Iatrogenic dry eye disease (DED) has emerged as a significant but overlooked complication in both ophthalmic surgery and aesthetic medicine. Characterized by disruption of tear film homeostasis, ocular surface inflammation, and neurosensory dysfunction, this condition may arise acutely or chronically following medical interventions. The Tear Film and Ocular Surface Society Dry Eye Workshop II and III reports have highlighted iatrogenic DED as a distinct clinical entity, underscoring its multifactorial etiology and the need for tailored risk mitigation strategies. Refractive procedures such as laser in situ keratomileusis and photorefractive keratectomy are frequently implicated due to corneal nerve transection and subsequent hypoesthesia, which impair blink dynamics and lacrimal gland feedback. Cataract surgery, though largely safe, contributes via surface desiccation, intraoperative light exposure, and topical medication toxicity. Oculoplastic interventions, including blepharoplasty, introduce mechanical alterations that disrupt eyelid function and tear film distribution. Moreover, the growing demand for periocular cosmetic procedures such as botulinum toxin injections and permanent eyeliner tattooing has introduced additional risks, particularly in individuals with preexisting meibomian gland dysfunction or marginal tear function. Emerging evidence suggests that the cumulative effect of repeated exposures and inadequate preoperative screening has led to a rise in persistent ocular surface morbidity. Prevention therefore necessitates a multidisciplinary approach encompassing ophthalmologists, dermatologists, plastic surgeons, and primary care providers. Systematic pretreatment ocular surface assessment, patient counseling, and adoption of minimally disruptive techniques are essential. By integrating evidence-based risk stratification into routine care, clinicians can significantly reduce the burden of iatrogenic DED and preserve long-term visual quality and patient satisfaction in the face of expanding therapeutic and cosmetic practices.
Objectives: To compare the refractive profiles and clinical characteristics of affected and fellow eyes in unilateral Duane retraction syndrome (DRS), emphasize subtype-related variations, and assess the impact of motility restriction and ocular findings on refractive status. Materials and Methods: This retrospective cross-sectional study included 191 patients with unilateral DRS, comprising type I (n=162), type II (n=7), and type III (n=22). Best-corrected visual acuity (BCVA), cycloplegic autorefraction, astigmatism classification, and ocular alignment/motility findings were analyzed across DRS subtypes. Results: The mean age at examination was 6.67±7.13 years, and 62.3% of the patients were female. Amblyopia was observed in 23.0% of patients, anisometropia in 18.6%, and abnormal head posture in 52.7% of patients. Esotropia (42.0%) was more prevalent than exotropia (11.7%), and the majority of patients (61.4%) exhibited grade 4 horizontal limitation. Compared with fellow eyes, DRS eyes exhibited a substantially lower BCVA (p<0.001), higher spherical power (p=0.025), and greater cylindrical power (p<0.001). In both DRS (60.7%) and non-DRS (72.3%) eyes, the predominant pattern was with-the-rule astigmatism. There were no discernible variations in astigmatism subtypes among motility limitation grades or DRS subtypes. The cylindrical refractive error was independently associated with abnormal head posture (p=0.007) and horizontal deviation type (p=0.029) according to multiple regression analysis. Conclusion: Unilateral DRS is characterized by diminished visual function and increased refractive error, with cylindrical outcomes affected by head posture and type of deviation. The findings highlight the importance of integrating motility parameters into refractive evaluation and surgical planning in DRS.
Objectives To determine optimal cut-off values for first and average non-invasive tear break-up time (NIBUT-f and NIBUT-av, respectively) in dry eye disease (DED), as well as evaluate their correlation with other tests. Materials and Methods This retrospective study included 46 patients with DED and 35 healthy controls. All subjects were assessed using the Ocular Surface Disease Index questionnaire. NIBUT measurements and meibography images were obtained using the Sirius topography device. The conventional diagnostic tests Schirmer-I, tear break-up time (TBUT), ocular surface staining (OSS), Marx line score, and lid wiper epitheliopathy (LWE) grade were performed. Results The cut-off values of NIBUT-f and NIBUT-av for DED diagnosis were identified as 10.7 and 12.2 seconds, respectively. The area under the curve (AUC) was 0.93 (95% confidence interval [CI]: 0.889-0.992) for NIBUT-f and 0.92 (95% CI: 0.872-0.985) for NIBUT-av. For the differentiation between evaporative and mixed DED subtypes, the NIBUT-av cut-off value was 7.2 seconds, with an AUC of 0.63 (95% CI: 0.512-0.743). NIBUT-av showed a positive correlation with TBUT (p<0.001, r=0.905) and Schirmer-I (p<0.001, r=0.403) but a negative correlation with OSS (p<0.001, r=-0.700), meibomian gland loss (p<0.001, r=-0.601), LWE grade (p<0.001, r=-0.597), and Marx line score (p<0.001, r=-0.539). Conclusion NIBUT is a highly sensitive and specific non-invasive diagnostic tool for DED that correlates with other ocular surface and meibomian gland function tests.
