Study Outcomes Overview

This study looked at long-term effects on the tear film and eye surface in people who had corneal transplant surgery in one eye, either penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK), and compared them to the person’s unoperated fellow eye. The surgeries were done on average 3.4 years ago, mostly to treat keratoconus, a condition that causes the cornea to thin and bulge. One surgery was done due to scarring from a past eye infection.

Key findings:

• The operated eyes had:

  • Shorter tear film breakup time, meaning the tear film didn’t stay stable for as long.

  • Worse corneal sensitivity (the eye surface was less responsive to touch).

  • Lower nerve density just beneath the cornea.

  • More staining with fluorescein dye, indicating more damage or dryness on the eye surface.

• However, there were no significant differences between operated and unoperated eyes in:

  • The oily layer of the tear film (lipid layer)

  • The volume of tears (measured by tear meniscus height)

  • Redness of the white part of the eye (conjunctival hyperaemia)

  • Other staining or structural changes in the eyelid glands

• Eyes with lower sensitivity tended to have poorer tear film stability and more surface damage.

In summary: Even several years after corneal transplant surgery (especially PK), patients may continue to have long-term changes to their eye surface and tear film, such as increased dryness and reduced sensitivity.

Reference:

This study tested how comfortable different commercial eyelid cleansers are when applied to the eyes, particularly those designed to treat Demodex mites, a common cause of eyelid irritation and inflammation.

Participants (who did not wear contact lenses) tried five different eyelid cleansers, one at a time, on separate days. The cleansers were:

• OCuSOFT Oust Demodex (OD)

• I-MED I-Lid’n Lash Plus (ILL+)

• Labtician BlephaDex (BD)

• Chrissanthie Eye Cleanse (EC)

• Théa Blephademodex (BDdx)

Saline was also used as a control. Researchers looked at eye comfort, tear film stability, redness, and staining of the eye surface within 10 minutes of applying each product.

Key findings:

• All products caused temporary eye discomfort, but it didn’t last long:

  • BD: discomfort lasted about 1 minute

  • OD: about 2 minutes

  • BDdx: 2 minutes and 15 seconds

  • ILL+: 2.5 minutes

  • EC: just over 3 minutes

• EC caused the most noticeable short-term changes, including:

  • A drop in tear film stability (the tear film became less stable)

  • Increased redness

  • More staining on the eye surface and eyelids

• ILL+ also caused more redness, but other changes were mild across the cleansers.

In summary: While all the eyelid cleansers were generally well-tolerated in healthy eyes, some caused more temporary discomfort or irritation than others, especially EC and ILL+. This kind of information can help people know what to expect when starting lid hygiene treatments and may help improve comfort and consistency in their use.

Reference:

This study looked at how people blink and whether the shape of their upper eyelid (such as having a single or double eyelid crease) affects how well their eyelids close and align during blinking. Participants were grouped based on their eyelid type:

• Single eyelid crease (no fold)

• Partial eyelid crease

• Double eyelid crease (a defined upper fold)

Researchers used high-speed video to film the way people blinked during normal activities. They also tested how well the eyelids met by placing a small drop of dye on the eyelid edge to see if blinking could remove it.

Key findings:

• On average, people blinked about 17 times per minute.

• Incomplete blinking (where the eyelids don’t fully close) was common in all groups but especially high in the single eyelid crease group (83%).

• The way the upper and lower eyelids lined up (sagittal misalignment) during blinking was similar across all eyelid types.

• Only a strong, deliberate blink (squeezing the eyes shut) could remove the dye drop from the eyelid edge, and this was consistent in all groups.

In summary: Most people don’t fully close their eyes when they blink normally, and a slight misalignment of the eyelids is common, regardless of their eyelid shape.

Reference:

This international survey asked nearly 1,000 people from Canada, Mexico, New Zealand, Taiwan, and the UK about their experiences managing dry eye symptoms.

Key findings:

• Most people had been experiencing dry eye symptoms for several years, longest in Canada (around 4 years) and shortest in Taiwan (around 2 years).

• Symptom severity varied between countries, but the overall impact on daily life was similar.

• Less than half of the people with symptoms had seen a healthcare professional for it.

• Around half of the respondents had tried a treatment, usually over-the-counter eye drops (artificial tears) or warm compresses.

• These treatments were generally rated as moderately helpful.

In summary: Many people with dry eyes are managing their symptoms on their own without seeing an eye care professional. This means they may be missing out on getting a proper diagnosis and more targeted, effective treatments.

Reference:

This study looked at how long hours spent on screens, like gaming, phones, or computers, may affect eye health in young people. Participants took part in a short iPad-based survey. They answered questions about their screen habits and any dry eye symptoms they had. While they were doing the survey, the iPad’s camera secretly recorded how often they blinked. We also used a simple test to estimate how stable their tear film (the layer of moisture on the eye) was.

Key findings:

• Participants averaged nearly 44 hours of screen time per week.

• 90% had symptoms consistent with dry eye disease.

• Nearly 1 in 4 showed signs of reduced tear film stability.

• People who spent more time on screens had worse symptoms, blinked more, and had poorer tear film stability.

In summary: Long hours on screens are linked to dry eye symptoms and changes in blinking, even in young people. Eye care professionals may need to screen for dry eye more often in younger patients, especially those using screens heavily. Teaching people how to use screens in a healthier way could help protect their eye health and comfort over time.

Reference:

This study looked at how everyday habits, like screen use and diet, might affect the risk of developing dry eye disease. Participants answered questions about their lifestyle (e.g. screen time, caffeine intake), and their eyes were examined for signs and symptoms of dry eye using international guidelines.

Key findings:

• About 1 in 3 participants met the criteria for dry eye disease.

• People who were older, female, of East Asian ethnicity, or who spent more time on digital screens were more likely to have dry eye.

• Interestingly, people who consumed more caffeine (like coffee or tea) were less likely to have dry eye symptoms.

In summary: Spending too much time on screens may increase your risk of dry eye, but drinking caffeinated drinks might offer some protection. These results suggest that simple lifestyle changes, like managing screen use, could help reduce the risk of developing dry eye disease.

Reference:

This study explored whether people with dry eye disease tend to feel more stressed and how they rated their overall health than those without it. Participants took part in a one-time clinic visit. They answered questions about their stress levels and general health, and we assessed the condition of their eyes using standard dry eye tests.

Key findings:

• People who said they were in better health were less likely to have dry eye disease or related problems, like low tear production or blocked eyelid oil glands.

• Those who reported feeling more psychological stress were more likely to have dry eye disease and related issues.

In summary: The findings of this study highlight the wide-reaching impacts of dry eye disease. Managing dry eye well may help improve general well-being, and in some cases, it may be helpful for patients to seek support for stress or mental health alongside their eye care.

Reference:

This study tested how well two different types of artificial tear eye drops work over six months in people with dry eye disease. One was a lipid-based drop (which helps with oily tear layer problems), and the other was a non-lipid-based drop (which mainly adds moisture). The goal was to see if one worked better than the other, and how quickly improvements happened. Everyone used their assigned eye drops at least four times a day for six months. They were regularly checked for symptoms and eye surface health, but neither they nor the researchers knew which type of drop they were using.

Key findings:

• Both types of drops reduced dry eye symptoms (like burning, dryness, and discomfort) starting from the first month.

• Eye surface health (such as tear stability and staining on the eye surface) began to improve around the fourth month.

• Only the lipid-based drops improved the oily (lipid) layer of the tear film, and this was especially true in people who had a thin or poor oil layer to begin with.

• By the end of the study, about 1 in 5 people no longer met the criteria for having dry eye disease.

In summary: Using artificial tears regularly can lead to long-term improvements in both symptoms and tear film quality. While both types helped, people with evaporative dry eye (linked to oil layer problems) may benefit more from lipid-based drops. This research helps guide more tailored treatment choices based on the specific type of dry eye a person has.

Reference:

This study looked at whether applying castor oil to the eyelids could help treat blepharitis, a common condition that causes inflammation, redness, and crusting along the eyelid margins. Participants applied castor oil to one eye (randomly chosen) twice a day for four weeks, while the other eye was left untreated for comparison.

Key findings:

• After four weeks, the eyes treated with castor oil showed significant improvements in symptoms like irritation and discomfort.

• There were also visible improvements in eyelid health, such as less thickening, redness, crusting, and dandruff around the eyelashes.

• No side effects were reported, suggesting the treatment was well tolerated.

In summary: Applying castor oil to the eyelids twice daily led to improvements in the signs and symptoms of blepharitis, with no reported side effects. These promising results support castor oil as a potential treatment option. A larger clinical trial has since been conducted to further evaluate the effectiveness of castor oil for blepharitis, and those results will be published in due course.

Reference:

This study looked at whether doing simple blinking exercises throughout the day could help reduce symptoms of dry eye disease (DED), especially in people who use screens a lot. People tend to blink less and not as completely when looking at screens, which can affect the tear film and lead to dry eye symptoms. Participants were instructed to do a 10-second blinking routine every 20 minutes while awake, for four weeks.

Key Findings:

• Eye symptoms improved significantly, based on two standard questionnaires (DEQ-5 and OSDI).

• The number of incomplete blinks decreased, meaning people blinked more fully.

• Tear film stability improved slightly.

• No significant changes were found in the amount of tears or the oily layer of the tear film.

In summary: Blinking exercises can improve symptoms and blinking patterns in people with dry eyes, although they cause only small changes in tear film quality. This low-cost, low-effort routine could be a helpful habit to reduce dry eye symptoms, particularly for people who spend a lot of time using digital screens.

Reference:

This study explored how common dry eye disease (DED) and related eye conditions are among 45-year-old New Zealanders, using a large group of participants from a well-known birth cohort study. Researchers assessed 885 men and women from the Dunedin Multidisciplinary Health and Development Study, all aged 45, by examining their eye surface and tear film health. They looked for signs of dry eye, poor tear production, blocked oil glands in the eyelids (meibomian gland dysfunction), and signs of eye surface damage even in people without symptoms.

Key findings:

• Almost half of all participants (45%) showed some clinical signs of dry eye.

• 9% were diagnosed with dry eye disease.

• 37% had signs of damage on the eye surface but no noticeable symptoms.

• 2% had poor tear production (aqueous tear deficiency), and 7% had blocked eyelid oil glands (meibomian gland dysfunction).

• Women were more likely than men to show signs of dry eye and related conditions.

In summary: Dry eye signs are common at age 45, even in people who don’t feel any symptoms. The high rate of asymptomatic ocular surface disease presents an opportunity for preventative public health intervention.

Reference:

This study looked at different ways of checking for Demodex mites, tiny organisms that can live in the hair follicles of eyelashes and are often linked to irritated or inflamed eyelids (blepharitis). The aim was to find a method that works well in everyday eye care clinics, is easy to perform, and gives reliable results.

Key findings:

• The best method involved removing the dandruff-like buildup (collarettes) at the base of the lash and pulling the lash sideways while keeping it in place. This allowed the greatest number of mites to be seen without having to remove the lash.

• This method found nearly four mites per lash on average, which was more than with other techniques.

• Other methods, including pulling the lash out or using an advanced imaging system, were less effective at spotting mites.

In summary: This study found a simple and reliable way to check for Demodex mites during a regular eye exam using tools already in most eye clinics. By gently cleaning and pulling the lash sideways, eye care providers can see more mites and better diagnose Demodex-related eyelid problems.

Reference:

This study looked at whether certain health conditions or medications might be linked to each of these dry eye types. Participants took part in a single-session eye check. The team assessed their tear quality, eyelid gland function, and medical history. They diagnosed participants using internationally accepted criteria for the two main types of dry eye disease.

Key findings:

• 29% of participants had dry eye disease

• 11% had too little tear production

• 26% had blocked or underperforming oil glands (meibomian gland dysfunction)

Specific health links included:

• Rheumatologic conditions (like arthritis) and antidepressants were linked to not producing enough tears

• Age, East Asian ethnicity, thyroid disease, migraines, and oral contraceptive use were associated with oil gland issues

In summary: Certain health problems and medications may increase the risk of developing different types of dry eye. Asking about general health is important when assessing dry eye, as it could help guide treatment and referrals to other healthcare providers.

Reference:

This study tested whether intense pulsed light (IPL) therapy could help people with meibomian gland dysfunction (MGD), a common cause of evaporative dry eye. This study was motivated by a 2015 pilot study conducted by the Ocular Surface Lab, which showed significant improvements in the clinical signs and symptoms of MGD.

People who took part were randomly assigned to receive either 1) a sham treatment 2) IPL therapy with five light pulses per eye 3) IPL therapy with four light pulses per eye. Everyone received several treatments over a few months.

Key findings:

• Both four and five-pulse IPL treatment groups had improved symptoms, including less dryness, irritation, and meibomian gland blockage.
• Both IPL treatment groups increased the thickness of the oily layer in tears (which helps prevent eyes from drying out).
• Improvements continued to build up over time, with sustained results seen by day 75 in both IPL treatment groups.
• However, the five-pulse group improved sooner from day 45 onward.

In summary: IPL therapy can help relieve dry eye symptoms and improve tear film quality in people with meibomian gland dysfunction (MGD). A five-flash IPL treatment has shown better clinical results than a four-flash treatment. For best outcomes, it’s recommended to start with at least four treatment sessions to build up sustained therapeutic effects before assessing overall effectiveness.

Reference:

This study tested whether an eye cream made with Manuka Honey could help treat blepharitis, a common condition that is associated with dry eye. Participants with blepharitis applied the Manuka Honey microemulsion cream to one closed eyelid every night for three months. The other eye was not treated and served as a comparison. Researchers checked eye health and comfort at the beginning, after one month, and after three months.

Key findings:

• Treated eyes had less dryness and discomfort after one month, with further improvement by three months.

• By the end of the study, treated eyes showed:

  • Better tear film stability (tears stayed on the eye surface longer)

  • Thicker oily tear layer, which helps prevent evaporation

  • Less damage to the lower eyelid lining

• The cream also reduced the presence of bacteria and Demodex mites, both linked to blepharitis.

• There were no changes in vision and no major side effects.

In summary: Using the Manuka Honey eye cream every night for three months helped reduce blepharitis symptoms, improved tear quality, and lowered harmful bacteria and mites on the eyelids. The treatment was well tolerated and shows promise as a gentle, natural option for managing blepharitis.

Reference:

Craig JP, Cruzat A, Cheung IMY, Watters GA, Wang MTM. Randomized masked trial of the clinical efficacy of MGO Manuka Honey microemulsion eye cream for the treatment of blepharitis. Ocul Surf. 2020 Jan;18(1):170-177. doi: 10.1016/j.jtos.2019.11.009. Epub 2019 Nov 20. PMID: 31759183.

OSL researchers: Professor Jennifer Craig, Dr Andrew Cruzat,* Dr Isabella Cheung,* Dr Michael Wang

* Former OSL researchers

Warm eyelid masks are often used to help people with dry eye disease or blocked eyelid oil glands. This study tested how different heat settings on one such mask affect the temperature of the eyes and the stability of the tear film. Participants tried a special eyelid warming device on three separate days. Each time, the mask was used for 10 minutes at a different temperature: 45°C, 50°C, or 55°C. Before and after each session, researchers measured eyelid temperature, eye surface temperature, tear film stability, and the oily layer on the tear film.

Key findings:

• All temperature settings increased eye temperature, improved tear film stability, and thickened the tear film’s oily layer.
• The 55°C setting was most effective, raising eye temperature by about 4°C and boosting tear film stability more than the lower settings.
• The higher the heat, the greater the benefit, though all settings helped.

In summary: This eyelid mask improved key signs of dry eye, and higher temperatures worked better. These findings help guide eye care professionals when recommending warming masks—especially for patients with meibomian gland dysfunction or tear film issues.

Reference:

Wang MTM, Liu LJ, McPherson RD, Fuller JR, Craig JP. Therapeutic profile of a latent heat eyelid warming device with temperature setting variation. Cont Lens Anterior Eye. 2020;43(2):173-177. doi:10.1016/j.clae.2019.09.004

OSL researchers: Dr Michael Wang, Professor Jennifer Craig

Digital screen use is often linked to dry eye symptoms, but what about wearing virtual reality (VR) headsets? This study looked at whether VR headset wear affects the tear film, the layer of moisture that protects and nourishes the eye. Regular computer users participated in this study. On different days, they either wore a VR headset for 40 minutes, or used a standard desktop computer for the same amount of time.

Key findings:

• Wearing a VR headset slightly warmed the eyelids and eye surface more than a desktop screen

• Tear film quality improved with VR headset wear, especially the oily (lipid) layer and overall tear stability

• These improvements were measurable and statistically significant, even with modest temperature changes

In summary: VR headset wear helped improve tear film quality more than using a regular computer screen. While more research is needed, VR headsets might offer a new tool for relieving dry eye symptoms, especially for people who work with screens all day.

Reference:

Turnbull PRK, Wong J, Feng J, Wang MTM, Craig JP. Effect of virtual reality headset wear on the tear film: A randomised crossover study. Cont Lens Anterior Eye. 2019 Dec;42(6):640-645. doi: 10.1016/j.clae.2019.08.003. Epub 2019 Aug 29. PMID: 31474438.

OSL researchers: Dr Michael Wang, Professor Jennifer Craig

This study looked at whether using an eyelid massage device (called Eyepeace) could help people with meibomian gland dysfunction (MGD), a common cause of dry eye. The researchers compared the device with the traditional method of using your fingers to massage the eyelids after warm compresses. Participants with dry eye symptoms took part. For two weeks, one eye (randomly chosen) got a device-applied massage, and the other eye received manual massage using the fingertips. Eye health and tear film quality were checked at the start, right after the first treatment, and again after two weeks of daily use.

Key findings:

• Both massage methods improved tear quality right after use.
• After two weeks, the device massage slightly improved the oily (lipid) layer of the tears more than the manual method, but this difference was small and not likely to be noticeable to patients.
• No other significant changes in eye health were observed. Both techniques were safe, with no adverse effects.

In summary: Using a massage device after warm compresses may offer a small benefit over fingertip massage for people with MGD. However, the added benefit was minor. More research is needed to test the device in larger groups and for longer periods, especially in people with more severe dry eye.

Reference:

Wang MTM, Feng J, Wong J, Turnbull PR, Craig JP. Randomised trial of the clinical utility of an eyelid massage device for the management of meibomian gland dysfunction. Cont Lens Anterior Eye. 2019 Dec;42(6):620-624. doi: 10.1016/j.clae.2019.07.008. Epub 2019 Jul 26. PMID: 31358441.

OSL researchers: Dr Michael Wang, Professor Jennifer Craig

This study looked at whether Asian and Caucasian adults living in the same area experienced differences in dry eye symptoms and tear film quality. Researchers aimed to understand if ethnicity might affect the health of the eye’s surface and tear production. Asian and Caucasian participants matched by age and gender, took part. Each person completed a set of dry eye symptom questionnaires and had a clinical eye exam measuring tear quality and eye surface health.

Key findings:

• Asian participants were more likely to have dry eye disease symptoms and signs than Caucasian participants (74% vs. 51%).
• Asians had poorer tear film stability, lower lipid quality, worse meibomian gland function, and more incomplete blinking (81% of Asians vs. 45% of Caucasians).
• These issues could contribute to more discomfort and eye surface problems in the Asian group. Overall, the odds of having dry eye symptoms were nearly 3 times higher in Asian participants.

In summary: These findings suggest that ethnic background can influence eye health, especially when it comes to dry eye disease. People of Asian descent may be more prone to dry eye, possibly due to differences in blinking habits and eyelid gland function. This could help eye care professionals personalise treatment based on each individual’s background.

Reference:

Craig JP, Lim J, Han A, Tien L, Xue AL, Wang MTM. Ethnic differences between the Asian and Caucasian ocular surface: A co-located adult migrant population cohort study. Ocul Surf. 2019 Jan;17(1):83-88. doi: 10.1016/j.jtos.2018.09.005. Epub 2018 Sep 22. PMID: 30253249.

Craig JP, Wang MT, Kim D, Lee JM. Exploring the Predisposition of the Asian Eye to Development of Dry Eye. Ocul Surf. 2016;14(3):385-392. doi:10.1016/j.jtos.2016.03.002

OSL researchers: Professor Jennifer Craig, Dr Ally Xue, Dr Michael Wang

This study looked at whether children from Asian and Caucasian ethnic backgrounds show early signs that could increase their risk of dry eye disease as they grow older. Children (ages 5 to 18) born in New Zealand took part. They were grouped by both ethnicity and eyelid shape: Asian single eyelid (ASL), Asian double eyelid (ADL), and Caucasian double eyelid (CDL). Researchers focused on eye surface health, tear film quality, blinking habits, and eyelid anatomy.

Key findings:

• Incomplete blinking was much more common in both Asian groups compared to the Caucasian group.
• Although tear film quality and dry eye symptoms were similar across all groups, there were notable differences in eyelid gland structure: Asian children had more gland shortening, while Caucasian children had more twisting (tortuosity) in their glands.
• Asian single eyelid children also showed more signs of eyelid friction on the eye surface, and greater corneal astigmatism (a type of curvature irregularity of the front of the eye).

In summary: While dry eye symptoms weren’t yet present in childhood, the study found early anatomical and blinking differences in Asian children that may increase their risk for dry eye disease later in life. These findings highlight the importance of monitoring eyelid function and blinking from a young age, especially in children with Asian single eyelids, as these factors may influence future eye comfort and vision health.

Reference:

Kim JS, Wang MTM, Craig JP. Exploring the Asian ethnic predisposition to dry eye disease in a pediatric population. Ocul Surf. 2019;17(1):70-77. doi:10.1016/j.jtos.2018.09.003

OSL researchers:

Professor Jennifer Craig, Dr Ji Soo Kim,* Dr Michael Wang

* Former OSL researchers

The aim of this study was to test a new, simple method for collecting tiny samples from the surface of the eye to study gene activity. This technique could help scientists better understand how different eye diseases affect the surface of the eye at a molecular level. Cells were gently collected from the ocular surface using the EYEPRIM device, with and without anaesthetic drops, in a quick, non-invasive procedure. Gene activity was then analysed using highly sensitive qPCR and droplet digital PCR.

Key findings:

• The method successfully produced high-quality samples that could be used to detect even very small amounts of gene activity.
• There were no issues with contamination or interference, and the process was safe, consistent, and easy to perform in a clinical setting.
• The technique was tested on 92 samples from 46 people, and it worked reliably in a real-world study.

In summary: This new approach provides a gentle and accurate way to measure cellular changes on the eye’s surface, potentially allowing researchers and eye care providers to better understand eye diseases, track how the eye responds to treatments, and diagnose conditions more precisely.

Reference:

Ganesalingam K, Ismail S, Craig JP, Sherwin T. Use of a Purpose-Built Impression Cytology Device for Gene Expression Quantification at the Ocular Surface Using Quantitative PCR and Droplet Digital PCR. Cornea. 2019;38(1):127-133. doi:10.1097/ICO.0000000000001792

Ganesalingam K, Ismail S, Sherwin T, Craig JP. Molecular evidence for the role of inflammation in dry eye disease. Clin Exp Optom. 2019;102(5):446-454. doi:10.1111/cxo.12849

OSL researchers:

Professor Jennifer Craig, Dr Kalaivarny Ganesalingam*

* Former OSL researchers

This study tested a quick and easy Blink Test to see how well it could help identify people with dry eye disease (DED), a common condition where the eyes don’t stay properly lubricated. The goal was to see if this self-test could be a useful screening tool, especially for people without access to specialist eye clinics. Participants did a Blink Test, which involved looking at a screen and timing how long they could keep their eyes open without blinking or feeling discomfort. They also completed a dry eye symptoms questionnaire, and had their tear film and eye surface examined using clinical tests based on standard dry eye diagnostic criteria (TFOS DEWS II).

Key findings:

• If someone blinked within 10 seconds, it was often a sign of dry eye.
• The Blink Test alone correctly identified dry eye in 66% of people with the disease and correctly ruled it out in 88% without it.
• When the Blink Test was combined with a questionnaire, it became even more accurate: identifying dry eye in 71% and ruling it out in 90%.
• The Blink Test also had a moderate correlation with tear stability, which is one of the key signs of dry eye.

In summary: The Blink Test is a fast and easy way to help screen for dry eye, even without advanced eye equipment. It may help people at home check for signs of dry eye, clinics or pharmacies identify who might benefit from a full eye exam.

Reference:

Wolffsohn JS, Craig JP, Vidal-Rohr M, Huarte ST, Ah Kit L, Wang M. Blink Test enhances ability to screen for dry eye disease. Cont Lens Anterior Eye. 2018;41(5):421-425. doi:10.1016/j.clae.2018.06.003

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang

This study looked at how incomplete blinking, when the eyelids don’t fully close, affects tear quality, eye surface health, and dry eye symptoms. Researchers wanted to understand whether people who blink incompletely are more likely to experience dry eye disease. All participants had their tear film, blink pattern, glands in the eyelids, and eye comfort assessed in a single visit.

Key findings:

• People with incomplete blinking were twice as likely to meet the criteria for dry eye disease. They had: worse dry eye symptoms, more meibomian gland dropout, thinner protective oil layers on the tear film, poorer quality of oil from their glands, more eyelid inflammation and notching.
• Interestingly, the number of blinks per minute was not linked to eye health; it was the quality of the blink (whether it was full or not) that mattered most.

In summary: If you blink partially or incompletely, especially during screen time, you may be at greater risk of developing evaporative dry eye.

Reference:

Wang MTM, Tien L, Han A, et al. Impact of blinking on ocular surface and tear film parameters. Ocul Surf. 2018;16(4):424-429. doi:10.1016/j.jtos.2018.06.001

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang

This study aimed to explore how long-term use of glaucoma eye drops might affect the tear film, eye surface health, and dry eye symptoms. It focused on whether the eye receiving treatment showed more signs of dryness or irritation than the untreated eye. Participants using glaucoma drops in one eye only for at least 6 months took part. Both eyes were tested and compared in the same session.

Key findings:

• Compared to the untreated eye, the eye receiving glaucoma drops showed: weaker tear stability, higher tear saltiness (osmolarity), more redness (inflammation), worse eyelid margin health, lower tear volume.
• However, dry eye symptoms reported by participants were not significantly different between the two eyes. There were no major differences in gland health or surface staining.

In summary: Long-term use of glaucoma drops may lead to subtle signs of ocular surface dryness and inflammation, which can get worse over time.

Reference:

Wong ABC, Wang MTM, Liu K, Prime ZJ, Danesh-Meyer HV, Craig JP. Exploring topical anti-glaucoma medication effects on the ocular surface in the context of the current understanding of dry eye. Ocul Surf. 2018;16(3):289-293. doi:10.1016/j.jtos.2018.03.002

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang

This study compared two common ways of testing tear film stability, a key part of diagnosing dry eye disease. Researchers wanted to know which method is better at telling apart people with and without dry eye symptoms: 1) Fluorescein Tear Break-Up Time (TBUT): a traditional method using dye and a blue light; 2) Non-Invasive Keratograph Break-Up Time (NIKBUT): a modern, automated method using a special camera (no dye needed).

Key findings:

• NIKBUT times were longer than TBUT for all participants.
• TBUT results varied less, but were less reliable.
• NIKBUT was better at detecting dry eye, with higher accuracy and a better balance between sensitivity and specificity.
• The best NIKBUT cut-off for detecting dry eye was 9 seconds or less.
• The best TBUT cut-off was 5 seconds or less, but it was less accurate overall.

In summary: The standard tear stability test using fluorescein dye gave quicker but less varied results, while the newer, automated scan was better at spotting signs of dry eye.

Reference:

Wang MTM, Craig JP. Comparative Evaluation of Clinical Methods of Tear Film Stability Assessment: A Randomized Crossover Trial. JAMA Ophthalmol. 2018;136(3):291-294. doi:10.1001/jamaophthalmol.2017.6489

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang

This study looked at whether lipid-based eye drops (Systane® Balance) could better protect the eyes from environmental stress, like wind or dry air, compared to standard non-lipid eye drops (Systane® Ultra). Researchers wanted to see which type of drop keeps the eyes more stable and comfortable in people with mild to moderate dry eye symptoms. After applying the drops, participants with diagnosed dry eye sat in front of a fan for 2.5 minutes to simulate a dry, windy environment.

Key findings:

• Both eye drops improved tear film stability, helping to prevent it from breaking up too quickly.
• But the lipid-based drop created a thicker oily (lipid) layer on the eye, was more effective at keeping the tear film stable even after exposure to the fan, and was rated as more comfortable by 67% of participants.

In summary: Both types of eye drops (with and without lipids) helped protect against harsh environments in people with mild-to-moderate dry eye when used once, but the lipid-based drops worked slightly better as a preventive treatment.

Reference:

Gokul A, Wang MTM, Craig JP. Tear lipid supplement prophylaxis against dry eye in adverse environments. Cont Lens Anterior Eye. 2018;41(1):97-100. doi:10.1016/j.clae.2017.09.013

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang

This study looked at how well three different warm therapies work to treat meibomian gland dysfunction (MGD), a common cause of dry eye, across people with different levels of meibomian gland loss (called “dropout”). The goal was to see if people with mild or severe gland loss benefit equally from treatment. During the study, participants received one of the following treatments: a latent heat mask, a liposomal spray, or a heated warm compress. The quality of their tear film and dry eye symptoms were measured before and after treatment.

Key findings:

• People with more gland loss generally had more severe symptoms.
• After treatment, tear film stability improved, especially in the pronounced gland dropout group.
• The lipid (oily) layer of the tear film also improved in almost half of all participants.
• These improvements happened regardless of which treatment was used.
• None of the treatments made symptoms or tear quality worse

In summary: Even if you have significant meibomian gland loss, warm eye treatments like masks, sprays, or compresses can still help improve tear quality and comfort. These findings support the use of warm therapies for a wide range of dry eye severity levels.

Reference:

Turnbull PRK, Misra SL, Craig JP. Comparison of treatment effect across varying severities of meibomian gland dropout. Cont Lens Anterior Eye. 2018;41(1):88-92. doi:10.1016/j.clae.2017.09.004

OSL researchers:

Professor Jennifer Craig

This study compared two common eyelid cleaning methods: a specially made eyelid cleanser (TheraTears® SteriLid®) and diluted baby shampoo (Johnson’s® No More Tears®). Each participant used one product on one eye and the other product on the other eye, twice a day for four weeks.

Key findings:

• Both treatments helped improve some signs and symptoms of blepharitis.

• However, the dedicated eyelid cleanser performed better overall. It reduced inflammation, improved the quality of the tear film, and helped with eyelid health more effectively than baby shampoo.

• Most participants preferred using the eyelid cleanser over baby shampoo.

• The baby shampoo caused some negative effects, including signs that it might harm the cells that help keep the eye moist and healthy.

In summary: While both products helped, the dedicated eyelid cleanser worked better and was gentler on the eyes. More research is needed to understand if using baby shampoo over the long term could cause damage to the eye’s natural protective cells.

Reference:

Sung J, Wang MTM, Lee SH, Cheung IMY, Ismail S, Sherwin T, Craig JP. Randomized double-masked trial of eyelid cleansing treatments for blepharitis. Ocul Surf. 2018 Jan;16(1):77-83. doi: 10.1016/j.jtos.2017.10.005. Epub 2017 Nov 8. PMID: 29128682.

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang, Dr Isabella Cheung*

* Former OSL researchers

This study looked at whether using a small USB-powered desktop humidifier could help relieve dry eyes in people who use computers for long periods, something that’s especially common in dry office environments. Forty-four computer users took part. Each person spent an hour using a computer in two different settings: one with a desktop humidifier running and one without it. Eye moisture and stability were measured before and after each session, and participants reported how comfortable their eyes felt.

Key findings:

• The humidifier increased local air humidity by about 5%.

• It did not change the amount of tear fluid or the oily layer of tears.

• However, it improved tear stability (how long tears stay on the eye without breaking up) by about 4 seconds.

• More people felt more comfortable with the humidifier than without it (36% vs. 5%).

In summary: While the desktop humidifier didn’t change tear volume, it helped keep tears stable longer and made eyes feel more comfortable during computer use. Even a small boost in air moisture may make a noticeable difference for dry eye relief in dry office environments.

Reference:

Wang MTM, Chan E, Ea L, Kam C, Lu Y, Misra SL, Craig JP. Randomized Trial of Desktop Humidifier for Dry Eye Relief in Computer Users. Optom Vis Sci. 2017 Nov;94(11):1052-1057. doi: 10.1097/OPX.0000000000001136. PMID: 29035923

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang

The aim of this research was to test whether a new Manuka Honey eye cream is safe and comfortable to use around the eyelids. Manuka honey has natural antibacterial and healing properties, so the cream may help people with blepharitis, a common condition that causes inflamed and irritated eyelids. Healthy participants applied the Manuka Honey eye cream to one closed eyelid overnight for 2 weeks (the other eye was untreated for comparison).

Key findings:

• The eye cream did not affect vision or cause significant irritation.
• There were no major changes in tear quality or signs of inflammation.
• No serious side effects were reported.
• Two participants experienced brief stinging when some cream accidentally got into the eye, but it cleared up quickly with rinsing.

In summary: The Manuka Honey eye cream was safe and well tolerated in healthy people, with no negative effects on vision, eye comfort, or tear film health. These results suggest the cream is suitable for further testing in people with blepharitis, to see if it helps improve their symptoms.

Reference:

Craig JP, Wang MTM, Ganesalingam K, et al. Randomised masked trial of the clinical safety and tolerability of MGO Manuka Honey eye cream for the management of blepharitis. BMJ Open Ophthalmol. 2017;1(1):e000066. Published 2017 Aug 4. doi:10.1136/bmjophth-2016-000066

Craig JP, Rupenthal ID, Seyfoddin A, et al. Preclinical development of MGO Manuka Honey microemulsion for blepharitis management. BMJ Open Ophthalmol. 2017;1(1):e000065. Published 2017 Aug 7. doi:10.1136/bmjophth-2016-000065

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang, Kalaivarny Ganesalingam,* Dr Isabella Cheung*

* Former OSL researchers

This study looked at whether two types of lipid-based dry eye treatments, a lubricant eye drop and a liposomal spray, could help improve tear film quality in people who wear eyeliner makeup, which can sometimes affect tear film stability. Participants wore pencil eyeliner on the skin just above their upper lashes, one eye received a lipid eye drop (Systane® Balance), and the other eye received a liposomal spray (Tears Again®).

Key findings:

• Both treatments improved the tear film’s oily layer.

• However, both also led to more makeup particles entering the tear film.

• Neither treatment improved overall tear film stability or reduced evaporation.

• The eye drop and spray worked similarly, with no clear advantage of one over the other.

In summary: Both the lipid-based eye drop and phospholipid spray caused visible residue on eyeliner in makeup wearers. While they thickened the eye’s protective oil layer, neither actually helped keep tears stable.

Reference:

Wang MTM, Cho ISH, Jung SH, Craig JP. Effect of lipid-based dry eye supplements on the tear film in wearers of eye cosmetics. Cont Lens Anterior Eye. 2017;40(4):236-241. doi:10.1016/j.clae.2017.03.001

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang

This study looked at how different amounts of fluorescein dye, a dye used to check for dry eye, can affect the results of tear film break-up time (TBUT), which is a common test used to measure how quickly the tear film starts to dry on the eye. Participants had their tear stability measured in three different ways: 1) without any dye (non-invasive test), 2) with a very small amount (1 microliter) of dye using a special controlled applicator, and 3) with a typical larger amount of dye using a standard strip.

Key findings:

• The standard method with more dye gave shorter (worse) tear break-up times, likely because the excess fluid disrupted the tear film.

• The minimal dye method gave results that were similar to the non-invasive test, and more accurate.

• All methods were statistically related, but using less dye caused less disturbance to the eye’s natural tear film.

In summary: The standard fluorescein test gave shorter tear break-up times, while using smaller drops or no drops at all gave similar results. This implies that using less fluorescein solution helps get more accurate measurements of tear stability.

Reference:

Mooi JK, Wang MTM, Lim J, Müller A, Craig JP. Minimising instilled volume reduces the impact of fluorescein on clinical measurements of tear film stability. Cont Lens Anterior Eye. 2017;40(3):170-174. doi:10.1016/j.clae.2017.01.004

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang

This study surveyed New Zealand optometrists and ophthalmologists to understand how they diagnose and manage dry eye disease, and whether their approaches align with evidence-based recommendations. Participants from both professions were invited to complete an anonymous online survey.

Key findings:

• Most clinicians use a combination of patient symptoms and gland checks (meibomian glands) to diagnose dry eye.

• However, few use formal questionnaires or grading tools, even though these are recommended in research.

• Eyelid hygiene and preservative-free eye drops are the most commonly recommended treatments for all severity levels.

• Ophthalmologists are more likely than optometrists to use oral antibiotics like tetracyclines for more severe cases.

• Both groups get most of their treatment guidance from professional conferences, rather than directly from scientific journals.

In summary: Consistent with evidence-based guidelines, New Zealand eye care professionals use both patient symptoms and clinical tests to diagnose and treat dry eye, matching treatment to disease severity. However, they could do better at keeping up with the latest findings, and most prefer learning through professional conferences.

Reference:

Xue AL, Downie LE, Ormonde SE, Craig JP. A comparison of the self-reported dry eye practices of New Zealand optometrists and ophthalmologists. Ophthalmic Physiol Opt. 2017;37(2):191-201. doi:10.1111/opo.12349

OSL researchers:

Professor Jennifer Craig, Dr Ally Xue

This study looked at whether a liposomal eye spray (Tears Again®), applied to closed eyelids, could improve comfort and tear film stability in people who wear silicone hydrogel contact lenses, without causing unwanted effects on vision or lens cleanliness. Participants who wore contact lenses had one eye randomly chosen to receive liposomal spray four times a day, while the other eye acted as a control.

Key findings:

• The sprayed eyes showed improved tear film stability and a thicker lipid layer (which helps reduce dryness).

• More participants reported feeling greater comfort in the sprayed eye.

• No negative effects were seen on visual clarity or lens cleanliness.

In summary: The phospholipid spray helped contact lens wearers by making tears more stable, increasing the tear lipid layer, and improving comfort. It didn’t blur vision or cause extra oil buildup on lenses.

Reference:

Wang MT, Ganesalingam K, Loh CS, et al. Compatibility of phospholipid liposomal spray with silicone hydrogel contact lens wear. Cont Lens Anterior Eye. 2017;40(1):53-58. doi:10.1016/j.clae.2016.11.002

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang, Kalaivarny Ganesalingam *

* Former OSL researchers

The study aimed to find out whether people with meibomian gland dysfunction (MGD), a common cause of dry eye, have different bacteria on their eyelids compared to people without MGD. Participants had swabs taken from the edge of their eyelids before and after squeezing the meibomian glands. The types of bacteria were identified in the lab.

Key findings:

• People with and without MGD had similar types of bacteria on their eyelids.

• Squeezing the glands did not change the bacteria present.

• Having anterior blepharitis (inflammation at the base of the eyelashes) or wearing contact lenses did not affect the bacterial types found.

• Interestingly, contact lens wearers often had no detectable bacteria, suggesting lenses might reduce bacteria on the eyelids.

• Across all groups, Staphylococcus aureus was more common than expected, while other typical skin bacteria were less common.

In summary: Researchers found slight variations in the types of bacteria living on the eye’s surface compared to other studies, likely due to climate differences. The overall bacterial community remained consistent whether patients had severe meibomian gland dysfunction, eyelid inflammation (blepharitis), or wore contact lenses. This suggests that treatments targeting this shared microbiome could benefit a wide range of patients.

Reference:

Watters GA, Turnbull PR, Swift S, Petty A, Craig JP. Ocular surface microbiome in meibomian gland dysfunction. Clin Exp Ophthalmol. 2017;45(2):105-111. doi:10.1111/ceo.12810

OSL researchers:

Professor Jennifer Craig

This study compared two types of warm eye compresses to see which one worked better for people with mild to moderate dry eye caused by meibomian gland dysfunction (MGD). Participants used two different warm compresses at the same time, one on each eye: one was a microwave-heated flaxseed eye bag (MGDRx Eye Bag), the other was a self-heating eye mask (EyeGiene). The researchers measured outer and inner eyelid temperatures, tear film lipid layer grade (LLG), and noninvasive tear film breakup time (NIBUT) before and after 10 minutes of treatment.

Key findings:

• Both treatments led to improved tear quality and stability compared to baseline.

• There was no significant difference in effectiveness between the two treatments.

• 78% of participants preferred the eye bag over the eye mask.

In summary: Both warm compresses helped improve tear quality and stability in people with dry eye. However, the microwave-heated eye bag warmed the eyes more and was preferred by most users for home treatment.

Reference:

Wang MT, Jaitley Z, Lord SM, Craig JP. Comparison of Self-applied Heat Therapy for Meibomian Gland Dysfunction. Optom Vis Sci. 2015;92(9):e321-e326. doi:10.1097/OPX.0000000000000601

OSL researchers:

Professor Jennifer Craig, Dr Michael Wang