caroline A. Blackie, TearScience (E);Donald R. Korb, TearScience (F)Program Number: 6018 Poster Board Number: A0081Presentation Time: 10:30 AM - 12:15 PMThe effect of increased periocular humidity on lipid layerthickness and ocular comfort of symptomatic contact lenswearersSamuel Kim 1 , Caroline A. Blackie 1, 2 , Donald R. Korb 1, 2 .1 TearScience, Morrisville, NC; 2 Korb Associates, Boston, MA.Purpose: To determine whether increasing periocular humiditywould 1) increase the thickness of the tear film lipid layer over thefront surface of a soft hydrogel contact lens, 2) increase wearingcomfort for symptomatic lens wearers.Methods: Symptomatic soft contact lens wearing patients wererecruited from a single practice in MA. All patients (n = 25; 5 males,17 females) had worn their lenses for a minimum of 2 hours and amaximum of 5 hours prior to examination. Inclusion criteria:minimum contact lens wear of twice a week for 5 or more hours at atime; minimum symptom score when wearing the lenses = 3 on ascale of 1-5 (1 = asymptomatic, 5 = intolerable discomfort).Exclusion criteria: all toric lenses; all lenses of over 7.75D, age over50 years, keratoconus. At three time points during the study(immediately prior to wearing goggles, after 20 mins of continuousgoggle wear and 15 minutes after the goggles were removed) patientswere required to fill out a symptom questionnaire to assess theirocular comfort. The lipid layer thickness (LLT) was observed andsemiquanitatively graded (in 30 nm increments) using aninterferometer immediately following each symptom assessment.Results: The mean age of the patients was 37.9+/-10.4 years. Afterthe goggles had been worn for 20 mins, 88% reported an increase intheir lens wearing comfort of at least one grade and 72 % evidencedan increase in LLT of at least 30nm (1 grade). After the goggles hadbeen removed for 15 mins, only 12% maintained a comfortimprovement of at least one grade; 8% reported feeling 1 grade worsethan baseline, and only 8% maintained the increase in LLT of at leastone grade (30nm); 12% evidenced a decrease in LLT of 30nm frombaseline.Conclusions: Increasing the periocular humidity results in anincrease in the LLT of the tear film over the front surface of thecontact lens and simultaneously improves lens-wearing comfort.Presumably, the increased LLT is due to decreased evaporation,which results in a thicker overall tear layer, improved protection ofthe ocular surface, improved hydrodynamic lubrication for the lidwiper and increased contact lens wearing comfort.Commercial Relationships: Samuel Kim, TearScience (E);Caroline A. Blackie, TearScience (E); Donald R. Korb,TearScience (F)Program Number: 6019 Poster Board Number: A0082Presentation Time: 10:30 AM - 12:15 PMThe Avian Membrana Nictitans: Anatomy and FunctionCharles S. Schobert, Leandro B. Teixeira, Richard R. Dubielzig. Deptof Pathobiological Sciences, UW-Madison School of Vet Med,Madison, WI.Purpose: To document the anatomy and function of the avianmebrana nictitans (MN) using gross dissection, light and electronmicroscopy. The MN is located at the medial canthus and it is used toclean, moisten, and protect the cornea by making extremely rapidexcursions over the surface. We document the special anatomicfeatures involved in MN function in birds.Methods: Globes and attached nictitans were submitted to COPLOWfrom a Bald Eagle, Haliaeetus leucocephalus, and a Mallard duck,Anas platyrhynchos. The eagle globe was dissected to show the pathof the pyramidalis tendon as it travels from the pyramidalis muscleanchored on the posterior sclera to the ventral MN where contractionpulls the MN over the corneal surface. The duck head was sectionedin the frontal plane making step sections to document the anatomy.The MN of the eagle was examined by light microscopy andtransmission electron microscopy (TEM).Results: We show the anatomy of the pyramidalis muscle and tendonand the support of the tendon by a sling from the quadratus muscle asit swings around the optic nerve. The quadratus is also anchored onthe posterior sclera superiorly in the vertical plane. Histology of theeagle MN shows a collagenous stroma with significant elastin andrichly endowed with nerves. The bulbar epithelium of the MNundulates and mucin is entrapped in a unique cellular process calledthe feather epithelium. The duck MN does not have featherepithelium possibly because the tear film would be under water,precluding the need for other MN structures. On TEM theconjunctival epithelium on the bulbar surface of the third eyelidpresented two layers of short columnar cells. The superficial cellspresented a centrally located villous projection with multipleperpendicular secondary projections producing a “fish spine”arrangement. The core of the villous projections containedlongitudinally arranged cytoskeletal elements. The remaining surfacewas rich with microvillar projections.Conclusions: The avian MN functions to clean, moisten, anddistribute tears to the corneal surface. Understanding the anatomy andfunction of the MN helps to understand one aspect of enhanced visualfunction in birds.Commercial Relationships: Charles S. Schobert, None; LeandroB. Teixeira, None; Richard R. Dubielzig, OSOD, LLC (I), Allergan(C)Program Number: 6020 Poster Board Number: A0083Presentation Time: 10:30 AM - 12:15 PMPrevalence of incomplete blinking in dry eye patients evaluatedwith tear film interferometryJoanne Shen. Mayo Clinic in Arizona, Scottsdale, AZ.Purpose: To describe the prevalence of incomplete blinking in dryeye patients evaluated with Lipiview® tear film interferometry.Methods: 72 dry eye patients' medical records and Lipiview® datawere retrospectively examined between March and November 2012at Mayo Clinic in Arizona. Demographics were recorded. Videoanalysis and data output from Lipiview® testing were evaluated.Results: The average patient's age was 67 years, with median age of70 years. The group included 61 women (84%) and 11 men. Lipidtear film thickness was measured in Interferometric Color Units(ICU). Normal ICU is greater than 40. The average ICU was 63, withmedian of 56. Video analysis of the 143 eyes which had completetesting revealed that 82% of the eyes (118/143) were observed tohave incomplete or partial blinking. Of the 118 incomplete blinkingeyes, 16% (19/118) had abnormal ICU. Of the 25 complete blinkingeyes, 32% (8/25) had abnormal ICU. Analysis of variance did notreveal statistical significance between these two groups of patients(p=0.36).Conclusions: Incomplete blinking is frequently found in patientswith dry eye syndrome undergoing Lipiview® interferometric lipidtear film analysis. Incomplete blinking may be a significantcontributor to dry eye syndrome and is caused by neurogenic,post/surgical, mechanical, contact lens wear, or prolonged computeruse. However, in this study incomplete blinking did not correlate withdecreased lipid tear film thickness. This study is limited by its small©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.
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