The aim of the DEWS Definition and Classification Subcommittee was to provide a contemporary definition of dry eye disease, supported within a comprehensive classification framework. A new definition of dry eye was developed to reflect current understanding of the disease, and the committee recommended a three-part classification system. The first part is etiopathogenic and illustrates the multiple causes of dry eye. The second is mechanistic and shows how each cause of dry eye may act through a common pathway. It is stressed that any form of dry eye can interact with and exacerbate other forms of dry eye, as part of a vicious circle. Finally, a scheme is presented, based on the severity of the dry eye disease, which is expected to provide a rational basis for therapy. These guidelines are not intended to override the clinical assessment and judgment of an expert clinician in individual cases, but they should prove helpful in the conduct of clinical practice and research.

The definition and classification of dry eye disease: Report of the definition and classification subcommittee of the international Dry Eye WorkShop (2007)

结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

The subcommittee reviewed the prevalence, incidence, risk factors, natural history, morbidity and questionnaires reported in epidemiological studies of dry eye disease (DED). A meta-analysis of published prevalence data estimated the impact of age and sex. Global mapping of prevalence was undertaken. The prevalence of DED ranged from 5 to 50%. The prevalence of signs was higher and more variable than symptoms. There were limited prevalence studies in youth and in populations south of the equator. The meta-analysis confirmed that prevalence increases with age, however signs showed a greater increase per decade than symptoms. Women have a higher prevalence of DED than men, although differences become significant only with age. Risk factors were categorized as modifiable/non-modifiable, and as consistent, probable or inconclusive. Asian ethnicity was a mostly consistent risk factor. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable, particularly costs due to reduced work productivity. Questionnaires used to evaluate DED vary in their utility. Future research should establish the prevalence of disease of varying severity, the incidence in different populations and potential risk factors such as youth and digital device usage. Geospatial mapping might elucidate the impact of climate, environment and socioeconomic factors. Given the limited study of the natural history of treated and untreated DED, this remains an important area for future research.

TFOS DEWS II Epidemiology Report.

The role of the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Diagnostic Methodology Subcommittee was 1) to identify tests used to diagnose and monitor dry eye disease (DED), 2) to identify those most appropriate to fulfil the definition of DED and its sub-classifications, 3) to propose the most appropriate order and technique to conduct these tests in a clinical setting, and 4) to provide a differential diagnosis for DED and distinguish conditions where DED is a comorbidity. Prior to diagnosis, it is important to exclude conditions that can mimic DED with the aid of triaging questions. Symptom screening with the DEQ-5 or OSDI confirms that a patient might have DED and triggers the conduct of diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Meibomian gland dysfunction, lipid thickness/dynamics and tear volume assessment and their severity allow sub-classification of DED (as predominantly evaporative or aqueous deficient) which informs the management of DED. Videos of these diagnostic and sub-classification techniques are available on the TFOS website. It is envisaged that the identification of the key tests to diagnose and monitor DED and its sub-classifications will inform future epidemiological studies and management clinical trials, improving comparability, and enabling identification of the sub-classification of DED in which different management strategies are most efficacious.

TFOS DEWS II Diagnostic Methodology report

PurposeTo describe the Oxford Scheme for grading ocular surface staining in dry eye and to discuss optimization of stain detection using various dyes and filters. Also, to propose a sequence of testing for dry eye diagnosis.MethodsThe grading of corneal and conjunctival staining is described

Grading of corneal and conjunctival staining in the context of other dry eye tests.

Biodegradable drug delivery systems comprising an enantiomeric excess of S(-)-ketorolac and a biodegradable polymer matrix that can release ketorolac into an eye or joint for an extended period of time are described. The drug delivery systems may be used to treat one or more inflammation-mediated conditions, such as ocular pain and/or inflammation following an ocular surgery such as cataract surgery.

Ketorolac-containing sustained release intraocular drug delivery systems

A composition comprising from 0.005% to 0.02% of bimatoprost by weight, and from 100 ppm to 250 ppm of benzalkonium chloride, wherein said composition is an aqueous liquid that is formulated for ophthalmic administration.

Improved bimatoprost ophthalmic solution.

The present invention is directed to an aqueous ophthalmic solution comprising an effective amount of ketorolac which comprises carboxymethyl cellulose which promotes epithelial wound healing in a patients cornea.

Ketorolac compositions for corneal wound healing

Disclosed herein are emulsions comprising testosterone or related androgens, castor oil, cyclodextrin, Pemulen TR-2, Polyoxyl 40, and other ingredients. The compositions are useful for treating keratoconjunctivitis sicca and meibomian gland disease.

Non-irritating testosterone emulsions

Purpose To evaluate the intraocular pressure (IOP)-lowering efficacy of a preservative-free formulation of fixed-combination bimatoprost/timolol (FCBT PF) in treatment (tx)-naive vs previously treated patients.



Methods A double-masked, randomized, parallel-group study compared FCBT PF with preserved FCBT (Ganfort) in 561 patients diagnosed with glaucoma or ocular hypertension who were tx naive or had inadequate IOP lowering with previous tx. IOP was measured at 0, 2, and 8 hours at baseline and weeks 2, 6, and 12. Subgroup analysis evaluated average IOP change from baseline in tx-naive vs previously treated, washed out patients.



Results FCBT PF was equivalent to Ganfort, producing numerically greater (0.2 to 0.5 mmHg) IOP lowering than Ganfort during follow-up. With FCBT PF, IOP mean changes from baseline (mmHg) ranged from −8.7 to –9.8 in tx-naive patients (n=50) and –7.3 to –8.5 in previously treated patients (n=228). Baseline IOP, age, diagnosis, and corneal pachymetry were significant covariates of IOP lowering. In an analysis of covariance model with these factors as covariates, differences between tx-naive and previously treated patients ranged from 0.8 to 1.7 mm Hg favouring tx-naive patients and were significant (p≤0.018) at 7 of 9 timepoints.



Conclusion FCBT PF had a favourable IOP-lowering effect compared with Ganfort and reduced IOP more effectively in tx-naive than previously treated patients. This can be attributed in part to the removal of preservative (BAK) optimizing the efficacy of timolol in FCBT PF.



Commercial interest

Rhett M. Schiffman

Papers

Ketorolac-containing sustained release intraocular drug delivery systems

Improved bimatoprost ophthalmic solution.

Ketorolac compositions for corneal wound healing

Non-irritating testosterone emulsions

Efficacy of a preservative-free fixed combination of bimatoprost and timolol in treatment-naïve versus previously treated patients