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      Instability of Tear Film after Novel Coronavirus Disease: A Noninvasive and No Contact Method by a Scheimpflug-Placido Disc Topographer

      Author(s): 1 , 2 , 2 , 3
      Publication date Created:
      Publication date (Electronic):
      Journal: Klinische Monatsblätter für Augenheilkunde
      Publisher: Georg Thieme Verlag KG

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          Abstract

          Purpose To compare the topographical tear film break-up time (T-BUT) between individuals recovering from COVID-19 and control subjects using a noninvasive and noncontact technique with a Scheimpflug-Placido disc topographer.

          Methods One-hundred and twenty-two eyes from 61 post-COVID-19 patients and 124 eyes from 62 control subjects were included in this prospective study. All participants underwent detailed ophthalmological examination including best-corrected visual acuity, intraocular pressure measurements, slit lamp examination, and fundoscopy as well as qualitative and quantitative evaluation of the noninvasive first tear film break-up time (NIF-BUT) and noninvasive average tear film break-up time (NIAvg-BUT) with T-BUT measured with a Sirius (CSO – Costruzione Strumenti Oftalmici S. r. l., Italy) corneal topography device.

          Results The mean NIF-BUT in post-COVID-19 and control patients was 5.2 ± 3.4 vs. 6.5 ± 3.2 sec, respectively. The mean NIAvg-BUT in the corresponding groups was 7.5 ± 3.5 vs. 8.8 ± 3.0 sec, respectively. Both NIF-BUT and NIAvg-BUT were significantly lower in the post-COVID-19 group than in controls (p = 0.004 vs. 0.020). Topographical tear film break-up at any time during the test (17 sec) was observed qualitatively in 79 eyes (64.8%) in the post-COVID-19 group and 57 eyes (46%) in the control group (p = 0.003). Moreover, temporal quadrant involvement occurred significantly more frequently in the post-COVID-19 group (p = 0.028).

          Conclusion Tear film stability assessment based on T-BUT showed shorter NIF-BUT and NIAvg-BUT in post-COVID-19 patients as compared to the control group. Our results suggest that post-COVID-19 patients have impaired stability of tear film, and therefore require closer monitoring regarding dry eye. In addition, tear film instability in post-COVID-19 patients can be reliably detected using a noninvasive and noncontact technique that is more comfortable for both patients and physicians.

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          Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis

          I Hamming, W Timens, MLC Bulthuis … (2004)
          Abstract Severe acute respiratory syndrome (SARS) is an acute infectious disease that spreads mainly via the respiratory route. A distinct coronavirus (SARS‐CoV) has been identified as the aetiological agent of SARS. Recently, a metallopeptidase named angiotensin‐converting enzyme 2 (ACE2) has been identified as the functional receptor for SARS‐CoV. Although ACE2 mRNA is known to be present in virtually all organs, its protein expression is largely unknown. Since identifying the possible route of infection has major implications for understanding the pathogenesis and future treatment strategies for SARS, the present study investigated the localization of ACE2 protein in various human organs (oral and nasal mucosa, nasopharynx, lung, stomach, small intestine, colon, skin, lymph nodes, thymus, bone marrow, spleen, liver, kidney, and brain). The most remarkable finding was the surface expression of ACE2 protein on lung alveolar epithelial cells and enterocytes of the small intestine. Furthermore, ACE2 was present in arterial and venous endothelial cells and arterial smooth muscle cells in all organs studied. In conclusion, ACE2 is abundantly present in humans in the epithelia of the lung and small intestine, which might provide possible routes of entry for the SARS‐CoV. This epithelial expression, together with the presence of ACE2 in vascular endothelium, also provides a first step in understanding the pathogenesis of the main SARS disease manifestations. Copyright © 2004 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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            COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses

            Muhammad Adnan Shereen, Suliman Khan, Abeer Kazmi … (2020)
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              TFOS DEWS II Definition and Classification Report

              Jennifer Craig, Kelly Nichols, Esen K Akpek … (2017)
              The goals of the TFOS DEWS II Definition and Classification Subcommittee were to create an evidence-based definition and a contemporary classification system for dry eye disease (DED). The new definition recognizes the multifactorial nature of dry eye as a disease where loss of homeostasis of the tear film is the central pathophysiological concept. Ocular symptoms, as a broader term that encompasses reports of discomfort or visual disturbance, feature in the definition and the key etiologies of tear film instability, hyperosmolarity, and ocular surface inflammation and damage were determined to be important for inclusion in the definition. In the light of new data, neurosensory abnormalities were also included in the definition for the first time. In the classification of DED, recent evidence supports a scheme based on the pathophysiology where aqueous deficient and evaporative dry eye exist as a continuum, such that elements of each are considered in diagnosis and management. Central to the scheme is a positive diagnosis of DED with signs and symptoms, and this is directed towards management to restore homeostasis. The scheme also allows consideration of various related manifestations, such as non-obvious disease involving ocular surface signs without related symptoms, including neurotrophic conditions where dysfunctional sensation exists, and cases where symptoms exist without demonstrable ocular surface signs, including neuropathic pain. This approach is not intended to override clinical assessment and judgment but should prove helpful in guiding clinical management and research.
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                Author and article information

                Journal
                Title: Klinische Monatsblätter für Augenheilkunde
                Abbreviated Title: Klin Monbl Augenheilkd
                Publisher: Georg Thieme Verlag KG
                ISSN (Print): 0023-2165
                ISSN (Electronic): 1439-3999
                Publication date Created: March 22 2022
                Publication date Created: March 2022
                Publication date (Electronic): October 21 2021
                Publication date (Print): March 2022
                Volume: 239
                Issue: 03
                Pages: 338-345
                Affiliations
                [1 ]Department of Ophthalmology, Mardin State Hospital, Mardin, Turkey
                [2 ]Department of Chest Diseases, Mardin State Hospital, Mardin, Turkey
                [3 ]Ophthalmology, Kayseri City Education and Research Hospital, Kayseri City Hospital, Kayseri, Turkey
                Article
                DOI: 10.1055/a-1585-2239
                PubMed ID: 34674204
                SO-VID: 9d1db03c-47b1-4bf1-a58a-9c829d6ab5ca
                Copyright © © 2022
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