OBJECTIVE: Aimed to create a nomogram using clinical and eye-specific metrics to predict the efficacy of intravenous glucocorticoid (IVGC) therapy in patients with active and moderate-to-severe Thyroid-Associated Ophthalmopathy (TAO).
METHODS: This study was conducted on 84 eyes from 42 moderate-to-severe TAO patients who received systemic IVGC therapy, and 42 eyes from 21 controls. Data were collected retrospectively from June 2020 to December 2021. The least absolute shrinkage and selection operator (LASSO) method was used to identify predictive factors for \"unresponsiveness\" to IVGC therapy. These factors were then analyzed using logistic regression to create a nomogram. The model\'s discriminative ability was robustly assessed using a Bootstrap resampling method with 1000 iterations for receiver operating characteristic (ROC) curve analysis.
RESULTS: The LASSO analysis identified six factors with non-zero coefficients as significant, including Schirmer I test values, Meibomian gland (MG) diameter, MG length, disease duration, whole capillary vessel density (VD) in the radial peripapillary capillary (RPC), and whole macular VD for the superficial retinal capillary plexus (SRCP). The subsequent logistic regression model highlighted MG length, whole macular VD for SRCP, and disease duration as independent predictors of IVGC therapy response. The constructed nomogram demonstrated an area under the curve (AUC) of 0.82 (95% CI: 0.73-0.91), affirming the model\'s consistent and reliable ability to distinguish between responsive and non-responsive TAO patients.
CONCLUSIONS: Our nomogram, combining MG length (<4.875 mm), SRCP VD (<50.25%), and disease duration (>5.5 months), reliably predicts lower IVGC therapy effectiveness in active, moderate-to-severe TAO patients.

Meibomian gland dysfunction (MGD) is a group of disorders linked by functional abnormalities of the meibomian glands. Current studies on MGD pathogenesis focus on meibomian gland cells, providing information on a single cell\'s response to experimental manipulation, and do not maintain the architecture of an intact meibomian gland acinus and the acinar epithelial cells\' secretion state in vivo. In this study, rat meibomian gland explants were cultured by a Transwell chamber-assisted method under an air-liquid interface (airlift) in vitro for 96 h. Analyses for tissue viability, histology, biomarker expression, and lipid accumulation were performed with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and TUNEL assays, hematoxylin and eosin (H&E) staining, immunofluorescence, Quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR), transmission electron microscopy (TEM), and western blotting (WB). MTT, TUNEL, and H&E staining indicated better tissue viability and morphology than the submerged conditions used in previous studies. Levels of MGD biomarkers, including keratin 1 (KRT1) and 14 (KRT14) and peroxisome proliferator-activated receptor-gamma (PPAR-γ), along with oxidative stress markers, including reactive oxygen species, malondialdehyde, and 4-hydroxy-2-nonenal, gradually increased over culture time. The MGD pathophysiological changes and biomarker expression of meibomian gland explants cultured under airlift conditions were similar to those reported by previous studies, indicating that abnormal acinar cell differentiation and glandular epithelial cell hyperkeratosis may contribute to obstructive MGD occurrence.

BACKGROUND: Orthokeratology lenses, which are worn overnight, are recommended for reducing myopia progression. They lie on the cornea and can influence the ocular surface by temporarily reshaping the corneal surface through a reverse geometry design. This study investigated the effect of overnight orthokeratology lenses on tear film stability and meibomian gland status in children aged 8-15 years.
METHODS: This prospective, self-controlled study included 33 children with monocular myopia who were prescribed orthokeratology lenses for at least one year. The experimental group (ortho-k group) comprised 33 myopic eyes. The control group comprised the emmetropic eyes of the same participants. Tear film stability and meibomian gland status were measured using a Keratograph 5M (Oculus, Wetzlar, Germany). Paired t-tests and Wilcoxon signed-rank tests were used to compare the data between the two groups.
RESULTS: At the one-year visit, the non-invasive first tear film break-up time (NIBUTf) values were 6.15 ± 2.56 s and 6.18 ± 2.61 s in the experimental and control groups, respectively. The lower tear meniscus height was 18.74 ± 0.05 μm and 18.65 ± 0.04 μm in these groups, respectively. No significant difference was observed in loss of meibomian glands or non-invasive average tear film break-up time between the experimental and control groups using Wilcoxon signed-rank tests.
CONCLUSIONS: The stability of the tear film and meibomian gland status were not significantly affected by wearing orthokeratology lenses overnight, indicating that continuous use of orthokeratology lenses for 12 months has a minimal effect on the ocular surface. This finding can help guide the clinical management of tear film quality with respect to the use of orthokeratology contact lenses.

Exocrine meibomian glands (MGs) play a central role in the ocular physiology and biochemistry by producing in situ and, mostly, de novo a secretion (meibum), which is composed of a complex mixture of homologous lipids of various classes, in a metabolic pathway termed meibogenesis. Recent in vivo experiments with a number of mouse models demonstrated that inactivation of any of the major genes of meibogenesis led to alterations in the lipid composition of meibum and severe ocular and MG abnormalities that replicated various human ocular pathologies. However, the role of dietary lipids in meibogenesis, and in the onset and/or alleviation of these diseases, remains controversial. To uncover the role of dietary lipids, the metabolic transformations of a dietary lipid tracer-stable isotope-labeled glyceryl tri(oleate-1,2,3,7,8-13C5) (13C15-TO)-were investigated using liquid chromatography-high-resolution mass spectrometry. We demonstrated that major metabolic transformations of the tracer occurred in the stomach and small intestines where 13C15-TO underwent immediate and extensive transesterification into 13C5- and 13C10-substituted triacylglycerols of various lengths, giving a mixture of 13C-labeled compounds that remain virtually unchanged in the mouse plasma, liver, and white adipose tissue but were almost undetectable in the feces. Importantly, the tracer and its metabolites were virtually undetectable in MGs, even after 4 weeks of daily supplementation. Notably, unbiased principal component analysis of the data revealed no measurable changes in the overall chemical composition of meibum after the treatment, which implies no direct effect of dietary triacylglycerols on meibogenesis, and left their systemic effects as the most likely mechanism.

UNASSIGNED: To assess air pollution-induced changes on ocular surface and tear cytokine levels.
UNASSIGNED: As a prospective multicenter cohort study, 387 dry eye disease (DED) participants were recruited from five provinces in China and underwent measurements of ocular surface disease index (OSDI), Schirmer\'s I test (ST), tear meniscus height (TMH), tear film break-up time (TBUT), corneal fluorescein staining (CFS), meibomian gland (MG) function, and tear cytokines. The associations between ocular surface parameters and exposure to particulate matter (PM), ozone (O3), nitrogen dioxide (NO2), and sulfur dioxide (SO2) for 1 day, 1 week, and 1 month before the examination were analyzed in single- and multi-pollutant models adjusted for confounding factors.
UNASSIGNED: In the multi-pollutant model, the OSDI score was positively correlated with PM with diameter ≤2.5 μm (PM2.5), O3, and SO2 exposure [PM2.5: β (1 week/month) = 0.229 (95% confidence interval (CI): 0.035-0.424)/0.211 (95% CI: 0.160-0.583); O3: β (1 day/week/month) = 0.403 (95% CI: 0.229-0.523)/0.471 (95% CI: 0.252-0.693)/0.468 (95% CI: 0.215-0.732); SO2: β (1 day/week) = 0.437 (95% CI: 0.193-0.680)/0.470 (95% CI: 0.040-0.901)]. Tear secretion was negatively correlated with O3 and NO2 exposures but positively correlated with PM2.5 levels. Air pollutants were negatively correlated with TBUT and positively related with CFS score. Besides SO2, all other pollutants were associated with aggravated MG dysfunction (MG expression, secretion, and loss) and tear cytokines increasement, such as PM2.5 and interleukin-8 (IL-8) [β (1 day) = 0.016 (95% CI: 0.003-0.029)], PM with diameter ≤10 μm (PM10) and IL-6 [β (1 day) = 0.019 (95% CI: 0.006-0.033)], NO2 and IL-6 [β (1 month) = 0.045 (95% CI: 0.018-0.072)], among others. The effects of air pollutants on DED symptoms/signs, MG functions and tear cytokines peaked within 1 week, 1 month, and 1 day, respectively.
UNASSIGNED: Increased PM2.5, O3, and SO2 exposures caused ocular discomfort and damage with tear film instability. PM10 exposure led to tear film instability and ocular injury. PM, O3, and NO2 exposures aggravated MG dysfunction and upregulated tear cytokine levels. Therefore, each air pollutant may influence DED via different mechanisms within different time windows.

Symptom overlap between meibomian gland dysfunction (MGD) and dry eye (DE) makes it difficult to distinguish between these two conditions on the basis of symptoms alone. We searched for characteristic symptoms that might help to distinguish MGD from DE on the basis of a population-based study. Subjects comprised 311 residents of Takushima island (18 to 96 years), including 117 individuals with MGD and 114 with DE. Responses to a symptom-related questionnaire (19 items) were subjected to factor analysis, and univariate regression analysis was performed to identify ocular surface parameters associated with characteristic symptoms of MGD. Factor analysis revealed aggregation of symptoms according to three factors: Factor 1 related to Symptom Score, Factor 2 to DE, and Factor 3 to MGD. Symptoms associated with DE included 11 items, whereas the only item related to MGD was tearing sensation. Pearson\'s correlation analysis revealed that tearing sensation was associated with tear meniscus height (TMH), noninvasive tear-film breakup time, fluorescein staining score, meiboscore, meibum grade, and Schirmer value. Subjects with MGD experienced significantly more tearing and had a larger TMH than did those without MGD (p = 0.0334). Tearing sensation may thus be a characteristic symptom of MGD. Physicians should suspect MGD who complain of tearing sensation.

To evaluate demographic and lifestyle factors associated with aqueous deficient and evaporative dry eye disease.
A total of 1125 general public visitors (707 females, mean ± SD age, 33 ± 21, range 5-90 years) at the Royal Society Summer Science Exhibition were recruited in a cross-sectional study. A demographic and lifestyle factor questionnaire was administered, and dry eye symptomology (DEQ-5 score), ocular surface characteristics (conjunctival hyperaemia, and infrared meibography), and tear film parameters (tear meniscus height, non-invasive breakup time, and lipid layer grade) were evaluated for the left eye of each participant within a single session. The diagnostic criteria for dry eye disease subtypes were adapted from the rapid non-invasive dry eye assessment algorithm.
Overall, 428 (38%) participants fulfilled the diagnostic criteria for dry eye disease, 161 (14%) with aqueous deficient dry eye disease, and 339 (30%) with evaporative dry eye disease. Multivariate logistic regression demonstrated that advancing age, female sex, reduced sleep duration, higher psychological stress, and poorer self-perceived health status were independently associated with aqueous deficient dry eye disease (all p < 0.05). Significant risk factors for evaporative dry eye disease included advancing age, East and South Asian ethnicity, contact lens wear, increased digital device screen exposure, higher psychological stress, and poorer self-perceived health status (all p < 0.05).
Both subtypes of dry eye disease were associated with several unique and shared demographic and lifestyle factors. The findings of this study could inform future research design investigating the utility of targeted screening and risk factor modification for the prevention and management of dry eye disease.

BACKGROUND: To investigate aqueous and lipid layers of the tear film as well as meibomian gland structure by meibography in psoriatic patients in the Iranian population.
METHODS: This case-control study was conducted on 31 psoriasis patients and 31 controls in Birjand University of Medical Sciences in 2018. The sampling method was available from the date of approval of the proposal in the Ethics Committee until it reached the sample size. After entering the study, patients were examined individually with a slit lamp. Then, Ocular Surface Disease Index (OSDI) score assessment, Schirmer test 1, lacrimal measurement with SM tube, tear break-up time (TBUT), and meibomian glands imaging by SBM Sistemi were done. Finally, the obtained data were entered into SPSS 15 software and analyzed at a significant level of less than 0.05.
RESULTS: The two groups were matched according to age and gender (p = 0.39 and p = 0.80; respectively). With the exception of the SM Tube score, the mean of all tear film and meibomian glands functional and structural parameters including Schirmer test 1, TBUT, and meibography were significantly different between patients and control groups. Moreover, the proportion of abnormal OSDI (OSDI ⩾ 13) and the dry eye was significantly higher in psoriasis patients.
CONCLUSIONS: Psoriasis is associated with dry eye as well as meibomian glands atrophy and dysfunction.

Aqueous-deficient dry eye (ADDE) and meibomian gland dysfunction (MGD) can be refractory to therapy. Intense pulsed light (IPL) was recently introduced as an effective treatment for MGD. We here evaluated the efficacy of IPL combined with MG expression (MGX) compared with MGX alone (n = 23 and 20, respectively) for patients with refractory ADDE with mild MGD at three sites. Symptom score, visual acuity (VA), noninvasive breakup time (NIBUT) and lipid layer thickness (LLT) of the tear film, lid margin abnormalities, fluorescein BUT (FBUT), fluorescein staining, tear meniscus height (TMH), meibum grade, meiboscore, and Schirmer\'s test value were assessed at baseline and 1 and 3 months after treatment. LLT, plugging, vascularity, FBUT and NIBUT were improved only in the IPL-MGX group at three months compared with baseline. All parameters with the exception of VA, meiboscore, TMH, Schirmer\'s test value were also improved in the IPL-MGX group compared with the control group at three months, as was VA in patients with central corneal epitheliopathy. Although IPL-MGX does not affect aqueous layer, the induced improvement in quality and quantity of the lipid layer may increase tear film stability and ameliorate symptoms not only for evaporative dry eye but for ADDE.

Obstructive meibomian gland dysfunction (MGD) can be refractory to medical therapy. Intraductal meibomian gland (MG) probing may offer a potential therapeutic approach for these patients, but no randomized trials have been conducted to date.
To assess clinical changes after intraductal MG probing for patients with refractory obstructive meibomian gland dysfunction.
Randomized, double-masked, sham-controlled clinical trial.
Single-center, tertiary referral center.
42 patients with refractory obstructive MGD associated with lid tenderness.
Enrolled patients received one of the following treatments: 1) MG probing plus post-procedural topical sulfacetamide/prednisolone ointment (Blephamide®), 2) MG probing plus post-procedural lubricating ointment (GenTeal), or 3) sham probing plus GenTeal ointment. The probing was performed on the upper lids of both eyes.
Primary outcome measures were symptoms as measured by Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE), as well as tear break-up time (TBUT). Secondary outcome measures were other clinical signs. Safety of the procedure was also evaluated by investigating the treatment-related adverse events. At baseline and 4 weeks after the procedure a masked observer evaluated the following outcome measures: symptom questionnaires, including OSDI and SANDE, upper lid tenderness, lid margin telangiectasia, corneal fluorescein staining, conjunctival lissamine green staining, TBUT, Schirmer\'s test, and meibomian glands yielding liquid secretion (MGYLS).
Compared to baseline, the MG probing/Blephamide® group showed significant improvements in both OSDI and SANDE scores and the MG probing/GenTeal group demonstrated a significant improvement only in SANDE score. In contrast, the Sham/GenTeal group did not show any statistically significant changes in symptoms. There were no statistically significant changes in clinical signs in any group at the 4-week visit, except for improvement of lid tenderness in the sham probing group.
MG probing/Blephamide® results in a significant improvement in symptoms in patients with refractory obstructive MGD without any significant effect on clinical signs. Larger studies are warranted to determine the efficacy of MG probing.
Clinicaltrials.gov(identifier NCT02256969, Filed on 08/13/2014).