Background: Sarcoidosis is a systemic inflammatory disease characterized by the formation of non-caseating granulomas, predominantly affecting the lungs and lymph nodes. However, the disease can affect any organ, including the eye, where it most commonly manifests as uveitis and dry eye disease (DED). The Ferning Test (FT), a non-invasive method for tear film analysis, offers insight into tear quality. Through this study, we aimed to evaluate the ability of the FT to diagnose and differentiate DED in patients with sarcoidosis. Methods: The study included a sample of 30 patients, divided into three groups, each consisting of 10 patients: one group of patients with sarcoidosis and dry eye disease (S-DED), one group of patients with DED without other systemic pathologies, and a control group of healthy individuals. Tear film samples were collected from the right eye of each participant, without stimulation, by microcapillarity. A drop of tear was spread on a microscope slide, allowed to dry, and then examined under a microscope to analyze the crystallization pattern. Results: Microscopic analysis revealed a significant difference in the structure and morphology of crystallization, as well as in the number of formed branchings, in sarcoidosis patients compared to patients in the other two groups. This finding suggests a distinct alteration in tear film composition in patients with sarcoidosis. Conclusions: Based on these results, the FT represents a valuable and promising tool for the diagnosis of DED associated with sarcoidosis. Being a non-invasive, easy-to-perform, and inexpensive test, it can be widely implemented in any ophthalmology department, opening perspectives for the test to become an important component among the diagnostic elements of dry eye syndrome in patients with sarcoidosis.

Tear film alterations are commonly associated with ocular pathology. The tear film plays a vital role in maintaining the optical properties of the cornea and contains essential elements required for healing and preserving the integrity of the ocular surface. As a biological fluid, the tear film is easily collected using non-invasive techniques, making it a promising candidate for analysis and often referred to as an ideal biofluid. Several studies have attempted to identify biomarkers in the tear film that could be linked to systemic or ocular disorders, with the goal of developing tools for diagnosis or even early prevention. The quality and quantity of the tear film are influenced by hormonal status, emotional experiences related to social and familial events, and the work environment. Systemic disorders are often reflected at the ocular level through alterations in the tear film. Obesity is a well-recognized public health concern, extensively studied and investigated, much like other common systemic conditions. The presence of low-grade, chronic inflammation associated with excess body weight has been validated in several studies. The strategies for preventing obesity induced dry eye disease are based on regular physical activity, maintaining adequate hydration through sufficient fluid intake, weight loss, and the supplementation of essential fatty acids. This narrative literature review aims to highlight the tear film alterations associated with obesity. The article is intended for ophthalmologists, general practitioners, nutritionists, and researchers.

Background/Objectives: End-stage renal disease (ESRD) is characterized by profound and progressive microvascular dysfunction that contributes significantly to systemic morbidity. Because the retinal and renal microcirculations share structural and physiological similarities, optical coherence tomography (OCT) and OCT angiography (OCTA) have emerged as promising tools for detecting ocular microvascular changes that may parallel systemic vascular injury. This systematic review aimed to consolidate evidence on chronic retinal and choroidal alterations in ESRD as assessed by OCT and OCTA. Methods: A systematic search of PubMed/MEDLINE (inception–June 2025) was performed using combinations of terms related to OCT, OCTA, ESRD, and hemodialysis. After removing duplicates and screening titles, abstracts, and full texts, we included clinical studies involving adults with ESRD or undergoing dialysis that reported chronic or baseline OCT/OCTA findings. Non-English publications, editorials, conference abstracts, case reports, and studies limited to acute pre-/post-dialysis changes were excluded. Seventeen studies met eligibility criteria. Acute findings were summarized narratively only when no chronic data existed for a specific parameter but were not incorporated into the primary synthesis. Results: Across eligible studies, chronic structural and perfusion abnormalities were consistently reported, including thinning of the retinal nerve fiber and ganglion cell layers, reduced macular and peripapillary vascular densities, enlarged foveal avascular zones, and decreased choroidal thickness. These alterations aligned with markers of disease severity and systemic microvascular burden. Conclusions: Retinal imaging reveals reproducible chronic microvascular changes in ESRD and may serve as an accessible adjunct for systemic vascular assessment. We highlight the potential significance of retinal vascular screening in this population and the need for more standardized imaging protocols to support the effective integration of retinal biomarkers into CKD diagnostic and monitoring strategies.

Objectives: The study examined tear and serum alterations using the ferning test and quantified the number of branches formed during the controlled drying of these biological fluids (tears and serum), in order to identify a potential diagnostic patterning test in individuals with obesity. Methods: A total of 61 patients aged between 25 and 72 years were enrolled (median age [interquartile range] = 39.0 [26] years). BMI values ranged from 19.1 to 47.5 kg/m², with a median BMI (interquartile range) of 29.3 (12.1) kg/m². Results: The Kruskal–Wallis test showed statistically significant differences among at least two Schirmer classes with respect to the number of branches observed in dried tears at a brightness threshold of 220 (H(2) = 8.485, p = 0.014). According to the Dunn post hoc test, Schirmer Class 1 showed a markedly lower number of branches compared with Classes 2 and 3 (p < 0.031 and p < 0.021), whereas no significant difference was found between Classes 2 and 3. The Kruskal–Wallis test further suggested the presence of statistically significant differences in the number of branches in dried serum, quantified using ImageJ2 at a brightness threshold of 190, across visceral fat classes (H(2) = 9.583, p = 0.008). Dunn’s post hoc tests revealed that the number of branches in serum analyzed at a brightness threshold of 190 was significantly higher in visceral fat class 3 compared to class 1 (p_holm = 0.006), while no statistically significant differences were observed between classes 1 and 2 or between classes 2 and 3 (p_holm > 0.05). Conclusions: In addition to other obesity-specific complications patients with obesity exhibit an increased risk of developing dry eye syndrome. The combined assessment of DPT in both the tear film and serum may represent a new method for analyzing obesity-associated biomarkers. Further studies are required to determine the sensitivity and specificity of these approaches in diagnosing systemic alterations induced by excess adipose tissue.

Background: Multiple sclerosis (MS) is a chronic, immune-mediated disorder of the central nervous system (CNS), characterized by inflammation, demyelination, and neurodegeneration, resulting in the disruption of axonal signal conduction. Optic neuritis (ON) occurs in over 70% of MS cases, highlighting the involvement of the optic nerve in the progression of the disease. Optic nerve atrophy secondary to the inflammatory episode can be observed during fundoscopy as pallor in the temporal quadrant or of the entire optic disc. Our study aims to evaluate the diagnostic capacity of fundus ophthalmoscopy when compared with the temporal thickness of the pRNFL (peripapillary retinal nerve fiber layer) measured using optical coherence tomography (OCT). Methods: We analyzed 88 eyes from 44 relapsing remitting MS patients using fundus photography (FP) and OCT optic disc measurements, correlating the temporal pallor of the optic disc seen in fundus photographs (FPs) with structural parameters obtained using OCT. Results: Our analysis revealed the significant capacity of optic disc pallor grading using FPs in MS patients in order to discriminate between normal and quadrants with pallor (p = 0.006) or strong pallor (p = 0.003) and between ones with light pallor and moderate pallor (p = 0.002) or strong pallor (p = 0.001), while being unable to clearly differentiate between normal quadrants and ones with light pallor (p = 0.608) or between pallor and strong pallor (p = 0.33). Conclusions: Fundoscopy and FP are useful screening tools in evaluating optic nerve atrophy in MS patients that could be used to assess neurodegeneration because of their universal availability. With the proposed inclusion of the optic disc as the fifth part of the CNS, the optic nerve will benefit from multiple exploratory techniques in order to increase the understanding of disease progression and patient quality of life.

(1) Purpose: The study investigated the correlation between variations in body mass index (BMI) and tear crystallization class according to the Masmali classification. Moreover, it examined the potential diagnostic value of a patterning test within the population affected by obesity. (2) Methods: A total of 61 patients were investigated, with ages ranging from 25 to 72 years (median age [interquartile range] = 39.0 [26] years). BMI values ranged from 19.1 to 47.5 kg/m², with a median BMI (interquartile range) of 29.3 (12.1) kg/m². (3) Results: The Kruskal–Wallis test was used to assess differences in BMI across the Masmali classes and revealed statistically significant disparities between at least two groups (p = 0.024). The rank η² value of 0.094 shows a small-to-moderate effect size, suggesting that approximately 9% of the variance in rank distributions is explained by the Masmali classification. The post hoc Dunn test with Bonferroni and Holm corrections showed that patients classified as Masmali grade 2 exhibited a significantly higher BMI compared to those in grade 0 (p = 0.009), whereas no statistically significant differences were identified between grades 0 and 1 or between grades 1 and 2. The analysis of variance (ANOVA) revealed a statistically significant difference among Masmali Classes 0, 1, and 2 with respect to the number of branching structures in dried tear samples analyzed at a brightness threshold of 220. The effect size (η² = 0.263) shows that approximately 26% of the variability in branching number can be attributed to the severity of tear film dysfunction as defined by the Masmali classification. Accordingly, as the Masmali score increases, the number of branches decreases significantly, particularly among patients with elevated BMI. (4) Conclusion: The findings suggest that when classified according to the Masmali scale the dry eye syndrome exhibits a distinct crystallization pattern in patients with excess body weight. Specifically, higher BMI values are associated with a marked decrease in the number of fern-like branches identified in the tear ferning test.