Fatores clínicos e preditores do ressecamento ocular em pacientes no período pós-operatório / Factores clínicos y predictores de sequedad ocular en pacientes postoperados / Clinical factors and predictors of dry eye in postoperative patients

Objetivo: avaliar os fatores clínicos preditores para o ressecamento ocular e para o diagnóstico de enfermagem Risco de ressecamento ocular em pacientes no pós-operatório em Unidade de Recuperação Pós-Anestésica. Método: estudo transversal realizado entre maio e agosto de 2017. Amostra foi de 157 pacientes adultos submetidos a procedimentos cirúrgicos eletivos. Os dados foram analisados mediante estatística descritiva e inferencial. Resultados: o diagnóstico clínico de ressecamento ocular prevaleceu em 85,35% dos pacientes, e o diagnóstico de enfermagem Risco de ressecamento ocular em 14,65%. Observou-se diferenças estatísticas entre a hiperemia, lacrimejamento excessivo e teste de Schirmer insuficiente com o diagnóstico de ressecamento ocular no olho direito e com o diagnóstico Risco de ressecamento ocular. No olho esquerdo o teste de Schirmer foi insuficiente. Conclusão: a hiperemia, o lacrimejamento excessivo e o teste de Schirmer insuficiente são fatores clínicos preditores relevantes no perioperatório para promover medidas preventivas e/ou detectar precocemente o ressecamento ocular.

Objetivo: evaluar los predictores clínicos de ojo seco y el diagnóstico de enfermería Riesgo de ojo seco en pacientes postoperados en la Unidad de Recuperación Postanestésica. Material y método: estudio transversal realizado entre mayo y agosto de 2017. La muestra fue de 157 pacientes adultos sometidos a procedimientos quirúrgicos electivos. Los datos se analizaron mediante estadística descriptiva e inferencial. Resultados: el diagnóstico clínico de ojo seco predominó en el 85,35% de los pacientes, y el diagnóstico de enfermería Riesgo de ojo seco en el 14,65%. Se observaron diferencias estadísticas entre la hiperemia, el lagrimeo excesivo y el test de Schirmer insuficiente con el diagnóstico de sequedad ocular en el ojo derecho y con el diagnóstico Riesgo de ojo seco. En el ojo izquierdo el test de Schirmer fue insuficiente. Conclusión: la hiperemia, el lagrimeo excesivo y el test de Schirmer insuficiente son predictores clínicos perioperatorios relevantes para promover medidas preventivas y/o la detección precoz del ojo seco.

Objective: to evaluate the clinical predictors for dry eye and the nursing diagnosis Risk of dry eye in postoperative patients in the Post-Anesthesia Care Unit. Method: cross-sectional study conducted between May and August, 2017. The sample was 157 adult patients undergoing elective surgical procedures. Data were analyzed using descriptive and inferential statistics. Results: the clinical diagnosis of dry eye prevailed in 85.35% of patients, and the nursing diagnosis Risk of dry eye in 14.65%. Statistical differences were observed between hyperemia, excessive tearing and insufficient Schirmer test with the diagnosis of ocular dryness in the right eye and with the diagnosis Risk of dry eye. In the left eye the Schirmer test was insufficient. Conclusão: hyperemia, excessive tearing and insufficient Schirmer test are relevant perioperative clinical predictors to promote preventive measures and/or early detection of dry eye.

Enfermedad del ojo seco / Dry Eye Disease

El ojo seco es una condición frecuente que tiene un impacto importante sobre la calidad de vida, pues conlleva a una sensación de incomodidad y discapacidad visual. Adicionalmente, puede tener un efecto pernicioso sobre procedimientos quirúrgicos oculares, lo que compromete el resultado de las cirugías de córnea, catarata y refractiva. Este síndrome de disfunción lagrimal es un padecimiento multifactorial, derivado de una deficiencia o evaporación excesiva de la lágrima. Se realizó una búsqueda en la literatura científica, con el objetivo de describir de forma general la enfermedad del ojo seco, brindando información actualizada en relación a su concepto, epidemiología, clasificación, factores de riesgo, fisiopatología, síntomas y signos, retos diagnósticos atendiendo a la complejidad de la entidad y tratamiento. La identificación temprana de los subtipos y el control de la severidad es crucial para mejorar el bienestar del paciente. La carga económica en la sociedad, y el impacto de la enfermedad en el individuo, a través de su efecto sobre la visión, calidad de vida y productividad laboral, así como en su esfera psicológica y física son considerables. Por ello, es importante que los oftalmólogos con el apoyo de los tecnólogos en optometría y óptica diagnostiquen y traten la enfermedad en sus fases iniciales, en la que los signos y síntomas todavía no son graves, lo que permitirá ralentizar su evolución natural, y posiblemente disminuir las consecuencias perjudiciales que provoca(AU)

Dry eye is a common condition that has a significant impact on quality of life, leading to a feeling of discomfort and visual impairment. Additionally, it can have a pernicious effect on ocular surgical procedures, compromising the outcome of corneal, cataract and refractive surgeries. This lacrimal dysfunction syndrome is a multifactorial condition, derived from a deficiency or excessive tear evaporation. A search of the scientific literature was carried out with the aim of describing dry eye disease in a general way, providing updated information regarding its concept, epidemiology, classification, risk factors, pathophysiology, symptoms and signs, diagnostic challenges considering the complexity of the condition and its treatment. Early identification of subtypes and control of severity is crucial to improve patient welfare. The economic burden on society, and the impact of the disease on the individual, through its effect on vision, quality of life and work productivity, as well as on the psychological and physical aspects, are considerable. Therefore, it is important that ophthalmologists with the support of optometrists and ophthalmic technologists diagnose and treat the disease in its early stages, when signs and symptoms are not yet severe, which will slow down its natural progression, and possibly reduce the resulting harmful consequences(AU)

Síndrome do olho seco / Dry eye syndrome

A Síndrome do Olho Seco é uma condição ocular crônica, de origem multifatorial, caracterizada pelo círculo vicioso de instabilidade do filme lacrimal e sua hiperosmolaridade, que causam inflamação da superfície ocular e anormalidades neurossensoriais (NELSON et al., 2017; TSUBOTA et al., 2017; ZEMANOVÁ, 2021). A doença é classificada em dois subtipos, sendo: deficiência aquosa, quando há produção lacrimal reduzida ou hiperevaporativo, em que o filme lacrimal se evapora de forma excessiva em decorrência de alteração na produção de algum dos componentes da lágrima por disfunção da glândula meibomiana (MGD). Cerca de 10% dos indivíduos apresentam deficiência aquosa e mais de 80% a hiperevaporação. No entanto, também pode ocorrer uma combinação de ambos (MESSMER, 2015)

Dry Eye Syndrome is a chronic eye condition, of multifactorial origin, characterized by the vicious circle of tear film instability and its hyperosmolarity, which cause ocular surface inflammation and neurosensory abnormalities (NELSON et al., 2017; TSUBOTA et al., 2017; ZEMANOVÁ, 2021). The disease is classified into two subtypes, namely: water deficiency, when there is reduced tear production, or hyperevaporative, in which the tear film evaporates from excessive form due to alteration in the production of some of the tear components due to meibomian gland dysfunction (MGD). About 10% of individuals have water deficiency and more than 80% have hyperevaporation. However, a combination of both can also occur (MESSMER, 2015)

Horas pantallas y miopía en niños / Screen Hours and Myopia in Children

La masificación del Internet y comunicación móvil, así como el mayor acceso a herramientas digitales y de dispositivos electrónicos ha modificado la calidad de vida y salud de la población mundial, con un impacto especialmente importante en los niños. El uso desmedido de pantallas constituye un problema en esta población por su impacto en el sedentarismo, sobrepeso, alteraciones en el comportamiento, trastornos depresivos y del sueño, pero también por el efecto que tiene sobre el sistema visual en desarrollo: predispone a síndrome de ojo seco, a un exceso de acomodación-convergencia, provoca un desenfoque hipermetrópico de la fóvea (se cree que esto estimula el crecimiento axial), aumenta la tensión del cuerpo ciliar y músculos extraoculares, además de los efectos nocivos de la luz azul-violeta para las estructuras intraoculares. Estudios sugieren que los niños son más propensos a desarrollar miopía por estar menos expuestos a la luz natural y pasar más tiempo en ambientes cerrados ante pantallas, muchos incluso han demostrado una asociación entre el uso de pantallas, el trabajo cercano y la presencia de miopía, pero no existen datos concluyentes que aíslen un riesgo independiente. A partir de esta revisión se concluye que la prevalencia de la miopía está aumentando con base en una etiología multifactorial(AU)

The massification of the Internet and mobile communication, as well as increased access to digital tools and electronic devices, have changed the quality of life and health of the world's population, with a particularly important impact on children. The excessive use of screens is a problem among this population because of its impact on sedentary lifestyles, overweight, behavioral alterations, depressive and sleep disorders; but also because of its effect on the developing visual system, since it predisposes to dry eye syndrome, excessive accommodation-convergence, causes hypermetropic defocus at the fovea (this is believed to stimulate axial growth), increases the tension of the ciliary body and extraocular muscles, in addition to the harmful effects of blue-violet light on intraocular structures. Studies suggest that children are more prone to developing myopia because they are less exposed to natural light and spend more time in indoor environments in front of screens; many studies have even shown an association between the use of screens, close-eye work and the presence of myopia, but there are no conclusive data that isolate an independent risk. From this review, the prevalence of myopia is concluded to be increasing based on a multifactorial etiology(AU)

Evaluation of ocular psoriasis with meibography

Abstract Background: Previous studies has shown that dry eye test abnormalities, meibomian gland dysfunction (MGD), may occur in psoriasis. Objectives: The authors aimed to evaluate the dry eye disease (DED), MGD, in psoriasis patients with meibography which is a current, objective, noninvasive method for patients with meibomian gland diseases, to investigate the relationship between disease severity and ocular involvement. Methods: This study included 50 participants with psoriasis and 50 healthy individuals. All subjects were examined by the same dermatologist and referred for ophthalmological examination including meibomian gland obstruction, lid margin alterations assessment, ocular surface disease index assessment, tear film break-up time test, Schirmer test, corneal conjunctival fluorescein staining assessment. Additionally, upper and lower lids were evaluated for meibomian gland loss with meibography. Results: MGD (28%), meibomian gland loss (MGL) (29.5%), upper meiboscore (0.61 ± 0.81), lower meiboscore (0.46 ± 0.61), DED (22%) were significantly higher in the psoriasis group compared with the control group (p = 0.008, p < 0.001, p = 0.027, p = 0.041, p = 0.044, respectively). There was a significant relationship between MGD and psoriasis area severity index (PASI) (p = 0.015, Odds Ratio = 1.211). There was a significant positive relationship between MGL with PASI (p < 0.001, r = 608) and psoriasis duration (p < 0.001, r = 0.547). Study limitations: Smaller study group and inability to detect quality changes of meibum with meibography were limitations of the study. Conclusions: Psoriasis may affect the meibomian gland morphology, may cause structural changes in meibomian glands, and as a result of these may cause MGD and DED. Therefore, ophthalmologists and dermatologists should be aware of this situation and co-evaluate the patients in this respect.

Olho seco e COVID-19: uma revisão narrativa / Dry eyes and COVID-19: a narrative review

RESUMO Com o advento do cenário pandêmico causado pelo SARS-CoV-2, no início do ano de 2020, foi notado um vasto quadro clínico entre os indivíduos infectados. Dentre os sintomas oculares mais comuns ocasionados pela COVID-19, o olho seco tornou-se bastante prevalente nesse meio. O estudo do tipo revisão narrativa busca avaliar os fatores de risco associados ao surgimento ou à intensificação dos quadros de olho seco na população durante o período pandêmico. A partir da análise bibliográfica, foi descrita a influência da ventilação por pressão positiva, do uso de máscaras de forma incorreta e de telas eletrônicas e da ansiedade e da depressão como fatores predisponentes ao desenvolvimento da doença do olho seco. No entanto, ainda é notada a necessidade de estudos mais explicativos para estabelecer a relação direta entre a causalidade dos fatores.

ABSTRACT With the advent of the pandemic scenario caused by SARS-CoV-2 in the beginning of the year 2020, a vast clinical picture was noticed among the infected individuals. Among the most common eye symptoms caused by Covid-19, dry eye (DE) has become quite prevalent in this environment. The narrative review study seeks to assess the risk factors associated with the emergence or intensification of DE conditions in the population during the pandemic period. A literature review showed the influence of positive pressure ventilation, incorrect use of masks, as well as electronic screens, in addition to anxiety and depression as predisposing factors for the development of dry eye disease. However, the need for more explanatory studies and for establishing a direct relationship between the causality of the factors is still noted.

Comparison of the clinical effects of two different doses (0. 05% and 0. 1%) of topical cyclosporine A in dry eyes with meibomian gland dysfunction / Comparação de efeitos clínicos de duas doses diferentes (0, 05% e 0, 1%) de ciclosporina A tópica em olhos secos com disfunção da glândula tarsal

ABSTRACT Objective: To compare the clinical efficacy of two different doses of topical cyclosporine A used in addition to artificial tears in the treatment of patients with meibomian dysfunction and secondary dry eye. Methods: Fifty patients aged 18 to 40 years, who presented to our clinic between June 2020 and June 2021 were included in our study. Patients were divided into two groups as Group A (topical cyclosporine A 0.05%) and Group B (topical cyclosporine A 0.1%). All the patients underwent a detailed ophthalmological examination, basal Ocular Surface Disease Index measurement, and Schirmer 1 and tear break-up time tests at all visits. Results: The mean age was 32±7.1 years in Group A and 30.7±8.5 years in Group B. In Group A, there were 15 women and ten men, and Group B consisted of 14 women and 11 men. There was no difference between the groups in terms of age and gender distribution (p>0.05). Schirmer 1 and tear break-up time results and Ocular Surface Disease Index score also did not significantly differ between the groups (p>0.05). Conclusion: Cyclosporine A 0.05% and 0.1% eye drops were both seen to be effective in managing dry eye disease in patients with meibomian gland dysfunction.

RESUMO Objetivo: Comparar a eficácia clínica de duas doses diferentes de ciclosporina A tópica utilizada além da lágrima artificial no tratamento de pacientes com disfunção da glândula tarsal e olho seco secundário. Métodos: No estudo, foram incluídos 50 pacientes com idades entre 18 e 40 anos, que se apresentaram em nossa clínica entre junho de 2020 e junho de 2021. Os pacientes foram divididos em dois grupos: Grupo A (ciclosporina A 0,05% tópica) e Grupo B (ciclosporina A 0,1% tópica). Todos os pacientes foram submetidos a um exame oftalmológico detalhado, medição basal do Índice de Doença da Superfície Ocular, e testes de Schirmer 1 e de tempo de ruptura em todas as visitas. Resultados: A idade média foi de 32±7,1 anos no Grupo A e 30,7±8,5 anos no Grupo B. No Grupo A, havia 15 mulheres e dez homens, e o Grupo B consistia de 14 mulheres e 11 homens. Não havia diferença significativa entre os grupos em termos de distribuição por idade e gênero (p>0,05). Os resultados do Schirmer 1 e do tempo de ruptura e do Índice de Doenças da Superfície Ocular também não apresentaram diferença significativa entre os grupos (p>0,05). Conclusão: Observou-se que os colírios de ciclosporina A 0,05% e 0,1% são eficazes no tratamento da síndrome do olho seco em pacientes com disfunção da glândula tarsal.

Digital asthenopia: blue-blocking lenses and + 0,40D additional power in the near zone, for eye strain, accommodation and convergence functions / Astenopia digital: avaliação de lentes com filtro de luz azul e poder adicional de +0,40D na zona de perto, para fadiga visual e nas funções de convergência e acomodação

ABSTRACT Purpose Evaluate blue-violet light filter and additional power of +0.40 D in the near zone ophthalmic lenses, on convergence, accommodative functions, and symptoms of digital asthenopia (DA). Methods Randomized study in cross-over design conducted on 49 volunteers (age, 29 ± 5.5 years; male: female, 18:31). Each subject wore test (+0.40 D in the near zone) and control lenses (regular single vision) for 4 weeks in randomized order. Both lenses had a selective blue-violet light filter. A baseline measurement was taken with the subjects' current updated glasses. Accommodation amplitude (AA) and near point of convergence (NPC) were measured binocularly with the RAF ruler. DA was evaluated by a questionnaire. Results No significant difference (p=.52) was found for AA comparing baseline (11.50±1.88 D), test (11.61± 1.62 D), and control SV lenses (11.88±1.50 D). No significant difference was found for NPC (p=.94), between baseline (6.50 ± 2.89cm), test (6.71± 3.49) and control SV lenses (6.82± 3.50 cm). No significant difference was found comparing test and control SV lenses in symptoms of DA (p=0.20). Conclusions The +0.40 D lenses have no negative impact on convergence or loss of accommodation power. The +0.40 D and control SV lenses had a similar impact on attenuating symptoms of DA.

RESUMO Objetivo Avaliar os efeitos do uso de lentes oftálmicas com filtro seletivo de luz azul-violeta, sem e com poder adicional de + 0,4D na zona de perto nas funções de acomodação e convergência e para sintomas de astenopia digital (AD). Métodos Ensaio clínico controlado, randomizado e mascarado, com 49 voluntários (idade, 29 ± 5,5 anos; masculino: feminino, 18: 31). Cada participante usou lentes de teste (+0,40 D na zona de perto) e controle (visão simples), por 4 semanas de forma randomizada. Ambas as lentes tinham filtro seletivo de luz azul-violeta. A medição inicial (baseline) foi feita com os óculos atualizados de cada participante. A amplitude de acomodação (AA) e o ponto de convergência próximo (PPC) foram medidos binocularmente com a régua RAF. A AD foi avaliada por um questionário. Resultados Não houve diferença estatisticamente significante (p=0,52) para as medidas de AA comparando as lentes baseline (11,50±1,88 D), teste (11,61±1,62 D) e controle VS (11,88±1,50 D). Nenhuma diferença significativa foi encontrada para a medida do PPC (p=0,94), entre as lentes baseline (6,50 ± 2,89cm), teste (6,71±3,49) e controle VS (6,82±3,50 cm). Nenhuma diferença significativa foi encontrada comparando lentes teste de VS e controle nos sintomas de AD (p=0,20). Conclusões As lentes com +0,40 D não têm impacto negativo na convergência ou na perda de acomodação. As lentes +0,40 D e controle VS, tiveram impacto semelhante na redução dos sintomas de AD.

Clinical observation of Tiaoshen acpuncture for dry eye syndrome with yin deficiency of liver and kidney / 中国针灸

OBJECTIVE@#To compare the curative effect of Tiaoshen acupuncture combined with artificial tears and artificial tears alone for dry eye syndrome with yin deficiency of liver and kidney.@*METHODS@#A total of 70 patients of dry eye syndrome with yin deficiency of liver and kidney were randomized into an acupuncture combined with medication group (35 cases, 2 cases dropped off) and a medication group (35 cases, 3 cases dropped off). In the medication group, 0.1% sodium hyaluronate eye drop was applied, 3 times a day, 1 drop each time. On the basis of the treatment as the medication group, Tiaoshen acupuncture was applied at Shenting (GV 24), Shenmen (HT 7), Benshen (GB 13), Taixi (KI 3), Taichong (LR 3), Guangming (GB 37), Fengchi (GB 20), Tongziliao (GB 1), Yuyao (EX-HN 4) in the acupuncture combined with medication group, Tongziliao (GB 1) and Yuyao (EX-HN 4) were connect with electroacupuncture, the needles were retained for 30 min, once a day, 6 times a week. Both groups were treated for 2 weeks. Before and after treatment, the clinical symptom score, SchirmerⅠtest (SⅠT), break-up time (BUT), corneal fluorescein staining (FL) score and Hamilton anxiety scale (HAMA) score were observed in the two groups, and the clinical efficacy was compared in the two groups.@*RESULTS@#Compared before treatment, the clinical symptom scores, corneal FL and HAMA scores were decreased (P<0.05), the levels of SⅠT and BUT were increased after treatment in the two groups (P<0.05). After the treatment, the clinical symptom score, FL and HAMA scores in the acupuncture combined with medication group were lower than the medication group (P<0.05), the levels of SⅠT and BUT in the acupuncture combined with medication group were higher than the medication group (P<0.05). The total effective rate in the acupuncture combined with medication group was 90.9% (30/33), which was higher than 71.9% (23/32) in the medication group (P<0.05).@*CONCLUSION@#Tiaoshen acupuncture combined with artificial tears could promote the secretion of tears for patients of dry eye syndrome with yin deficiency of liver and kidney, repair corneal defect and prolong tear film break-up time, and alleviate anxiety state, its curative effect is better than simple artificial tears.

Clinical profile of dry eye disease at the Philippine General Hospital

Objectives@#To describe the population of dry eye disease (DED) patients seen at the Philippine General Hospital (PGH) Dry Eye Clinic, and to compare the diagnosis, type, and severity of DED using Oculus Keratograph® 5M (Oculus GmbH, Wetzlar, Germany) with clinical diagnosis.@*Methodology@#This was a single-center comparative, cross-sectional study. Newly-diagnosed DED patients were recruited for the dry eye group. A subset of healthy volunteers without DED was also recruited for the control group. The clinical data for both groups were collected, and the Ocular Surface Disease Index (OSDI) questionnaire was administered. Standard clinical dry eye testing and Keratograph testing were subsequently done. The PGH Dry Eye Clinic definitions were used to classify the types of dry eye. @*Results@#Eighty (80) eyes of 40 patients per group were examined. For the dry eye group, the mean age and OSDI scores were significantly higher, while the average tear break up time (TBUT) was significantly lower. There was no significant difference in average basal secretion test (BST) and Schirmer 1 measurements between the two groups. 73% had evaporative type dry eye, while 27% had mixed type. Majority of the DED patients were females of >50 years old with mild evaporative type. Foreign body sensation was the most common symptom. Overall, there was poor agreement between clinical and Keratograph assessments of diagnosis and severity among patients in the dry eye group, but there was acceptable agreement when assessment was done in the control group.@*Conclusions@#DED patients at the PGH have similar characteristics to reported DED of other Asian populations. Evaporative or short TBUT type dry eye is the most frequently seen. Further formal validity study is needed for Oculus Keratograph® 5M to increase the value of its data to be included in routine dry eye screening.

Infrared Imaging Meibomian Gland Segmentation System Based on Deep Learning / 中国医疗器械杂志

In order to better assist doctors in the diagnosis of dry eye and improve the ability of ophthalmologists to recognize the condition of meibomian gland, a meibomian gland image segmentation and enhancement method based on Mobile-U-Net network was proposed. Firstly, Mobile-Net is used as the coding part of U-Net for down sampling, and then features are extracted and fused with the features in decoder to guide image segmentation. Secondly, the segmentation of meibomian gland region is enhanced to assist doctors to judge the condition. Thirdly, a large number of meibomian gland images are collected to train and verify the semantic segmentation network, and the clarity evaluation index is used to verify the meibomian gland enhancement effect. The experimental results show that the similarity coefficient of the proposed method is stable at 92.71%, and the image clarity index is better than the similar dry eye detection instruments on the market.

Subconjunctival adalimumab for treatment of dry eye disease in Sjögren's syndrome / Tratamento de olho seco com adalimumabe subconjuntival em pacientes portadores da síndrome de Sjögren

ABSTRACT Objective To describe the use of subconjuctival administration of the anti-tumor necrosis factor agent adalimumab for treatment of dry eye in patients with Sjögren's syndrome, and to investigate conjunctival healing. Methods Prospective, nonrandomized, noncomparative interventional case series including consecutive patients with Sjögren's syndrome and dry eye disease treated with subconjunctival adalimumab, who were refractory to conventional treatment. Patients with infectious ocular surface involvement or structural changes in the tear pathway or eyelids were excluded. Data recorded included age, sex, lissamine green staining pattern, Schirmer test results, intraocular pressure, conjunctival mobility, tear break up time and findings of biomicroscopic evaluation, following fluorescein dye instillation. The Ocular Surface Disease Index questionnaire validated for the Portuguese language was used for subjective assessment of patients. Results Eleven eyes of eight patients were studied. Mean patient age was 53±13.4 years. Patients were treated with subconjunctival injection of 0.03 mL of adalimumab and followed for 90 days thereafter. There were no statistically significant objective improvement (objective tests results; p>0.05) and no statistically significant changes in intraocular pressure (p=0.11). Questionnaire responses revealed a significant improvement in ocular symptoms (p=0.002). Conclusion Based on the Ocular Surface Disease Index questionnaire, subconjunctival administration of adalimumab improved dry eye symptoms. However, objective assessments failed to reveal statistically significant improvements.

RESUMO Objetivo Descrever o uso subconjuntival do antifator de necrose tumoral adalimumabe para o tratamento do olho seco em pacientes com síndrome de Sjögren e avaliar a cicatrização conjuntival. Métodos Série de casos intervencionista com desenho prospectivo, não randomizado, não comparativo. O medicamento adalimumabe foi aplicado em região subconjuntival em pacientes com síndrome de Sjögren e olho seco que eram resistentes a outras terapias convencionais. Pacientes com patologias oculares de origem infecciosa ou com alterações estruturais nas vias lacrimais e pálpebras foram excluídos do estudo. Os dados coletados incluíram idade, sexo, teste com lisamina verde, teste de Schirmer, pressão intraocular, mobilidade conjuntival, teste de ruptura do filme lacrimal, e avaliação biomicroscópica com colírio de fluoresceína. Além disso, o questionário Ocular Surface Disease Index validado para a língua portuguesa foi aplicado com objetivo de avaliar subjetivamente a resposta dos pacientes ao tratamento. Resultados Onze olhos de oito pacientes foram estudados. A idade média dos pacientes foi de 53±13,4 anos. A dose aplicada de adalimumabe subconjuntival foi de 0,03mL, e a duração do seguimento foi de 90 dias após a injeção. Não houve melhora estatisticamente significativa nos testes objetivos (todos apresentaram p>0,05). A pressão intraocular também não sofreu variações estatisticamente significativas (p=0,11). Entretanto, por meio do questionário, foi registrada melhora significativa dos sintomas oculares (p=0,002). Conclusão O uso do adalimumabe subconjuntival melhorou os sintomas de olho seco, avaliados por meio do questionário Ocular Surface Disease Index, mas não houve melhora estatisticamente significativa na avaliação objetiva.

Características epidemiológicas, clínicas y oftalmológicas de pacientes con queratoconjuntivitis seca / Epidemiological, clinical and ophthalmologic characteristics of patients with keratoconjunctivitis Sicca

Introducción: La queratoconjuntivitis seca es una enfermedad de causa multifactorial, que afecta la producción de lágrimas y la superficie ocular, a la vez que ocasiona malestar, visión borrosa e inestabilidad de la película lagrimal. Métodos: Se realizó un estudio descriptivo y transversal de 50 pacientes con diagnóstico de queratoconjuntivitis seca, atendidos en el Centro Oftalmológico del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero hasta julio de 2020. Objetivo: Caracterizar a los pacientes con queratoconjuntivitis seca según variables epidemiológicas clínicas y oftalmológicas. Resultados: En la serie predominaron las féminas (66,0 %), los pacientes mayores de 60 años (40,0 %), la lectura excesiva como factor de riesgo (42,0 %), la irritación, la fatiga ocular y la visión borrosa como criterios diagnósticos, además de la disminución del tiempo de rotura de la película lagrimal en 68,0 % de la muestra, entre otros resultados. Conclusión: La queratoconjuntivitis seca, desde el punto de vista clínico y epidemiológico fue similar a lo descrito en la bibliografía especializada en cuanto a los grupos de edades, sexo y principales síntomas descritos.

Introduction: The keratoconjunctivitis sicca is a disease of multifactorial cause that affects the production of tears and the ocular surface, at the same time that causes discomfort, blurred vision and instability of the lacrimal thin layer. Methods: A descriptive and cross-sectional study of 50 patients with diagnosis of keratoconjunctivitis sicca, assisted in the Ophthalmolgic Center of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, was carried out from January to July, 2020. Objective: To characterize patients with keratoconjunctivitis sicca according to clinical, epidemiologic and ophthalmologic variables. Results: In the series there was a prevalence of the females (66.0 %), patients over 60 years (40.0 %), excessive reading as risk factor (42.0 %), irritation, ocular fatigue and blurred vision as diagnostic criteria, besides the decrease of the lacrimal thin layer break up time in 68.0 % of the sample, among other results. Conclusion: The keratoconjunctivitis sicca was similar to that described in the specialized literature review as for the age groups, sex and main described symptoms from the clinical and epidemiologic points of view.

COVID-19 inductor del síndrome visual informático y sus afectaciones a las personas / COVID-19 inducer of computer visual syndrome and its effects on people

El objetivo de este artículo es analizar la literatura existente sobre el SVI y sus afectaciones a las personas producto por alta exposición a equipos electrónicos generados por la pandemia del COVID-19 El tipo de investigación es revisión de literatura, de diseño bibliográfico o documental; el método de investigación empleado fue el de revisión de literatura. La población estuvo constituida por 35 artículos y la muestra de 19 artículos en diversos idiomas, seleccionados de manera intencional de acuerdo a criterios de inclusión y exclusión previamente establecidos; las técnicas e instrumentos empleados para el recojo de información fueron el análisis documental, y el fichaje y la computadora respectivamente. Entre los principales resultados se tiene que el SVI tiene gran prevalencia en personas que tienen gran periodo de exposición a pantallas de dispositivos electrónicos, asimismo, vinculados a fallas en las condiciones ergonómicas en sus estaciones de trabajo o estudio. Se concluye, el promedio de prevalencia del SVI en los artículos revisados es de 73.2%, siendo el máximo 98.7% y el mínimo 50%, siendo más frecuente en mujeres; respecto a los síntomas más frecuente que se presentan se tienen: dolor en ojos, cansancio visual o visión borrosa, picazón, sequedad en los ojos, sensación de empeoramiento de la vista, lagrimeo y párpados pesados(AU)

The objective of this article is to analyze the existing literature on IVS and its effects on people as a result of high exposure to electronic equipment generated by the COVID-19 pandemic. The type of research is literature review, bibliographic or documentary design; the research method used was the literature review. The population consisted of 35 articles and the sample of 19 articles in various languages, intentionally selected according to previously established inclusion and exclusion criteria; the techniques and instruments used for the collection of information were the documentary analysis, and the signing and the computer respectively. Among the main results is that SVI has a high prevalence in people who have a long period of exposure to electronic device screens, also linked to failures in ergonomic conditions in their workstations or study. It is concluded that the average prevalence of SVI in the reviewed articles is 73.2%, the maximum being 98.7% and the minimum 50%, being more frequent in women; Regarding the most frequent symptoms that appear, there are: pain in the eyes, visual fatigue or blurred vision, itching, dry eyes, sensation of worsening of sight, tearing and heavy eyelids(AU)

Autonomic cardiac modulation in postmenopausal women with dry eye syndrome: a cross-sectional analytical study

SUMMARY OBJECTIVE The aim of this study was to assess cardiac autonomic modulation in postmenopausal women with and without dry eye syndrome (DES) and to identify associations between clinical and socioeconomic factors. METHODS A cross-sectional study was carried out at the Institute of Ocular Surgery of the Northeast (ICONE), Brazil. Convenience sample of postmenopausal women, over 40 years old, who were divided into two groups: with and without DES. Clinical, sociodemographic, and ophthalmological characteristics of these women were assessed. Capture of RR intervals was performed using a cardio frequency meter. Differences between the groups were analyzed using the Chi-square test, the Student's t test, and the Mann-Whitney test. RESULTS Women with DES were present in 60.4% (n=58), highest median age (63.5 years, 95%CI 62.0-67.9; p<0.001), median length of time menopause (19 years old, 95%CI 10.4-24.0; p<0.001). There was a difference in the standard deviation of all normal-to-normal index between the groups. However, when the differences were adjusted to the clinical model, no association was found between DES and heart rate variability (HRV). CONCLUSIONS The analysis of cardiac autonomic modulation in postmenopausal women is similar in the presence or absence of DES. Clinical factors, time of menopause, and intensity of symptoms were not associated with HRV indices.

Homeostasis de la superficie ocular y cirugía de catarata / Ocular surface homeostasis and cataract surgery

La cirugía de catarata es la intervención oftalmológica que más se realiza a nivel mundial, fundamentalmente en personas de la tercera edad, donde coinciden cambios en la película lagrimal. Muchas veces después de operados, debido a alteraciones en la homeostasia de la superficie ocular, los pacientes mantienen síntomas muy molestos, como lagrimeo y sensación de cuerpo extraño, que les hacen dudar del buen resultado de la cirugía. Se hace una revisión del tema, para entender el porqué de esta sintomatología, sus causas y los exámenes necesarios a realizar previos a la cirugía, con el objetivo de alcanzar una mejor evolución posoperatoria. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud(AU)

Cataract surgery is the most common ophthalmological procedure worldwide. It is particularly frequent in the elderly, due to the changes undergone by the tear film in advanced ages. On many occasions and due to ocular surface homeostatic alterations, patients continue to experience great discomfort after the operation, such as lacrimation or a foreign body sensation, which makes them doubt the satisfactory outcome of the surgery. A review was conducted about the topic to understand the reasons for these symptoms, their causes and the preoperative tests required to achieve a better postoperative evolution. Use was made of the platform Infomed, specifically the Virtual Health Library(AU)

Lacrimal gland atrophy and dry eye related to isotretinoin, androgen, and prolactin: differential diagnosis for Sjögren's syndrome / Atrofia das glândulas lacrimais e olho seco relacionados aisotretinoína, androgênio e prolactina: diagnóstico diferencial com a síndrome de Sjögren

ABSTRACT This report is of three cases of sicca syndrome, initially suspected to be Sjögren's syndrome, which was ruled out by clinical and laboratory investigations. The patients were a 24-year-old woman, a 32-year-old man, and a 77-year-old woman with chronic symptoms of sicca syndrome, including dry eye syndrome. The first case was associated with the use of isotretinoin, a retinoic acid. The second was associated with the use of anabolic androgenic steroids, and the third was related to a prolactin- secreting pituitary adenoma. All cases manifested sicca, including dry eye syndrome, after those events, and the manifestations persisted. Magnetic resonance imaging revealed bilateral atrophy of the lacrimal gland. The medical history, ocular examinations, laboratory exams, and magnetic resonance images confirmed dry eye syndrome; however, the exams were all negative for Sjögren's syndrome. The lacrimal gland was absent on magnetic resonance imaging in all three cases. The clinical history revealed that the signs and symptoms appeared after chronic exposure to retinoic acid, anabolic androgenic steroids, and a prolactin-secreting pituitary adenoma, respectively. Chronic isotretinoin, anabolic androgenic steroids, and prolactin-secreting pituitary adenoma or, in this last case, its inhibitory treatment, can cause lacrimal gland atrophy, sicca syndrome, and dry eye syndrome, and a differential diagnosis of Sjögren's syndrome. Further studies on doses, time, and other susceptibilities to the long-lasting adverse effects of retinoic acid, anabolic androgenic steroids, and the repercussions of prolactin-secreting pituitary adenoma are necessary to confirm and expand upon these associations.

RESUMO O relato descreve três casos de síndrome de sicca, inicialmente suspeitos de serem a síndrome de Sjögren, que fo­ram negados pela investigação clínica e laboratorial. O primeiro associado ao uso de isotretinoína, um ácido retinóico, o segundo ao uso de esteroides androgênicos anabolizantes e o terceiro relacionado ao adenoma da hipófise secretora da prolactina, todos manifestaram sicca, incluindo a síndrome do olho seco após esses eventos e as manifestações persistem. A ressonância magnética revelou atrofia bilateral da glândula lacrimal. Eles eram uma mulher de 24 anos, um homem de 32 anos e uma mulher de 77 anos com sintomas crônicos da síndrome de sicca, incluindo a síndrome do olho seco. A história médica, o exame ocular, os exames laboratoriais e a ressonância magnética foram confirmados como síndrome do olho seco, no entanto, todos os exames foram negativos para a síndrome de Sjögren. A glândula lacrimal estava ausente na ressonância magnética nos três casos. A história clínica revelou que sinais e sintomas se manifestaram após exposição crônica ao ácido retinóico, esteróides anabolizantes androgênicos e adenoma secretivo da prolactina hipofisária, respectivamente. Isotretinoína crônica, esteroides anabólicos androgênicos e adenoma hipofisário secretor de prolactina ou, neste último caso, seu tratamento inibitório pode ser a causa da atrofia da glândula lacrimal, síndrome da sicca e síndrome do olho seco e diagnóstico diferencial da síndrome de Sjögren. Estudos adicionais sobre doses, duração e outras suscetibilidades aos efeitos adversos duradouros do ácido retinóico, esteroides androgênicos anabólicos e repercussões do adenoma da hipófise secretora da prolactina são necessários para confirmar e detalhar essas associações.

Astenopia digital em controladores de tráfego aéreo: diagnóstico e avaliação na Força Aérea Portuguesa / Digital-related eye strain in air traffic control specialists: diagnosis and evaluation in the Portuguese Air Force staff

RESUMO A função de controlador aéreo exige várias horas de visualização de ecrãs, o que torna esses profissionais um grupo particularmente exposto à astenopia digital. Procuramos, com este artigo de revisão, compreender quais os métodos quantitativos e qualitativos usados atualmente para diagnosticar e avaliar a fadiga ocular em controladores de tráfego aéreo. Trata-se de pesquisa bibliográfica utilizando as bases de dados PubMed® e ClinicalKey®, usando palavras-chave, tendo sido selecionados artigos de revisão e estudos observacionais com publicação posterior ao ano 2000, de modo que os termos buscados estivessem no título e/ou resumo do trabalho. Excluímos artigos em línguas que não inglesa. Existem vários métodos para melhor caracterizar a astenopia digital, destacando-se os subjetivos, como questionários, e os objetivos, que procuram, por um lado, diagnosticar o olho seco, bem como alterações da acomodação e da convergência. Da análise efetuada, ressaltou-se uma escassez de estudos prospectivos com Níveis de Evidência moderados e altos relacionados com a aplicação dos vários métodos de diagnóstico. A Computer-Vision Symptom Scale parece ser um questionário confiável e que pode ser aplicado aos controladores de tráfego aéreo, para diagnóstico de astenopia digital. Vários métodos objetivos podem também ser utilizados para essa avaliação, sendo importante, numa fase posterior, aplicar esses dois tipos de métodos de diagnóstico para avaliar a prevalência dessa patologia em controladores de tráfego aéreo.

ABSTRACT The work of air traffic control specialists require several hours looking at screens, and they comprise a group particularly exposed to digital-related eye strain. In this review we aim to understand the quantitative and qualitative methods currently used to diagnose and evaluate asthenopia in air traffic control specialists. A bibliographic search was carried out at the databases PubMed® and ClinicalKey®, using keywords, and selecting review articles and observational studies, dated after 2000, containing the keywords in the title and/o abstract. Articles not published in English were excluded. There are several subjective and objective methods to better describe digital-related eye strain, including questionnaires, aiming to make diagnosis of dry eye disease or changes in accommodation and convergence. From our analysis, there are few prospective studies with moderate and high levels of evidence regarding these diagnostic methods. The Computer-Vision Symptom Scale seems to be a reliable questionnaire to be applied to air traffic control specialists, for diagnosis of digital-related eye strain. Several objective methods can also be employed in this evaluation, and, in a later stage, it will be important to apply both diagnostic methods to evaluate the prevalence of this condition in air traffic control specialists.

Design and Implementation of User-oriented Auxiliary Treatment Instrument for Meibomian Gland Dysfunction / 中国医疗器械杂志

Dry eye is a common ophthalmic disease caused by eye maladjustment due to meibomian gland dysfunction (MGD), which is often accompanied by symptoms such as increased tear film osmotic pressure and ocular surface inflammation. In the treatment of dry eye patients, dredging gland obstruction caused by meibomian gland secretion is an effective treatment method. Based on electrothermal effect and hyperelasticity of the silicone, an auxiliary treatment instrument for MGD is designed, which can improve the blood circulation of the glands through heat compress and massage to achieve the purpose of dredging the meibomian glands. The therapy device can display the temperature and pressure during the treatment in real time, so that the surgeon can grasp the progress of the treatment in real time. The therapy device constructs a user-oriented interactive interface based on parametric modeling method, which can be customized by 3D printing according to the user's eyeball geometric parameters. The designed therapeutic device was finally tested on New Zealand white rabbits. The experimental results show that the therapeutic device has significant effectiveness and safety, as well as clinical application prospects.

Ecografía de la glándula salival mayor en pacientes con síndrome seco: descripción de una cohorte colombiana, reporte preliminar / Major salivary gland ultrasound in patients with dry syndrome: Description of a Colombian cohort, and a preliminary report

RESUMEN Introducción: El síndrome de Sjögren (SS) es una enfermedad autoinmune que afecta a las glándulas exocrinas condicionando síndrome seco. Los criterios diagnósticos se basan en pruebas serológicas, oftalmológicas, histopatológicas y flujo salival. Se ha propuesto el uso de la ecografía glandular salival como prueba diagnóstica. Escasos estudios se han realizado en Latinoamérica. Objetivo: Describir las alteraciones ecográficas en las glándulas salivales en una población colombiana que asiste al servicio de reumatología con síntomas secos. Materiales y métodos: Estudio de corte transversal; análisis preliminar de 50 pacientes que asisten por consulta externa (agosto de 2019 a enero de 2020). Evaluación sociodemográfica y clínica a través de cuestionario estructurado, pruebas paraclínicas y oftalmológicas, biopsia de glándula salival menor y valoración ecográfica de las glándulas salivales mayores (puntuación 0-6 basada en De Vita). Análisis univariado y bivariado (Chi-cuadrado y prueba de Fischer). Resultados: El 94% de la población eran mujeres y el 38% tenían SS. El promedio de edad fue de 55,9 ± 9,6 arios. La proporción de pacientes con ecografía positiva para el SS y diagnóstico por criterios del SS es mayor respecto a los pacientes con ecografía negativa (p< 0,0001). Los pacientes con ecografía positiva presentaron mayor proporción de anti-La (p = 0,002), ANA (p = 0,008), anti-Ro (p< 0,0001), linfopenia (p = 0,007), xerostomía objetiva (p = 0,019) y subjetiva (p = 0,041). Conclusiones: La ecografía podría considerarse una herramienta útil en el diagnóstico del SS, dado que los pacientes que presentan alteraciones ecográficas glandulares tienen una mayor proporción de perfil inmunológico positivo (anti-Ro, ANA, anti-La) y su positividad se encuentra asociada al SS por criterios. Se requieren nuevos estudios para evaluar las características operativas de la prueba.

ABSTRACT Introduction: Sjögren's syndrome (SS) is an autoimmune disease affecting the exocrine glands causing dry syndrome. The diagnostic criteria are based on serological, ophthalmological, histopathological, and salivary flow tests. The use of salivary gland ultrasound has been proposed as a diagnostic test. Few studies have been carried out in Latin America. Objective: To describe the ultrasound patterns in the salivary glands in the Colombian population seen in the Rheumatology Department due to dry symptoms. Materials and methods: Cross-sectional study; a preliminary analysis was performed on 50 patients attending the Outpatient Clinic (August-January 2020). A sociodemographic and clinical evaluation was made using a questionnaire. Paraclinical and ophthalmological tests, minor salivary gland biopsy, and ultrasound assessment of the major salivary glands (De Vita score 0-6) were the main items to evaluate. Univariate and bivariate analyses (Chi-squared, Fischer test) were performed. Results: Most (94%) of the population were women, and 38% had SS. The mean age was 55.9±9.6 years old. The proportion of patients with positive ultrasound for SS and a diagnosis using SS criteria was higher compared to patients with negative ultrasound (p<.0001). Patients with positive ultrasound had a higher proportion of anti-La (p=.002), ANAS (p=.008), anti-Ro (p<.0001), lymphopenia (p=.007), and objective and subjective xerostomia (p=.019 and p=.041, respectively). Conclusions: Ultrasound assessment could be considered a useful tool in the diagnosis of SS, since more patients presenting with glandular ultrasound abnormalities have a higher positive immunological profile (anti-Ro, ANAS, anti-La) and their positivity is associated with SS criteria. New studies are required to evaluate the operational characteristics of the test.