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Baratta RO, Schlumpf E, Del Buono BJ, DeLorey S, Ousler G, Calkins DJ. A Phase 2 Trial to Test Safety and Efficacy of ST-100, a Unique Collagen Mimetic Peptide Ophthalmic Solution for Dry Eye Disease. Ophthalmol Sci 2024; 4:100451. [PMID: 38317866 PMCID: PMC10838901 DOI: 10.1016/j.xops.2023.100451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024]
Abstract
Objective Dry eye disease (DED) is a worldwide source of ocular discomfort. This first-in-human phase 2 clinical study determined the efficacy of treating signs and symptoms of DED using an ophthalmic solution of synthesized mimetic of human collagen (ST-100). Design This double-masked, randomized, study compared high (60 μg/mL) and low (22 μg/mL) dose ST-100 to vehicle utilizing the Ora, Inc. Controlled Adverse Environment (CAE) during a 28-day period. Participants Participants included males and females ≥ 18 years of age with signs and symptoms of DED for ≥ 6 months that worsened during CAE exposure who were not taking any topical prescription therapeutic. Intervention Participants applied ST-100 or vehicle placebo topically to both corneas (1 drop) twice daily via a blow-fill-sealed preservative-free container. Main Outcome Measures The prespecified primary efficacy sign end point was mean change from baseline (CFB) in total corneal fluorescein staining, and the primary symptom end point was mean CFB in ocular discomfort. A secondary prespecified efficacy end point was CFB in unanesthetized Schirmer's test for tear film production. Results Of 160 subjects in the intent-to-treat population (112 female, 48 male, median age 64), 146 completed the study. Total corneal fluorescein staining CFB improved for high-dose ST-100, with superiority over vehicle when both eyes were considered together (2-sample t test: P = 0.0394). High-dose ST-100 was superior to vehicle in Schirmer's CFB for the study eye (least squares mean difference [confidence interval] = 2.3 [0.6, 4.0], P = 0.0094). For study eyes, the proportion of Schirmer's test responders (CFB ≥ 10 mm, Schirmer's responder rate) was 12.2% for high-dose ST-100 versus 0.0% for vehicle (P = 0.0266). The CFB for ocular discomfort score improved in study eyes for high- and low-dose ST-100 (paired t test, P = 0.0133, P = 0.0151, respectively) but without superiority over vehicle (ANCOVA: P = 0.5696, P = 0.8968, respectively). ST-100 Schirmer's responders also demonstrated total elimination of worsening of corneal fluorescein stain during the stress of CAE sessions. Conclusions ST-100 significantly improved tear production and related outcomes in DED and was well-tolerated in reducing symptoms. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | | | | | | | | | - David J. Calkins
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
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Abusharha A, Pearce EI, Alsaqar A, Fagehi R, Afsar T, Razak S. Efficacy of hydroxypropyl-guar drops in improving tear film index and ocular surface dynamics using two treatment methods under a controlled desiccating environment. Int Ophthalmol 2024; 44:175. [PMID: 38615085 DOI: 10.1007/s10792-024-03122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/25/2024] [Indexed: 04/15/2024]
Abstract
AIM This study aimed to assess the efficacy of hp-guar eye drops on tear film index and ocular surface dynamics under desiccating conditions using protection and relief treatment modalities. METHODOLOGY The 12 normal, non-dry eye participants were subjected to adverse environmental conditions using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the ambient temperature was 21 °C. The participants were screened for ocular symptoms, tear osmolarity, ocular surface temperature (OST), tear production using the Ocular Surface Disease Index questionnaire (OSDI), OcuSense TearLab Osmometer, FLIR System ThermaCAM P620, and Schirmer strips. Tear production was calculated by the Tear Function Index test (TFI). RESULTS The mean tear film osmolarity decreased significantly from 296 mOsm/L at 40% RH to 285 mOsm/L at 5% RH (p = 0.01). Conflicting responses were seen for osmolarity in protection and relief. Mean tear osmolarity was significantly higher in the protection method in comparison to the relief method (p = 0.005). The mean TFI increased from 557 at 40% to 854 at 5% (p = 0.02). A significant increase in TFI was observed in the relief method in comparison with both 40% (p = 0.001) and 5% (p = 0.04). In the relief method, the mean TFI score went up to 1139 when hp-guar was installed. A significant improvement in ocular comfort was experienced in both the protection (p = 0.041) and relief (p = 0.010) methods at 5% RH. The instillation of hp-guar drops in the relief method resulted in a significant reduction in OST. The mean OST dropped to 33.01 ºC, significantly lower than the recorded OST for both normal (p = 0.040) and dry (p = 0.014) environmental conditions. CONCLUSION Hp-guar drops significantly improve tear film parameters under a desiccating environment, however, tear film parameters respond differently to the management modalities. In the protection method, tear film osmolarity was protected against a dry environment, while in the relief mode, an improvement in tear production and a decrease in ocular surface temperature were seen. Hp-guar performance could be maximized for the management of exposure to adverse environments by using a treatment protocol that targets the most affected parameters in each group of patients. Using CEC has the potential to provide researchers with a readily available method to evaluate the efficiency of tear supplementation.
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Affiliation(s)
- Ali Abusharha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, 12372, Riyadh, Saudi Arabia
| | - E Ian Pearce
- Department of Vision Science, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddence Road, Glasgow, G4 0BA, UK
| | - Ali Alsaqar
- Department of Optometry, College of Applied Medical Sciences, King Saud University, 12372, Riyadh, Saudi Arabia
| | - Raied Fagehi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, 12372, Riyadh, Saudi Arabia
| | - Tayyaba Afsar
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, 12372, Riyadh, Saudi Arabia
| | - Suhail Razak
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, 12372, Riyadh, Saudi Arabia.
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Abusharha A, Pearce EI, Afsar T, Razak S. Evaluation of therapeutic efficacy of Emustil drops for ocular discomfort and tear film osmolarity using different treatment management modes under dry environmental conditions. BMC Ophthalmol 2024; 24:129. [PMID: 38523298 PMCID: PMC10962139 DOI: 10.1186/s12886-024-03390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND We aimed to check the efficacy of Emustil (oil in water emulsion) drops on tear film index and ocular surface dynamics in dry environments through protection and relief treatment modalities. METHODS The subjects were exposed to a dry environment using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the temperature was 21 °C and screened for ocular symptoms, tear osmolarity, ocular surface temperature (OST) and tear production using ocular Surface Disease Index questionnaire (OSDI), OcuSense TearLab Osmometer, FLIR System ThermaCAM P620 and Schirmer strips/phenol red test respectively. Tear production was calculated by the Tear Function Index test (TFI). RESULTS The mean tear film osmolarity decreased significantly from 296.8 mOsm/l at 40% RH to 291 mOsm/l at 5%. (p = 0.01). Instillation of Emustil resulted in a significant increase in tear osmolarity in the relief method compared with osmolarity seen at 5% RH when no drop was used. The mean PRT value decreased from 26 ± 9 in normal conditions (40% RH) to 22 ± 4 mm in dry conditions (5% RH). Emustil drops did not induce any significant change in tear production in the PRT test. No significant change was found in OST following exposure to 5% RH. OST did not show a statistically significant change with the emulsion when used for relief (p > 0.05). The mean score of ocular discomfort observed was 70 at 5% RH. Still, the instillation of the oil-in-water emulsion (Emustil) resulted in a noticeable decrease in visual discomfort to 37 (p = 0.00) in protection and 59 in relief (p = 0.05). Emustil drops substantially improved tear film parameters under a desiccating environment, however, tear film parameters respond differently to the management modalities. In the protection method, tear film osmolarity was protected against a dry environment, while in the relief mode, tear production was improved. CONCLUSION CEC allows for a thorough evaluation of tear film parameters and dry eye treatment protocols in labs, providing greater confidence when applying them to patients. In addition, our study showed that Emustil not only provides protection and relief for dry eyes but also helps to maintain ocular homeostasis in desiccating environments. This indicates a promising potential for improving dry eye treatment protocols.
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Affiliation(s)
- Ali Abusharha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - E Ian Pearce
- Glasgow Caledonian University, 70 Cowcaddence Road, G4 0BA, Glasgow, UK
| | - Tayyaba Afsar
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Suhail Razak
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
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Bayram LC, Isler CT, Ekebas G. Determination of reference values for tear production and intraocular pressure in Pygoscelis penguins of the Antarctic Peninsula. BMC Vet Res 2023; 19:235. [PMID: 37946185 PMCID: PMC10636934 DOI: 10.1186/s12917-023-03794-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND According to the literature review, this is the first study investigating tear production (TP) and intraocular pressure (IOP) in the Pygoscelis penguins living in their natural habitat. The study aimed to establish normal values for standard ocular tests in the genus Pygoscelis, namely, the Adélie (Pygoscelis adeliae), gentoo (Pygoscelis papua), and chinstrap (Pygoscelis antarctica) penguins, in four different islands of Antarctica. Sampling was made by specifically using the left eye of the penguins. The Schirmer's tear test type I (STT-I) and the Tonovet® (rebound tonometer) were used to measure the TP and the IOP, respectively. RESULTS The mean TP and IOP values of 129 Adélie, chinstrap, gentoo, and 120 adult Adélie, gentoo penguins were determined as 10.2 ± 4.0 mm/min and 38.9 ± 13.2 mmHg, respectively. No statistical difference was detected between the penguin species for the mean IOP values, while the difference was determined in all the locations. However, statistical differences in the mean TP values were determined between all locations. CONCLUSION The results of this study provide a reference range of Schirmer's tear test (STT) and IOP values in Pygoscelis penguins and show that the IOP is significantly affected by locations. This result can be attributed to the harsh climatic conditions of the Antarctic Peninsula that change very quickly. The described data may help diagnose clinical pathological findings in Pygoscelis penguins. The STT and rebound tonometry appears to be safe and reproducible methods in Pygoscelis penguins, as the results were obtained quickly and were well tolerated by the birds. Based on our results, we propose that similar studies can be initiated in crowded colonies of three penguin species of this genus on the Antarctic Peninsula, the southern Shetland Islands, and other frequently visited islands in Antarctica.
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Affiliation(s)
- Latife Cakir Bayram
- Department of Pathology, Faculty of Veterinary Medicine, Erciyes University, Kayseri, 38280, Turkey.
| | - Cafer Tayer Isler
- Department of Surgery, Faculty of Veterinary Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Görkem Ekebas
- Department of Pathology, Faculty of Veterinary Medicine, Erciyes University, Kayseri, 38280, Turkey
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Pinard CL. Diagnostic Tests Used During the Ocular Examination. Vet Clin North Am Small Anim Pract 2023; 53:279-298. [PMID: 36813386 DOI: 10.1016/j.cvsm.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
This article provides a review of the required ocular tests during the ophthalmologic examinations of canine and feline patients. Knowledge of medications affecting ocular parameters and awareness of available instrumentation and test materials is essential for accurate diagnoses.
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Affiliation(s)
- Chantale L Pinard
- Department of Clinical Studies, University of Guelph, Ontario Veterinary College, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada.
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Tomar MPS, Bansal N. Enzyme histochemical characterization of orbital glands in fetuses of Indian buffalo ( Bubalus bubalis). PeerJ 2023; 11:e15196. [PMID: 37065703 PMCID: PMC10100827 DOI: 10.7717/peerj.15196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/15/2023] [Indexed: 04/18/2023] Open
Abstract
Background The orbital glands, viz. lacrimal gland, superficial and deep gland of third eyelid (LG, SGT and HG), are important for normal eye functions. These glands have different functions in various animals. The information about the enzyme histochemical nature of prenatal orbital glands in Indian buffalo seems to be unavailable. Therefore, the study was planned on orbital glands of six full term recently died fetuses from animals with dystocia. Methods The frozen sections of all these glands were subjected to standard localization protocols for Alkaline Phosphatase (AKPase), Glucose 6 phosphatase (G-6-Pase), Lactate dehydrogenase (LDH), Succinate dehydrogenase (SDH), Glucose 6 phosphate dehydrogenase (G-6-PD), Nicotinamide Adenine Dinucleotide Hydrogen Diaphorase (NADHD), Nicotinamide Adenine Dinucleotide Phosphate Hydrogen diaphorase (NADPHD), Dihydroxy phenylalanine oxidase (DOPA-O), Tyrosinase, non-specific esterase (NSE) and Carbonic anhydrase (CAse). Results The results revealed a mixed spectrum of reaction for the above enzymes in LG, SGT and HG which ranged from moderate (for LDH in SGT) to intense (for most of the enzymes in all three glands). However, DOPA-O, Tyrosinase and CAse did not show any reaction. From the present study, it can be postulated that the orbital glands of fetus have a high activity of metabolism as it has many developmental and functional activities which were mediated with the higher activity of the enzymes involved.
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Affiliation(s)
| | - Neelam Bansal
- Veterinary Anatomy, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
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Wirta DL, Senchyna M, Lewis AE, Evans DG, McLaurin EB, Ousler GW, Hollander DA. A randomized, vehicle-controlled, Phase 2b study of two concentrations of the TRPM8 receptor agonist AR-15512 in the treatment of dry eye disease (COMET-1). Ocul Surf 2022; 26:166-173. [PMID: 35970431 DOI: 10.1016/j.jtos.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Dry eye disease (DED) symptoms can negatively impact quality of life (QoL). AR-15512, a transient receptor potential melastatin 8 (TRPM8) agonist, was evaluated as a potential therapy for DED. METHODS In a Phase 2b study, patients with DED were randomized 1:1:1 to 0.0014% AR-15512, 0.003% AR-15512, or vehicle twice daily for 12 weeks. Eligibility criteria included DED signs and symptoms of prespecified severity levels. Outcomes assessed were DED signs (Schirmer score ± anesthetic, ocular surface staining, hyperemia), symptoms (Ocular Discomfort [ODS-VAS], Symptoms Assessment iN Dry Eye [SANDE], Eye Dryness-VAS, Ocular Pain-VAS), QoL-VAS, and adverse events. Co-primary endpoints were changes from baseline in ODS-VAS and anesthetized Schirmer score at Day 28. RESULTS 0.003% AR-15512 (n = 122) was associated with early and sustained improvements in unanesthetized Schirmer score (Days 1 and 14, p < 0.0001), as well as improvements in ocular surface staining (Days 14 and 84, p ≤ 0.0365) and hyperemia (Day 84, p < 0.0215). Statistically significant improvements in symptoms were observed for the 0.003% concentration on SANDE (Days 14, 28, and 84, p ≤ 0.0254), ODS-VAS (Day 84, p = 0.0281), Eye Dryness-VAS (Day 84, p = 0.0302), and multiple QoL measures (Days 14, 28, and 84, p < 0.05). There were no significant differences between active and vehicle groups for the co-primary endpoints. The most common adverse events were burning and stinging upon instillation. CONCLUSIONS Although predefined co-primary study endpoints were not met, AR-15512 demonstrated statistically significant improvements in DED signs, symptoms, and disease-related QoL.
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Lazareva Y, Rayisyan M, Mironova E. Features of the clinical picture of keratitis in horses with different forms of the course of the disease. Open Vet J 2022; 12:830-838. [PMID: 36650853 PMCID: PMC9805768 DOI: 10.5455/ovj.2022.v12.i6.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Keratitis is a common cause of eye diseases in horses, often resulting in complete loss of vision. Aim The purpose of this article is to study the features of the clinical picture of primary and secondary keratitis in horses, depending on the form of the course of the disease. Methods The study was conducted in 2019 at 22 private horse breeding farms. The study involved 80 horses with keratitis, which were divided into two equal groups depending on the diagnosis of primary or secondary keratitis. Results The effectiveness of the therapies was compared 1, 3, and 6 months after the start of treatment. Following a 1-month therapy, only a minority of horses with primary keratitis had their eye functions fully restored, the number of horses with macula was two times higher (p ≤ 0.05), the number of horses with nebula was seven times higher (p ≤ 0.001), and leukomas were reported in most of the cases ( p ≤ 0.0001). Conclusion The effectiveness of the therapy for keratitis is directly related to the peculiarities of treatment and adherence to the regimen.
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Affiliation(s)
- Yuliya Lazareva
- Department of Biology and General Genetics, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia,Corresponding Author: Yuliya Lazareva. Department of Biology and General Genetics, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
| | - Maria Rayisyan
- Department of Regulatory Relations of Circulation of Medicines and Medical Devices, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina Mironova
- Department of Polyclinic Therapy, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Shoari A, Kanavi MR, Rasaee MJ. Inhibition of matrix metalloproteinase-9 for the treatment of dry eye syndrome; a review study. Exp Eye Res 2021; 205:108523. [PMID: 33662353 DOI: 10.1016/j.exer.2021.108523] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/06/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Dry eye syndrome (DES) and tear dysfunction are multifactorial conditions affecting meibomian glands, lacrimal glands, and ocular surface. This ocular disorder can cause eye irritation, irregular cornea, corneal barrier disruption, and blurred vision. Uncontrolled increase in matrix metalloproteinase-9 (MMP-9) level and activity has been detected in the tears and ocular surface in the patients with DES, which has been proved to be related to disruption of tight junctions in apical corneal epithelium associated with severe signs of DES. These uncontrolled activities of MMP-9 lead to desquamation of ocular surface epithelia. Therefore, this review study was conducted to summarize the evidence regarding MMP-9 contribution in DES, and inhibition of MMP-9, as a therapeutic target for treatment of DES. For this purpose, herein, the related studies designed novel pharmaceutical compounds for direct and indirect inhibition of MMP-9 as treatment approaches for DES were reviewed. These compounds were designed to improve corneal barrier function, reduce inflammation on ocular surface, and restore tear production.
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Affiliation(s)
- Alireza Shoari
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Javad Rasaee
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Ibrahim A, Ahmed AF. The Impact of Surgical Excision of the Orbital Lacrimal Gland on the Aqueous Tear Production and Ocular Surface Health in Donkeys (Equus asinus). J Equine Vet Sci 2021; 97:103344. [PMID: 33478769 DOI: 10.1016/j.jevs.2020.103344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/02/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022]
Abstract
The exact contribution of the orbital lacrimal gland (OLG) is unknown and is still a subject of debate and inconsistency in literature. Currently, there are no detailed studies addressing the influence of the OLG removal on tear production in equines. This study aimed to address the influence of surgical excision of the OLG on aqueous tear production and ocular surface health in donkeys. The study was conducted on six clinically healthy donkeys with no ophthalmic abnormalities. In each donkey, the OLG of the left eye was surgically excised, whereas the right eye was served as a control. External ophthalmic examination, Schirmer tear test (STT) I and II, tear pH, fluorescein staining test were conducted on both eyes, preoperatively and at one-week intervals for 60 days, postoperatively. There were significant decreases in STT I and II values (P = .0001 and .0001, respectively), whereas tear pH values showed a significant increase (P = .0001) in the operated eyes compared with the control ones. There were no overt clinical signs characteristics of keratoconjunctivitis sicca (KCS) in the operated eyes. However, there was evidence of microinjury of the keratoconjunctival epithelium evidenced by positive fluorescein uptake, postoperatively. Surgical excision of the OLG significantly diminished the aqueous tear production and threatened the corneal epithelium as a result of corneal dehydration. On the contrary to the recommendations of other studies, eyes subjected to this procedure should receive treatment of dry eye to prevent development of KCS, postoperatively.
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Soifer M, Mousa HM, Stinnett SS, Galor A, Perez VL. Matrix metalloproteinase 9 positivity predicts long term decreased tear production. Ocul Surf 2020; 19:270-274. [PMID: 33098983 DOI: 10.1016/j.jtos.2020.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate long-term correlations between Matrix Metalloproteinase-9 (MMP-9) testing and dry eye (DE) parameters. Additionally, to evaluate variability in MMP-9 results over time and with anti-inflammatory treatment. METHODS Retrospective cohort study of DE patients with equal MMP-9 testing results (positive or negative) in both eyes and a minimum of 6 months of follow up. Our main outcome measure was to examine whether initial MMP-9 status affected change in DE parameters over time. Secondarily, we evaluated the frequency of MMP-9 status change over time and examined whether MMP-9 status change was impacted by treatment. RESULTS 67 patients (76% female) fit the inclusion criteria. Mean age was 63 years with a mean follow up of 10.6 months. The majority (37/67, 55%) had concomitant systemic immune disease. MMP-9 testing was positive in both eyes in 39 individuals (58%) and negative in both eyes in 27 (42%) individuals. Of all DE parameters, initial MMP status predicted change in tear production. Individuals in the MMP-9 positive group had a greater decrease in production from baseline to final visit compared to the negative group (-2.6 vs 2.1, P = 0.013). In those initially MMP-9 positive, the frequency of becoming MMP-9 negative was higher in eyes treated with anti-inflammatory therapy compared to artificial tears (22.9% vs 3.3%, P = 0.106). However, only Lifitegrast 5% showed statistical significance compared to artificial tears (31.3% vs 3.3%, P = 0.044). CONCLUSIONS Eyes with detectable MMP-9 had significantly decreased tear production over time compared to those without detectable MMP-9. Anti-inflammatory treatment more frequently normalized MMP-9 compared to PFATs.
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Affiliation(s)
- Matias Soifer
- Foster Center for Ocular Immunology, Duke Eye Institute, USA; Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27705, USA
| | - Hazem M Mousa
- Foster Center for Ocular Immunology, Duke Eye Institute, USA; Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27705, USA
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27705, USA
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Victor L Perez
- Foster Center for Ocular Immunology, Duke Eye Institute, USA; Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27705, USA.
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Kovalcuka L, Nikolajenko M. Changes in intraocular pressure, horizontal pupil diameter, and tear production during the use of topical 1% cyclopentolate in cats and rabbits. Open Vet J 2020; 10:59-67. [PMID: 32426258 PMCID: PMC7193883 DOI: 10.4314/ovj.v10i1.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Cyclopentolate is not commonly used as mydriatic drug in veterinary medicine because of limited data on the local and systemic effects in animals. Aim To determine the effects of topical 1% cyclopentolate hydrochloride on intraocular pressure (IOP), horizontal pupil diameter (HPD) and tear production in the cat and rabbit's eye during the first hour and up to 36 hours after treatment. Methods One drop of 1% cyclopentolate hydrochloride was used in the left eye in 10 clinically and ophthalmologically healthy domestic cats and 10 rabbits. IOP and HPD were recorded every 5 minutes during the first hour, then every 2 hours during the following 12-hour period, and at 24 and 36 hours after application. Schirmer tear test (STT) was measured at 30 and 60 minute after treatment, then in same time points as IOP and HPD. Rebound tonometer (TonoVet®) was used to assess IOP, Jameson calliper to measure HPD and STT to determine the tear production. Results 1% cyclopentolate increased IOP in cats, reaching a maximum (28.1 ± 5.4 mmHg) at T 50 and in rabbits at T25 (16.7 ± 1.3 mmHg). Maximal mydriasis in cats was observed at T 40 and lasted 24-36 hours, but in rabbits at T 25, and returned to pre-treatment values at T 10h-T 12h. In cats, STT decreased in both eyes 30 minutes after treatment and remained lower throughout the 36-hour period. In rabbits, STT decreased in the treated eye 30 minutes after treatment, but all following STT measurements returned to normal pre-treatment levels. Conclusion Study showed novel data about the effects of 1% cyclopentolate to IOP, HPD, STT in cats and rabbits. Cyclopentolate in cats caused mydriasis 20-40 minutes after the treatment by increasing IOP, at the same time, pupil diameter reached pre-treatment values 24-36 hours after treatment. In rabbit's mydriasis occurred faster, 10-25 minutes after treatment without significant IOP increase and mydriasis lasted 10-12 hours. Significant STT decrease was recorded in cats, but more likely were connected to stress factors. This drug could be considered as a therapeutical alternative in rabbit more than in cats.
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Affiliation(s)
- Liga Kovalcuka
- Faculty of Veterinary Medicine, Clinical Institute,Latvia University of Life Sciences and Technologies, Jelgava, Latvia
| | - Madara Nikolajenko
- Faculty of Veterinary Medicine, Clinical Institute,Latvia University of Life Sciences and Technologies, Jelgava, Latvia
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Agarwal P, Dhakad V, Sharma D. Feasibility of Parotid Duct Transposition for the Treatment of Dry Eye: A Cadaveric Study. Indian J Otolaryngol Head Neck Surg 2019; 71:29-32. [PMID: 30906709 PMCID: PMC6401063 DOI: 10.1007/s12070-018-1559-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 11/25/2022] Open
Abstract
Total dry eye is encountered less frequently, but it may lead to blindness. Transposition of parotid duct to the conjunctival cul-de-sac is a method of treatment for advanced cases of xerophthalmia to prevent blindness. Tears and parotid secretions have similar composition; therefore saliva provides an excellent replacement for tears. Limitation of this procedure is that the length of the parotid duct may not be adequate to reach the conjunctival cul-de-sac. This study was conducted in 30 fresh cadavers to assess the length of parotid duct and technical feasibility of parotid duct transposition for the treatment of dry eye. The parotid duct was dissected and resting length of parotid duct was measured on both sides without stretching. The distance between ear lobule to lateral canthus was also measured on both sides in each cadaver. The length of parotid duct ranges from 4.5 to 7 cm with average length was 5.8 cm. The majority of the cadavers had parotid duct length of 6 cm. Length of the right and left parotid duct was found to be equal in all cadavers. Parotid duct reached comfortably in 24 cadavers (80%) while it was short in 6 cadavers (20%) by 1-1.50 cm in length. Parotid duct can be transposed easily to the lower conjunctival cul-de-sac in majority of the cases. If the parotid duct is falling short than a cuff of the buccal mucosa can be taken in order to gain length.
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Affiliation(s)
- Pawan Agarwal
- Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, M.P. 482003 India
- 292/293, Napier Town, Jabalpur, M.P. 482001 India
| | - Vinod Dhakad
- Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, M.P. 482003 India
| | - D. Sharma
- Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, M.P. 482003 India
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McLaughlin PJ, Sassani JW, Titunick MB, Zagon IS. Efficacy and safety of a novel naltrexone treatment for dry eye in type 1 diabetes. BMC Ophthalmol 2019; 19:35. [PMID: 30691415 PMCID: PMC6348650 DOI: 10.1186/s12886-019-1044-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/18/2019] [Indexed: 11/13/2022] Open
Abstract
Background Dry eye disease (DED) is a prevalent complication of diabetes and presents as reduced tear production and/or increased corneal surface sensitivity often with secondary ocular surface changes. This study examined the safety and efficacy of a proprietary new eye drop formulation for topical treatment of DED. Methods Type 1 diabetes (T1D) was established in male Sprague-Dawley rats to study the efficacy and safety of the investigational compound that contained 20 μg/ml of naltrexone (NTX). Tear production was measured by the Schirmer’s 1 test, and ocular surface sensitivity was measured using an aesthesiometer. Diabetic rats received twice daily applications of a single drop (~ 0.02 ml) of the proprietary formulation (NTX-001) or vehicle onto one eye. For comparison, some diabetic rats received eye drops containing NTX in sterile Vigamox®. Safety was monitored by assessment of ocular histopathology in naïve male rats and naïve male rabbits receiving twice daily treatment of two drops for 30 days. Results Dry eye in T1D rats was reversed within hours of a single treatment of NTX-001, and over a period of 10 days NTX-001 restored corneal sensitivity and reversed dry eye relative to values measured in diabetic rats receiving vehicle. In comparison to NTX dissolved in Vigamox®, the proprietary NTX-001 was more effective at reversing dry eye. Safety studies in naïve rats and rabbits revealed no visible ocular pathology after 30 days of treatment. Conclusions An investigational new eye drop containing 20 μg/ml NTX effectively reversed tear film deficits and restored corneal surface sensitivity in diabetic animals without causing toxic side effects.
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Affiliation(s)
- Patricia J McLaughlin
- Department of Neural and Behavioral Science, The Pennsylvania State University College of Medicine, MC H109, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Joseph W Sassani
- Department of Ophthalmology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Michelle B Titunick
- Department of Neural and Behavioral Science, The Pennsylvania State University College of Medicine, MC H109, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Ian S Zagon
- Department of Neural and Behavioral Science, The Pennsylvania State University College of Medicine, MC H109, 500 University Drive, Hershey, PA, 17033-0850, USA
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Sheppard JD, Torkildsen GL, Geffin JA, Dao J, Evans DG, Ousler GW, Wilson J, Baba SN, Senchyna M, Holland EJ. Characterization of tear production in subjects with dry eye disease during intranasal tear neurostimulation: Results from two pivotal clinical trials. Ocul Surf 2018; 17:142-150. [PMID: 30472141 DOI: 10.1016/j.jtos.2018.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/13/2018] [Accepted: 11/21/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE The intranasal tear neurostimulator (ITN) activates the nasolacrimal pathway, which is involved with basal and bolus tear secretion. These studies characterized the acute and long-term effectiveness of the ITN in stimulating tear production in subjects with dry eye disease (DED). METHODS Study 1: Randomized, double-masked, dual-controlled, 1-day crossover. Study 2: Single-arm, open-label, 180-day prospective cohort. Eligible subjects had basal unstimulated Schirmer test (with anesthesia) ≤10 mm and intranasal cotton swab-stimulated Schirmer test at least 7 mm greater in the same eye, and Ocular Surface Disease Index® ≥13 and ≥ 23, in Studies 1 and 2, respectively. Study 1: Subjects (n = 48) received three randomized test applications: active intranasal, extranasal (active control), and sham intranasal (inactive control) stimulation, 3 min/application with 1-hour minimum between applications. Primary outcome measure was the difference in Schirmer test scores during active intranasal and control applications. Study 2: Subjects (n = 97) performed intranasal neurostimulation for ≤3 min/application, 2-10 times/day. Primary outcome measure was the difference in Schirmer scores (stimulated minus unstimulated) at day 180. Both studies recorded device-related adverse events (AEs). RESULTS Study 1: Schirmer scores (mean ± SEM) were significantly greater (p < 0.0001) with active intranasal (25.3 ± 1.5 mm) vs extranasal (9.5 ± 1.2 mm) and sham (9.2 ± 1.1 mm) applications. Study 2: Schirmer scores were significantly greater (p < 0.0001) with ITN stimulation vs unstimulated at day 180 (17.3 ± 1.3 mm vs 7.9 ± 0.7 mm). No serious device-related AEs were reported in either study. CONCLUSION The ITN was well-tolerated and effective in stimulating tear production with acute and long-term use in DED. CLINICALTRIALS. GOV IDENTIFIER NCT02680158 and NCT02526290.
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Affiliation(s)
- John D Sheppard
- Virginia Eye Consultants and Eastern Virginia Medical School, Norfolk, VA, USA.
| | | | | | - Jung Dao
- Cornea and Cataract Consultants of Arizona, Phoenix, AZ, USA
| | | | | | | | | | | | - Edward J Holland
- Cincinnati Eye Institute and the University of Cincinnati, Cincinnati, OH, USA
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16
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Kovalcuka L, Boiko D, Williams DL. Tear production and intraocular pressure values in clinically normal eyes of whooper swans (C ygnus cygnus). Open Vet J 2018; 8:335-339. [PMID: 30483458 PMCID: PMC6172406 DOI: 10.4314/ovj.v8i3.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 09/03/2018] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to determine the normal range of tear production and values of intraocular pressure (IOP) in clinically normal eyes of whooper swans (Cygnus cygnus). A total of 86 birds: 81 cygnets (6-10 weeks old) and 5 moulting - adult swans (3-6 years old) were examined in this study. Both eyes of all birds underwent a complete ophthalmic examination, including evaluation of tear production with the phenol red thread test (PRTT) and the assessment of the IOP by rebound tonometry, employing the TonoVet® device. The mean ± standard deviation of PRTT values were as follows: all cygnets (81) 22.59±3.48 mm/15s, male cygnets (45) 22.64±3.54 mm/15s, female cygnets (36) 22.53±3.44 mm/15s. IOP was as follows: all cygnets 11.30±3.55 mmHg, male cygnets 10.93±3.56 mmHg, female cygnets 11.74±3.50 mmHg. No statistically significant differences between right and left eye and between female and male cygnets were found for IOP and PRTT values. This study provides the reference values for the PRTT and IOP in healthy whooper swan cygnets, showing that PRTT determination of the tear production and rebound tonometry to evaluate the IOP methods are practical methods for ophthalmic examination in swans.
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Affiliation(s)
- Liga Kovalcuka
- Latvia University of Life Sciences and Technologies, Faculty of Veterinary Medicine, Clinical Institute, K. Helmaņa iela 8, Jelgava, LV - 3004, Latvia
| | - Dmitrij Boiko
- Institute of Biology, University of Latvia, Miera 3, Salaspils, LV-2169, Latvia
| | - David L Williams
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
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Rentka A, Nagy A, Harsfalvi J, Szucs G, Szekanecz Z, Gesztelyi R, Szodoray P, Kemeny-Beke A. Association between objective signs and subjective symptoms of dry eye disease in patients with systemic sclerosis. Rheumatol Int 2017; 37:1835-45. [PMID: 28884335 DOI: 10.1007/s00296-017-3794-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/09/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the association between clinical signs and symptoms of dry eye disease (DED) in patients with systemic sclerosis (SSc). This cross-sectional observational study included 19 SSc patients and 19 normal subjects with no ocular symptoms or ocular surface disorders. Clinical parameters included tear film break-up time (tBUT), Schirmer I, lissamine green (LG) dye, and tear film osmolarity tests, tear production, and tear secretion flow. For assessment of the dry eye symptoms, the Ocular Surface Disease Index (OSDI) questionnaire was administered to all patients. The following mean values were found in SSc patients: OSDI 33.6 ± 19.86; osmolarity of the tear fluid 310.8 mOsmol/l ± 14.47; tBUT time 5.158 ± 2.328 s; Schirmer I test 5.395 mm/5 min; LG grading score 2.026 ± 0.8893; collected tear fluid volume 6.397 ± 2.761 µl. The calculated average tear velocity was 4.654 ± 1.963 µl/min. A significant correlation was found between the OSDI as a subjective parameter and disease duration. Early recognition of dry eye symptoms, a possible extra-intestinal manifestation of SSc, should be included in the check up of the disease to reduce ocular complications. The objective tear functional tests were strongly influenced by individual factors like age and disease duration.
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18
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Williams DL, Burg P. Tear production and intraocular pressure in canine eyes with corneal ulceration. Open Vet J 2017; 7:117-125. [PMID: 28616393 PMCID: PMC5440610 DOI: 10.4314/ovj.v7i2.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/25/2017] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate changes in lacrimation and intraocular pressure (IOP) in dogs with unilateral corneal ulceration using the Schirmer tear test (STT) and rebound (TonoVet®) tonometry. IOP and STT values were recorded in both ulcerated and non-ulcerated (control) eyes of 100 dogs diagnosed with unilateral corneal ulceration. Dogs presented with other ocular conditions as their primary complaint were excluded from this study. The mean ± standard deviation for STT values in the ulcerated and control eyes were 20.2±4.6 mm/min and 16.7±3.5 mm/min respectively. The mean ± standard deviation for IOP in the ulcerated and control eyes were 11.9±3.1 mmHg and 16.7±2.6 mmHg respectively. STT values were significantly higher (p<0.000001) in the ulcerated eye compared to the control eye while IOP was significantly lower (p<0.0001). There is an increase in lacrimation and a decrease in IOP in canine eyes with corneal ulceration. The higher tear production in ulcerated eyes shows the importance of measuring STT in both eyes in cases of corneal ulceration, since this increased lacrimation may mask an underlying keratoconjunctivitis sicca only evident in the contralateral eye. The lower IOP in ulcerated eyes is likely to relate to mild uveitic change in the ulcerated eye with a concomitant increase in uveoscleral aqueous drainage. While these changes in tear production and IOP in ulcerated eyes are widely recognised in both human and veterinary ophthalmology, it appears that this is the first controlled documented report of these changes in a large number of individuals.
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Affiliation(s)
- David L Williams
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Philippa Burg
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
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Fiorello CV, Freeman K, Elias BA, Whitmer E, Ziccardi MH. Ophthalmic effects of petroleum dispersant exposure on common murres (Uria aalge): An experimental study. Mar Pollut Bull 2016; 113:387-391. [PMID: 27743656 DOI: 10.1016/j.marpolbul.2016.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 06/06/2023]
Abstract
The safety of chemical dispersants used during oil spill responses is largely unknown in birds. We captured common murres in Monterey Bay, CA and exposed them to Corexit EC9500a, crude oil, or a combination in artificial seawater. We performed ophthalmic examinations and measured intraocular pressures and tear production before and after exposure. Loglinear analysis found that exposure to oil or dispersant was related to the development of conjunctivitis and corneal ulcers. Odds ratios for birds exposed to oil or dispersant were positive and significant for the development of conjunctivitis, while odds ratios for the development of corneal ulcers were positive and significant only for birds exposed to a high concentration of oil. Ocular exposure to dispersants and petroleum in seabirds may cause conjunctivitis and may play a role in the development of corneal ulcers. These results have implications for policymakers who develop protocols for the use of dispersants during marine oil spills.
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Affiliation(s)
- Christine V Fiorello
- Oiled Wildlife Care Network, One Health Institute, 1089 Veterinary Medicine Drive, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
| | - Kate Freeman
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Becky A Elias
- Oiled Wildlife Care Network, One Health Institute, 1089 Veterinary Medicine Drive, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Emily Whitmer
- Oiled Wildlife Care Network, One Health Institute, 1089 Veterinary Medicine Drive, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Michael H Ziccardi
- Oiled Wildlife Care Network, One Health Institute, 1089 Veterinary Medicine Drive, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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