***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE The lipid tear film stabilizes the tears by lowering the surface tension and preventing aqueous tear evaporation and may be analyzed by kinetic analysis of the tear interference images . This study investigated changes in the lipid film after application of a new emulsion-based eye drop of Refresh Endura ( Allergan , Irvine , CA ) in normal subjects and patients with dry eyes . DESIGN Comparative , nonr and omized interventional study . PARTICIPANTS Five normal subjects and 10 aqueous tear deficiency ( ATD ) patients with or without lipid tear deficiency were enrolled prospect ively . METHODS A complete eye examination was performed , including symptom score , tear break-up time , dye staining , and fluorescein clearance test . One eye received a single dose of emulsion eye drop ( EED ) , whereas the other eye received nonpreserved saline as a control . Kinetic analysis of tear interference images taken by DR-1 ( Kowa , Japan ) was performed before and at various times after instillation of the drops . MAIN OUTCOME MEASURES Symptoms , pattern , thickness , and spread time of the tear film . RESULTS Compared with the control , all eyes receiving EED showed rapid restructuring of the preexisting lipid film . In normal persons , restructuring result ed in a thick lipid b and across the cornea and a significant increase of the lipid film thickness . For ATD patients , EED application result ed in either a scant , irregular tear film , which became covered by the lipid film , or a modified lipid film changed without forming a b and or irregularities .  Emulsion eye drops tended to be more comfortable in patients with more severe ATD . Kinetic analysis showed that the mean spread time improved for all patients after EED when compared with baseline or with controls ( P<0.05 ) . CONCLUSIONS Emulsion eye drop produces significant changes in the tear film of normal and dry eye patients . Further investigation with a prolonged period of treatment is warranted to establish whether EED may help improve the spread and thickness of the lipid tear film in moderate and severe dry eyes BACKGROUND Most marketed artificial tears are substitutes for the aqueous layers of the tear film ; therefore , frequent instillation of artificial tears is necessary . Newer gel- , cellulose- , and mineral oil-based formulations have been design ed to overcome the disadvantages of current aqueous tear substitutes by offering prolonged retention times . OBJECTIVES The aim of this study was to compare the efficacy , safety , and local tolerance of artificial tears containing carbomer-based lipids or hydroxypropyl (HP)-guar gel in patients with dry eye syndrome . METHODS A 4-week , prospect i ve , r and omized , parallel-group , comparative , noninferiority study was conducted at the Taipei Medical University Hospital ( Taipei , Taiwan ) in patients with dry eye syndrome who were r and omly assigned to 1 of 2 treatment groups : the carbomer-based lipid-containing ( CBLC ) gel group and the HP-guar gel group . The primary end point was global assessment of study treatment by the patients at weeks 2 and 4 . All patients met the diagnostic criteria of impaired tear function and ocular surface abnormalities . Outcomes measured at baseline and 2 and 4 weeks included Schirmer 's test values , tear breakup time ( TBUT ) , and a patient subjective assessment of symptoms . Safety and tolerability were assessed by clinical ly significant changes in terms of incidence of adverse events and conducted by unmasked investigators . RESULTS A total of 30 Taiwanese patients with dry eye syndrome were included and r and omly assigned to the 2 treatment groups : the mean ( SD ) age was 40.37 ( 14.96 ) years in the CBLC gel group and 49.49 ( 12.20 ) years in the HP-guar gel group . At baseline , the mean ( SD ) Schirmer 's test value was 4.53 ( 2.28 ) mm in the right eye and 5.13 ( 2.42 ) mm in the left eye in the CBLC gel group ; 4.40 ( 2.16 ) mm in the right eye and 4.20 ( 1.78 ) mm in the left eye for the HP-guar gel group . The mean ( SD ) for both eyes was 4.83 ( 2.36 ) mm in the CBLC gel group and 4.30 ( 2.08 ) mm in the HP-guar gel group . There was no statistically significant difference between Schirmer 's scores at baseline . Patients in both treatment groups experienced an improvement from baseline in symptoms and signs , Schirmer 's test value , and TBUT at 2 and 4 weeks after treatment . The Schirmer 's test score increased to a mean of 8.20 ( 4.49 ) mm in the right eye and 9.33 ( 4.94 ) mm in the left eye in the CBLC gel group after 2 weeks , and increased to 10.07 ( 5.56 ) mm in the right eye and 10.86 ( 5.58 ) mm in the left eye after 4 weeks . The increases in Schirmer 's test score and TBUT were also observed in the HP-guar gel group . The Schirmer 's test score increased to 5.13 ( 2.18 ) mm in the right eye and 5.60 ( 2.74 ) mm in the left eye after 2 weeks , and increased to 6.93 ( 3.37 ) mm in the right eye and 6.53 ( 3.16 ) mm in the left eye after 4 weeks . The increase in Schirmer 's test values in both eyes was significantly greater at 2 and 4 weeks in the CBLC gel group than that in the HP-guar gel artificial tear group ( all , P < 0.05 ) . Subjective patient assessment was better with the CBLC group ( excellent and good reported by 26.6 % and 73.4 % , respectively , of the CBLC gel group vs 13.4 % and 33.4 % of the HP-guar gel group at 4 weeks ; both , P = 0.004 ) . CONCLUSIONS Both artificial tear formulations were effective in relieving  dry eye syndrome in these patients . The tolerance of CBLC gel artificial tears was comparable to that of HP-guar gel artificial tears OBJECTIVE To compare the efficacy and safety of cyclosporin A ( [ CsA ] 0.05 % and 0.1 % ophthalmic emulsions ) to vehicle in patients with moderate to severe dry eye disease . DESIGN Multicenter , r and omized , double-masked , parallel-group , 6-month , vehicle-controlled . PARTICIPANTS A total of 877 patients with defined moderate to severe dry eye disease ( 292 to 293 in each treatment group ) . METHODS Two identical clinical trials ; patients were treated twice daily with either CsA , 0.05 % or 0.1 % , or vehicle . The results of these two trials were combined for analysis . MAIN OUTCOME MEASURES EFFICACY corneal and interpalpebral dye staining , Schirmer tear test ( with and without anesthesia ) , tear break-up time , Ocular Surface Disease Index ( OSDI ) , facial expression , patient subjective rating scale , symptoms of dry eye , investigator 's evaluation of global response to treatment , treatment success , and daily use of artificial tears . SAFETY occurrence of adverse events , best-corrected visual acuity , intraocular pressure , biomicroscopy , and blood trough CsA concentrations . RESULTS Treatment with CsA , 0.05 % or 0.1 % , gave significantly ( P < or = 0.05 ) greater improvements than vehicle in two objective signs of dry eye disease ( corneal staining and categorized Schirmer values ) . CsA 0.05 % treatment also gave significantly greater improvements ( P < 0.05 ) in three subjective measures of dry eye disease ( blurred vision , need for concomitant artificial tears , and the physician 's evaluation of global response to treatment ) . There was no dose-response effect . Both CsA treatments exhibited an excellent safety profile , and there were no significant topical or systemic adverse safety findings . CONCLUSIONS The novel ophthalmic formulations CsA 0.05 % and 0.1 % were safe and effective in the treatment of moderate to severe dry eye disease yielding improvements in both objective and subjective measures . Topical CsA represents a new pharmacologically based treatment for dry eye disease that may provide significant patient benefits Purpose : Meibomian gl and dysfunction ( MGD ) is a common clinical problem that is often associated with evaporative dry eye disease . Alterations of the lipids of the meibomian gl and s have been identified in several studies of MGD . This prospect i ve , observational , open-label clinical trial documents the improvement in both clinical signs and symptoms of disease and spectroscopic behavior of the meibomian gl and lipids after therapy with topical azithromycin ophthalmic solution . Methods : Subjects with symptomatic MGD were recruited . Signs of MGD were evaluated with a slit lamp . Symptoms of MGD were measured by the response of subjects to a question naire . Meibum lipid , lipid-lipid interaction strength , and conformation and phase transition parameters were measured using Fourier transform infrared spectroscopy . Results : In subjects with clinical evidence of MGD , changes in ordering of the lipids and result ant alteration of phase transition temperature were identified . Topical therapy with azithromycin relieved signs and symptoms and restored the lipid properties of the meibomian gl and secretion toward normal . Conclusions : Improvement in phase transition temperature of the meibomian gl and lipid with the determined percent trans rotomer composition of the lipid strongly suggests that the ordering of the lipid molecules is altered in the disease state ( MGD ) and that azithromycin can improve that abnormal condition toward normal in a manner that correlates with clinical response to therapy BACKGROUND Most of the eye drops currently used replace only the aqueous phase of the tear film . But , due to the fact that , with approximately 80 % of the patients with a dry eye , a disturbance of the lipid phase is present , an approach for new treatment methods needed to be found . We examined a new therapy concept with an eye spray containing liposomes for the therapy of the " dry eye " in a long-term study . GOAL An examination of the effectiveness of a liposome eye spray ( TEARS AGAIN , Optima Pharmaceutical GmbH , Germany ) in patients with " dry eye " compared with a spray containing a balanced salt solution was carried out . METHODS Between August 2003 and May 2004 a double-blind study with 382 patients was accomplished . The treatment group ( V ; n = 191 ) was compared with the control group ( K ; n = 191 ) for a period of 6 months regarding the following examination criteria : eyelid edge parallel conjunctival folds ( LIPCOF ) , BREAK UP time ( BUT ) , Schirmer I test , best corrected visual acuity , as well as slit lamp findings of the cornea and conjunctiva . Follow-up was after 4 weeks and 6 months . The statistical analysis was performed with the statistical program SPSS v.11.5 . RESULTS The examined parameters such as LIPCOF , BUT and Schirmer were significantly better in the treatment group than in the control group . We found likewise significant improvements of the inflammations of the edge of eyelid with a remarkable decrease of around 89.5 % . Question ing of the patients result ed in , among other things , the belief that the liposome eye spray led altogether to a clear subjective improvement of the symptoms in 72 % of the cases , although an initial burning sensation was mentioned after the application . All patients were of the opinion that application with a spray is more favourably and more pleasant than teardrops . CONCLUSION The liposome tear substitute shows statistically significant advantages against a balanced salt solution . This new liposome eye spray represents a new , revolutionary and effective procedure in the therapy of the " dry eye " . Considering the disturbance of the lipid phase in 80 % of the patients , TEARS AGAIN ought to be a first choice treatment OBJECTIVE To investigate the efficacy , safety , formulation tolerability , and optimal dosing of a novel cyclosporin A oil-in-water emulsion formulation for the treatment of moderate-to-severe dry eye disease . DESIGN R and omized , multicenter , double-masked , parallel-group , dose-response controlled trial . PARTICIPANTS Total enrollment : 162 patients ; cyclosporin A groups : 129 patients ; vehicle group : 33 patients . INTERVENTION Patients instilled study medication ( cyclosporin A ophthalmic emulsion 0.05 % , 0.1 % , 0.2 % , or 0.4 % , or vehicle ) twice daily into both eyes for 12 weeks , followed by a 4-week posttreatment observation period . MAIN OUTCOME MEASURES EFFICACY rose bengal staining , superficial punctate keratitis , Schirmer tear test , symptoms of ocular discomfort , and the Ocular Surface Disease Index ( OSDI ; a measure of symptom frequency and impact on vision-related functioning ) . SAFETY biomicroscopy , cyclosporin A blood levels , conjunctival microbiology , intraocular pressure , visual acuity , and monitoring of adverse events . RESULTS In a subset of 90 patients with moderate-to-severe keratoconjunctivitis sicca , the most significant improvements with cyclosporin A treatment were in rose bengal staining , superficial punctate keratitis , s and y or gritty feeling , dryness , and itching , with improvements persisting into the posttreatment period in some treatment groups . There was also a decrease in OSDI scores , indicating a decrease in the effect of ocular symptoms on patients ' daily lives . There was no clear dose-response 
    Output:
    
Most studies have demonstrated the effectiveness of LCLs on improving select signs of dry eye .