Dry eye related corneal neuralgia / 中华实验眼科杂志

In recent years, corneal neuralgia in dry eye patients has received more and more clinical attention.Corneal neuralgia refers to the increasing pain of cornea in response to normal painless stimuli, which has a serious negative effect on patients' work and daily life.Corneal neuralgia is often one of the common symptoms of dry eye.Dry eye can also cause corneal sensation decline and the mechanism is still unclear.Patients with dry eye often exhibit structural and functional changes in ocular surface nerve, so understanding the mechanism of dry eye-related neurological abnormalities will help to treat and prevent dry eye-related neurological abnormalities.Various factors such as instability of tear film, abnormal tear secretion, ocular surface inflammation, and increased osmotic pressure of tear film may be involved in dry eye-associated corneal neuralgia.Clinically, anti-inflammatory therapy, lubricating ocular surface, promoting regeneration of corneal nerve fibers, analgesic therapy targeting receptors, palpebral edge treatment, and systemic intervention if necessary are mainly performed based on the pathogenesis of dry eye related corneal neuralgia.In this article, the pathologic and influencing factors of corneal neuralgia were summarized, and the pathogenesis of dry eye-related corneal neuralgia were investigated to help the clinical diagnosis and treatment of dry eye-related corneal neuralgia.

Palliative Radiation Therapy for Choroidal Metastases: A Report of Three Cases

We here report three cases of choroidal metastases with ocular pain and visual symptoms treated with palliative irradiation. Case 1: A 71-year-old woman was treated with chemotherapy for multiple metastases after surgery for right breast cancer. Sixteen years after surgery, a right choroidal metastasis with ocular pain and visual disturbance was detected. Palliative irradiation to this lesion achieved reduction in ocular pain and shrank the tumor. Case 2: A 54-year-old man presented with right ocular pain and abnormal vision and was diagnosed as having right lung cancer with multiple systemic metastases. Palliative irradiation to a right choroidal metastasis achieved reduction in ocular pain and shrank the tumor. Case 3: A 71-year-old woman developed left eye pain 17 months after surgery for lung cancer in the right upper lobe. She was diagnosed as having a left choroidal metastasis. After palliative irradiation, the tumor shrank and the left eye pain temporarily resolved. Palliative radiation therapy for choroidal metastasis with ocular pain and visual symptoms seems to be effective in improving symptoms.

Trigeminal neuralgia after corneal transplantation - a case report / Neuralgia do trigêmeo pós-transplante de córnea - relato de caso

ABSTRACT Description of a patient with Fuchs endothelial dystrophy submitted to a corneal transplant, performed by Descemet membrane endothelial keratoplasty, which evolved with sudden, paroxysmal pain in the frontotemporal region, postoperatively. Due to the ophthalmologic picture of the patient, the attending physician believed in possible rejection of the graft, neglecting the complaint of pain. Even after a successful second transplant, performed due to primary failure, disabling pain persisted and the physician did not manage it. After years of investigation, consulting with several specialists, it was concluded the patient presented trigeminal neuralgia that had not been treated since the surgical procedure. In addition, it led to several psychosocial consequences. Therefore, it is essential to be aware trigeminal neuralgia is a possible outcome of corneal transplantation, and its symptoms should not be neglected by the attending physician, thus contributing to better management for transplanted patients.

RESUMO Descrição do relato de caso de uma paciente com distrofia endotelial de Fuchs submetida a transplante de córnea, realizado pela técnica DMEK, que evoluiu com quadro de dor súbita, paroxística, em região frontotemporal, no pós-operatório. Devido ao quadro oftalmológico da paciente, o médico assistente acreditava em possível rejeição do enxerto, negligenciando a dor. Mesmo após sucesso do segundo transplante, realizado devido à falência primária, as dores incapacitantes persistiam, e nenhuma conduta, por parte do médico, foi realizada. Após anos de investigação, mediante consultas com diversos especialistas, concluiu-se que a paciente apresentava um quadro de neuralgia do nervo trigêmeo que não tinha sido tratada desde a realização do procedimento cirúrgico. Além disso, apresentava uma série de consequências psicossociais. Portanto, torna-se imprescindível entender que a neuralgia do nervo trigêmeo é um possível desfecho do transplante de córnea, e seus sintomas não devem ser negligenciados por parte do médico assistente, contribuindo para melhores condutas para os pacientes transplantados.

Miositis orbitaria, una causa de oftalmoplejia dolorosa en pediatría / Orbital myositis, a cause of pediatric painful ophthalmoplegia

INTRODUCCIÓN: La miositis orbitaria (MO) es un proceso inflamatorio grave de etiología desconocida que compro mete los músculos extraoculares. La presentación en edad pediátrica es rara y con frecuencia afecta a más de un individuo de una familia, lo que sugiere algún grado de predisposición genética. OBJETIVO: Describir un caso de miositis orbitaria de presentación en edad pediátrica, sus características clínicas, y la utilidad de la imagen por resonancia magnética para la confirmación del diagnóstico. CASO CLÍNICO: Paciente femenina de 13 años que presenta cefalea aguda, dolor periorbitario derecho, exacerbado con los movimientos oculares y visión borrosa a quien se le realizaron estudios para miopatía tiroidea, enfermedades infecciosas, autoinmunidad y cáncer que fueron negativos. En la imagen por resonancia magnética se evidenció miositis del músculo recto medio derecho, sin evi dencia de neuritis óptica. Recibió tratamiento con glucocorticoides sistêmicos intravenosos seguido de esteroides orales con mejoría clínica completa. CONCLUSIONES: La MO tiene etiología desconocida, y puede tener un curso maligno. Dada su presentación clínica inespecífica, el estudio diagnóstico diferencial debe ser amplio, y su estudio debe considerar realizar resonanacia magnética. El inicio temprano del tratamiento con esteroides evita el daño permanente de los músculos extraoculares.

INTRODUCTION: Orbital myositis (OM) is a serious inflammation of extraocular muscles with unknown etiology. Pe diatric presentation is rare and often affects more than one individual in a family, suggesting a genetic predisposition. OBJECTIVE: To describe a pediatric case of orbital myositis, its clinical characteristics, and the usefulness of MRI for confirming the diagnosis. CLINICAL CASE: A 13-year-old female patient presenting with acute headache, right periorbital pain, exacerbated by eye movements, and blurred vision. We ruled out thyrotoxic myopathy, infectious diseases, autoimmunity, and malignancy. An MRI showed right medial rectus muscle myositis and no evidence of optic neuritis. She was treated with intravenous systemic glucocorticoids followed by oral steroids with complete clinical resolution. CONCLUSIONS: OM has unknown etiology and can present a malignant course. Due to its unspecific clinical presentation, a comprehensive differential diagnosis should be made and it should consider performing MRI. Early treatment avoids permanent damage of extraocular muscles.

El paciente con dolor ocular en urgencias / Patient with ocular pain in emergency department

RESUMEN La región ocular es una zona que puede ser origen de patologías dolorosas por compromiso primario del ojo que produzcan cefalea como síntoma asociado. A su vez, puede ser la localización de dolor referido por patologías neurológicas. De allí que su evaluación se realice usualmente en forma multidisciplinaria por neurología y oftalmología. Los pacientes con examen oftalmológico anormal suelen tener una aproximación clínica más simple, lo que permite un diagnóstico más rápido y un tratamiento más eficaz; el reto es la aproximación al paciente con dolor ocular y examen normal. Por lo general, los oftalmólogos se refieren a este como "ojo blanco o tranquilo" y los pacientes son diferidos a valoración por neurología.

SUMMARY The ocular region is an area that can be the origin of painful pathologies due to primary involvement of the eye that produce headache as an associated symptom and in turn be the location for referred pain in neurological pathologies, its evaluation is usually performed by neurologist and ophthalmologist. Patients with an abnormal ophthalmologic examination usually have a simpler clinical approach allowing a faster diagnosis and a more effective treatment, the challenge is the approach to the patient with eye pain but with normal examination, ophthalmologists usually refer to this condition as "white or quiet eye" and those patients are deferred to assessment by neurology to rule out organicity.

Tratamento do olho cego doloroso por glaucoma neovascular com ciclofotocoagulação transescleral / Transescleral cyclophotocoagulation treatment for painful eye with glaucoma neovascular

Resumo Objetivo: Avaliar a efetividade e o perfil de segurança da ciclofotocoagulação transescleral padrão (CTCTE) e sua variação técnica denominada slow cooking (CTCTE SC) em pacientes com olho cego doloroso por glaucoma neovascular. Métodos: Pacientes foram submetidos a exame oftalmológico, graduando o nível da dor através de escala gráfica/numérica e divididos em dois grupos, um para tratamento com CTCTE e outro CTCTE SC. O acompanhamento foi realizado no primeiro, trigésimo e nonagésimo dias. Resultados: Dos 26 pacientes inclusos, 11 (42,3%) eram do sexo masculino. A idade média dos pacientes foi de 69 anos. Destes, 16 pacientes foram submetidos ao tratamento CTCTE e 10 pacientes a CTCTE SC. A pressão intraocular (PIO) teve média pré tratamento de 49 ± 23 mmHg no grupo CFCTE e medias no 1º, 30º e 90º dias pós-operatórios respectivamente: 32 ± 24 mmHg, 38 ± 18 mmHg, 43 ± 10 mmHg. No grupo submetido a técnica CFCTE SC a PIO prévia foi 54 ± 16 mmHg e médias no 1º, 30º e 90º dias pós-operatórios respectivamente: 38 ± 22 mmHg, 39 ± 10 mmHg , 44 ± 09 mmHg. A redução da dor foi efetiva em 88,4% pacientes. Durante o pós-operatório foi verificado hiperemia, quemose e hifema. Não foram observadas complicações graves. Conclusão: O tratamento do olho cego doloroso com ciclofotocoagulação transescleral com baixa carga foi um procedimento seguro e eficaz na resolução da dor, mas apresentou um baixo nível de redução da pressão intraocular em ambas técnicas usadas.

Abstract Objective: To evaluate the effectiveness and safety profile of standard transescleral cyclophotocoagulation (CTCTE) and its technical variation of slow cooking (CTCTE SC) in patients with neovascular glaucoma pain. Methods: Patients underwent ophthalmological examination, grading their pain level through a graphical / numerical scale and divided into two groups, one for treatment with CTCTE and another CTCTE SC. Follow-up was performed on the first, thirtieth and ninetieth days. Results: Of the 26 patients included, 11 (42.3%) were male. The average age of the patients was 69 years. Of these, 16 patients underwent CTCTE treatment and 10 patients underwent CTCTE SC. Intraocular pressure (IOP) had a mean pre-treatment of 49 ± 23 mmHg in the CFCTE group and medians at the 1st, 30th and 90th postoperative days respectively: 32 ± 24 mmHg, 38 ± 18 mmHg, 43 ± 10 mmHg. In the group submitted to the CFCTE SC technique, the previous IOP was 54 ± 16 mmHg and averages on the 1st, 30th and 90th postoperative days respectively: 38 ± 22 mmHg, 39 ± 10 mmHg, 44 ± 09 mmHg. Pain reduction was effective in 88.4% patients. During the postoperative period, hyperemia, chemosis and hyphema were observed. No serious complications were observed. Conclusion: Painful blind eye treatment with low load transscleral cyclophotocoagulation was a safe and effective procedure for pain resolution, but presented a low level of intraocular pressure reduction in both techniques used.

Two Cases of Ocular Pain Successfully Treated with Orento / 日本東洋医学雑誌

There are cases of intractable eye pain, which can be difficult to treat. The late Shogo Yamamoto treated un­explained eye pain with various Chinese herbal prescriptions. Among them, there were clinical trials of heating agents including orengedokuto and hangeshashinto, but no trials of orento are mentioned. Further, no trials of cases of eye pain treated with orento were found in several other collections of clinical trials ;however, here we report on two cases of intractable eye pain of unknown origin that showed significant effects when admin­istered orento. In case 1, unexplained eye pain appeared after cataract surgery and after various treatments were found to be ineffective, acupuncture treatment in our hospital showed a positive effect. In case 2, unex­plained eye pain developed without any obvious cause, and the pain was increased by acupuncture treatment at our hospital. A common finding in both cases was objective cooling of the upper abdomen. The eye pain was considered to be upper heat and the abdominal pain to be middle cold, thus a diagnosis of upper heat and mid­dle cold was made and orento administration begun. We therefore consider that orento could be listed as a treatment for unexplained eye pain.

Application effect of bandage corneal contact lens in ptosis during surgical treatment / 中国基层医药

Objective To study the application effect of bandage corneal contact lens in ptosis during surgical treatment.Methods A total of 62 patients(73 eyes) with primary congenital ptosis in the First People's Hospital of Xiantao from March 2013 to March 2016 were randomly divided into group A,group B and group C.All of the three groups were treated by shortening levator palpebrae superioris muscle.The A group[20 cases(24 eyes)] began to wear bandage corneal contact lens during the operation.The B group [22 cases (25 eyes)] began to wear bandage corneal contact lens at the end of surgery.And the C group [20 cases (24 eyes)] took conventional methods for covering operative eyes.Postoperative follow-up lasted for 3 months,the postoperative FL staining scores and ocular pain severity were compared among the three groups.Results Comparison of postoperative FL staining scores:there was no statistically significant difference between B group and C group at postoperative 1 day(q =0.537,P ＞ 0.05),but the differences between B group and A group were statistically significant (q =10.876,11.298,all P ＜ 0.05),the differences among the three groups were statistically significant at the 7th day after surgery (q =8.682,4.048,4.722,all P ＜ 0.05).There was no statistically significant difference between B group and A group at postoperative 2 weeks (q =1.635,P ＞ 0.05),but the differences between group A/B and group C were statistically significant (q =8.747,7.201,all P ＜ 0.05).There were no statistically significant differences among the three groups at postoperative 3 months (q =1.607,0.186,1.438,all P ＞ 0.05).Comparison of postoperative ocular pain severity:there were no statistically significant differences among the three groups at postoperative 1 day (q =0.986,0.586,0.410,all P ＞ 0.05).At postoperative 7 days,there was no statistically significant difference between A group and B group (q =0.948,P ＞ 0.05),but the differences between A/B group and C group were statistically significant (q =4.743,3.843,all P ＜ 0.05).There were no statistically significant differences among the three groups at postoperative 1 month (q =3.181,0.599,2.654,all P ＞ 0.05).Postoperative upper eyelid radian and double eyelid plasty in all of 62 cases(73 eyes) was satisfied and the width of palpebral fissure when look straight was normal and locating above superior margin of pupil,but there were 16 eyes with slightly hypophasis which were all naturally closed good after 1 to 2 months without surgical incision infection and corneal infection.Conclusion It is effective to protect the cornea since intraoperative application of bandage corneal contact lens,and it with high safety to wear corneal contact lens shortly after surgery,which can promote corneal epithelial wound healing,reducing incidence of exposure keratitis,at the same time,it can obviously relieve ocular pain in patients.

Inflammatory cytokines research progress on the increase of pain during the second-eye cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#In the field of cataract, there is such a widespread phenomenon: the majority of patients have complained thatthe second-eye phacoemulsification is often more painful than the first-eye surgery. Recent studies on this phenomenon have found that after cataract surgery in the first eye, in the second-eye aqueous humor there is a high expression of cytokines which is monocyte chemotactic factor-1.It is the focus of the present study to analyze the mechanism of the increase of pain in the second eye with cataract surgery from the molecular level. Monocyte chemotactic factor-1(monocyte chemoattractant protein, MCP-1)which is considered to be a new member of the family of pain,is an important factor resulting in pain, and its specific receptor CCR2 binding exerts its biological activity. This is a review of the inflammatory cytokine research progress on the increase of pain during the second-eye cataract surgery.

Treatment of patients with painful blind eye using stellate ganglion block / Tratamento de pacientes portadores de olho cego doloroso por meio de bloqueio de gânglio estrelado

BACKGROUND AND OBJECTIVES: management of pain in painful blind eyes is still a challenge. Corticosteroids and hypotensive agents, as well as evisceration and enucleation, are some of the strategies employed so far that are not always effective and, depending on the strategy, cause a deep emotional shock to the patient. Given these issues, the aim of this case report is to demonstrate a new and viable option for the management of such pain by treating the painful blind eye with the stellate ganglion block technique, a procedure that has never been described in the literature for this purpose. CASE REPORT: six patients with painful blind eye, all caused by glaucoma, were treated; in these patients, VAS (visual analogue scale for pain assessment, in which 0 is the absence of pain and 10 is the worst pain ever experienced) ranged from 7 to 10. We opted for weekly sessions of stellate ganglion block with 4 mL of bupivacaine (0.5%) without vasoconstrictor and clonidine 1 mcg/kg. Four patients had excellent results at VAS, ranging between 0 and 3, and two remained asymptomatic (VAS = 0), without the need for additional medication. The other two used gabapentin 300 mg every 12 h. CONCLUSION: currently, there are several therapeutic options for the treatment of painful blind eye, among which stand out the retrobulbar blocks with chlorpromazine, alcohol and phenol. However, an effective strategy with low rate of serious complications, which is non-mutilating and improves the quality of life of the patient, is essential. Then, stellate ganglion block arises as a demonstrably viable and promising option to meet this demand.

JUSTIFICATIVA E OBJETIVOS: o manejo da dor em olhos cegos dolorosos ainda é um desafio. Corticosteroides e hipotensores, bem como evisceração e enucleação, são algumas das estratégias até então empregadas, nem sempre eficazes e que, a depender da estratégia, causam um profundo abalo emocional no paciente. Dadas essas questões, o objetivo deste relato de caso é demonstrar uma nova e viável opção para o manejo desse tipo de dor por meio do tratamento do olho cego doloroso com bloqueios de gânglio cervicotorácico, técnica nunca descrita na literatura para esse fim. RELATO DE CASO: foram tratados seis pacientes portadores de olho cego doloroso, todos por glaucoma, nos quais a EVA (escala visual analógica para avaliação da dor em que 0 é ausência de dor e 10 é a maior dor já experimentada) variava de 7 a 10. Optou-se por sessões semanais de bloqueio de gânglio cervicotorácico com 4 mL de bupivacaína (0,5%) sem vasoconstritor e clonidina 1 mcg/Kg. Quatro pacientes apresentaram excelente resultado EVA, com variação entre 0 e 3, e dois permaneceram assintomáticos (EVA = 0), sem necessidade de medicação suplementar. Os outros dois usaram gabapentina 300 mg de 12 em 12 horas. CONCLUSÃO: atualmente, várias são as opções terapêuticas para o tratamento do olho cego doloroso, entre as quais se destacam os bloqueios retrobulbares com clorpromazina, álcool e fenol. No entanto, uma estratégia eficaz, com pequeno índice de complicações graves, não mutilante e que melhore a qualidade de vida do paciente é imprescindível. O bloqueio do gânglio cervicotorácico surge, pois, como uma opção comprovadamente viável e promissora para atender a essa demanda.

Tolosa-Hunt Syndrome in a Child / 대한소아신경학회지

Tolosa-Hunt syndrome is a rare disease caused by non-specific inflammation of the cavernous sinus, superior orbital fissure and the apex of the orbit. It is characterized by ophthalmoplegia, unilateral headache or periorbital pain. Brain magnetic resonance imaging (MRI) usually shows an inflammation of cavernous sinus. It is known that steroid pulse therapy is effective. In this case, we diagnosed a 12-year-old female with Tolosa-Hunt syndrome suffered from left ophthalmoplegia and left sided headache. Her Brain MRI showed mild enlargement of left cavernous sinus. After methylprednisolone pulse therapy and following dexamethasone treatment, her symptoms were markedly improved. In children who suffer from periorbiral pain and ophthalmoplegia, proper brain MRI could be helpful in differential diagnosis including Tolosa-Hunt syndrome.

Acute Severe Eye Pain and Epistaxis in a 16-year-old Male Teenager ‐ What Clinical Clues May Aid a GP In Diagnosing Acute Sinusitis?

A 16-year-old teenager presented with acute severe eye pain and mild epistaxis. The family physician diagnosed an ophthalmologic emergency requiring evaluation. Acute sinusitis was not entertained. Subsequently, ENT evaluation and CT scan confirmed maxillary and anterior ethmoidal sinusitis. This lead to a search for criteria to improve diagnosis of acute sinusitis in the GP setting. Two or more of these symptoms ‐ mucopurulent rhinorrhoea, nasal obstruction/congestion, facial pain/pressure and decreased sense of smell increase its likelihood. Other important issues discussed include differential diagnosis of eye pain associated with epistaxis, potential orbital complications of sinusitis and causes of the quiet, non-red eye.