International Sicca Award

- Edition 2005 -

Research Projects Poland

Karolina Agopsowicz, MD, Jaroslaw Marek, MD, PhD, Ratal Splawski R, MSc, Krzysztof Dudek, MSc, PhD

The influence of selected environmental physical factors on tear film disturbances in office workers

Abstract
Nowadays, ocular problems in patients working with computers are very common. Furthermore, because of prolonged working time office workers are more prone to environmental hazard. Air conditioning, that contributes to drying the air, apart from lowering the temperature, is an equally important risk factor. Tear film instability is one of many problems resulting from environmental risk factors mentioned above. It has been presumed that increased tears evaporation associated with rare blinking rate and low humidity of the air in workplace environment cause ocular troubles and pathological changes called the dry eye syndrome.
Purpose: The purpose of this research is to investigate the influence of these factors (working time, humidity and velocity of the air in the room) on the occurrence of tear film disturbances. The tests will be performed on a group of 60 selected office workers working in comparable microclimatic conditions. We will use traditional "invasive" tests: Schirmer's test, BUT with fluorescein and lissamine green staining; we will also use "nonivasi-ve" methods of tear film evaluation: Tearscope, infrared camera and blinking rate recording. We will assess the usefulness and sensitivity of these methods in dry eye syndrome diagnosing.

Nella Zywalewska, Malgorzata Mrugacz
Childrens' Eye Clinic, Medical Academy, Bialystok

Evaluation of selected parameters of immunological response in inducing ocular changes in dry eye syndrome

Abstract
Purpose: To evaluate the role of selected parameters of immunological response in inducing ocular changes in dry eye syndrome, particularly HLA-DR and ICAM-1 expression in conjunctival cells and markers of apoptosis (s-Fas and s-Fas ligand) concentration in the tear fluid.
Materials and Methods: We will perform ophthalmic examination with diagnostic tests for dry eye syndrome in 30 patients with dry eye and 30 controls. We will test HLA-DR and ICAM-1 expression in conjunctival epithelial cells using flow cytometry method. We will also use ELI-SA tests to assay s-Fas and s-fas ligand concentration in the tear fluid. Performing these tests we will attempt to answer the question about the role of inflammation in ocular changes related to dry eye syndrome. Furthermore, evaluating the relationship between inflammation and apoptosis in dry eye syndrome we will hope to contribute to find whether or not immunological indicators facilitating dry eye diagnosis exist. Results of the research will enable us to better understand pathogenetic mechanisms of ocular changes developing in dry eye syndrome.

Malgorzata Pizon, Magdalena Homziuk

Comparison of topical cyclos-porine or oral multivitamin supplementation influence on tears secretion in dry eye patients undergoing bone marrow transplantation

Abstract
Purpose: To answer the question what is the influence of topical cyclosporine administration on tears secretion, to determine the influence of multivitamin supplementation on tears secretion in dry eye patients, to compare the influence of both treatment methods on tears secretion.
Materials and Methods: Two groups of patients will take part in the study: patients with symptoms of dry eye following marrow transplantation due to AMI who received systemic treatment with cyclosporine and healthy volunteers - control group. We will perform visual acuity test, anterior segment and fundus examination, intraocular pressure measurement and use diagnostic tests for dry eye syndrome (Schirmer l, Schirmer II, BUT, FDDT, pachymetry, rose bengal and fluorescein staining) prior to treatment, after 4 weeks and at the end of the study in all participants. We will compare the results between both groups and we will make statistical analysis of the results. We will also prepare photographic documentation of the study. Predicted duration of the study - 8 weeks.

Agnieszka Kujawa, MD, Radoslaw Rozycki, MD
Eye Clinic, the Military Institute of Medicine, Warsaw

Immunological phenome-nons in tearfilm pathology. Is Cyclosporine the turn-point in the treatment of Sjogren's Syndrome?

Abstract
Purpose: To present the latest method of the causal treatment of dry eye syndrome related to Sjogren's Syndrome. The treatment normalizes immunological processes on the surface of the eye globe.
Materials and Methods: 5 patients (4 women, 1 man, 45-59 years old; average age of 55,5 years) with most prominent subjective symptoms and most unfavourable tests results have been selected from among 25 Sjogren's Syndrome patients which are observed in our clinic and treated with 0,05 % Cyclosporine solution. Subjective complaints were assessed according to the Dr. Mann Pharma/Bausch&Lomb protocol.
The results of Schirmer's test II fluctuated between 1 to 5 milimeters (mean value 2,2 mm) prior to treatment. The tear film break-up time measures ranged from 3 to 6 seconds (mean value 4,8 sec.). We obtained the maximum score - 9 in the test of conjunctival and corneal cells staining with lissamine green. We started to treat patients with 0,05 °/o topical Cyclosporine administered twice daily into both eyes recommending additional artificial tears (Artelac) supplementation at least two times a day and Vidisic at bedtime - depending on patient's decision. Predicted treatment duration - 6 months.

Sebastian Gajda,
Ewa Langwinska-Wosko,
Anna Ambroziak
Eye Clinic, Medical Academy, Warsaw

Characteristics of kerato-conus in the scanning slit corneal topography measurement system ORBSCAN II in patients with dry eye syndrome

Abstract
Purpose: To find a method of differentiating characteristics of keratoconus due to dry eye syndrome and true ke-ratoconus or irregular astigmatism for other reasons utilizing ORBSCAN II by Orbtek Inc (Bausch&Lomb) system. We will also evaluate the possible influence of artificial tears administration prior to examination on clinically significant changes in the results of ORBSCAN topography in patients with symptoms of dry eye and keratoconus characteristics and in patients with early keratoconus and we will investigate possible influence of artificial tears instillation on the results of pachymetry.
Materials and Methods: We will recruit ambulatory patients from the Eye Clinic of Medical Academy in Warsaw. Patients with noninvasive BUT test results < 15 sec (Tear-scope-plus by Keeler) or basic aqueous tears component secretion test results < 10 mm following instillation of topical anaesthetic (Novesin by Novartis Ophthalmics) will be eligible for the study. We will exclude patients wearing contact lenses, undergoing ocular surgery or with conditions which may affect the results of corneal topography. We will perform corneal topography in all patients with irregular astigmatism of at least 1.0 D and we will carry out another examination after artificial tears administration (Artelac by Dr. Mann Pharma). Then patients will receive artificial tears - 1 drop every two hours and we will repeat corneal topography in 2nd and 4th week of treatment. The control group will consist of patients with diagnosed keratoconus in one eye and only irregular astigmatism in the other eye.

Jaroslawa Krajka-Lauer
Eye Clinic, Medical Academy, Gdansk

Tear film disturbances in pregnant women

Abstract
We will examine pregnant women (volunteers only) which are the patients of the Institute of Obstetrics, Medical Academy in Gdansk. We will perform ophthalmological examination and diagnostic tests for dry eye syndrome: mucin crystallization test, Schirmer I, noninvasive BUT test, BUT, fluorescein and lissamine green staining. All patients together with author of the research will fill the Dry Eye Questionnaire (enclosed), prepared for the study.
The purpose of the study is to determine the prevalence of dry eye syndrome in pregnant women and to find when the symptoms exacerbate. We will also try to determine which layer of the tear film is subject to maximum changes in preqnant women.

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