The Ocular Surface and Its Symbolism
Juan Murube, MD, PhD
The Ocular Surface 2007;5:6-12©2007 Ethis Communications, Inc. Vol 5: No 1

Gross Characteristics of Normal Human Lacrimal Glands
Mortimer Lorber, MD
The Ocular Surface 2007;5:13-22©2007 Ethis Communications, Inc. Vol 5: No 1
Because human lacrimal glands are rarely completely removed at surgery and not extirpated during routine autopsy, knowledge of their normal measurements and orbital position has not been significantly updated from early descriptions. Judged retrospectively, these have appreciable shortcomings. For example, most published lacrimal gland weights and dimensions have not always been accompanied by such basic information as the mean or range of values, the number of glands examined, the donors’ genders and ages, and whether the specimens came from living donors (exenteration), recently deceased ones (autopsy), or embalmed cadavers. Consequently, it is appropriate to survey the literature about a fundamental aspect of this major contributor to aqueous tear secretion - its gross anatomy. The data reviewed would constitute the basis for future studies to be carried out in conformity with modern standards for literary citation and performance of statistical analyses. These should better delineate normal human lacrimal gland mass, size, and contours and supplement current knowledge of variations in the organ’s orbital relationships with extraocular muscles and the globe. By doing so, more definitive characterizations of these as well as the prevalence of each will be obtained. Perhaps additional clinical relevance of lacrimal gland gross anatomy will result.

Science and Strategy for Preventing and Managing Corneal Ulceration
Sonal S. Tuli, MD,¹ Gregory S. Schultz, PhD,^1,2 and Donald M. Downer, MD¹
The Ocular Surface 2007;5:23-39©2007 Ethis Communications, Inc. Vol 5: No 1
Corneal ulcers can cause significant loss of vision from scarring and astigmatism, but rapid management can limit the destruction and improve outcomes. Infectious ulcers usually resolve with antimicrobial treatment. Noninfectious ulcers, however, present a diagnostic and therapeutic challenge. They can often be resolved by eliminating toxic medications and providing surface support with lubrication and collagenase inhibitors, but resistant ulcers may need more aggressive therapy with bandage contact lenses, tarsorrhaphy, or autologous serum. Ulcers impending perforation require urgent surgical management (e.g., tissue glue, conjunctival flaps, or keratoplasty). Topical steroids are useful when the ulceration is secondary to inflammatory mediators, but they are contraindicated in corneal melts with minimal inflammation, such as those associated with Sjogren syndrome. Systemic immunomodulation is required in addition to topical therapy in the presence of autoimmune disease. Understanding of the pathological processes that occur in different types of corneal ulcers is essential to formulation of a logical and effective treatment plan. Newer, more targeted treatment modalities may offer treatment options that have greater efficacy and fewer adverse effects.

Therapeutic and Ocular Surface Indications for Scleral Contact Lenses
Ken Pullum, BSc, FCOptom, Dip CLP,^1,2 and Roger Buckley, FRCS, FRCOphth, HonFCOptom^1,3
The Ocular Surface 2007;5:40-49©2007 Ethis Communications, Inc. Vol 5: No 1
Contrary to popular perception, the large size and scleral bearing surface of scleral contact lenses (ScCLs) can be beneficial in the management of certain ocular surface disorders. They can provide retention of a precorneal tear reservoir for corneal hydration with total protection from the external environment and from the lid margins and lashes. They can relieve pain, prevent exposure keratitis, and enhance epithelial healing. The use of ScCLs is limited in large part by ophthalmologists’ perception of excessive complexity. Actually, while some cases are challenging, many are straightforward. This review summarizes indications for therapeutic use of ScCLs and describes techniques and considerations that contribute to their clinical success.

Development and Validation of a Short Global Dry Eye Symptom Index
Debra A. Schaumberg, ScD, OD, MPH,^1,3 Abha Gulati, MD,¹ William D. Mathers, MD,⁴ Thomas Clinch, MD,⁵ Michael A. Lemp, MD,⁵ J. Daniel Nelson, MD,⁶ Gary N. Foulks, MD, FACS ,⁷ Reza Dana, MD, MSc, MPH^1,2
The Ocular Surface 2007;5:50-57©2007 Ethis Communications, Inc. Vol 5: No 1
We have developed and evaluated the repeatability of a short questionnaire based on a visual analog scale (VAS) to quantify the frequency and severity of symptoms of dry eye syndrome (DES). The “Symptom Assessment iN Dry Eye” (SANDE) questionnaire utilizes a 100 mm horizontal V AS technique to quantify patient symptoms of ocular dryness and/or irritation. Fifty-two subjects with DES were prospectively enrolled and followed-up at 2 and 4 months with repeated administrations of the SANDE questionnaire and clinical ocular surface evaluation. Subjects demonstrated a wide range of symptom scores indicative of the variability of the disease. Analyses comparing the repeatability of SANDE scores from baseline to the 2-month follow-up indicated a significant downward regression of scores toward the mean. In contrast, repeatability measures were consistently good for questionnaires administered within a few days of one another (ICC ranging from 0.53 to 0.76). Bland-Altman analysis demonstrated that 50% of repeated SANDE symptom scores were within 10 mm of each other, 80% were within 20 mm, and 95% were within less than 30 mm. These data describe good repeatability for the SANDE symptom score when repeated assessments are made within a few days. The results are encouraging and suggest that further refinement and testing of the SANDE questionnaire in larger populations may result in a reliable questionnaire to detect change in irritative symptoms over time.

Pipeline
Gary D. Novack, PhD, Features Editor, Pipeline
The Ocular Surface 2007;5:58-61©2007 Ethis Communications, Inc. Vol 5: No 1

Ocular Surface Research at Glasgow Caledonian University, Scotland
Alan Tomlinson, PhD, DSc, FCOptom
The Ocular Surface 2007;5:62-64©2007 Ethis Communications, Inc. Vol 5: No 1