Ocular Foreign Bodies: A Review

A foreign body is any abnormal substance or object that does not belong to the body (eye). The incidence of foreign body in the eye is high especially in the industrial towns. It can occur at any age and in both genders. It affects the eye by mechanical effects, by introduction of infection or by specific reaction.

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Novasorb Cationic Nanoemulsion and Latanoprost

Glaucoma is the leading cause of blindness all over the world after cataract blindness. In 2010, worldwide 60.5 million people were expected to have OAG (Open angle glaucoma) and ACG (Angle closure glaucoma), increasing to 79.6 million by 2020, and of these, 74% will have OAG1. Asians represent 47% of those with all glaucoma and 87% of those with ACG1. 4.5 million people with OAG and 3.9 million people with ACG were expected to have bilateral blindness in 2010, rising to 5.9 and 5.3 million people in 2020, respectively.

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Ocular Biometry in Patients with Primary Open Angle Glaucoma

Glaucoma is the leading cause of blindness all over the world after cataract blindness. In 2010, worldwide 60.5 million people were expected to have OAG (Open angle glaucoma) and ACG (Angle closure glaucoma), increasing to 79.6 million by 2020, and of these, 74% will have OAG1. Asians represent 47% of those with all glaucoma and 87% of those with ACG1. 4.5 million people with OAG and 3.9 million people with ACG were expected to have bilateral blindness in 2010, rising to 5.9 and 5.3 million people in 2020, respectively.

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Autologous Serum Eye Drop in Refractory Neurotrophic Corneal Ulcer: A Case Report

To report a case of refractive neurotrophic corneal ulcer, treated successfully with 20% autologous serum eye drops. A 20 year old male presented with redness and foreign body sensation since three months associated with photophobia and progressive diminution of vision of both the eyes, right eye more than left, since 2 months. At presentation, the best corrected visual acuity in the right eye was 1/60 and left 6/12.

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Visual Eyes Optometry

In visual eye optometry comprehensive eye examination is done. It deals with visions sharpness, eye and vision problems. Maintenance of good eye health is explained by visual eyes optometry.

Manuscript submission: Authors are requested to submit manuscripts at https://www.editorialmanager.com/lifesciences/ or send as an e-mail attachment to the Editorial Office at optometry@clinicalmedicaljournals.com

A rare case of Cornelia de Lange syndrome with Glaucoma

An eight months old baby was presented with no tolerance to bright light, chronic watering and discharge from both eyes since birth. There was no family history or consanguinity. The child presented strange facial features of microcephaly, synophrys, smooth philtrum, thin upper lip and hirsutism. Close examination of the eyes presented myopic astigmatism and abnormal intraocular pressure. The child underwent trabeculotomy and the case was diagnosed Cornelia de Lange syndrome. It is a multiple congenital anomaly syndrome with intrauterine growth retardation, developmental delay, mental retardation, distinctive facial features, respiratory and feeding difficulties, gastroesophageal dysfunction, and cardiac septal defects. Cornelia de Lange syndrome occurs due to the mutation of at least five genes. However, Cornelia de Lange syndrome with congenital glaucoma is a very rare case.

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The Incidence of Rhegmatogenous Retinal Detachment in Kumamoto, Japan between 2009 and 2011

Rhegmatogenous retinal detachment (RRD) is a blinding disease characterized by the separation of the inner neurosensory retina from the outer retinal pigment epithelium due to a break in the retina. Fluid accumulates in the subretinal space through the break in the retina, and the decreasing function of the neurosensory retina leads to vision loss.

Previous studies have reported that the annual incidence of RRD was 7.98-18.2 per 100,000 people. Because the incidence of RRD is influenced by demographic characteristics, severe myopia, and history of cataract surgery, the incidence varies widely by region and age group. In Japan, a previous retrospective study reported that the incidence of RRD in Kumamoto Prefecture was 10.4 per 100,000 people (9.6 in males, 11.2 in females). However, this study was conducted in 1990, and the demographic characteristics in Kumamoto have changed during the last 20 years. To date, some studies have reported the incidence of RRD over a 20-year period; however, no studies have compared the 20-year data with the data from the same region 20 years previously in an Asian population.

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Concomitant Intraocular and Orbital Space-Occupied Lesions

Retinoblastoma in children and uveal melanoma in adults represent two of the most common primary intraocular tumors. The incidence of orbital lesions in rank order of occurrence include: thyroidal associated ophthalmopathy, vascular lesions, idiopathic inflammatory pseudotumor, and lymphoproliferative neoplasia. Patients demonstrating a concomitant intraocular and orbital space occupied lesion are relatively rare and, to the best of our knowledge, this is the first report stressing the underlying causes of concomitant intraocular and intraorbital lesions in the literature. In this paper, we present eight cases showing simultaneous intraocular and orbital soft tissue masses and highlight their clinical, pathological and imaging features.

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Overview of Retina and Vitreous Diseases

A large variety of conditions can involve the retina and vitreous which are not readily visible, such as uveitis, retinal vasculopathy, retinal detachments or tears, macular holes, macular degeneration, diabetic retinopathy, retinopathy of prematurity, retinitis pigmentosa, retinoblastoma, flashes and floaters, vitreous hemorrhage, and eye tumor. These diseases affect millions of people and endanger their visual function, sometimes irreversibly. A prompt and correct diagnosis of retina and vitreous diseases is critical for restoring the lost vision or maintain the present visual acuity.

Ocular Biometry in Patients with Primary Open Angle Glaucoma (POAG)

Glaucoma is the leading cause of blindness all over the world after cataract blindness. In 2010, worldwide 60.5 million people were expected to have OAG (Open angle glaucoma) and ACG (Angle closure glaucoma), increasing to 79.6 million by 2020, and of these, 74% will have OAG1. Asians represent 47% of those with all glaucoma and 87% of those with ACG1. 4.5 million people with OAG and 3.9 million people with ACG were expected to have bilateral blindness in 2010, rising to 5.9 and 5.3 million people in 2020, respectively .

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Endophthalmitis Prevention, Diagnostic Procedures and Treatment

Endophthalmitis is a severe inflammation of the inner eye's structures, caused by an exogenous or endogenous infection with microorganisms which can multiply rapidly. It occurs most frequently after intraocular surgery. Moreover, it can also be a consequence of a penetrant eye injury or a hematogenous dissemination of microorganisms. The most common pathogens of this inflammation are bacteria, next to fungi and less frequently parasites.

The occurrence, severity and clinical presentation of endophthalmitis depend on the way of infection, the number and virulence of pathogenic bacteria, as well as the patient's immunity state. The type of endophthalmitis can suggest the possible causative agent. Furthermore, it can help determine therapeutic approach or antibiotics to choose. The more virulent are the causative agents, the early the symptoms and signs of endophthalmitis appear. Such types of endophthalmitis have a bad course and poor prognosis concerning visual function. In these cases the red fundus reflex is lost quite at the beginning of the disease. Patients treated with prompt vitrectomy and intravitreal injections of antibiotics have statistically better visual outcomes and less likelihood of severe visual loss.

Ergonomic Challenges of Employees Using Computers at Work in a Tertiary Institution in Ghana

Office work is rapidly changing, as new developments in computer technology which make jobs easier are emerging. This emergence presents occupational health and safety problems for both management and employees. While the first few decades of the development of the computer for business focused mainly on automating a wide range of industrial processes, the next step brought personal computers as productivity tools and entertainment devices to homes and workplaces everywhere. More recent refinements in computers and information technology such as mobile devices have led to a host of business and consumer-focused "apps" designed to help people to be more organized, efficient and productive.

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Ocular Foreign Bodies: A Review

A foreign body is any abnormal substance or object that does not belong to the body (eye). The incidence of foreign body in the eye is high especially in the industrial towns. It can occur at any age and in both genders. It affects the eye by mechanical effects, by introduction of infection or by specific reaction. Introduction of a foreign body is a significant disturbance and can create health problem. The study of the foreign body presents unparalleled opportunities for reducing morbidity and for realizing significant savings in both financial and human terms.

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Ischaemic Optic Neuropathy Non Arteritic/NA-AION

Ischaemic optic neuropathy (ION) is the commonest adult optic nerve disorder encountered worldwide and can be expected to increase in incidence in our ageing population. In a recent review of 121 cases the mean age was 61 years. The condition has been classified as a) anterior (AION) affecting the optic nerve head and b) posterior (PION) involving that portion of the optic nerve behind its immediate retrolaminar portion.

The SCHEIE Visual Field Grading System

No method of grading visual field (VF) defects has been widely accepted throughout the glaucoma community. The SCHEIE (Systematic Classification of Humphrey visual fields-Easy Interpretation and Evaluation) grading system for glaucomatous visual fields was created to convey qualitative and quantitative information regarding visual field defects in an objective, reproducible, and easily applicable manner for research purposes.

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Cornelia de Lange Syndrome with Congenital Glaucoma

Cornelia De Lange syndrome (CDLS), also known as Brachmann de Lange syndrome is a rare syndrome. It is characterised by distinctive facial dysmorphism, growth retardation, developmental delay, upper limb reduction defects, gastroesophageal dysfunction, ophthalmologic and genitourinary anomalies, hirsutism, pyloric stenosis, congenital diaphragmatic hernias, cardiac septal defects, and hearing loss. The syndrome was first described by a Dutch paediatrician named Cornelia de Lange, in 1933.

Though the genetic basis of this syndrome is not clear, a majority of cases are due to spontaneous mutations. The defective gene can be inherited from either parent, making it autosomal dominant type of inheritance. Synophrys, long curled lashes, myopia, and hypertrichosis of the brows. These patients have also been found to have ptosis, epiphora, nasolacrimal duct obstruction, and microcornea, congenital glaucoma, corneal opacities, iris heterochromia and optic nerve head pallor/atrophy.

Impact of Amblyopia Treatment on Vision-Related Quality Of Life

Treatment of amblyopia during childhood can have both positive and negative impacts in later life. The treatment of amblyopia could influence Vision-related Quality of Life in adults and children, particularly social relationships and emotions. For example, children with a history of occlusion were 35% to 37% more likely than children without visual defects to have suffered from verbal or physical bullying at school. Many parents associate occlusion treatment with a decrease in children’s self-confidence because of poor vision during occlusion and report greater distress and more conflict at home.

Koklanis et al. conducted a study in Australia on the psychosocial impact of amblyopia and its treatment from both the children (aged 3 to 15 years) and parents’ perspectives. The investigators performed a semi-structured interview with both children with amblyopia and their parents. In addition, parents were asked to complete a psychological inventory, the Behaviour Assessment System for Children. The study showed that dealing with stigma and the perceptions and responses of peers were found to be of central significance in amblyopia therapy and that stigma and the perceptions of peers had adverse consequences for some children’s identity and psychosocial well being.

Comparison of Combined Bevacizumab plus Dexamethasone Vs. Ranibizumab Monotherapy as First-Line Therapy in Patients with Treatment Naive Neovascular Age-Related Macular Degeneration in Real-Life Clinical Practice: A Retrospective Case-Series Analysis

Age related macular degeneration (AMD) is a major cause of legal blindness in elderly individuals in the western world. It affects the macula, initially with characteristic retinal pigment epithelium (RPE) changes (mottling, hyper/hypopigmentation) and drusen deposition (dry AMD). Of note is the presence of a series of inflammatory factors between the RPE and Bruch's membrane. The progression of AMD leads either to late stage geographic atrophy of the macular RPE, or to neovascularization (neovascular AMD), due to vascular endothelial growth factor (VEGF) production.

Neovascular AMD is the most vision-threatening form of the disease. Visual impairment in neovascular AMD is caused by the formation of a choroidal neovascular membrane (CNV) beneath the macula with consequent subretinal leakage, hemorrhage and intraretinal fluid accumulation. Inflammatory factors and VEGF are the main contributing mediators involved in the progression of AMD, participating in a vicious cycle involving hypoxia, oxidative stress, inflammation, edema and neoangiogenesis.

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Refractive Errors among Administrative Staff of Senior High Schools in the Kumasi Metropolis

Refractive error is a condition in which the eye in its relaxed state is unable to sharply see images due to failure of the optical system to bring parallel rays of light reflected off objects) of regard to a sharp focus on the retina. As a result, there is relatively poor vision as images of objects are seen to be blurred. There are different types of refractive errors and they include hyperopia, myopia, and astigmatism, with overlapping forms. Myopia and hyperopia are said to occur when the optical system of the eye brings parallel rays of light into focus in front and at the back of the fovea, respectively. Astigmatism on the other hand occurs when rays of light from different planes do not come to the same point on the fovea.

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Cornelia de Lange Syndrome with Congenital Glaucoma

Cornelia De Lange syndrome (CDLS), also known as Brachmann de Lange syndrome is a rare syndrome. It is characterised by distinctive facial dysmorphism, growth retardation, developmental delay, upper limb reduction defects, gastroesophageal dysfunction, ophthalmologic and genitourinary anomalies, hirsutism, pyloric stenosis, congenital diaphragmatic hernias, cardiac septal defects, and hearing loss. The syndrome was first described by a Dutch paediatrician named Cornelia de Lange, in 1933.

Though the genetic basis of this syndrome is not clear, a majority of cases are due to spontaneous mutations. The defective gene can be inherited from either parent, making it autosomal dominant type of inheritance.

Synophrys, long curled lashes, myopia, and hypertrichosis of the brows. These patients have also been found to have ptosis, epiphora, nasolacrimal duct obstruction, and microcornea, congenital glaucoma, corneal opacities, iris heterochromia and optic nerve head pallor/atrophy.

Periorbital Cellulitis that Developed after Alternative Medication of Hirudo Medicinalis Application

We aimed to present a case of periorbital (preseptal) cellulitis that developed after Hirudo medicinalis alternative medicine application for glaucoma treatment which can be rarely seen in routine ophthalmology practice. A 36 year old woman with a glaucoma was admitted to our outpatient clinic because of redness, pain and swelling around the right eye for three days and gave a history of leech application 1 week ago, that recommended by her relatives as a remedy for glaucoma.

Orbital cellulitis was excluded and cure was achieved with oral ciprofloxacin and flurbiprofen treatment. Patients with chronic diseases such as glaucoma, they are abandoning the treatment over time, will seek solutions from alternative medicine. These inappropriate treatments without scientific evidence can cause various complications. Physicians should maintain proper communication with the patients inform them about their chronic diseases (e.g. glaucoma) to make them the part of the solution and treatments.

Moving Toward Consensus Terminology in Ophthalmic Practice

The dual purposes of this review are to point out inherent problems in communication due to lack of consensus terminology, and to review preferred ophthalmic terms or to suggest others in order to improve eye care. With advances in informatics and the ongoing evolution of modern health care delivery, a common lexicon will also improve basic research and clinical outcomes. It is hoped that this paper will raise awareness of these issues and open profession-wide discussion with the ultimate goal of improving medical communication for ophthalmic patient care.

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Combined Hamartoma of RPE and Retina

A 10 year old male patient presented with diminished vision in his right eye since 6 years. He had not taken any treatment for the same. On examination visual acuity in the right eye was 20/720 and left eye was 20/20. Anterior segment was normal in both eyes. Fundus examination of the right eye showed an ill-defined pigmented lesion measuring 14 mm × 10 mm in its greatest dimensions.

Un-doing All that Good Work! Glaucoma After Vitrectomy and Silicone Oil Injection for the Treatment of Complicated Retinal Detachment

A fifty-two year old bilaterally pseudophakic Caucasian gentleman having a retinal detachment secondary to two retinal breaks superotemporally in his right eye underwent twenty-three gauge pars plana vitrectomy (PPV), endophotocoagulation and perfluoroethane (C2F6) gas insertion.

He presented five weeks later with a total retinal detachment in the same eye presumed consequent to a retinal break inferotemporally thought to represent temporal extension of the initial retinal tear beyond the margin of the aforementioned retinopexy. Twenty gauge PPV was performed, cryotherapy was applied to the retinal break, indirect retinal photocoagulation carried out and 16% perfluoropropane (C3F8) inserted into the vitreous cavity.

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Corneal Toxicity after Self-Application of Calotropis procera (Ushaar) Latex: Case Report and Analysis of the Active Components

Calotropis procera (ushaar) produces a copious amount of latex, which has both inflammatory and anti-inflammatory pharmacological properties. Local application produces an intense inflammatory response and causes significant ocular morbidity.

We report corneal toxicity following self-application of latex from C. procera in a 74-year-old man. He reported painless decreased vision in the affected eye with diffuse corneal edema, and specular microscopy revealed a reduced endothelial cell count. After he was treated with topical corticosteroids, his visual acuity improved from HM to 20/80. The composition of the active compounds in the latex was analyzed. When topically administered, the latex may cause severe ocular injuries and a loss of endothelial cells over a period of time. Public education, early recognition of such injuries, and timely intervention may prevent permanent ocular damage.

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Stereoscopic Memory When Stimuli No Longer Persist: Void and Binocular Intervals in Alternating Monocular Presentations

It was early realized by Exner in 1875 that stereopsis could occur when both eyes together receive the two images of a stereo pair one after the other. Stereopsis occurs even when a void interval is inserted between the presentations of each image.

For instance, Ogle found that stereopsis occurred when two 18 ms presentations were separated by a void interval of 100 ms. Stereopsis has also been studied with protocols in which the two images of a stereo pair were presented cyclically, in alternation to the two eyes. Guilloz - who was motivated by a practical interest in 3d X-ray radioscopy - produced cyclical presentations to the two eyes using a disk rotating in front of a stereoscope lenses. He also described how natural scenes are perceived through his apparatus.

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Hypotony as a Hazard of Trabeculectomy with Mitomycin C

An eighty two year old Caucasian lady with primary open angle glaucoma attended eye clinic. She was using guttate latanoprost 50 g/ml, Brimonidine 2 mg/ml and combined Dorzolamide 20 g/ml and Timolol 5 mg/ml.

This lady was myopic with right eye manifest refraction spherical equivalent of -2.00 and left eye manifest refraction spherical equivalent of -8.00 dioptres. The left eye was amblyopic as a result of this anisometropia. This lady had had bilateral uncomplicated cataract extractions by phacoemulsification with intraocular lens implantation and subsequently bilateral neodymium yttrium aluminium garnet or Nd: YAG laser posterior capsulotomies.

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Aberrometric Outcomes of Intrastromal Corneal Ring Segment (KeraRing 355) Implantation Using Pocket Maker Microkeratome in Patients with Keratoconus

Keratoconus, the most common primary corneal ectasia, is a bilateral asymmetric corneal degeneration which accompanies with local corneal thinning and occurs mostly in inferior and central part of the cornea. Initiating in puberty, Keratoconus (KCN) often progresses until fourth decade of life.

Affecting all ethnic groups equally, KCN usually causes high myopia and irregular astigmatism which results in poor quality of vision. Based on disease severity, many treatment modalities exist including glasses and contact lenses for mild to moderate disease while corneal graft preserved for more advanced disease. High costs, need to long follow-ups, long periods for visual rehabilitation, risks of graft rejection or infection, wound dehiscence and suture-related problems make corneal grafts preserved for the last therapeutic choice by many ophthalmologists.

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Ocular Foreign Bodies: A Review

A foreign body is any abnormal substance or object that does not belong to the body (eye). The incidence of foreign body in the eye is high especially in the industrial towns. It can occur at any age and in both genders. It affects the eye by mechanical effects, by introduction of infection or by specific reaction. Introduction of a foreign body is a significant disturbance and can create health problem. The study of the foreign body presents unparalleled opportunities for reducing morbidity and for realizing significant savings in both financial and human terms.

Interpupillary Distance Measurements among Students in the Kumasi Metropolis

The aim was to obtain interpupillary distance (IPD) measurements of students in the Kumasi Metropolis. The study will provide a database for manufacturers of spectacle frames and optical equipment with Ghana as the target population. The IPD is a crucial measure that needs to be considered before frames can be selected for patients who have been prescribed with spectacle corrections. IPD data from other populations are unsuitable due to variations with age, sex and race.

A cross-sectional study involving 500 students, aged 10 to 20 years and selected from Junior and Senior High Schools in the Kumasi Metropolis, was carried out. Interpupillary distances were measured using the pupillometer and the PD rule.

Results: Out of the 500 students, 290 (58%) were males. The study revealed that the distance and near IPD measured with pupillometer in students was 65.53 ± 3.348 mm and 61.60 ± 3.054 mm respectively. Furthermore, the IPD was 64.48 ± 3.429 mm and 62.01 ± 3.464 mm for distance and near, respectively, when measured with a PD rule.

Surgical Management of Glaucoma in Sturge-Weber Syndrome

Sturge-Weber syndrome (SWS) or encephalo-trigeminal hemangiomatosis is a sporadic, mesodermal phakomatosis characterised by hemangiomas involving many parts of the body, particularly ocular, intracranial and facial cutaneous structures.

Glaucoma is a common feature, with an incidence of 30%-71% in patients with Sturge-Weber syndrome. Many mechanisms of raised intraocular pressure have been described in the past, the most consistent being congenital trabeculodysgenesis, increased episcleral venous pressure and hypersecretion due to ciliary body angioma.

An increased risk of intra and post-operative complications has been noted with glaucoma filtering procedures in these patients, predominantly due to rupture of the fragile vasculature in the choroidal hemangiomas, leading to expulsive choroidal haemorrhage or exudative choroidal detachment (CD) caused by sudden decompression during or after filtering procedures. Prohylactic sclerotomies have been advocated, to be performed prior to ocular decompression, during filtering procedures in order to avoid these complications.

Calotropis procera produces Inflammatory Effects omn Cornea, Poses threat to the eyes

Calotropis procera is a flowering plant native to North Africa, South Asia and Indonesia. The flowers produce bitter and sticky toxic milk. It possesses both inflammatory and anti-inflammatory pharmacological properties. Topic application of latex from C. procera I affects eye with diffuse corneal edema. It resulted in reduced endothelial cell count and severe ocular injuries and a loss of endothelial cells over a period of time. Public education, early recognition of such injuries, and timely intervention may prevent permanent ocular damage.

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Ocular Biometry in Patients with Primary Open Angle Glaucoma (POAG)

Glaucoma is the leading cause of blindness all over the world after cataract blindness. In 2010, worldwide 60.5 million people were expected to have OAG (Open angle glaucoma) and ACG (Angle closure glaucoma), increasing to 79.6 million by 2020, and of these, 74% will have OAG1. Asians represent 47% of those with all glaucoma and 87% of those with ACG1. 4.5 million People with OAG and 3.9 million people with ACG were expected to have bilateral blindness in 2010, rising to 5.9 and 5.3 million people in 2020, respectively.

There are approximately 11.2 million persons aged 40 years and older with glaucoma in India. Primary open angle glaucoma is estimated to affect 6.48 million persons. The estimated number with primary angle-closure glaucoma is 2.54 million. Those with any form of primary angle-closure disease could comprise 27.6 million persons.

Mascara: A Cause of Thermal Burn after Cautery for Eye Lid Lesion Excision; A Case Report

Surgical fires are rare in ophthalmic surgery. Occurrence poses disastrous risks on the eye and the patient. Mascara can play a role in the occurrence of flash fires in the vicinity of surgical fields by acting as a fuel source. We report a case of thermal burn of eye lashes, eyelid skin and eye brow hair in a patient who was wearing mascara while cautery was applied to her eyelid lesion after excision. Mascara had caused a spark fire when applying cautery after eyelid lesion excision in a young patient. Conclusion: Surgeons as well as the entire ophthalmic care team should be aware of this incident to try to minimize the risk of thermal injury by working in a make-up free ophthalmic field.

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Sports-Related Concussion: The Eyes Have It

Concussion is a form of mild traumatic brain injury (TBI) owing to structural, metabolic and functional changes involving white mater tracts of the central nervous system in the absence of macroscopic findings. Sports-related concussion is a rapidly evolving condition stimulating interest among lay and scientific communities. 

Recent studies have shown a high rate of under reporting of concussion signs and symptoms by athletes and side line personnel. Accordingly, reliable and validated testing strategies are necessary to insure timely detection and removal from play for individuals suspected of concussion. Vision and visual motor problems are commonly reported among athletes following concussion. This is to be expected as it is estimated that approximately 50% of the brain is devoted to vision and visual motor processing. As such, testing of vision and ocular motility function are critical to the evaluation of a concussed individual.

Novasorb Cationic Nanoemulsion and Latanoprost: the Ideal Combination for Glaucoma Management?

Novasorb is a patented eye drop formulation platform developed to optimise the interaction of the eye drop-the cationic nanoemulsion-with the different layers of the tear film, mainly with the tear film lipid layer (TFLL), and the ocular surface. 

The composition of the cationic nanoemulsion was designed to mimic the attributes and functions of the tear film and TFLL, and take advantage of the negatively-charged mucin layer covering the corneal and conjunctival epithelium, to increase its spreading and residence time on the ocular surface. Consequently, Novasorb®-based artificial tears (AT, e.g. Cationorm®) are functionally and mechanically very close to a healthy tear film; with an iso-osmolar to slightly hypo-osmolar aqueous phase, polar (cetalkonium chloride, CKC) and nonpolar (mineral oils or medium chain triglycerides, MCT) lipids, and surfactants (e.g. Tyloxapol and Poloxamer) that mimic the surface active proteins present at the interface with the TFLL.