Surto de conjuntivite aguda no período de 2017-2018 em Recife, Brasil / Outbreak of acute conjunctivitis in the period 2017-2018 in Recife, Brazil

RESUMO Objetivo: Avaliar o perfil clínico, epidemiológico e o impacto econômico do surto de conjuntivite no período 2017-2018 no município de Recife-PE. Métodos: Estudo transversal com base na análise de prontuários de pacientes com diagnóstico de conjuntivite, atendidos na emergência da Fundação Altino Ventura entre dezembro/2017 e março/2018. Os dados coletados incluíram manifestações oculares no exame, complicações subsequentes, manejo e dias de licença médica. Resultados: Dos 12.712 pacientes atendidos na FAV entre dezembro de 2017 e março de 2018, 6.359 (50,0%) foram diagnosticados com conjuntivite, dos quais 3.543 pacientes (55,7%) foram atendimentos únicos. A média de idade dos pacientes ao atendimento foi de 29,5 ± 14,1 anos (variação, 1-85 anos), com distribuição semelhante entre os sexos (2.288 casos [50,1%] masculino; 2.282 casos [49,9%] feminino). O diagnóstico mais comum foi conjuntivite sem pseudomembrana (5.645 casos [88,8%]). Hiperemia conjuntival (6.278 casos [98,7%]) e reação folicular (6.255 casos [98,4%]) foram os achados mais frequentes ao exame. A complicação mais frequente foi pseudomembrana (1.062 casos [16,7%]). Os colírios lubrificantes (4.308 [67,7%]) e os colírios de associação antibiótico com corticoide (2.033 [32%]) foram os mais prescritos no tratamento. A média de dias de atestado médico foi de 4,8 ± 2,9 dias (variação, 1- 47 dias) e a perda de produtividade estimada em R$1.159.329,14. Conclusão: O surto de conjuntivite em Pernambuco foi responsável por metade das consultas em um pronto-socorro oftalmológico. Surtos de conjuntivite podem causar um impacto econômico, uma vez que afeta principalmente adultos jovens em idade produtiva. As características clínicas observadas sugerem um surto de conjuntivite de etiologia viral.

Abstract Purpose: To evaluate the epidemiological and clinical profile and economic impact of the acute conjunctivitis outbreak in the period of 2017-2018 in Recife-PE. Methods: Cross-sectional study based on the analysis of medical records of patients diagnosed with conjunctivitis at the emergency room of the Altino Ventura Foundation (FAV) between December 2017 and March 2018. The collected data included ocular manifestations at examination, subsequent complications, management, and days of sick leave. Results: Out of 12,712 patients assisted at FAV from December 2017 to March 2018, 6,359 (50.0%) were diagnosed with conjunctivitis. The mean age of patients was 29.5 ± 14.1 years (range, 01-85 years), with similar distribution between sex (2,288 50.1% male; 2,282 49.9% female). The most common diagnosis was non-pseudomembranous conjunctivitis (5,645 cases 88.8%). Conjunctival hyperemia (6,278 cases 98.7%) and follicular reaction (6,255 cases 98.4%) were the most frequent ocular findings. The most common complication was pseudomembrane in 1,062 cases (16.7%). Lubricants (4,308 67.7%) and antibiotic associated to corticosteroid eyedrops (2,033 32.0%) were the most prescribed medications. The average days of sick leave per patient was 4.8 ± 2.9 days (range, 1- 47 days) and the productivity loss estimated in R$1.159.329,14. Conclusion: The conjunctivitis outbreak in Pernambuco, Brazil was responsible for half of the consultations in an ophthalmic emergency room. Conjunctivitis outbreaks may cause an economic impact as it mostly affects young adults in their productive ages and take in average a 5-day sick leave. The clinical characteristics observed suggest an outbreak of conjunctivitis of viral etiology.

Effectiveness of using preservative-free artificial tears versus preserved lubricants for the treatment of dry eyes: a systematic review / Eficácia do uso de colírios sem preservativos comparados com colírios com preservativos no tratamento do olho seco: uma revisão sistemática

ABSTRACT This systematic review aimed to assess the effectiveness of using preservative-free artificial tears versus preserved lubricants for the treatment of dry eyes in Universidade Federal de Alagoas (PROSPERO 2018 CRD42018089933). Online databases were searched (LILACS, EMBASE, MEDLINE, and CENTRAL) from inception to April 2018; references from included papers were also searched. The following keywords were used: lubricants OR artificial tears OR artificial tears, lubricants AND dry eye OR dry eye syndrome OR syndromes, dry eye OR dry eyes. Among the 2028 electronic search results, 29 full papers were retrieved and four were considered relevant. The number of participants from these studies ranged from 15 to 76. Meta-analysis was possible for the following outcomes: score of symptoms according to the Ocular Surface Disease Index - Allergan (OSDI), tear secretion rate using the Schirmer test, tear evaporation rate using the tear film breakup time test, burning, foreign body sensation, and photophobia. No statistically significant difference was observed between the two groups, and no side effects were attributed to the interventions. Evidence proving that preservative-free artificial tears are more effective than preserved artificial tears is lacking.

RESUMO Esta revisão sistemática teve como objetivo avaliar a eficácia do uso de lágrimas artificiais sem conservantes em comparação com lubrificantes preservados no tratamento do olho seco na Universidade Federal de Alagoas (PROSPERO 2018 CRD42018089933). As bases de dados online foram pesquisadas (LILACS, EMBASE, MEDLINE e CENTRAL) desde o início até abril de 2018; referências de artigos incluídos também foram pesquisadas. Foram utilizados os seguintes descritores: lubrificantes OU lágrimas artificiais OU lágrimas artificiais, lubrificantes E olho seco OU síndrome do olho seco OU síndromes, olho seco OU olhos secos. Dos 2028 resultados de busca eletrônica, 29 artigos completos foram recuperados, e quatro foram considerados relevantes. O número de participantes desses estudos variou de 15 e 76. A meta-análise foi possível para as seguintes variáveis: escore de desfecho dos sintomas de acordo com o Índice de Doença da Superfície Ocular - Allergan (OSDI), taxa de secreção lacrimal pelo teste de Schirmer, taxa de evaporação lacrimal usando o teste de tempo de ruptura do filme lacrimal, queimação, sensação de corpo estranho e fotofobia. Nenhuma diferença estatisticamente significativa foi observada entre os dois grupos, e nenhum efeito adverso foi atribuído às intervenções. Evidências provando que as lágrimas artificiais sem conservantes são mais eficazes do que as lágrimas artificiais preservadas estão faltando.

Os efeitos a longo prazo do uso de concentrado de plaquetas em olho seco diabético: uma série de casos / The long-term effects of platelet-rich plasma in diabetic dry eye: a series of cases

Resumo Objetivo: Avaliar a eficácia a longo prazo após 6 meses de uso do colírio de concentrado de plaquetas (CCP) autólogo no olho seco sintomático de pacientes diabéticos. Métodos: Um estudo de intervenção com único grupo prospectivo tipo série de casos; dez pacientes diabéticos com doença do olho seco refratário que usaram o CCP e foram reavaliados 6 meses após suspensão do tratamento. Na etapa inicial 221 pacientes diabéticos foram avaliados quanto a olho seco, destes 12 foram submetidos ao CCP, e avaliados para sintomas, escore de OSDI (Ocular Surface Disease Index), TFBUT (Tear Film Break Up Time) e Teste de Schirmer. Nesta etapa do estudo os pacientes foram reconvocados após 6 meses de suspensão do CCP, e o escore de OSDI, TFBUT e teste de Schirmer foram revistos. Resultados: Houve diferença estatisticamente significante nos escores de OSDI e TFBUT entre o basal (antes do tratamento com CCP) e após 1 mês do uso do CCP ; entre o basal e após 6 meses de suspensão do uso do CCP, e entre os valores após 1 mês de uso e após 6 meses sem uso (p= 0,005, p=0,010 e p= 0,028, p=0,04, p= 0,03 e p=0,02 respectivamente). Nos resultados do Teste de Schirmer não houve diferença significativa em nenhuma das comparações (p=0,09, p= 0,26, p=0,47 respectivamente). Conclusões: O CCP após 6 meses de uso apresenta evidências de que ainda seria eficaz mesmo com a suspensão do colírio.

Abstract Objective: To evaluate the long-term efficacy of autologous platelet -rich plasma (PRP) in the symptomatic dry eye of diabetic patients after 6 months of treatment suspension. Methods: A single intervention group, prospective study, series of cases; ten diabetic patients with refractory dry eye disease who used PRP and were reassessed 6 months after discontinuation of treatment. At the initial stage 221 diabetic patients were evaluated for dry eye, of these 12 were submitted to CPC, and evaluated for symptoms, Ocular Surface Disease Index (OSDI), TFBUT (Tear Film Break Up Time) and Schirmer's Test. At this stage of the study, patients were recruited after 6 months of CCP suspension, and the OSDI, TFBUT and Schirmer test scores were reviewed. Results: There was a statistically significant difference in the OSDI and TFBUT scores between the baseline (before PRP treatment) and after 1 month of PRP use; between the baseline and after 6 months of PRP use, and between the values after 1 month of use and after 6 months of non-use (p = 0.005, p = 0.010 and p = 0.028, p = 0.04, p = 0 , 03 and p = 0.02, respectively). Schirmer test values had no significant difference in any of the comparisons (p = 0.09, p = 0.26, p = 0.47 respectively). Conclusions: PRP after 6 months of use presents evidence that it would still be effective even with suspension of eye drops.

A Case of Toxic Keratoconjunctivitis by Self-application of Human Breast Milk

PURPOSE: We report a case of toxic keratoconjunctivitis resulting from the self-application of human breast milk as a traditional folk remedy for allergic conjunctivitis. CASE SUMMARY: An 82-year-old woman presented with pain and conjunctival hyperemia in the right eye that had been worsening for three days. Two months previously, she was treated with antiallergic eye drops for allergic conjunctivitis at another eye clinic. However, the symptoms did not improve. She applied her daughter-in-law's breast milk into her right eye as a folk remedy for three days. The pain and conjunctival hyperemia worsened. At the initial visit, her corrected visual acuity was 0.3 in the right eye. Slit lamp examination demonstrated conjunctival hyperemia, punctate epithelial erosion at the central cornea, corneal keratic precipitates and white-colored deposits in the peripheral cornea combined with irregularly shaped small nodules. There was no anterior chamber inflammation. There was no medical history of rheumatoid arthritis or tuberculosis. Blood tests for serum and other infectious and inflammatory levels for infection and inflammatory markers were performed followed by application of topical steroids and antibiotics with artificial tears. After 3 weeks of treatment, conjunctival hyperemia and corneal deposits had almost resolved and best-corrected visual acuity improved to 1.0. CONCLUSIONS: The self-application of human breast milk may cause toxic keratoconjunctivitis. Therefore, efforts should be made, actively, to inform and educate the elderly in rural areas not to use human breast milk as a folk remedy.

Fine dust and eye health

This paper aims to make recommendations for the management of eye health related to fine dust exposure. Fine dust is one of the biggest problems related to air pollution in Korea and is becoming a social issue. Fine dust can be classified into fine dust, ultrafine dust, and nanoparticles according to the size of the constituent particles. Although studies evaluating the harmful effects of particulate matter (PM) have been conducted mainly on cardiovascular and respiratory diseases, the ocular surface is a tissue that is continuously exposed to the atmosphere. Eye symptoms caused by PM exposure include eye redness, irritation, and sensation of a foreign body. Typical eye diseases caused by PM exposure include conjunctivitis, dry eye disease, and blepharitis. PM is thought to induce and exacerbate ocular surface diseases and lead to damage through oxidative stress, toxicity, and immune and inflammatory reactions on the ocular surface. For eye health management related to PM exposure, it is necessary to reduce the chance of exposure to PM in advance according to the PM forecast, avoid additional repeated exposure after PM exposure, and remove PM through eye washing and eyelid cleaning. In addition, eye drops, such as artificial tears, diquafosol, and cyclosporin A, can be used to prevent and treat ocular surface disease and deterioration of the damage. In patients who already have ocular surface disease, the harmful effects of PM exposure may be greater and more attention should be paid to eye health management.

Comparative study on the efficacy of non-steroidal, steroid and non-use of anti-inflammatory in the treatment of acute epidemic conjunctivitis

Abstract Purpose To evaluate the effects of prednisolone against sodium diclofenac both with ciprofloxacin compared to artificial tears on the symptoms and signs of acute viral conjunctivitis. Methods Study included 37 patients diagnosed with acute conjunctivitis and distributed by three groups: A (1% prednisolone acetate + ciprofloxacin (0.3%); B (Sodium diclofenac (0.1%) + ciprofloxacin (0.3%) and C (artificial tears + ciprofloxacin (0.3%). Patients received medication 6/6 hours daily. Signs and symptoms (e.g. lacrimation, burning, photophobia, etc.) were scored at baseline and on the first, third, fifth and seventh days and in the end of treatment using a standardized questionnaire and slit lamp anterior segment examination. Results All three groups demonstrated an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group A and B and B and C in the study visits ( p >0.05). However, the comparison between groups A and C showed a clinical trend (p=0.05) on third evaluation suggesting better clinical action using the corticosteroids. Conclusion The prednisolone acetate was not superior to the use of sodium diclofenac or artificial tears in relieving the signs and symptoms of viral conjunctivitis.

Development and in vitro/in vivo evaluation of thermo-sensitive in situ gelling systems for ocular allergy

Ocular allergy is one of the most common disorders of the eye surface. Following diagnosis this condition is typically treated with preparations containing antihistamines. However, anatomy of the eye and its natural protective mechanisms create challenges for ocular drug delivery. Rapid elimination of antihistamine substances due to short residency times following application can lead to insufficient treatment of ocular allergies. With this in mind, the aim of this study was to prepare a controlled ocular delivery system to extend the retention time of olopatadine hydrochloride (OLO) and in doing so to reduce the need for frequent application. We developed extended-release ocular in situ gelling systems for which in vivo retention times were determined in sheep following in vitro characterization and cytotoxicity studies. In vivo results were then compared to commercially available Patanol eye drops. the transparent gels formulated using appropriate amounts of polymers and having longer ocular retention times appear to be a viable alternative to commercially available eye drops.

Topical ophthalmic antimicrobials: unfulfilled demands and possibility of new investments in Brazil and in the United States

In general, topical ophthalmic drug products, especially those used for treating infections, present low effectiveness because of various reasons, from unfavorable drug physicochemical properties to physiological protective mechanisms of the eye. The fact is such group of products holds room for improvement, which could mean the development of better drugs or dosage forms. To achieve this, the knowledge of market composition is essential. The present work studied and compared the antimicrobial ophthalmic markets of Brazil and of the United States (US). Official databank of Brazilian Health Regulatory Agency and of US Food and Drug Administration were assessed for registered antimicrobial topical ophthalmic drug products. Brazilian market has registered greater number of drug products (119) than the US (94), but the latter involves more variety of substances and dosage forms. In both countries, non-innovative products registered as solutions of antibacterials, especially fluoroquinolones and aminoglycosides lead the market. Despite the clinical demand, the US has only one group of antimycotics (polyenes) registered, while in Brazil, there is not any ophthalmic antimycotic product marketed. This study evidences there is not only space for development of newer drugs and formulations but also a demand for already existing technologies and products in both countries.

Utilização de lente de contato escleral na abordagem terapêutica da úlcera neurotrófica corneana / Use of scleral contact lens in the therapeutic approach of corneal neurotrophic ulcer

Resumo Neste artigo descrevemos como conduzimos com sucesso um caso de úlcera neurotrófica não responsivo à terapia convencional com o uso de lente de contato escleral e as vantagens desta terapêutica.

Abstract In this paper we describe how we successfully conducted a case of neurotrophic ulcer not responsive to conventional therapy using scleral contact lens and the advantages of this therapy.

O uso do concentrado de plaquetas na oftalmologia: uma revisão de literatura / The use of platelet rich-plasma in Ophthalmology: a literature review

Resumo Esta revisão tem por objetivo elencar as condições oftalmológicas em que tem sido utilizado o concentrado de plaquetas (CP), assim como as suas propriedades bioquímicas e fisiológicas. O CP possui tanto o potencial anticatabólico, presente no soro autólogo, quanto substâncias com propriedades anabólicas, que em conjunto são responsáveis pelos seus benefícios no tratamento de doenças da superfície ocular. Atualmente há um lapso de ensaios clínicos neste tema, tanto na oftalmologia como em outras áreas médicas, existindo mais estudos e relatos sobre o uso de soro autólogo. Em oftalmologia, o CP tem sido usado no tratamento do olho seco sintomático, úlceras corneanas, queimaduras oculares dentre outras aplicações, sendo uma alternativa eficaz em diversas patologias oculares; portanto, é evidente a importância de mais estudos nesse tema, para comprovar a efetividade do produto.

Abstract The aim of this review is to list the ophthalmological conditions in which platelet concentrate (CP) has been used, as well as its biochemical and physiological properties. The CP has both anticatabolic potential, present in autologous serum, and substances with anabolic properties, which together are responsible for its benefits in the treatment of ocular surface diseases. There is currently a shortage of clinical trials in this area, both in ophthalmology and other medical areas, with more studies and reports on the use of autologous serum. In ophthalmology, CP has been used in the treatment of symptomatic dry eye, corneal ulcers and ocular burns, among other applications, being an effective alternative in several ocular pathologies; therefore, it's evident the importance of more studies in this topic to prove the efficiency of this product.

Eficacia del sondaje intraductal en la disfunción de las glándulas de Meibomio / Efficacy of intraductal probing in Meibonian gland dysfunction

Objetivo: determinar la efectividad del sondaje intraductal en el tratamiento de la disfunción de las glándulas de Meibomio. Métodos: se realizó un estudio descriptivo, longitudinal, prospectivo, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período de marzo del año 2014 al mismo mes del año 2015 en 50 ojos (25 pacientes) con diagnóstico de disfunción de las glándulas de Meibomio, a los que se les realizó el sondaje intraductal. Resultados: el tiempo de ruptura de la película lagrimal preoperatorio mínimo fue de 1 segundo y el máximo de 9; al mes y a los seis meses el tiempo de ruptura de la película lagrimal mínimo era de 9 segundos y el máximo de 13. En el preoperatorio los 50 ojos tuvieron tiempo de ruptura de la película lagrimal ˂ 10 segundos; en cambio, al mes y a los seis meses el 50 por ciento tenían tiempo de ruptura de la película lagrimal de ≥ 10 segundos. El índice de enfermedad de la superficie ocular preoperatorio fue 87,80 ± 9,48; a la semana 64,00 ± 10,20; al mes 35,30 ± 9,55 y a los seis meses 36,10 ± 10,37, con diferencia significativa con respecto al preoperatorio ( p= 0,000); no entre el posoperatorio de uno y seis meses (p= 0,6135). Los lubricantes fueron necesarios en todos antes y después del procedimiento; pero al mes y a los seis meses todos los usaban con menor frecuencia. No hubo complicaciones; 5 ojos (10 por ciento) necesitaron un segundo tratamiento y el tiempo promedio fue de 4,4 meses. Conclusiones: el sondaje intraductal de las glándulas de Meibomio es un procedimiento único, seguro, con baja necesidad de retratamiento, que reduce la necesidad del uso de lubricantes, por lo que es un tratamiento efectivo en la disfunción de estas(AU)

Objective: to determine the effectiveness of intraductal probing in treatment of Meibonian gland dysfunction. Methods: a prospective, longitudinal and descriptive study was conducted in 50 eyes (25 patients), who had been diagnosed as Meibonian gland dysfunction and performed the intraductal probing at Ramon Pando Ferrer Cuban Institute of Ophthalmology in the period March 2014 to March 2015. Results: the minimal length of time of rupture of the lachrymal film before surgery was one second and the maximum 9 seconds; after one month and six months the minimal value was 9 seconds and the maximum value was 13. In the preoperative period, 50 eyes showed length of time of rupture of the lachrymal film below 10 seconds; however, one month and six months later, 50 percent of patients had length of time of rupture of the lachrymal film equal or over 10 seconds. The preoperative index of disease of the ocular surface was 87.80 ± 9.48; after one week was 64.00 ± 10.20; after one month 35.30 ± 9.55 and after six months 36.10 ± 10.37, with significant difference in the preoperative (p= 0.000); but it was non-significant between the postoperative term at one month and at six months (p= 0.6135). Oils were necessary in all the eyes before and after the surgical procedure; however, one month and six months later, all the patients used them less frequently. There were no complications, five eyes (10 percent) required a second treatment and the average time elapsed was 4.4 months(AU) Conclusions: the intraductal Meibonian gland probing is a safe, single procedure with almost no requirement for retreatment, which reduces the need for the use of oils and is and effective therapy for Meibonian gland dysfunction.

Variação do volume de gotas de colírios lubrificantes disponíveis no mercado brasileiro / Variation in the volume of lubricating eyedrops available in the brazilian market

RESUMO Objetivo: Avaliar a variação intra e interexaminadores do volume de gotas dispensados de frascos de colírios lubrificantes disponíveis no mercado. Métodos: Foram estudados cinco frascos de colírios lubrificantes e dezenove voluntários participaram deste estudo. A massa média de gotas de 20µl dos colírios foi obtida utilizando micropipeta e balança de precisão e como padrão para comparação com a massa das gotas obtidas pelos voluntários. Cinco gotas de cada frasco foram pesadas individualmente com o tubo de colírio perpendicular à balança, usando o primeiro e segundo dedos da mão direita, de forma que a pressão fosse aplicada somente no meio do frasco. Os experimentos foram realizados em uma sala climatizada a temperatura ambiente (21±1°C). Resultados: Todos os frascos de colírios apresentaram variação estatisticamente significante das massas das gotas obtidas pelos examinadores quando comparadas com a massa média padrão de 0,0182±0,0014g, com exceção da comparação entre os dados do colírio A com o colírio D, que não apresentou variação estatisticamente significante. Conclusão: O presente estudo demonstra a ausência de uniformidade das gotas dispensadas pelos frascos de colírios disponíveis no mercado e a sua inadequação à real necessidade, uma vez que as gotas dispensadas são maiores do que o indicado. Esse fato torna-se um problema quando se trata de período de tratamento prolongado, especialmente com colírios dispendiosos como os indicados para a terapêutica do glaucoma. Nesse sentido, a padronização das gotas de colírios se faz necessária.

ABSTRACT Objective: To evaluate the intra and inter variations of eye drops volume dispensed from bottles available on the market. Methods: Five bottles of lubricant eye drops were studied and nineteen volunteers participated in this study. The average mass from 20µl of eye drops was obtained using accuracy micropipette and balance, and used as standard for comparison with the mass of the drops obtained by the volunteers. Five drops of each vial were individually weighed with the tube perpendicular to the balance, using the first and second fingers of the right hand, so that the pressure was applied only in the middle of the flask. The experiments were performed in a room temperature (21±1°C). Results: All eye drops bottles showed a statistically significant variation on masses of the drops obtained by examiners when compared with the standard average weight of 0.0182±0,0014g, except when compared A with D eye drops, with no statistically significant variation. Conclusion: This study demonstrates the lack of uniformity of drops dispensed by eye drops bottles available in the market and its inadequacy to the real need, since the dispensed drops are larger than indicated.This fact becomes a problem when it comes to long treatment period, especially with expensive drops as indicated for glaucoma therapy. In this sense, the standardization of drops of eye drops is necessary.

Efeito de intervenções de enfermagem na prevenção de olho seco em pacientes críticos: ensaio clínico randomizado / Effect of nursing interventions on dry eye prevention in critically ill patients: Randomized Clinical Trial

Objetivo: Avaliar o efeito de intervenções de enfermagem (lágrima artificial em gel e lágrima artificial líquida) na prevenção de olho seco em pacientes internados em Unidade de Terapia Intensiva geral de adultos, de um hospital filantrópico no Brasil. Casuística e Métodos: Foram incluídos pacientes clínicos e cirúrgicos admitidos na Unidade de Terapia Intensiva geral de adultos de um hospital filantrópico, que atendessem aos seguintes critérios: ter mais de 18 anos; não apresentar olho seco no momento da admissão; estar em terapia de ventilação mecânica; piscar de olhos menor que 5 por minuto e avaliação na escala de coma de Glasgow menor ou igual a 7. A amostra final foi composta por 140 indivíduos que foram alocados aleatoriamente para os grupos do estudo, sendo 70 pacientes para o grupo lágrima artificial líquida e 70 pacientes para o grupo lágrima artificial gel. Os pacientes foram acompanhados por 5 dias consecutivos e avaliados diariamente através do exame ocular com o teste de fluoresceína, que avalia a presença de lesões corneanas, e pelo teste de Schirmer I, para se verificar a quantidade de lágrima produzida. A avaliação do efeito do cuidado ocular foi medido comparando cada grupo, bem como os dois grupos entre si, através do valor da incidência de olho seco (desfecho primário) encontrado em cada grupo. Os resultados foram apresentados por meio de frequência simples, medidas de tendência central (média) e medidas de variabilidade (desvio-padrão), a fim de caracterizar e descrever a população de pacientes. As comparações entre os grupos foram realizadas por teste exato de Fisher e pelo teste não paramétrico de Mann-Whitney. Foi calculada a taxa de incidência global do olho seco e o efeito das intervenções foi expresso por meio do risco relativo e intervalo de 95% de confiança, sendo este ajustado por fatores de risco (idade, sexo e exposição ocular), em um modelo de regressão de Poisson. Resultados: A incidência global de olho seco até ...

Objective: To evaluate the effect of nursing interventions (artificial tear on gel and liquid artificial tear) in the prevention of dry eye in patients hospitalized in an adult General Intensive Care Unit of a philanthropic hospital in Brazil. Casuistry and Methods: We included clinical and surgical patients admitted to the General Intensive Care Unit of adults of a philanthropic hospital, who met the following criteria: being over 18 years old; dry eye at admission; being in mechanical ventilation therapy; blink of less than 5 per minute and Glasgow coma scale score less than or equal to 7. The final sample consisted of 140 individuals randomly allocated to the study groups, of which 70 were patients for the liquid artificial tear group and 70 patients for the artificial tear gel group. The patients were followed for 5 consecutive days and evaluated daily through the ocular examination with the fluorescein test, which evaluates the presence of corneal lesions, and the Schirmer I test, in order to verify the amount of tear produced. The evaluation of the ocular care effect was measured by comparing each group as well as the two groups with each other, using the value of dry eye incidence (primary outcome) found in each group. The results were presented by means of simple frequency, measures of central tendency (average) and measures of variability (standard deviation), in order to characterize and describe the population of patients. Comparisons between groups were performed by Fisher's exact test and the non-parametric Mann-Whitney test. The overall incidence rate of dry eye was calculated and the effect of the interventions was expressed by relative risk and 95% confidence interval, adjusted for risk factors (age, sex and ocular exposure) in a model of regression. Results: The overall incidence of dry eye up to the 5th day of hospitalization was higher in the liquid artificial tear group, and among...

Ocular Side Effects Induced by 0.25% Alcaftadine Ophthalmic Solution

PURPOSE: To report a case series of patients experiencing side effects of 0.25% alcaftadine eye drops and to analyze the possible reasons for the side effects. CASE SUMMARY: Medical records of 90 patients who had a history of alcaftadine eye drop use were retrospectively analyzed. Eight out of the 90 patients (8.9%) showed ocular side effects that required discontinuation of the alcaftadine eye drops. All eight cases of alcaftadine side effects showed palpebral and bulbar conjunctival injection, watery discharge, and lid swelling. During additional history collection, all patients with alcaftadine side effects confessed of overuse (more than twice/day) of the eye drops. Anticipation for fast symptom relief was the main reason for the alcaftadine overuse. In all side effect cases, patients were asked to stop alcaftadine eye drops and use preservative-free artificial tears and steroid eye drops. After discontinuation of 0.25% alcaftadine eye drops, regression of palpebral and bulbar conjunctival injection and lid swelling was observed. CONCLUSIONS: Overuse of 0.25% alcaftadine eye drops can induce ocular surface toxicity possibly due to toxicity of drug itself. The possible side effects of overuse of 0.25% alcaftadine eye drops should be fully explained to all patients before use.

Efficacy of Carboxymethylcellulose and Hyaluronate in Dry Eye Disease: A Systematic Review and Meta-Analysis / 가정의학회지

BACKGROUND: The efficacy of two artificial tears, carboxymethylcellulose (CMC) and hyaluronate (HA), was compared in the treatment of patients with dry eye disease. METHODS: We conducted a systematic review and meta-analysis on randomized controlled trials in the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. The efficacy was compared in terms of the mean change from baseline in tear break-up time. The meta-analysis was conducted using both random and fixed effect models. The quality of the selected studies was assessed for risk of bias. RESULTS: Five studies were included involving 251 participants. Random effect model meta-analysis showed no significant difference between CMC and HA in treating dry eye disease (pooled standardized mean difference [SMD]=-0.452; 95% confidence interval [CI], -0.911 to 0.007; P=0.053). In contrast, fixed effect model meta-analysis revealed significant improvements in the CMC group when compared to the HA group (pooled SMD=-0.334; 95% CI, -0.588 to -0.081; P=0.010). CONCLUSION: The efficacy of CMC appeared to be better than that of HA in treating dry eye disease, although meta-analysis results were not statistically significant. Further research is needed to better elucidate the difference in efficacy between CMC and HA in treating dry eye disease.

Percepção de autoinstilação de gotas oculares em idosos com ou sem dispositivo de apoio facial / Self instillation perception of eye drops in elderly patients with and without facial support device

RESUMO Objetivo: Determinar o grau de dificuldade para instilação tópica ocular em idosos, com ou sem o auxílio de dispositivo de apoio facial, por meio de questionário. Observar qual método foi tecnicamente melhor para aplicação tópica ocular de gotas. Métodos: O estudo foi um ensaio clínico, controlado, randomizado e pareado, realizado em 50 pacientes idosos de setembro de 2015 a junho de 2016 na Policlínica Ronaldo Gazolla, Lapa-Rio de Janeiro. Um frasco de colírio Optive® foi acoplado ao dispositivo de apoio facial denominado Eyedrop®. Cada participante instilou o colírio com ou sem o auxílio do dispositivo em cada um dos olhos, sendo que a seleção ocular foi feita aleatoriamente. Foi perguntado ao paciente questões pré-formuladas sobre a dificuldade de ambos os métodos e a técnica de administração tópica ocular foi avaliada. Resultados: A instilação de gotas foi considerada difícil ou muito difícil por 10% dos idosos com o auxílio do dispositivo e por 36% sem o auxílio (p = 0,0047). Houve toque da ponta do colírio com os tecidos oculares em 64% dos pacientes que não usaram o Eyedrop® e em 4% dos que o utilizaram (p=0,000001). A maior dificuldade descrita na instilação tradicional foi acertar o olho com a gota (32%) e com o dispositivo de apoio foi entender seu uso(4%). Conclusão: A maioria dos idosos instila colírios erroneamente, tocando a ponta do frasco em tecidos oculares, o que favorece sua contaminação. O dispositivo de apoio facial tornou mais segura e fácil a instilação.

ABSTRACT Objective: To determine the degree of difficulty for topical ocular instillation in the elderly, through a questionnaire, with or without the aid of facial support device. Observe which method was technically better to topical ocular application of drops. Methods: The study was a clinical trial, controlled, randomized and paired, which was conducted in 50 elderly patients from September 2015 to June 2016 at the Polyclinic Ronaldo Gazolla, Lapa, Rio de Janeiro. A Optive® eyedrop bottle was attached to a facial support device called Eyedrop®. Each participant instilled an eye drop with or without the device help in each of both eyes, wherein the eye selection was made randomly. He was asked to answer pre-formulated questions about the difficulty of both methods and the topical ocular administration technique was evaluated. Results: Eye drop instillation was difficult or very difficult for 10% of the elderly with the device aid and for 36% without it (p = 0.0047). There were bottle tip touch onto the ocular tissues in 64% of patients who did not use Eyedrop® and 4% who used it (p = 0.000001). The greatest difficulty described in traditional instillation was to head properly the eye drop (32%) and when the support device was used, it was to understand how to use it (4%). Conclusion: Most elderly instills eye drops mistakenly, touching the tip of the bottle onto ocular tissues, which favors contamination. The facial support device increased security and facility in instillation.

Comparisons for Evaluation of Efficacy and Safety of Cyclosporin A 0.05% Ophthalmic Emulsion Treatment Groups

PURPOSE: To evaluate and compare the efficacy and safety of cyclosporine 0.05% (Cyporin N eye drops 0.05%) to an active comparator (Restasis®) in moderate to severe dry eye patients. METHODS: This is a multicenter, randomized, double-blind, parallel, active control, non-inferiority, phase III study. Patients had a 2-week run-in period (during the run-in period, patients used artificial tears, if applicable), and afterward 158 patients were randomly assigned treatment for 12 weeks with cyclosporine 0.05% (with artificial tears, if applicable), in which the efficacy and safety were evaluated every four weeks. RESULTS: Corneal staining tests showed that in the per protocol set group, the study group was not inferior to the control group; the results for the full analysis set analytic group were the same. The number of adverse events reported from the 158 patients was not significantly different between groups (p = 0.1107). Additionally, other evaluations, including tolerability evaluations, clinical pathology examinations, and vital signs, show that there is no difference in terms of safety between the groups. CONCLUSIONS: Cyclosporine A 0.05% (Cyporin N eye drops 0.05%) is considered to have the same efficacy and safety compared to the active comparator.

Evaluation of Changes in Tear Film Lipid Layer Thickness Using Ocular Surface Interferometer after Artificial Tear Application

PURPOSE: The changes in tear film lipid layer thickness (LLT) after artificial tears application using LipiView®II interferometer were assessed. METHODS: We performed a prospective study of patients with dry eye disease. All subjects underwent measurement of tear film break-up time, Schirmer test, ocular surface staining, meibomian gland evaluation, and subjective score assessment using the Ocular Surface Disease Index. All subjects were randomly assigned to 1 of 3 groups using table of random numbers (group 1, sodium hyaluronate [HA] 0.1% eye drops without preservatives; group 2, HA 0.3% eye drops without preservatives and group 3, HA 0.1% with benzalkonium chloride 0.003%). LLT was measured before, immediately after and 1 hr, 3 hrs, and 6 hrs after artificial tears application. Additionally, the patients were divided into 2 subgroups depending on the presence of meibomian gland dysfunction (MGD) and further evaluated. RESULTS: Significant change in LLT was observed at 3 hrs after artificial tears instillation. LLT in groups 1 and 2 showed significant changes over time (p < 0.01 and p < 0.01, respectively). However, LLT in group 3 showed no change. LLT was unchanged in patients without MGD. Conversely, in MGD patients, a significant difference in LLT between groups 1 and 2 was observed immediately after and 1 hr and 3 hrs after instillation of artificial tears (p = 0.04, p < 0.01 and p = 0.02, respectively) but not at 6 hrs. However, no significant difference in LLT between groups 1 and 3 was observed in MGD patients. CONCLUSIONS: LLT after instillation of artificial tears measured using LipiView®II interferometer was affected by artificial tear concentration and presence of preservatives. Additionally, the presence of MGD can impact the pattern of LLT changes induced by artificial tear instillation. Therefore, LLT measurements using LipiView®II interferometer require at least a 6-hrs interval after use of eye drops, especially for patients with MGD or using artificial tears with preservatives.

Analysis of Tear Meniscus Change after Strabismus Surgery Using Optical Coherence Tomography

PURPOSE: In this study, the changes in ocular surface parameters and tear meniscus after strabismus surgery when treated with or without artificial tears were evaluated using optical coherence tomography (OCT). METHODS: The present study included 30 patients who received bilateral lateral rectus recession surgery for exotropia. The patients instilled artificial tear eye drops only in the left eye. Before and 2, 4, 8, and 12 weeks after surgery, tear film break-up time (BUT), Schirmer's test, corneal staining test, tear meniscus height and area were measured using OCT and compared in both eyes. Before and 8 weeks after surgery, conjunctival compression cytology test was performed. RESULTS: The mean patient age was 8.7 years. After 8 weeks, BUT and corneal staining scores were 12.3 ± 1.5 seconds and 1.3 ± 0.4 in patients treated with artificial tears and 9.5 ± 1.0 seconds and 2.0 ± 0.7 in patients not treated with artificial tears (both p < 0.000). Four weeks after surgery, tear meniscus height and area using OCT were 290.2 ± 42.3 µm and 566.7 ± 48.2 pixels in patients treated with artificial tears and 246 ± 45.5 µm and 504.0 ± 29.7 pixels in patients not treated with artificial tears (p = 0.045 and p = 0.019, respectively). Goblet cell count was significantly different between the eyes 8 weeks after surgery (p = 0.033). CONCLUSIONS: Instability of tear meniscus can be detected after strabismus surgery using BUT, Schirmer's test, corneal staining test, tear meniscus height and area, and OCT. After surgery, artificial tears help treat dry eye symptoms by corneo-conjunctival wound healing mechanism and increasing tear meniscus stability.