Smoking and the risk of dry eye: a Meta-analysis

The environment and dry eye-manifestations, mechanisms, and more

Dry eye disease (DED) is a multifactorial condition that often presents with chronic symptoms of pain (that can be characterized as "dryness," "burning," and "irritation," to name a few) and/or fluctuating or poor-quality vision. Given its multifactorial nature, several pathophysiologic mechanisms have been identified that can underlie symptoms, including tear film, ocular surface, and/or corneal somatosensory nerve abnormalities. Research has focused on understanding how environmental exposures can increase the risk for DED flares and negatively impact the tear film, the ocular surface, and/or nerve health. Given that DED is a common condition that negatively impacts physical and mental functioning, managing DED requires multiple strategies. These can include both medical approaches and modulating adverse environmental conditions, the latter of which may be a cost-effective way to avoid DED flares. Thus, an understanding of how environmental exposures relate to disease is important. This Review summarizes research on the relationships between environmental exposures and DED, in the hope that this information will engage healthcare professionals and patients to consider environmental manipulations in their management of DED.

Prevalence of Dry Eye Symptoms and Associated Risk Factors among University Students in Poland

Aim: The aim of the study was to demonstrate the prevalence and risk factors of dry eye symptoms (DES) among university students in Poland. Material and methods: A cross-sectional study survey was conducted among 312 Polish university students. The questionnaire consisted of the Ocular Surface Disease Index (OSDI), the 5-Item Dry Eye Questionnaire (DEQ-5) and questions regarding medical history and risk factors. Results: According to the OSDI, more than half of respondents (57.1%) have symptoms of ocular surface disease. Time spent using electronic devices is correlated with scores gathered in both OSDI and DEQ-5 (p < 0.001). There is a statistically significant dependence between psychotropics (p = 0.002), glucocorticosteroids usage (p = 0.026), the presence of depression (p < 0.001), diabetes (p = 0.01) or allergy (p = 0.008) and dry eye symptoms proved in both questionnaires. Respondents with refractive errors and those living in metropolitan areas have a statistically higher symptom intensity(p < 0.022). Stress felt by students is associated with higher DES risk. No correlation between DES and smoking habits was observed. The history of SARS-CoV-2 infection was associated with the severity of DES (p = 0.036). Conclusion: Pathogenesis of DES is multifactorial and its severity depends on several factors, both genetic and environmental. Its prevalence among the young population is underestimated. Determining risk factors will enable the implementation of appropriate prophylaxis and early diagnosis.

Risk of dry eye in headache patients: a systematic review and meta-analysis

OBJECTIVES

The objective of this meta-analysis was to identify whether headache increase the risk of dry eye disease (DED).

METHODS

PubMed, Web of Science, Cochrane Library and EMBASE databases were searched for relevant studies. The odds ratio (OR) of DED in all-cause headache was calculated via Stata software. To explore the source of heterogeneity, subgroup and sensitivity analyses were conducted. Funnel plots and Egger's test were performed to assess publication bias.

RESULTS

This meta-analysis included 11 studies. Pooled analysis indicated that all-cause headache was related to a higher risk of DED (OR = 1.586, 95% CI : 1.409-1.785, I² = 89.3%, p < .001). Migraine headache, tension headache and cluster headache were all related to a higher risk of DED (OR = 1.503, 95% CI: 1.369-1.650, I² = 81.8%, p < .001; OR = 1.610, 95% CI: 1.585-1.635, p < .001; OR = 2.120, 95% CI: 1.104-4.073, p = .024), respectively. The risk of DED in case-control studies was slightly higher than in cross-sectional studies and cohort study (OR = 1.707, 95% CI: 1.291-2.258, I² = 85.0%, p < .001; OR = 1.600, 95% CI: 1.590-1.610, I² = 0.0%, p < .001; OR = 1.440, 95% CI: 1.096-1.893, p = .009), respectively. Subgroup analysis in territory type showed that all-cause headache in America, Europe, Asia and Oceania were all related to a higher risk of DED.

CONCLUSIONS

This study indicates that headache is related to a higher risk of DED, especially in the migraine patients. These results suggest that headaches should be regarded as an independent risk factor for DED.KEY MESSAGESIn this meta-analysis, 11 studies (one cohort study, four case-control studies and six cross-sectional studies) covering 3,575,957 individuals were included.Pooled analysis indicated that all-cause headache was related to a higher risk of dry eye (OR = 1.586, 95% CI: 1.409-1.785, I² = 89.3%, p < .001).These results suggest that headaches should be regarded as an independent risk factor for dry eye.

Moxibustion with Walnut Shell Spectacles Could Improve the Objective Symptoms and Tear Film Stability of Patients with Dry Eye Disease: A Randomized Controlled Trial

Objectives

This study aims to evaluate the efficacy and acceptability of moxibustion with walnut shell spectacles in treating dry eye disease (DED) patients and to provide treatment options.

Methods

126 DED patients were randomly allocated into the moxibustion group (treated by moxibustion with walnut shell spectacles, 64 cases) and the artificial tears group (treated with sodium hyaluronate eye drops, 62 cases). Evaluate the changes in the ocular surface disease index (OSDI), the visual analogue scale (VAS) of ocular discomfort, the tear film break-up time (TBUT), corneal fluorescein staining (CFS), and the Schirmer I test during the trial at baseline and after 1-week, 2-week, 3-week, and 4-week treatment. Evaluate the OSDI scale and the ocular symptom VAS scale one month after the end of treatment.

Results

There were no significant differences in baseline characteristics between the two groups. For OSDI scores, the results showed that the efficacy of the moxibustion group was no less than that of the artificial tear group. For VAS of ocular discomfort, both groups significantly reduced their score compared with baseline, and for the moxibustion group, the decrease was more significant. For TBUT, FAS, and PPS, results showed that the efficacy of the moxibustion group was significant in both eyes after 4 weeks of treatment, but the right eye was in the artificial tear group. For CFS and Schirmer I test scores, there was no significant effect for both groups.

Conclusion

Moxibustion with walnut shell spectacles could improve the clinical symptoms and tear film stability of DED patients; however, it has no significant efficacy on improving corneal injury and tear secretion, just the same as sodium hyaluronate eye drops. Nevertheless, moxibustion with walnut shell spectacles may have better effects on the self-assessment of ocular discomfort than sodium hyaluronate eye drops.

Assessment of Tear Osmolarity in Smokers Using TearLab and I-Pen Systems

Purpose. Smoking has a negative effect on health and ocular tear film. The purpose of the current study is to investigate the correlation between the TearLab and I-Pen osmolarity scores in smokers and compare them with those of non-smoking healthy males. Methods. Thirty male smokers (25.3 ± 2.2 years) participated in the study. An age-matched (22.9 ± 2.0 years) control group of non-smoking healthy males (N = 30) was also recruited for comparison purposes. The ocular surface disease index (OSDI) was completed first, followed by the TearLab and I-Pen osmolarity measurements. Results. The median TearLab osmolarity score was lower (P < 0.001) than that obtained using the I-Pen in both the study and the control groups. The OSDI scores and osmolality measurements were higher (P < 0.001) in smokers than in the control subjects. In the smoker group, there were moderate correlations between the OSDI scores and the measurements obtained using the TearLab (Spearman’s correlation coefficient, r = 0.463; P = 0.010) and I-Pen (r = 0.449; P = 0.013) systems. In addition, there was a strong correlation between the osmolarity scores obtained from the TearLab and I-Pen systems in smokers (r = 0.911; P < 0.001). Conclusion. The I-Pen scores in smokers were significantly higher than those obtained using TearLab. The TearLab scores showed small variations compared with those obtained using I-Pen. A strong correlation was found between the TearLab and I-Pen scores in smokers. The osmolarity TearLab and I-Pen scores were significantly higher in smokers compared with normal eye subjects.

Evaluation of dry eye symptoms and risk factors among medical students in Serbia

BACKGROUND

Dry eye is a multifactorial disease defined less than 30 years ago. It is a relatively common disorder, affected by a number of well-known risk factors. Dry eye can be challenging to diagnose because of the possible discrepancy between patients' symptoms and clinical signs, and its overlap with other ocular surface diseases. Literature-wise, dry eye is usually associated with age and therefore investigated within older populations. Recently, studies focusing on young adult and student populations have demonstrated a higher prevalence of dry eye than previously expected.

AIM

The study aims to determine the frequency of dry eye symptoms in the student population, and the impact of students' activities and habits as potential risk factors.

METHODOLOGY

Our study involved 397 students from the medical school at the University of Belgrade, Serbia. Students were asked to complete an online survey that addressed general information, health, habits, and routine in everyday use of electronic devices. In addition, students completed a standard Ocular Surface Disease Index questionnaire.

RESULTS

The prevalence of dry eye was 60.5% (240/397) in our study population. Contact lens wear (p<0.001), allergies (p = 0.049) and increased number of hours per day using VD devices for studying purposes (p = 0.014) were associtated with a higher risk of dry eye disease. Risk factors that did not significantly impact dry eye were the use of oral contraceptives, smoking, systemic diseases, year of study and sex.

CONCLUSION

In our study, the prevalence of dry eye disease was similar or slightly higher than in previous studies among young adults. In addition, contact lenses, allergies and visual display devices were associated with the development of the dry eye.

Dry Eye Disease in Patients With Schizophrenia: A Case-Control Study

Objective

To evaluate the clinical features and inflammatory cytokines of dry eye disease (DED) in patients with schizophrenia.

Methods

This is a case-control study. The modified self-rating depression scale (M-SDS) and the ocular surface disease index (OSDI) were used to evaluate the symptoms of depression and DED, respectively. Lipid layer thickness (LLT), partial blink rate (PBR), meibomian gland loss (MGL), tear break-up time (TBUT), corneal fluorescein staining, Schirmer I-test, and eyelid margin abnormalities were also measured. A multiplex ELISA Quantibody array was used to detect the inflammatory cytokines in the tears of all participants.

Results

Forty schizophrenic patients and 20 control subjects were included. The mean age was 45.0 ± 9.5 years (range, 22–63 years) in schizophrenic patients and 45.4 ± 16.2 years (range, 23–76 years) in controls (P = 0.914). The ratio of male to female was 1.1 in schizophrenic patients and 1.0 in controls (P = 0.914). Ten women (52.6%) with schizophrenia and 2 (20%) in the control group (P = 0.096) were menopausal or post-menopausal. The OSDI [0.0 (0.0–4.2) vs. 7.3 (2.1–14.6)] and TBUT [4.5 (3.0–6.0) vs. 10.0 (3.5–11.0)] were significantly lower in patients with schizophrenia than in controls (P = 0.003 and P = 0.009, respectively). The rate of MGL [36.5 (17.5–47.5) vs. 8.5 (0.0–17.5)] increased in schizophrenic patients (P < 0.001). Among pro-inflammatory cytokines, the levels of interleukin (IL)-1α, IL-6, IL-11, IL-12A, IL-15, IL-17A, and granulocyte colony-stimulating factor (G-CSF) in tears were elevated in the schizophrenia group (all P < 0.01). Most of the chemokines examined were at increased levels in the tears of schizophrenics (all P < 0.05). The levels of matrix metalloproteinases-9 (MMP-9) and intercellular adhesion molecule-1 (ICAM-1) were also higher in the schizophrenic patients (all P < 0.001). The concentrations of IL-1Ra, tissue-inhibitor of metalloproteinase-1 (TIMP-1), and TIMP-2 in the schizophrenia group were decreased (all P < 0.001). In schizophrenic patients, the level of CCL2 in tears was positively correlated with OSDI (R = 0.34, P = 0.03). The increasing TIMP-1 and decreasing IL-5 were correlated with increasing LLT (R = 0.33, P = 0.035; R = −0.35, P = 0.027, respectively). The level of ICAM-1 was then positively correlated with partial blink rate (PBR) (R = 0.33, P = 0.035). There was a negative correlation between IL-8 and the Schirmer I-test (R = −0.41, P = 0.009).

Conclusions

Patients with schizophrenia were more likely to experience asymptomatic DED, with mild symptoms and obvious signs. The inflammatory cytokines in the tears of schizophrenic patients differed greatly from that of non-schizophrenic patients.

The Relationship Between Dry Eye in Adults with Indications for Kidney Transplantation and Influence Factors

Purpose

Patients with end-stage renal failure are susceptible to dry eye disease. This study explores the relationship between dry eye disease and influence factors.

Patients and Methods

The control group consisted of 57 healthy subjects who were kidney donors. They were of the same age and sex as the kidney transplant recipients. The outcome variable was the dry eye condition of the participants. The Schirmer test confirmed dry eye disease, TBUT (breakup time test), and the Eye Surface Disease Index (OSDI) questionnaire, using linear regression to evaluate the association.

Results

The total number of subjects was 146 (89 kidney recipients and 57 kidney donors). When univariate analysis found the level of visual acuity, the age group involved was statistically significant, while the other factors were not statistically significant. In multivariable logistic regression analysis, age (odds ratio: 2.8, p<0.05), smoking history (odd ratio: 0.1, p<0.05), corneal conjunctival calcification (odd ratio: 0.2, p<0.05); central corneal thickness (odd ratio: 1.02, p<0.05) is considered to be an influence factor for disease progression.

Conclusion

Age group, smoking history, corneal central thickness, and conjunctival calcification are factors for dry eye disease in patients preparing to receive a kidney. These results reinforce the evidence for multifactorial dry eye disease in patients with renal impairment.

Pancreatic Cancer and Primary Sjögren's Syndrome: A Case Report

Primary Sjögren syndrome (SS) is a chronic inflammatory systemic autoimmune disease with a high risk of malignancy development, namely, lymphoproliferative neoplasms. Few studies also reported a high risk of solid cancers; however, the coexistence of primary SS and pancreatic cancer has been rarely described. In this paper, we aim to describe a case of a 59-year-old woman who was an active smoker with sicca symptoms and symmetrical polyarthritis and was diagnosed with primary SS two years before the development of metastatic pancreatic adenocarcinoma. Despite institution of chemotherapy, the patient succumbed to the malignancy. Besides that, we explore the link between primary SS and solid cancers including the main predictors of malignancy and the role of primary SS as a paraneoplastic syndrome. Patients with primary SS should be closely monitored for malignancy, not only for hematological cancer, but also for solid tumors. Further research is necessary to understand which are the predictors of cancer proliferation in primary SS patients.

Reliability of Chinese web-based ocular surface disease index questionnaire in dry eye patients: a randomized, crossover study

AIM

To assess the reliability of web-based version of ocular surface disease index in Chinese (C-OSDI) on clinically diagnosed dry eye disease (DE) patients.

METHODS

A total of 254 Chinese participants (51% male, 129/254; mean age: 27.90±9.06y) with DED completed paper- and web-based versions of C-OSDI questionnaires in a randomized crossover design. Ophthalmology examination and DED diagnosis were performed prior to the participants being invited to join the study. Participants were randomly designated to either group A (paper-based first and web-based second) or group B (web-based first and paper-based second). Final data analysis included participants that had successfully completed both versions of the C-OSDI. Demographic characteristics, test-retest reliability, and agreement of individual items, subscales, and total score were evaluated with intraclass correlation coefficients (ICC), Spearman rank correlation, Wilcoxon test and Rasch analysis.

RESULTS

Reliability indexes were adequate, Pearson correlation was greater than 0.8 and ICCs range was 0.827 to 0.982; total C-OSDI score was not statistically different between the two versions. The values of mean-squares fit statistics were very low compared to 1, indicating that the responses to the items by the model had a high degree of predictability. While comparing the favorability 72% (182/254) of the participants preferred web-based assessment.

CONCLUSION

Web-based C-OSDI is reliable in assessing DED and correlation with the paper-based version is significant in all subscales and overall total score. Web-based C-OSDI can be administered to assess individuals with DED as participants predominantly favored online assessment.

Effect of topical 0.05% cyclosporine A on the tear protein lacritin in a rat model of dry eye

AIM

To observe the effect of topical 0.05% cyclosporine A (CsA) on the ocular surface and tear protein lacritin in a botulinum B-induced dry eye rat model.

METHODS

A total of 36 female SD rats were randomly divided into 3 groups, botulinum B was injected into the right lacrimal gland of all rats. Group A and group B were treated with 0.05% CsA and 0.1% sodium hyaluronate, respectively, 3 times daily. The control group was not treated. Basal tear flow, corneal epithelial defects, and lacritin levels were measured.

RESULTS

Tear secretion in all rats was reduced on day 3 and was even lower on day 7 postoperation (P<0.05). Tear secretion in group A increased by day 14 and was at the preoperative level on day 42. Tear secretion in group B and control rats was lower on days 14 and 42 compared with preoperative level (P<0.05). Corneal fluorescein staining in group A was higher on day 3, peaked on day 7, and then decreased gradually from day 7 until day 14, returning to normal by day 42 post-procedure. However, in group B, corneal fluorescein staining had improved, but was not fully recovered by day 42. Corneal fluorescein staining was more intense than before the operation and then in the control group at all time points. Tear protein lacritin levels reached the lowest levels on day 7 in all groups. In group A, tear protein lacritin levels began to increase on day 14 and were normal on day 42. In group B, tear protein lacritin levels began to increase on day 14, but had not completely recovered on day 42. In the control group, tear protein lacritin levels remained low post-procedure.

CONCLUSION

CsA 0.05% prompts tear protein lacritin expression in a rat model of dry eye and improves the signs and symptoms of dry eye disease.

Prevalence and risk factors of dry eye disease in North India: Ocular surface disease index-based cross-sectional hospital study

Purpose:

This study aims to study the prevalence of DED and analyze risk factors in North Indian population.

Methods:

This was a cross-section hospital-based, observational study. Cases enrolled over 2 years (systematic random sampling) were administered ocular surface disease index questionnaire to evaluate the prevalence and risk factors of DED. Schirmer's test and tear break-up time were performed only in the subset of patients giving consent. Categorical data were assessed with Chi-square/Fisher's Exact test, and odds ratio was analyzed using bivariate and multivariate logistic regression. P < 0.05 was statistically significant.

Results:

A total of 15,625 patients were screened. The prevalence of DED was 32% (5000/15625); 9.9% (496/5000) had mild DED; 61.2% (3060/5000) had moderate DED; and 28.9% (1444/5000) had severe DED. Age group of 21–40 years, male sex, urban region, and desk job were associated with increased risk of DED. Hours of visual display terminal (VDT) usage significantly correlated with DED (P < 0.001), and 89.98% of patients with 4 h or more of VDT use had severe dry eye. Cigarette smoking and contact lens usage had increased odds of developing severe DED (P < 0.001). Objective tests were undertaken in 552 patients; of these, 81.3% (449/552) had severe DED.

Conclusions:

The prevalence of DED in North India is 32%, with the age group of 21–40 years affected most commonly. VDT use, smoking, and contact lens use were associated with increased odds of developing DED.