1 438 Dry eye disease, II Wednesday, May 06, :00 AM 12:45 PM Exhibit Hall Poster Session Program #/Board # Range: /A0055 A0119 Organizing Section: Cornea Program Number: 4429 Poster Board Number: A0055 Detection of Tear Film Osmolarity Changes After Use of a Hydroxypropyl Guar-Based Lubricating Eye Drop Alison Ng 1, Adam Keech 2, Lyndon W. Jones 1. 1 Centre for Contact Lens Research, School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada; 2 FYidoctors, Grande Prairie, AB, Canada. Purpose: Tear film hyperosmolarity is a recognised hallmark of dry eye disease. Lubricating eye drops have been shown to improve signs and symptoms of dry eye disease. However, their effect upon tear osmolarity has not been established. This study aimed to evaluate tear osmolarity after using lubricating eye drops 4 times daily for 3 weeks. Methods: Thirty participants with dry eye disease (OSDI score 20 and tear osmolarity 300 mosm/l) were enrolled in this prospective, dispensing, non-randomized study involving a baseline visit and 3-week follow-up. The following ocular surface parameters were determined at baseline: osmolarity; non-invasive tear break up time (NITBUT); conjunctival hyperemia; corneal and conjunctival staining. Participants were instructed to instil one drop of a hydroxypropyl guar-based drop (Systane Ultra; Alcon, Fort Worth, TX) 4 times daily in each eye for 3 weeks and completed a symptom questionnaire between visits. At the follow-up visit, the OSDI questionnaire and ocular surface parameters were reassessed. At the end of these assessments, one drop of Systane Ultra was instilled into each eye and osmolarity was measured after 15 minutes to examine short-term changes in osmolarity. Results: Twenty eight participants completed the study (5M; 23F: median age 54 yrs, range yrs). At baseline, mean OSDI score was 44.94±15.23 and mean osmolarity were 312.5±10.6 / 308.8±12.6 mosm/l (OD/OS). After 3 weeks, mean osmolarity reduced to 306.4±16.8 / 305.1±9.9 mosm/l (OD/OS; p<0.05 and p=0.07, respectively). Statistically significant improvements in conjunctival hyperemia, central corneal staining (p<0.05 OU) and NITBUT (p<0.01 OD only) were observed. Mean OSDI scores reduced to 28.27±17.0 (p<0.01). A significant reduction in osmolarity was observed 15 minutes after instilling the lubricating drop (p<0.05 OU). There were no changes in acuity (all p>0.05). Conclusions: A significant, measurable reduction in osmolarity in addition to improvements in dry eye symptoms and some tear film parameters were observed after 3 weeks of daily use of a hydroxypropyl guar-based lubricant drop. A decrease in osmolarity was also demonstrated 15 minutes after drop instillation. Commercial Relationships: Alison Ng, Alcon Laboratories (F); Adam Keech, None; Lyndon W. Jones, Alcon Laboratories (F) Support: This study was funded by Alcon Laboratories. Program Number: 4430 Poster Board Number: A0056 The Effects of Ocular Surface Stimulation on Blinking and Tear Secretion Ziwei Wu 1, 4, Carolyn G. Begley 1, Nicholas Port 1, Arthur Bradley 1, Richard J. Braun 2, Peter E. King-Smith 3. 1 Optometry, Indiana University, Bloomington, IN; 2 Mathematical Sciences, University of Delaware, Minneapolis, MN; 3 College of Optometry, The Ohio State University, Columbus, OH; 4 New England College of Optometry, Boston, MA. Purpose: To determine how increasing ocular surface stimulation affects blinking and tear secretion. Methods: Ten healthy subjects concentrated on a visual task, while a pneumatic device generated air flow toward the central cornea. Six flow rates were randomly presented and one microliter 2% fluorescein was instilled before each trial (2mins) to visualize the lower meniscus. Interblink interval (IBI), tear meniscus height (TMH) and fluorescence intensity were measured simultaneously. Tear meniscus fluorescein concentration (TMFC) was calculated from intensity by a mathematical model. In order to normalize individual variation at the beginning of the trail, the maximum difference of TMH and TMFC within each trial were further calculated. Tear secretion response was disengaged from blinking, by calculating tear turnover rate within each IBI (IBI-TTR). The time to the tearing and blink response were quantified for each trial. Results: Blinking and tear secretion were increased with stimulation. The mean (±SD) IBI was decreased from 9.47±8.79 during the baseline to 1.39±1.11sec during maximum air stimulation. Ocular surface stimulation was significantly correlated with the log IBI, maximum difference of TMFC and TMH (Pearson s r= -0.47, 0.71 and 0.39, p<0.01, respectively). The IBI-TTR was increased from 0.014±0.013 during the baseline to 0.097±0.045 log(%)/sec during maximum air stimulation and it was significantly correlated with surface stimulation (Pearson s r= 0.61, p<0.001). Blinking and tearing responses were significantly correlated with each other (Pearson s r= 0.56, p<0.001). On average, the tear secretion lagged behind the blink response by 6.54±4.07sec. Conclusions: Both blinking and tear secretion showed a doseresponse relationship with increasing ocular surface stimulation, and were highly correlated with each other. The blink response was almost immediate, while tearing lagged by several seconds, possibly due to the time required for tears to arrive in the meniscus. Both of these protective responses originate with ocular surface stimulation, and thus depend on initiation by ocular surface sensory innervation. While this study tested young, healthy subjects to establish normal protective response of the ocular surface, these methods can be used to further understand potential deficiencies in these responses in ocular surface conditions such as dry eye. Commercial Relationships: Ziwei Wu, None; Carolyn G. Begley, None; Nicholas Port, None; Arthur Bradley, None; Richard J. Braun, None; Peter E. King-Smith, None Support: NH Grant R01EY Program Number: 4431 Poster Board Number: A0057 Dry eye profiles in patients with a positive elevated surface matrix metallopeptidase 9 point of care test versus negative patients Allister Gibbons 1, Nicole Lanza 2, Felipe Valenzuela 1, Victor L. Perez 1, Anat Galor 1, 3. 1 Bascom Palmer Eye Institute, Miami, FL; 2 University of Miami, Miller School of Medicine, Miami, FL; 3 Ophthalmology, Veterans Affairs Hospital, Miami, FL.
2 Purpose: To compare dry eye symptoms and signs in patients who tested positive, versus those tested negative for ocular surface matrix metallopeptidase 9 (MMP-9) detection using the InflammaDry point of care test (RPS, Tampa, FL). Methods: In this cross-sectional study, individuals with dry eye symptoms, as evidenced by dry eye questionnaire 5 (DEQ5) seen in the Miami Veterans Affairs eye clinic, were given standardized questionnaires to assess dry eye symptoms and ocular and non-ocular pain complaints. A complete evaluation was conducted to measure ocular surface signs of dry eye. MMP-9 testing was performed using the InflammaDry once in each eye, per the manufacturer s instructions. Our main outcome measure was the comparison of dry eye symptoms and signs in MMP-9 positive versus negative patients. Results: Of the 56 total patients, 46% were positive for MMP-9 by InflammaDry testing in either eye. No statistically significant differences in demographics, co-morbidities, medications, psychiatric status, ocular surface symptoms and signs of dry eye were seen in patients based on MMP-9 detection status. Conclusions: In our population, there was no difference in the profile of dry eye, in both symptoms and signs, between those testing positive versus negative for elevated levels of MMP-9 on the ocular surface. Commercial Relationships: Allister Gibbons, None; Nicole Lanza, None; Felipe Valenzuela, None; Victor L. Perez, Allergan (C), Baush Lomb (C), Eleven (C), EyeGate (C), Genentech (C), Parion (C), Rigel (C); Anat Galor, None Support: Supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research and Development s Career Development Award CDA S (Dr. Galor), NIH Center Core Grant P30EY and NIH Core Grant P30-EY14801, Research to Prevent Blindness Unrestricted Grant, Department of Defense (DOD- Grant#W81XWH and Grant# W81XWH ONOVA) (institutional). Program Number: 4432 Poster Board Number: A0058 Impression cytology of the lid wiper area Alex Muntz, Kevin van Doorn, Lakshman N. Subbaraman, Lyndon W. Jones. CCLR, University of Waterloo, Waterloo, ON, Canada. Purpose: Few reports on the cellular anatomy of the lid wiper (LW) area exist and only one makes use of cytological methods. Impression cytology (IC) is typically performed on bulbar or tarsal conjunctiva and thus requires optimization for use on the LW. The purpose of this study was to optimize a method of collecting, staining and imaging cells from the LW region using IC. Methods: Upon anesthesia (Alcaine, 0.5%), the upper lids of 5 subjects (n=10) were everted and IC was conducted using various membranes (MF-Millipore, PTFE Biopore Millipore, Opia EYEPRIM). Several fixatives (100% Methanol, 95% Ethanol), histological stains (Papanicolaou (hematoxylin GILL-1, OG-6, EA-65), Periodic Acid-Schiff (PAS) and Alcian Blue (AB)) and soak times (1,3,5 minutes) were tested. Varying concentrations of fluorescent dyes (Annexin V, Calcein AM, Ethidium homodimer-1) were tested and imaged using confocal laser scanning microscopy (CLSM). Results: IC delivered optimal results when using the PTFE Biopore membrane. Fixing in 95% Ethanol for >20 minutes then staining in 500ml each of AB, GILL-1, OG-6 and EA-65 for 3 minutes revealed the presence of goblet cells, mucins, cell nuclei and various degrees of pre- and para-keratinization. Calcein AM (4mM), Ethidium (4mM), Annexin V (5ml in 250ml buffer) were combined to successfully show metabolic activity, compromised cell membranes, nucleic acids and apoptosis in cells. Up to 200 microscopy digital images were captured for each sample and stitched into a high-resolution, large scale image of the entire IC span. Conclusions: We have developed a protocol consisting of an optimal selection of membrane, stains and imaging procedures and successfully showed that the sensitivity of IC is appropriate for identifying distinct cellular morphologies surrounding the LW area, as well as showing varying degrees of metabolic activity. To our knowledge, this is the first time this selection of fluorescent dyes was used to image LW IC membranes. This protocol will be effective in future studies to reveal undocumented details of the lid wiper area, such as assessing cellular particularities of contact lens wearers or patients with dry eye or lid wiper epitheliopathy. Squamous cells (left) of the muco-cutaneous junction and columnar cells from the tarsal conjunctival area. Cells show metabolic activity (green fluorescence of Calcein AM) and compromised cell membranes as shown by the penetration of Ethidium causing the red cell nucleus fluorescence Commercial Relationships: Alex Muntz, None; Kevin van Doorn, None; Lakshman N. Subbaraman, None; Lyndon W. Jones, None Program Number: 4433 Poster Board Number: A0059 Systematic review and meta-analysis on the efficacy of LipiFlow device in the treatment of Meibomian Gland Dysfunction Eddie Y. Liu 1, 4, Monali Malvankar 1, 3, Sera Thomas 3, John Costella 2, Cindy M. Hutnik 1, 5. 1 Ophthalmology, Western University, London, ON, Canada; 2 Taylor Library, Western University, London, ON, Canada; 3 Epidemiology, Western University, London, ON, Canada; 4 Schulich School of Medicine, London, ON, Canada; 5 Pathology, Western University, London, ON, Canada. Purpose: To determine the effectiveness of LipiFlow in the treatment of Meibomian gland dysfunction (MGD). Methods: Published and unpublished scientific work from January 1, 2000 to July 15, 2014 were systematically reviewed using bibliographic databases (MEDLINE, EMBASE, BIOSIS Previews, CINAHL, HEED, ISI Web of Science and Cochrane Library) and grey literature by key words and search strategies. Potential
3 studies were screened by two independent reviewers according to the following inclusion criteria: 1) research studies 2) human subjects older than 19 year of age with dry eyes and 3) treated with LipiFlow or a similar thermal pulsation device. Downs and Black checklist was used to assess study quality. Data was extracted by 2 independent reviewers from 13 eligible articles. Standardized mean difference (SDM) was computed as the effect size. Effect sizes were calculated for meibomian gland excretion (MG) score, tear break-up time (TFBUT), SPEED and OSDI questionnaires. Results: Up to 3 months after a single LipiFlow treatment, significant improvement from baseline measures were seen in MG scores (SMD 1.64, 95% CI: 1.42, 1.85), TFBUT (SMD 0.62, 95% CI: 0.42, 0.83), SPEED (SMD -1.15, 95% CI: -1.36, -0.95) and OSDI (SMD -0.81, 95% CI: -1.01, -0.60). Single study data also showed the following significant improvement: up to 48 months after a single Lipiflow treatment significant improvement was seen in MG score (SMD 2.68, 95% CI: 1.77, 3.59); 3 month following MeiboPatch compress with massage treatment significant improvement was seen in MG score (SMD 0.63, 95% Cl: 0.02, -0.81), SPEED (SMD -1.02, 95% Cl: -1.01, 0.30) and OSDI (SMD , 95% Cl: -1.37, -0.13); 3 month after warm compress with massage treatment significant improvement was seen in MG score (SMD 0.91, 95% Cl: 0.36, 1.46); and 2 weeks after iheat treatment significant improvement was seen in OSDI (SMD , 95% Cl: -0.65, -0.18). Conclusions: Lipiflow is an effective treatment option of MGD. It improves objective and subjective measures of dry eye symptoms up to 3 months after a single Lipiflow treatment. Further studies are needed to confirm the effectiveness at and beyond 1 year after treatment. Ultimately, the cost-effectiveness of Lipiflow treatment in the management of MGD will determine its clinical applicability. Commercial Relationships: Eddie Y. Liu, None; Monali Malvankar, None; Sera Thomas, None; John Costella, None; Cindy M. Hutnik, None Program Number: 4434 Poster Board Number: A0060 UNC Dry Eye Management Scale: Spanish Language Translation and Validation Study Jane Reeves Ellis 1, 2, Chris Hwang 2, 3, Jullia Rosdahl 1, Sue Tolleson- Rinehart 2, 4, Richard Davis 3. 1 Duke Department of Ophthalmology, Duke University School of Medicine, Durham, NC; 2 UNC Gillings School of Global and Public Health, Health Care & Prevention MD- MPH Program, University of North Carolina, Chapel Hill, NC; 3 UNC Department of Ophthalmology, University of North Carolina, UNC School of Medicine, Chapel Hill, NC; 4 Department of Pediatrics, University of North Carolina, School of Medicine, Chapel Hill, NC. Purpose: Dry eye disease (DED), a common, chronic disease that diminishes quality of life (QOL), is poorly managed given the poor correlation of patient-reported symptom severity and clinicianobserved disease severity. The UNC Dry Eye Management Scale (DEMS) was developed to improve DED management. The first aim of this study was to translate the UNC DEMS to Spanish and to conduct a feasibility and comprehensibility study of this Spanish DEMS in a Spanish-speaking population. A second aim was to perform initial validity and reliability testing of the Spanish DEMS. This study helps meet the urgent need for valid, reliable patient reported outcome measures (PROM) in languages other than English. Methods: To develop the Spanish DEMS, we used a cross-cultural adaptation method similar to the universal translation method recommended by proponents of PROM translation. Native bilingual speakers performed forward, back, and forward translations, later reconciled by a team. Pre-testing and cognitive interviewing were done in a pilot sample of 13 Spanish-speaking DED patients. I administered the Spanish DEMS to these patients and used cognitive interviewing to evaluate the questionnaire s comprehensibility and utility as an indicator of the effect of symptoms on QOL. I also obtained clinical assessments of disease severity (Schirmer s test, tear break-up time, Oxford grading scheme, and clinician-reported overall assessment). Results: Cognitive interviewing validated the translation. Patients understood and agreed with the wording of the questionnaire. To test internal validity, I compared Spanish DEMS scores to disease severity. Spearman s correlation coefficients showed weak degrees of correlation, as expected given the poor correlation of symptom severity and disease severity; the direction of the correlations was appropriate. To test external validity, I compared performance on the Spanish DEMS to performance on the English DEMS for patients of similar disease severity using the Mann-Whitney test. Performance on the two language versions was significantly similar in the mildto-moderate and severe disease categories. While strictly illustrative, initial analysis was promising for the future validation of the Spanish DEMS. Conclusions: The early stages of our research confirm the Spanish UNC DEMS is an easy to use, easy to understand questionnaire that can improve the management of Spanish-speaking DED patients. Commercial Relationships: Jane Reeves Ellis, None; Chris Hwang, None; Jullia Rosdahl, None; Sue Tolleson-Rinehart, None; Richard Davis, None Support: Translational and Clinical Sciences Institute (TraCS) 2KR491309
4 Program Number: 4435 Poster Board Number: A0061 Effects of punctal occlusion on tear cytokine levels and relationship to baseline clinical characteristics Louis Tong 1, Roger Beuerman 1, Susan Simonyi 2, David A. Hollander 3, Michael E. Stern 3. 1 Singapore National Eye Centre, Singapore, Singapore; 2 Allergan Singapore Ltd., Singapore, Singapore; 3 Allergan, Inc., Irvine, CA. Purpose: Punctal occlusion, which reduces tear turnover, is a common treatment option for dry eye. There is limited evidence that occlusion alters tear protein composition. This longitudinal study evaluated signs and symptoms, and tear cytokine levels after punctal occlusion and assessed factors associated with cytokine changes in dry eye patients. Methods: Non-adsorbable, parasol type silicone plugs were inserted bilaterally in the lower punctum of patients (n=29) with moderate dry eye and persistent symptoms (2 or more symptoms grade 3). Clinical signs and global symptom score were assessed and tears were tested for 15 cytokines and matrix metalloproteinase-9 (MMP- 9) by indirect immunofluorescence, at baseline up to 3 weeks after punctal occlusion. Multivariate analysis used repeat measure general linear modeling with dependent variables of cytokine and MMP-9 levels and effects of age, gender, baseline dry eye characteristics (Schirmer s score, tear break-up time, global irritation), and time (baseline, week 1, week 3) to identify factors associated with cytokine levels. Results: Punctal occlusion reduced fluorescein staining in all zones (P<.01) except inferior zone and decreased global irritation score (P<.001) after 3 weeks. Patients with low Schirmer s scores ( 8 mm) at baseline had higher levels of several cytokines, including TNF-α (P<.001), IL-2 (P<.03) and MIP-1α (P<.002). For most cytokines and MMP-9, there was no relationship between levels and time, and cytokine levels elevated at baseline remained high post-occlusion. Time was a significant factor only in a model of IFN-γ, IL-10, IL-12 and TNF-α, with cytokine levels adjusted by baseline Schirmer s and global irritation scores; increases in all four cytokines after punctal occlusion occurred in patients with Schirmer s score 8 mm and high irritation scores (>55.3) at baseline. The interaction of time and irritation scores was also significant in the model. Conclusions: Overall cytokine and metalloproteinase concentrations were not significantly affected following punctal occlusion. Cytokine modeling identified some baseline characteristics as potential factors associated with cytokine levels. The lack of a significant effect of punctal plugs on tear cytokines suggests that dry eye patients would benefit from earlier treatment with anti-inflammatory agents for management of their disease. Commercial Relationships: Louis Tong, None; Roger Beuerman, Allergan (C); Susan Simonyi, Allergan (E); David A. Hollander, Allergan (E); Michael E. Stern, Allergan (E) Clinical Trial: NCT Program Number: 4436 Poster Board Number: A0062 Reliability of a new modified tear-breakup-time method: Dry tear breakup time Kyung Tae Kim 1, Jae-hyung Kim 1, Ju Byung Chae 1, Young Tae Kong 2. 1 Ophthalmology, Chungbuk National University, Cheongju, Korea (the Republic of); 2 Kong Eye Clinic, Seoul, Korea (the Republic of). Purpose: Tear breakup time (TBUT) is a useful technique to diagnose dry eye disease (DED). Measuring TBUT using fluorescein strips adds supplemental normal saline (NS) to the tear film and does not represent the actual state of the tear film. We introduced a new TBUT dry tear breakup time (DBUT) and investigated its reliability. Methods: For measuring DBUT, 1 ml of 5% fluorescein solution was instilled on the end of an applicator using a micropipette. The applicator was sterilized using ethylene oxide gas after the fluorescein solution dried. The dried fluorescein was then instilled onto the lower palpebral conjunctiva without supplemental NS. Agreement between the two tests and their sensitivity and specificity were analyzed. Results: The average age of the patients was 32.1 ± 9.7 years (n = 124). The DBUT was lower than the TBUT, with a mean difference of 0.63 s. Both tests had a low statistically significant correlation with the Ocular Surface Disease Index. The cutoff value for the TBUT was 4.48 s, and the sensitivity and specificity were and 0.548, respectively. The area under the receiver operative characteristic (AUROC) curve was (95% confidence interval (CI): ). With a cutoff value of 3.5 s for the DBUT, the sensitivity and specificity were and 0.694, respectively. The AUROC curve was (95% CI: ). Conclusions: DBUT had a higher correlation with symptoms and a higher AUROC than conventional TBUT when DED was diagnosed with corneal staining. DBUT could be a useful and effective method in diagnosing DED. Commercial Relationships: Kyung Tae Kim, None; Jae-hyung Kim, None; Ju Byung Chae, None; Young Tae Kong, None Program Number: 4437 Poster Board Number: A0063 Prevalence of Dry Eye Disease in Rheumatoid Arthritis Patients Jasmine W. Yumori 1, Dat Trinh 2, Eric Lee 3, Tina Escobedo 3, 4, Gillian Hollands 1, Robert Gordon 1, Cheng-Tong Wang 5, Thang Le 3, Anthony Hou 3, Michael Finley 6. 1 Optometry, Western University of Health Sciences, Pomona, CA; 2 Family Medicine, Western University of Health Sciences, Pomona, CA; 3 Inland Rheumatology & Osteoporosis Medical Group, Upland, CA; 4 Graduate Nursing, Western University of Health Sciences, Pomona, CA; 5 Sociology, University of California, Irvine, Irvine, CA; 6 Clinical Affairs, Western University of Health Sciences, Pomona, CA. Purpose: Patients with rheumatoid arthritis (RA) often present to non-eye care practitioners with dry eye disease (DED) symptoms but without a clinical diagnosis of DED. We completed a prospective, observational 1-visit multi-center clinical study to determine the prevalence of DED on a large RA patient population recruited from non-eye care settings. Methods: 286 adult RA patients completed a rheumatologic and dry eye evaluation. All patients were asked to self-report a clinical diagnosis of DED. The mean age of patients was 58 years old; 14.3% were male and 85% were female, with unavailable gender information for 0.70%. The following rheumatologic tests were performed: Disease Activity Score in 28 joints (DAS28) and Cyclic Citruillinated Peptide IgG antibody (CCP IgG), C - Reactive Protein (CRP), and Rheumatoid Factor (RF) labs. The following dry eye tests were performed: Ocular Surface Disease Index (OSDI), tear osmolarity (TO), tear break-up time (TBUT), corneal/conjunctival staining, and Schirmer test (ST) without anesthetic. A Modified Dry Eye WorkShop (DEWS) Severity Scale (Table 1) was created to quantify DED severity level. A DED severity level was determined for each eye by averaging the severity level for each test. The eye with the higher DED severity level was used to identify each patient s overall DED severity level. Patients with an overall DED severity level greater than Level 1 were defined as having DED. Results: Data from the 286 RA patients was analyzed. 44% of patients reported a clinical diagnosis of DED. Mean rheumatologic test results were: DAS ±1.40, CCP IgG 91.77±105.80, CRP
5 0.58±1.58, and RF 77.44± Mean dry eye test results were: OSDI 37.21±25.54, TO ±16.32, TBUT 4.20±2.05, staining 4.45±4.52, and ST 11.15±8.99. The prevalence of DED (overall DED severity level greater than Level 1) in RA patients recruited from noneye care settings is 96.15% % of RA patients had an overall severity of at least Level 3. Conclusions: In this population of RA patients recruited from non-eye care settings there is a strong association between RA and DED. Earlier diagnosis and treatment of DED in collaboration with non-eye care professionals and eye care professionals in RA patients is essential. of Tokyo School of Medicine, and adhered to the tenets of the Declaration of Helsinki. Results: Among all subjects, double row MGOs were observed only in upper eyelids and never in lower eyelids. The incidences of the double rows MGOs were 30.7% in children, 32.1% in adult men, 30.0% in adult women, and 30.8% in elderly cadaver eyelids. Among adult men, the numbers of orifices in the upper eyelid was significantly higher in the double row group (n=18) compared to the single row group (n=38) (46.4±4.8 v.s. 36.0±5.3, p<0.0001). All other measurements were not statically different. In histological observation, orifices were connected to the central ducts on a one by one basis in both the single and the double row groups. Conclusions: Double row MGOs exist in about 30% of upper eyelids among healthy Japanese. They are thought to be congenital and one of the anatomical variations of Meibomian gland arrangements with normal function. Table 1: Modified DEWS Severity Scale Commercial Relationships: Jasmine W. Yumori, Allergan (F), TearLab (F); Dat Trinh, None; Eric Lee, None; Tina Escobedo, None; Gillian Hollands, None; Robert Gordon, None; Cheng- Tong Wang, None; Thang Le, None; Anthony Hou, None; Michael Finley, None Support: Allergan Medical Affairs Research Grant IIT Clinical Trial: NCT Program Number: 4438 Poster Board Number: A0064 Clinical and histological investigation of the double rows of Meibomian gland orifices Rika Shirakawa 1, Reiko Arita 2, 1, Masataka Ito 5, Hiromasa Sawamura 1, Shiro Amano 3, 4. 1 Ophthalmology, University of Tokyo, Tokyo, Japan; 2 Ophthalmology, Itoh Clinic, Saitama, Japan; 3 Inoue Eye Hospital, Tokyo, Japan; 4 Miyata Eye Hospital, Miyakonojyo, Japan; 5 Developmental Anatomy, National Defense Med College, Tokorozawa, Japan. Purpose: Although the double rows of meibomian gland orifices (MGOs) have been occasionally seen in daily clinical practice, little is known about their histological structure and influences on the ocular surface. We investigated lid margins and meibomian glands of healthy children and adults and cadaver eyelid tissue to explore the incidence, function and structure of double row MGOs. Methods: Subjects of in vivo observation consisted of children undergoing strabismus surgery under general anesthesia (13 boys and 13 girls) and healthy adult volunteers (56 men and 30 women). The number of MGOs and presence of double row MGOs were obtained after induction of general anesthesia. The eyelid width, number of MGOs in the upper and lower eyelids, fluorescein staining score, tear break-up time (BUT), meibum expressibility grade, tear meniscus height, Schirmer tear production test, meiboscores obtained by noncontact meibography (Topcon Corp.), non-invasive BUT and tear meniscus height measured by Keratograph5M (OCULUS Inc.) and eyelid thickness were obtained in adult men. Histological investigation was conducted on 13 cadaver eyelid tissues (8 men and 5 women). Continuous horizontal sections with hematoxylin and eosin staining were obtained and observed by light microscope. Double rows were defined where more than 5 orifices were aligned in a second row distinctly separate from the primary row. This study was approved by the institutional review board of University Commercial Relationships: Rika Shirakawa, None; Reiko Arita, Japan Focus Company (P), Topcon Corporation (P); Masataka Ito, None; Hiromasa Sawamura, None; Shiro Amano, None Program Number: 4439 Poster Board Number: A0065 Subjective discomfort onset and intensity are correlated to low corneal temperature in dry eye patients Piera Versura, Giuseppe Giannaccare, Michela Fresina, Emilio C. Campos. DIMES-Ophthalmology Unit, Alma Mater Studiorum University of Bologna, Bologna, Italy. Purpose: To measure corneal temperature in mild-moderate dry eye (DE) patients and to correlate values with the onset and intensity of subjective discomfort symptoms. Methods: 40 eyes of DE patients (n=20, DEWS severity grade 2-3) were included in the study along with 30 eyes of age-matched normal control subjects (n=15). Subjective symptoms of discomfort were scored with OSDI questionnaire and a 100 mm horizontal VAS (Visual Analogue Scale) technique served for measuring symptom intensity. Dynamic infrared non-contact thermal imaging (Tomey TG 1000, Nagoya, Japan) was used to measure Central Cornea Temperature (CCT, 4 mm circular area). After training, subjects were asked to force the eye to remain open and signal the moment of discomfort onset while forcedly still not blinking. Temperature was measured at eye opening (T0) and every second during 10 seconds of sustained eye opening (T1). Time of the first occurrence of discomfort sensation (Discomfort Onset Time, DOT) was measured by a chronometer and the corresponding CCT recorded. Schirmer I test, Break Up Time (BUT), Oxford grade score were performed in all subjects. Recorded temperature values were correlated (r or ρ coefficient) with the clinical tests, OSDI, VAS and DOT, and data were statistically evaluated (significance p<0.05). Results: Corneal temperature immediately after eye opening was significantly lower in DE patients as compared to controls, in correlation to subject age, VAS and BUT (r= -0.46, and 0.43