The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease. Its central mechanism is evaporative water loss leading to hyperosmolar tissue damage. Research in human disease and in animal models has shown that this, either directly or by inducing inflammation, causes a loss of both epithelial and goblet cells. The consequent decrease in surface wettability leads to early tear film breakup and amplifies hyperosmolarity via a Vicious Circle. Pain in dry eye is caused by tear hyperosmolarity, loss of lubrication, inflammatory mediators and neurosensory factors, while visual symptoms arise from tear and ocular surface irregularity. Increased friction targets damage to the lids and ocular surface, resulting in characteristic punctate epithelial keratitis, superior limbic keratoconjunctivitis, filamentary keratitis, lid parallel conjunctival folds, and lid wiper epitheliopathy. Hybrid dry eye disease, with features of both aqueous deficiency and increased evaporation, is common and efforts should be made to determine the relative contribution of each form to the total picture. To this end, practical methods are needed to measure tear evaporation in the clinic, and similarly, methods are needed to measure osmolarity at the tissue level across the ocular surface, to better determine the severity of dry eye. Areas for future research include the role of genetic mechanisms in non-Sjogren syndrome dry eye, the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation.

TFOS DEWS II pathophysiology report

https://minerva-access.unimelb.edu.au/bitstream/handle/11343/280247/PIIS2214109X20304885.pdf

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020.

Update on the Management of Infectious Keratitis

http://www.thelancet.com/article/S2589537022003546/pdf

Impact of COVID-19 vaccination on the risk of developing long-COVID and on existing long-COVID symptoms: A systematic review

Global initiative for the elimination of avoidable blindness

The story of the evolution of corneal grafting reads like a modem day epic: Complete with a cast of larger than life heroes, brilliant and heroic feats, inspired by the mundane. The history is also peppered with dismal, heart rending failures, foolhardy ventures, and the ultimate triumph of the indomitable human spirit over all odds. This review aims to highlight the significant milestones in the rich history of corneal transplantation, and to pay tribute to the many inspired and dedicated pioneers in this field for their perseverance and superior wisdom. It is also a salute and memorial to the patients who reposed their trust in the corneal surgeons, subjecting themselves to the trauma of surgery, often with less than optimal results. It was their collective, relentless toil and dynamic vision which has resulted in the state of the art surgical techniques which are the basis of modern day keratoplasty.

Evolution of keratoplasty: from darkness to light.

Ocular Surface Reconstructions

Advances in anterior segment examination

Advances in keratoplasty procedures: A review

Purpose To explore the burden, clinical features and associations of trichiasis due to trachomatous and non-trachomatous aetiologies. Methods Consenting patients presenting with trichiasis of either eyelid (of one or both eyes) attending the outpatient department, cornea and oculoplasty clinics of a tertiary eye care hospital in New Delhi between August 2018 to March 2020 were included. A comprehensive examination including visual acuity and anterior segment evaluation and photography was performed. Grade of trichiasis, laterality, presence and grade of entropion, and information on corneal opacity, conjunctival scarring, Herbert’s pits, and pannus, if present, were recorded in the case record form. Results Overall, 302 patients (454 eyes) with trichiasis were recruited. The most common attributed cause of upper eyelid trichiasis (276 patients, 405 eyes) was trachoma (26% of patients), followed by Stevens-Johnson syndrome (23%), blepharokeratoconjunctivitis (17%) and old age (10%). A total of 296/405 eyes (73%) had some form of corneal involvement. Trachoma was not identified as the cause of trichiasis in any eye with lower eyelid-only disease. Conclusion Only about a quarter of upper eyelid trichiasis in this peri-elimination setting was attributed to trachoma. A distinction between trachomatous and non-trachomatous trichiasis is imperative to meaningfully determine whether elimination of trachoma as a public health problem has occurred. These data may have implications for population-based estimates of TT prevalence in India and other peri-elimination settings.

/pdf/prospective-audit-of-the-phenotype-causes-and-correlates-of-1e9mkg5m.pdf

Prospective audit of the phenotype, causes and correlates of trachomatous and non- trachomatous trichiasis in a peri-elimination setting

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