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A decrease of the Tear Meniscus Height (TMH) has been proposed as a useful indicator for Aqueous Deficient Dry Eye (ADDE) categorization. The present study aimed to calculate a TMH cut-off criterion for the categorization or severity assessment of ADDE with the Tearscope. 200 participants with a previous Dry Eye Disease (DED) diagnosis according to TFOS DEWS-II criteria were recruited. TMH by slit-lamp illumination and Lipid Layer Pattern (LLP) with Tearscope were assessed to categorise the participants into the ADDE or the Evaporative Dry Eye (EDE) group. The ADDE group was also subdivided into Mild-moderate ADDE and Moderate-severe ADDE based on TMH with slit-lamp. Additionally, the TMH was measured by Tearscope (TMH-Tc). Receiver Operating Characteristics showed that the TMH-Tc have a diagnostic capability to differentiate between ADDE and EDE participants, and between Mild-moderate or Moderate-severe ADDE, with a cut-off value of 0.159 mm (AUC = 0.843 ± 0.035, p < 0.001; sensitivity: 86.4%; specificity: 75.4%) and 0.105 mm (AUC = 0.953 ± 0.025, p < 0.001; sensitivity: 98.1%; specificity: 80.0%), respectively. The present study proposed a cut-off criterion to differentiate between ADDE and EDE participants, or between ADDE severities through TMH assessed by Tearscope.

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Clinical relevance: Variation with time in the tear film parameters should be considered by the clinician, since the time when measurements are made can influence in a proper diagnosis. Background: A hallmark of dry eye is an unstable tear film associated with variability in objective daily measures. The purpose of the present study was to evaluate the inter-week repeatability of meibometry, Break-up Time (BUT) and Maximum Blink Interval (MBI) in healthy subjects. Methods: Forty healthy subjects were recruited for the study. Meibometry, BUT and MBI were performed two times in two sessions one-week apart. Meibum from the lower eyelid was collected and quantified with the Meibometer® MB550. Five meibomian curves were generated by tape and each peak value was averaged as a mean value per session. BUT and MBI were performed after fluorescein instillation three times recorded by a DV-3 camera attached to the slit-lamp. BUT and MBI videos were analysed by a second masked observer who quantified their values in frames. Both BUT and MBI values were calculated by averaging only the two most similar measurements of the three evaluated. Results: No statistical difference between inter-week sessions was obtained for the meibometry (p >0.340; Wilcoxon test), BUT (p >0.326; Wilcoxon test) and MBI values (p ≥0.248; Wilcoxon test). Inter-week differences were low for BUT and MBI when times analysed were no longer than 15 seconds (both p ≥0.586; Wilcoxon test). There was found a correlation between BUT and MBI (r ≥0.668, p <0.001; Spearman Rho), while a no statistical correlation was obtained between Meibometry results and BUT or MBI (all p ≥0.194; Spearman Rho). Conclusion:The present study showed that meibum secretion and the tear film stability present good intersession repeatability, and are stable along with sessions in healthy patients.

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The measurement of tear film osmolarity has been suggested as a gold standard in the diagnosis of dry eye. Many tear film physiological variables oscillate during the day, therefore previous reports have studied how this variable changes throughout the day.The present brief review article will summarize the current clinical knowledge and main conclusion of the diurnal osmolarity variation in the tear film. For this purpose, the review performs a critical analysis on sample size and characteristics, the differences in the diurnal osmolarity variation on healthy versus altered tear film conditions or environment eyes, and time of day and number of measurements done. A total of twenty-one studies where one of the main objectives was to analyse the variance of the tear film osmolar value along different time-points in a day on a human cohort were compared. Osmolar tear film value does appear to be somewhat influenced by the time of day in healthy subjects and patients with ocular surface disease or altered by environmental conditions. Both, healthy and no-physiological tear film stable cohorts, showed variations in results depending on the study: no variations during the day or statistical different values at some point in the day (these differences could be in the middle of the day or between the beginning and the end of the day, with higher values in the morning than in the afternoon, or even the opposite situation). The possibility of diurnal variations in tear film osmolarity should be considered by the clinician since the time of day when the tear film measurements are made can be critical in making the right diagnosis. Future studies in the diurnal variation field may have to use a wellestablished range of measurement time-points and a larger group of healthy and tear film altered by pathological or environmental conditions subjects. Van Setten 52Daily variation in osmolarity, maximal amplitude of osmotic variation, frequency of osmotic cycles, the level of osmolarity at which the variation does occurs could be the main factors that further characterize osmokinetics.Small sample analysed; wide time range stablished on time-point

Purpose To determine if the Meibomian Gland (MG) secretion quality is associated with symptoms of ocular discomfort, hours of Video Display Terminals (VDT) use, eyelid margin abnormalities, conjunctival hyperemia, and Meibomian Gland Loss Area (MGLA) in a sample of university students. Methods An online survey that included an Ocular Surface Disease Index (OSDI) questionnaire and an extra question about hours of VDT use recruited an initial sample of 183 participants. Only 120 participants that fulfilled the inclusion criteria were scheduled for a battery of ocular surface and MG specific exam. The tests include: 1) meibometry, 2) slit lamp exploration of eyelid margin abnormalities (irregularity, hyperemia and MG orifices plugging), MG secretion quality and conjunctival hyperemia, and 3) Meibography. Results Significant positive correlations between the MG secretion quality and eyelid margin hyperemia, MG orifices plugging, MGLA, nasal conjunctival hyperemia, and temporal conjunctival hyperemia (Spearman Rho; all r>0.186, p<0.042) were found. Multivariate regression found association between OSDI with hours of VDT use (B=0.316, p=0.007), and eyelid hyperemia (B=0.434, p≤ 0.001). A statistical association between MG secretion quality and eyelid margin hyperemia, MG orifices plugging, MGLA and conjunctival hyperemia (Fisher’s exact; all p<0.039) were found. Multivariate regression found association between MG secretion quality with MG orifices plugging (B=0.295, p=0.004) and meibometry (B=-0.001, p=0.029). Conclusion Participants with higher values in MG secretion quality have higher values in eyelid margin hyperemia, MG plugging, MGLA, and conjunctival hyperemia. No direct relationship between MG secretion quality and hours of VDT use or OSDI were found.