ABSTRACT
@#Dry eye disease (DED), currently and, perhaps, at long last a widely accepted prevalent ocular disorder, poses significant challenges, particularly in the developing world, including the Philippines. It disrupts the tear film, leading to discomfort and visual impairment, thereby affecting not only quality of life but economic productivity as well. The ubiquitousness of computer screen use and the evolution of cataract surgery into refractive surgery are only two causative factors of a complex, multivariate problem. Despite its global prevalence, a stark contrast exists in the awareness, diagnosis, and treatment of DED between developed and developing regions. This editorial aims to underscore these disparities, focusing on the crucial roles of healthcare awareness, diagnostic advancements, accessible treatment options, prioritization of governmental policies, and the ethical engagement of the pharmaceutical industry to enhance DED management in under-resourced settings.
Subject(s)
Dry Eye SyndromesABSTRACT
Objective@#This study determined the prevalence of dry eye disease (DED) in a community located in a highaltitude tropical city in the Philippines.@*Methods@#This was a cross-sectional study conducted in Barangay Lualhati in Baguio City from March 2019 to September 2022. Convenience sampling was done in recruiting adult permanent residents of the community. The participants underwent standardized DED evaluation consisting of symptom questionnaire, Ocular Surface Disease Index (OSDI) scoring, slit-lamp examination, fluorescein tear break-up time (TBUT) measurement, ocular surface fluorescein and lissamine green staining, and Schirmer test with and without topical anesthesia. DED was classified as aqueous tear deficiency type, evaporative type, or mixed type. @*Results@#Data from 272 participants were analyzed which represented 23% of the adult population of the community. There were 111 participants who fulfilled the DED definition, and the prevalence rate of DED was 41%. The mean age of those with DED was 43.0 ± 17.6 years while the mean age of those without DED was 51.8 ± 16.6 years (p<0.001). More females (60%) had DED than males (40%). Majority (82%) reported use of digital devices as the main exacerbating factor. Mean OSDI score was significantly higher in those with DED than in those without DED (27.2 + 6.8 and 10.7 ± 6.4, respectively) (p<0.001). Corneal and conjunctival staining scores were also significantly higher in subjects with DED. Evaporative DED was the most common (88.3%). Mixed-type DED was seen in 11.7%. None had pure aqueous tear deficiency dry eye.@*Conclusion@#The prevalence rate of DED is greater in areas of higher altitude and DED can be exacerbated by prolonged screen time. This condition is no longer just a problem of the elderly and is now also seen in younger patients. All symptomatic patients should undergo tear break-up time evaluation since evaporative or short TBUT is the predominant type of DED.
Subject(s)
Dry Eye Syndromes , Eye , Eye DiseasesABSTRACT
Objectives@#This study determined whether the use of an N95 face mask was associated with changes in ocular surface parameters and dry eye symptomatology among healthcare workers with no baseline dry eye disease. @*Methodology@#This was a prospective, analytical, quasi-experimental study. The ocular surface and dry eye symptomatology of 33 healthcare workers (n=66 eyes) were evaluated at baseline and 3 hours after use of 3M™ VFlex™ Particulate Respirator 9105 N95 mask (3M, Minnesota, USA). The following parameters were measured: ocular surface disease index (OSDI), tear break-up time (TBUT), tear break-up pattern (TBUP), non-invasive TBUT (NIKBUT), tear meniscus height (TMH), meibography, and bulbar conjunctival redness.@*Results@#Among all the parameters tested, only OSDI and bulbar redness showed significant changes when pre-N95 and post-N95 values were compared. Although each was interpreted as normal, the median OSDI score improved from 7 to 1 (p < 0.001). Median bulbar conjunctival redness score worsened from 0.9 to 1.1 (p < 0.001). @*Conclusion@#Among healthcare workers with no dry eye disease, the use of the 3M™ Vflex™ Particulate Respirator 9105 N95 mask was not associated with changes in TBUT, TBUP, NIKBUT, TMH, and meibogaphy. An improvement of dry eye symptoms was reported after VFlex™ mask use.
Subject(s)
COVID-19 , Dry Eye SyndromesABSTRACT
Sjögren's syndrome(SS)is a chronic autoimmune disease that affects exocrine glands, especially salivary and lacrimal glands. The main clinical manifestations are dry mouth and dry eyes, but also multi-organ and multi-system can be involved. Cold agglutinin disease(CAD)is an autoimmune disease characterized by red blood cell agglutination in the blood vessels of extremities caused by cold agglutinin at low temperature, resulting in skin microcirculation disturbance, or hemolytic anemia. Cold agglutinin disease is divided into two categories, primary cold agglutinin disease and secondary cold agglutinin disease. Primary cold agglutinin disease is characterized with cold agglutinin titer of 1 ∶4 000 or more and positive Coomb's test. However, the Coomb's test is not necessarily positive and the cold agglutinin titer is between 1 ∶32 and 1 ∶4 000 in secondary cold agglutinin disease. Here, we reported an elderly patient admitted to hospital due to fever. He was diagnosed with respiratory infection, but he showed incompletely response to the anti-infection treatment. Further laboratory tests showed the patient with positive ANA and anti-SSA antibodies. Additionally, the patient complained that he had dry mouth and dry eyes for 1 year. Schirmer test and salivate gland imaging finally confirmed the diagnosis Sjogren's syndrome. During the hospital stay, the blood clots were found in the anticoagulant tubes. Hemolytic anemia was considered as the patient had anemia with elevated reticulocytes and indirect bilirubin. In addition, further examination showed positive cold agglutination test with a titer of 1 ∶1 024, and cold agglutinin disease was an important type of cold-resistant autoimmune hemolytic anemia. Furthermore, the patient developed cyanosis after ice incubating at the tip of the nose. Hence, the patient was diagnosed as CAD and he was successfully treated with glucocorticoids instead of anti-infection treatments. Hence, the patient was diagnosed with SS combined with secondary CAD. SS combined CAD are rarely reported, and they are both autoimmune diseases. The abnormal function of B lymphocytes and the production of autoantibodies might be the common pathogenesis of them. Cold agglutinin disease can lead to severe hemolytic anemia, even life-threatening. In clinical practice, timely recognizing and dealing with CAD might promote the prognosis of the patient.
Subject(s)
Male , Humans , Aged , Anemia, Hemolytic, Autoimmune/diagnosis , Sjogren's Syndrome/diagnosis , Anemia, Hemolytic/complications , Dry Eye Syndromes/complications , AutoantibodiesABSTRACT
OBJECTIVE@#To compare the clinical efficacy of acupuncture, Chinese medication and combination of acupuncture and medication in the treatment of dry eye complicated with computer vision syndrome (CVS).@*METHODS@#A total of 152 patients with dry eye complicated with CVS were randomly divided into an acupuncture-medication group (38 cases, 1 case was removed), an acupuncture group (38 cases, 1 case dropped off), a Chinese medication group (38 cases, 1 case was removed), and a western medication group (38 cases, 1 case dropped off). In the western medication group, sodium hyaluronate eye drop combined with esculin and digitalis glycosides eye drop were used. In the acupuncture group, acupuncture was applied at bilateral Taiyang (EX-HN 5), Cuanzhu (BL 2), Fengchi (GB 20), Qimen (LR 14) , and Hegu (LI 4) etc., once a day. In the Chinese medication group, Yiqi Congming decoction formula ganule was given orally, one dose a day. In the acupuncture-medication group, acupuncture combined with Yiqi Congming decoction formula granule were used. All groups were treated for 14 d. The non-invasive first tear film break-up time (NIBUT f), non-invasive average tear film break-up time (NIBUT av), tear meniscus height (TMH), ocular surface disease index (OSDI) score, and CVS symptom score were compared between the patients of each group before and after treatment.@*RESULTS@#After treatment, the NIBUT f, NIBUT av, and TMH were increased compared with those before treatment in the patients of the 4 groups (P<0.01); the NIBUT f and NIBUT av in the acupuncture-medication group and the acupuncture group were higher than those in the Chinese medication group and the western medication group (P<0.05), and the TMH in the acupuncture-medication group and the Chinese medication group were higher than those in the acupuncture group and the western medication group (P<0.05). After treatment, the OSDI scores, the various scores and total scores of CVS (except for head symptom score in the western medication group) were decreased compared with those before treatment in the patients of the 4 groups (P<0.01). The OSDI score, total score, eye symptom score, and body symptom score of CVS in the acupuncture-medication group were lower than those in the acupuncture group, the Chinese medication group, and the western medication group (P<0.01, P<0.05), the head symptom score of the acupuncture-medication group was lower than that in the western medication group (P<0.05), and the CVS physical symptom scores and mental cognitive symptom scores of the acupuncture-medication group and the acupuncture group were lower than those in the Chinese medication group and the western medication group (P<0.05).@*CONCLUSION@#Acupuncture has advantages in improving NIBUT f, NIBUT av, and CVS physical symptoms and cognitive symptoms, and the Chinese medication has advantage in improving TMH. The combination of acupuncture and Chinese medication has better effects compared with monotherapy.
Subject(s)
Humans , Dry Eye Syndromes/etiology , Acupuncture Therapy , Computers , Treatment Outcome , Acupuncture Points , Ophthalmic SolutionsABSTRACT
OBJECTIVES@#To compare the clinical efficacy and safety of acupuncture and sodium hyaluronate eye drop in the treatment of aqueous deficiency dry eye.@*METHODS@#A total of 60 patients (120 eyes) with aqueous deficiency dry eye were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases, 1 case dropped out). In the control group, sodium hyaluronate eye drop were used, one drop at a time, 4 times a day, for 14 consecutive days. In the observation group, acupuncture was applied at bilateral Shangjingming (Extra), Cuanzhu (BL 2), Sizhukong (TE 23), Taiyang (EX-HN 5), and Tongziliao (GB 1) , once a day, treatment for 6 days with the interval of 1 day was required, for 14 consecutive days. The tear meniscus height (TMH), Schirmer Ⅰ test (SⅠT), ocular surface disease index (OSDI) score, non-invasive tear break-up time (NIBUT), and corneal fluorescein sodium staining (FLS) score were compared between the two groups before and after treatment, and the safety of the treatment of the two groups was observed.@*RESULTS@#Compared with those before treatment, after treatment, TMH, SⅠT and NIBUT were increased (P<0.01, P<0.05), and FLS scores were decreased (P<0.01) in the two groups; the score of OSDI was reduced (P<0.01) in the observation group. After treatment, in the observation group, TMH and SⅠT were higher than those in the control group (P<0.01), and the score of OSDI was lower than that in the control group (P<0.01). No adverse reactions and adverse events were observed in the two groups.@*CONCLUSIONS@#Acupuncture and sodium hyaluronate eye drop can both effectively treat aqueous deficiency dry eye, acupuncture has obvious advantages in improving TMH and basic tear secretion, and reducing the subjective symptoms of patients. Acupuncture for dry eye is safe.
Subject(s)
Humans , Hyaluronic Acid , Acupuncture Therapy , Dry Eye Syndromes/therapy , Eye , Tears , Ophthalmic Solutions , FluoresceinABSTRACT
The academic thoughts of professor GAO Wei-bin regarding the use of electroacupuncture in the treatment of dry eye are introduced. Professor GAO believes that the occurrence of dry eye is mainly related to the stagnation of qi and blood in the eye meridians, leading to inadequate nourishment of the eyes. The acupuncture treatment principle focuses on promoting blood circulation, clearing and benefiting the eye orifices. By integrating traditional acupuncture theory with modern neuroanatomy, the treatment approach centers on stimulating the lacrimal gland, emphasizing the importance of promoting, addressing symptoms as a priority, and considering both the root cause and symptoms.The precise acupoint selection is emphasized. Acupoints of periocular region, such as Taiyang (EX-HN 5) and Leixian point are selected along with Fengchi (GB 20) and Gongxue point to treat dry eye. Attention is also given to the use of electroacupuncture and the selection of its frequencies, emphasizing specific needling techniques based on the severity and classification of the disease.
Subject(s)
Humans , Electroacupuncture , Meridians , Acupuncture Therapy/methods , Acupuncture Points , Dry Eye Syndromes/therapyABSTRACT
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.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Perioperative Nursing , Dry Eye Syndromes/surgery , Eye Health , Postanesthesia Nursing , Cross-Sectional StudiesABSTRACT
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)
Subject(s)
Humans , Vision Disorders/diagnosis , Dry Eye Syndromes , Review Literature as TopicABSTRACT
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)
Subject(s)
Humans , Female , Adult , Middle Aged , Dry Eye Syndromes/classification , Dry Eye Syndromes/diagnosis , Dry Eye Syndromes/drug therapy , Dry Eye Syndromes/therapy , Dry Eye Syndromes/epidemiologyABSTRACT
ABSTRACT Ocular cicatricial pemphigoid (OCP) is a chronic, immune-mediated, bullous, cicatricial disease within the spectrum of mucocutaneous membranous pemphigoids (MMP). Although the diagnosis is often ophthalmological, due to the autoimmune nature of the pathology, it requires a joint approach with rheumatologists and immunologists. The objective of this narrative review was to explore the evidence available in the literature from 2000 to 2020 with respect to clinical manifestations, diagnosis, and treatment. The clinical presentation varies widely, from mild cases with slow progression of years of progression, to severe cases with a torpid and rapidly progressive evolution to fibrosis, refractory to multiple treatments. A com plete evaluation of the patient will help guide the diagnosis. The gold standard for diagnosis is conjunctival biopsy with direct immunofluorescence, although on occasions it can be reached if the symptoms are characteristic. Treatment is local and systemic according to its severity and evolution. The evidence on topical and systemic therapeutics is obtained mainly from uncontrolled observational and experimental studies. Immunomodulatory therapy has made it possible to preserve vision and, in many cases, prevent sequelae. The evolu tion is linked to the early diagnosis and immunosuppressive treatment, so it is essential to be aware of this disease, the diagnostic methods, as well as the immunomodulating and immunosuppressive therapies available.
RESUMEN El penfigoide ocular cicatrizal (POC) es una enfermedad crónica, inmunomediada ampollar, mucosinequiante, comprendida dentro del espectro de penfigoides membranosos mucocutáneos (PMM). El diagnóstico es, con frecuencia, oftalmológico, pero debido al carácter autoinmune de la patología, requiere el abordaje en conjunto con reumatólogos e inmunólogos. El objetivo de esta revisión narrativa fue explorar la evidencia disponible en la literatura, desde el año 2000 hasta el 2020, en lo que respecta a sus manifestaciones clínicas, diagnóstico y tratamiento. La presentación clínica varía ampliamente, desde casos leves con progresión lenta de años de evolución hasta casos severos con evolución tórpida y rápidamente progresiva a la fibrosis, refractarios a múltiples tratamientos. Una evaluación completa del paciente ayudará a guiar el diagnóstico. El estándar de oro diagnóstico es la biopsia conjuntival con inmunofluorescencia directa, si bien en ocasiones puede diagnosticarse por la clínica característica. El tratamiento es local y sistêmico de acuerdo con su severidad y evolución. En los últimos 20 anos, la evidencia sobre los tratamientos tópicos y sistêmicos corresponde en su mayoría a estudios observacionales y experimentales no controlados. Los métodos de tratamiento inmunomoduladores han permitido preservar la visión y, en muchos casos, prevenir secuelas. La evolución está ligada al diagnóstico temprano y a los tratamientos disponibles, por lo que es fundamental el conocimiento de esta patología, los métodos diagnósticos y los tratamientos inmunomoduladores e inmunosupresores.
Subject(s)
Male , Female , Middle Aged , Dry Eye Syndromes , Pemphigoid, Benign Mucous Membrane , Conjunctival Diseases , Eye DiseasesABSTRACT
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)
Subject(s)
Humans , Quality of Life , Internet , Electronics , Myopia/etiology , Sleep Wake Disorders , Dry Eye Syndromes , Life StyleABSTRACT
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.
Subject(s)
Humans , Psoriasis/complications , Dry Eye Syndromes/diagnosis , Eyelid Diseases/diagnostic imaging , Tears , Meibomian Glands/diagnostic imagingABSTRACT
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.
Subject(s)
Dry Eye Syndromes , PhilippinesABSTRACT
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.
Subject(s)
Humans , Deep Learning , Diagnostic Imaging , Dry Eye Syndromes , Image Processing, Computer-Assisted , Meibomian Glands/diagnostic imagingABSTRACT
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.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Dry Eye Syndromes/therapy , Kidney , Liver , Treatment Outcome , Yin Deficiency/therapyABSTRACT
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.
Subject(s)
Humans , Dry Eye Syndromes/etiology , COVID-19/complications , Anxiety/complications , Respiration, Artificial/adverse effects , Risk Factors , Computer Terminals , Depression/complications , Pandemics , Screen Time , SARS-CoV-2 , Masks/adverse effectsABSTRACT
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.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Dry Eye Syndromes/drug therapy , Cyclosporine/administration & dosage , Ophthalmic Solutions , Ophthalmic Solutions/therapeutic use , Tears/metabolism , Dry Eye Syndromes/etiology , Surveys and Questionnaires , Cyclosporine/therapeutic use , Meibomian Gland Dysfunction/complicationsABSTRACT
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.
Subject(s)
Humans , Male , Female , Adult , Lighting/adverse effects , Computers , Asthenopia/prevention & control , Eyeglasses , Filtration/instrumentation , Light/adverse effects , User-Computer Interface , Dry Eye Syndromes/etiology , Dry Eye Syndromes/prevention & control , Random Allocation , Asthenopia/etiology , Surveys and Questionnaires , Computers, Handheld , Smartphone , Accommodation, Ocular/physiologyABSTRACT
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.