Spectral domain optical coherence tomography for measuring tear film meniscus height and its relationship with epiphora

Assessment of punctal metrics and tear meniscus height in epiphora: clinical insights and diagnostic potential

PURPOSE

To use anterior segment optical coherence tomography (AS-OCT) to investigate differences in punctal dimensions, tear meniscus height (TMH), and cornea among epiphora patients and healthy individuals; to assess its utility in screening and diagnosing epiphora; and to examine its effects on the cornea.

STUDY DESIGN

Prospective, cross-sectional METHODS: A total of 43 patients (31 women) with epiphora (Munk score >2) and 58 healthy individuals (38 women) without ocular symptoms were enrolled in this study. AS-OCT (Maestro, Topcon) was used to measure TMH, outer punctal diameter (OPD), punctal depth (PD), and corneal epithelial thickness (CET). Corneal topography (Pentacam, Oculus) was used to assess corneal topographic parameters and corneal volume (CV). Correlations among OPD, TMH, and corneal parameters were analyzed.

RESULTS

No significant differences were found in age and sex among the groups (P = .909 and P = .482, respectively). Patients with epiphora exhibited significantly narrower OPD (229.6 ± 150.1 μm) and higher TMH (592.5 ± 315.3 μm) (both P <.001). CV was notably lower in the epiphora group (P = .015). The lower cutoff of OPD for epiphora was found to be 200 μm, and the lower cutoff of TMH for epiphora, 445 μm. Positive correlations were observed between OPD and CV (P = .001).

CONCLUSIONS

Patients with epiphora demonstrated narrower OPD, higher TMH, and lower CV than those of healthy individuals. These findings highlight the utility of AS-OCT in assessing epiphora and its effects on corneal health.

Lacrimal Canalicular Wall Dehiscence/Thinning Found in Adults: A Case Series

We retrospectively reviewed the medical records of all patients diagnosed with lacrimal canalicular wall dehiscence/thinning from January 2020 to January 2024 and found three patients. Two patients were male, and the other patient was female. Patient ages ranged from 53 to 82 years. None of the patients had a history of ocular trauma, congenital anomaly, or other ocular diseases except for cataract. All patients complained of epiphora, and the duration of symptom ranged from 15 months to 10 years. Unilateral involvement of the lower canaliculus and isolated single wall involvement affecting only the canalicular roof were observed in all patients. The roof was dehiscent in one case and thinned out in the other two cases. The dehiscent canaliculus was closed by sutures, and the thinned-out canalicular wall of one patient was covered using a conjunctival flap. However, recurrences were noted at two and five months after surgery.

Lacrimal gland activity in lacrimal drainage obstruction: exploring the potential cross-talk between the tear secretion and outflow

PURPOSE

To investigate the effects of lacrimal drainage obstructions on the lacrimal gland activity and if there exists a potential link between the two.

METHODS

Direct assessment of the lacrimal gland activity from the palpebral lobe was performed in consecutive patients diagnosed with unilateral primary acquired nasolacrimal duct obstruction (PANDO), along with Ocular Surface Disease Index (OSDI), non-invasive tear break up time (NIBUT; Oculus K5M), tear meniscus height and Schirmer I. The primary outcome measure was the difference in the tear flow rate between the eye with PANDO and the contralateral uninvolved eye.

RESULTS

Thirty patients (median age, 45.5 years; 25 females) with unilateral PANDO had epiphora for a mean duration of 20 months. The mean OSDI score was 6.3. NIBUT (mean 11.56 vs 11.58 s; p=0.49) and Schirmer I values (mean 18.83 vs 19.4 mm; p=0.313) were not significantly different between PANDO and non-PANDO eyes. The morphology of the palpebral lobe (size 29.3 vs 28.6 mm2, p=0.41) and the number of lacrimal ductular openings (median 2 vs 2.5) were similar between the two eyes. The mean tear flow from the lacrimal glands of the PANDO side was significantly reduced compared with the contralateral uninvolved side (0.8 vs 0.99 µL/min; p=0.014)).

CONCLUSION

Tear flow rate from palpebral lobes of patients with unilateral lacrimal outflow obstruction shows a significant reduction compared with the contralateral side. The potential ways of communications between the tear drainage and the tear production mechanisms need to be explored further.

Evaluation of the relationship between tear meniscus changes and quality of life outcomes after external dacryocystorhinostomy

PURPOSE

This study aims to investigate the effects of external dacryocystorhinostomy (DCR) surgery on tear meniscus parameters and assess its relationship with improvements in quality of life (QoL) in patients with nasolacrimal duct obstruction (NLDO).

METHODS

This prospective study included 30 patients diagnosed with NLDO who underwent external DCR surgery. Tear meniscus (TM) parameters, including height, depth and area, were measured using anterior segment optical coherence tomography. Lacrimal symptom questionnaire (LacQ), Munk scores and Glasgow benefit inventories (GBI) were collected. Statistical analysis was performed to evaluate the correlation between tear meniscus changes and improvements in QoL.

RESULTS

TM height, depth and area decreased from preoperative median measurements (0.09 mm2, 0.37 mm, 0.56 mm) to postoperative median measurements (0.03 mm2, 0.21 mm, 0.30 mm) (p < 0.001). Lacrimal symptom scores and Munk scores showed a significant improvement at 3-month postoperatively (p < 0.001). The GBI scores also demonstrated a significant improvement, indicating a positive impact on the patients' QoL. (p < 0.001). A statistically significant correlation was found between the change in TM parameters and LacQ lacrimal symptom scores.

CONCLUSION

External DCR surgery leads to significant improvements in tear meniscus parameters and quality of life outcomes in patients with NLDO. The decreased in TM height and TM area indicates improved tear film dynamics and decreased tear volume, which positively impact the patients' ocular comfort and overall well-being. This study highlights the importance of tear meniscus evaluation as a potential market for assessing the success of DCR surgery and its impact on patients' QoL.

[Risk factors, clinical features and indications for treatment of dry eye disease at a young age]

In recent decades, there has been an increase in the prevalence of dry eye disease (DED) not only in older people, but also in young people, which is potentially associated with the use of digital devices. Early detection of signs of DED and the appointment of preventive tear replacement therapy can help stabilize the tear film and slow down the progression of the disease.

PURPOSE

To study risk factors, prevalence and clinical manifestations of DED in young people, to determine indications and evaluate the effectiveness of treatment with artificial tears.

MATERIAL AND METHODS

The study included 91 patients aged 21 to 39 years (mean age 22.4±0.35 years), 63 (69.2%) women and 28 men (30.8%). All patients had tear film breakup time (TBUT) measured and underwent Schirmer I test, LIPCOF, ocular surface staining with vital dyes, lacrimal OCT-meniscometry and filled a questionnaire. To determine the effectiveness of the tear replacement therapy, 45 people prescribed sodium hyaluronate solution were randomly selected.

RESULTS

The time that study subjects spend using devices ranged from 6 to 18 hours per day, amounting to 11.5±0.35 hours on average. According to the results of the Ocular Surface Disease Index (OSDI) questionnaire, 92.9% of study participants were revealed to have subjective symptoms of eye irritation. A decrease in TBUT was recorded in 30.8% of cases, the results of the Schirmer I test were decreased in 82.4% of the subjects. Significant changes in OSDI, Schirmer test and TBUT were obtained as the result of treatment. Changes in the indicators of staining and OCT meniscometry were not reliable.

CONCLUSION

The most significant risk factor of developing DED at a young age is regular, prolonged visual work with digital screens. The main symptoms are subjective manifestations and TBUT.

Efficacy of pyridostigmine (Mestinon) in the relief of patients with epiphora

BACKGROUND

Although the mechanism is not clear, the inability of the orbicularis oculi muscle, especially the deeper segment (Horner muscle), is thought to be responsible in epiphora. This study evaluates the effect of the anticholinergic drug pyridostigmine (Mestinon) in patients with patent but dysfunctional lacrimal drainage system.

MATERIAL AND METHODS

Twenty patients with bilateral epiphora (mean age:60.78 ± 6.49 yrs) were included in this study. Patients with a patent lacrimal irrigation test based on persistent and symptomatic epiphora, wiping >10 times daily or continuous tearing and grade 4-5 epiphora according to Munk scale, showing neuropathic involvement in the orbicularis oculi muscle by the quantitative motor unit potential (MUP) analysis method were evaluated prospectively. Fluorescein dye disappearance test (a semi-quantitative assessment of delayed tear outflow) together with a Schirmer test reading were performed in order to detect dry eye. The patients were evaluated for tear meniscus measurements by anterior segment optical coherence topography (OCT) and non-invasive tear break-up time (NI-BUT) was measured by Oculus Keratograph 5 M. Those with a NI-BUT value above 10 s, without eyelid laxity, previous ocular surgery or ocular surface disease, or nasolacrimal duct obstruction, and who agreed to use the drug were included in the study. Each subject underwent OCT measurements of the lower tear meniscus of both eyes before and 15 mins after taking Mestinon (1 × 60 mg tablet). Upon measurement of the positive effect of the drug on tear meniscus height (TMH), the patients were asked to continue this regime daily for 1 month and then evaluated for relief in their epiphora complaints and any systemic drug side effects.

RESULTS

A total of 20 patients (40 eyes) with bilateral epiphora were included in the study. All eyes had grade 4 Munk-score epiphora, Schirmer's test was within the normal range in all eyes (mean, 14 ± 4 mm), and patent lacrimal irrigation test. The lower mean TMH reductions 15 min after Mestinon in the right and left eyes were 135.41 ± 85.47 and 55.44 ± 61.56 mm, respectively, a statistically significant decrease in both eyes (p = 0.001, p < 0.01). The mean tear meniscus area (TMA) in the right and left eyes was 131.83 ± 68.27 mm² and 62.72 ± 50.57 mm², respectively; 15 mins after administration of Mestinon, the mean TMA in the right and left eyes was 77.27 ± 48.34 and 59.18 ± 44.74 mm², respectively (p = 0.001, p < 0.01). The mean decreases of 54.56 ± 39.34 mm² in the right eye area and 3.53 ± 42.32 mm² in the left eye area were statistically significant (p = 0.041, p < 0.05).

CONCLUSION

Symptomatic relief for epiphora cannot be achieved with known treatment options due to lacrimal pump dysfunction. We found that pyridostigmine (Mestinon) provided relief in patients' complaints of epiphora consistent with a significant reduction in TMH levels.

Objective assessment of eyelid position and tear meniscus in facial nerve palsy

PURPOSE

To evaluate lower lid position and tear meniscus in peripheral idiopathic facial nerve palsy (FNP).

METHODS

A prospective study enrolled patients with peripheral idiopathic FNP and epiphora. Data were collected on patient demographics, House-Brackmann (HB) scale, digital photographs of the face, and tear meniscus at the 1st, 30, and 90 day after onset of FNP. Marginal reflex distance to the upper (MRD1) and lower eyelid (MRD2) were evaluated using ImageJ software. Anterior segment optical coherence tomography (OCT) was performed to measure the tear menis- cus. P< .05 was considered statistically significant.

RESULTS

Sixteen patients were evaluated. The HB scale at presentation was grade III in six patients (37.5%). At 90 day, nine patients (56.25%) were grade I-normal. Three (18.7%) had upper lid retraction, three (18.7%) upper eyelid asymmetry and 7 (43.75%), lower eyelid retraction. The difference between MRD2-FNP with MRD2-healthy side was 0.51 ± 1.9 mm at the 1st visit, decreasing to 0.09 ± 1.47 mm at 90 days (P= .877). Tear meniscus measurements were significantly higher in FNP at the 1st visit (P= .001). The decrease in MRD2 was statistically correlated with the reduction of the tear meniscus area (TMA) (r = 0.67; P= .007) at 90 days. No correlation was found between HB and TMA. There is a difference in TMA between age groups at the 1st day(p= .009). Eldest group had higher HB scales.

CONCLUSION

Quantitative evaluation of eyelid position and tear meniscus are effective to document the evolution of FNP and can serve as a clue of orbicularis recovery.

Evaluation of the upper and lower proximal lacrimal canaliculi using spectral-domain optical coherence tomography in normal Beagle dogs

OBJECTIVE

To confirm the feasibility of visualizing upper and lower proximal lacrimal canaliculi (LC) using spectral-domain optical coherence tomography (SD-OCT).

ANIMALS STUDIED

Eight eyes of four normal Beagle dogs.

PROCEDURES

To obtain an upper proximal LC image, the head was turned in the opposite direction to the eye being imaged, and the medial part of the upper eyelid was everted to expose the LC. To obtain a lower LC image, the lower eyelid was everted just below the punctum. Using "angle mode", the scan line was placed parallel on the long axis of the LC. The inlet LC width (LCW) was measured. Artificial tears (AT) were instilled, and LCW was compared before and after AT instillation. Additionally, the return time to the initial LCW inlet width was recorded.

RESULTS

Before AT instillation, there was a significant difference between the mean upper and lower LCW (91.8 ± 3.2 µm and 110.1 ± 8.4 µm, respectively). After AT instillation, the mean upper and lower LCW were 236.9 ± 27.7 µm and 238.4 ± 30.4 µm, respectively. Significant differences in the LCW before and after AT instillation in both the upper and lower LCWs were observed. The mean return time of the upper and lower LCW to their initial widths after AT instillation was within 4 min.

CONCLUSIONS

Spectral-domain optical coherence tomography was an effective method for providing high-resolution images of the upper and lower proximal LC. This method enables observation of LC changes after instillation of eyedrops in veterinary clinical practice.

Feasibility of Strip Meniscometry for Tear Volume Evaluation in Lacrimal Passage Obstruction

Strip meniscometry tube (SMTube) is useful for assessing tear volume in dry eye disease. We performed an in vitro and a clinical study to examine whether the SMTube can also be used to evaluate tear quantity in lacrimal passage obstruction (LPO). In vitro experiments showed that the SMTube value and the amount of water absorption were significantly correlated (R² = 0.816, p = 0.0008), but the measured value peaked when 4 μL was absorbed. In the clinical study, 12 eyes of 9 LPO patients and 17 eyes of 17 healthy control subjects were included. The patients’ SMTube values were significantly higher than those of the control subjects (p < 0.05). The SMTube value significantly decreased after silicon tube intubation (p < 0.05). Tear meniscus height (TMH) and area (TMA), measured by anterior segment optical coherence tomography, exhibited a significant positive correlation with the SMTube value (TMH, p < 0.001, R² = 0.396; TMA, p < 0.001, R² = 0.366). Moreover, the SMTube value significantly correlated positively with the subjective symptom of epiphora (p = 0.012, R² = 0.255). Thus, SMTube was useful for evaluating the tear volume and therapeutic effects in patients with LPO.