BILATERAL EYE INJURY WITH BILATERAL BLOWOUT FRACTURE CAUSED BY A HIGH-PRESSURE WATER JET IN 16-YEARS-OLD FIREMAN GIRL. CASE REPORT.

PURPOSE: The aim is to present a report of a case of bilateral eye injury with bilateral blowout fracture caused by a high-pressure water jet from a fire hose in a 16-year-old girl during a competition for young firefighters. METHODS: We present a case report of a 16-year-old female patient with bilateral extensive eyelid contusion, oedema and lacerations of upper eyelids, lacerations of bulbar conjunctiva, contusion of both eyes, left optic nerve and bilateral blowout fractures of orbits.  Results: The initial ocular examination revealed "hand motion" in the right eye and no light perception in the left eye. Intraocular pressure was low in both eyes. Motility of both eyes was reduced, especially in the left eye. Lacerations of the eyelids and conjunctiva required a surgical procedure. No repair of the upper canaliculus of the left eye was attempted. Paralytic mydriasis and loss of lens accommodation in both eyes did not change throughout the follow-up period. A surgical procedure was applied to resolve the left blowout fracture, ocular motility of the right eye improved spontaneously. Traumatic cataract developed in the left eye within 1 year after injury, requiring cataract surgery and posterior capsule lens implantation, the right lens remained clear. Massive scarring of the retina and choroid in the lower parts of the eyes and in the macula reduced best corrected visual acuity in the right eye to 0.15 and in the left eye to 0.08. Intraocular pressure is within normal limits without any glaucoma therapy. The follow up period is three years. CONCLUSION: This is the first reported case of child with an eye injury caused by a high-pressure water jet during a sports activity.

THE EFFECT OF THERAPY ON THE OCULAR SURFACE IN PATIENTS WITH UNILATERAL PEDIATRIC GLAUCOMA Purpose: The aim of the study was to evaluate ocular surface and.

PURPOSE: The aim of the study was to evaluate ocular surface and tear film in patients with pediatric (primary or secondary) unilateral glaucoma and compare results obtained from the treated eye and untreated healthy eye. METHODS: Patients with unilateral pediatric glaucoma, followed in the outpatient department of the Department of Ophthalmology, Motol University Hospital, were included in this study. Tear osmolarity, corneal epithelial thickness, lower tear meniscus area, Schirmer test, corneal fluorescein staining and tear break-up time test (TBUT) were evaluated in both healthy and treated eye. The Ocular Surface Disease Index (OSDI) was used to establish subjective impairment. The values obtained through testing the healthy and treated eye were compared. RESULTS: Thirteen patients met the inclusion criteria of the study. The mean age of the patients was 17.2 ± 8.1 years. There was statistically significant decrease in corneal epithelial thickness and TBUT in the treated eye (45.9 ± 5.3 µm, 6.0 ± 1.7 second resp.) compared to the healthy eye (50.2 ± 2.6 µm, 8.8 ± 3.2 second resp.; p = 0.0106, p = 0.0015 resp.). Fluorescein staining score of the ocular surface was higher in the treated eye (1.7 ± 2.1) than in the healthy eye (0.5 ± 0.8; p = 0.0243). We found no statistically significant difference in the other evaluated parameters between the treated and the healthy eyes. CONCLUSION: The results confirmed signs of ocular surface damage in treated eyes. The damage may be induced by chronic topical antiglaucoma therapy, but that could be a consequence of the previous ocular surgery as well. The possible damage of the ocular surface should be taken into account when selecting appropriate treatment in these patients.

The Importance of Evaluating the Development of Oct Findings During Conservative Treatment of Vitreomacular Traction Complicated by Macular Hole Formation.

Macular hole (MH) was considered untreatable condition for a long time until Kelly and Wendel described the posibility of surgical treatment with pars plana vitrectomy (PPV) in the nineties of the twentieth century. Since then have both surgical instruments and operation techniques developed rapidly and PPV has become the mainstay of MH therapy. Only stage I according to Gass classification which equates vitreomacular traction (VMT) according to Vitreomacular Traction Study group classification is routinely treated conservatively with observation only. It is however necessary to assess each case individually as some small and favourable MHs may close spontaneously. Here we present a case report of 59 years old woman with mild myopia and best corrected visual acuity (BCVA) 6/6 bilaterally. She presented on July 2017 with blurry vision in her right eye and was diagnosed with bilateral VMT according to optical coherence tomography. BCVA was 6/9 in her right eye and 6/6 in her left eye. During five weeks a full thickness MH developed in left eye that was accompanied by a decrease in BCVA to 6/12p. Considering favourable size and configuration of MH and the fact that the patient preferred conservative approach, we postponed the surgery, observed the MH and recommended bed rest. The MH closed spontaneously during five weeks with resulting BCVA 6/6. In her right eye the VMT released during four months with resulting BCVA 6/6 as well. The authors of the study declare that the formation and theme of the professional report and its publication are not in conflict of interest or supported by any pharmaceutical company.

SIMULTANEOUS BILATERAL ACUTE ANGLE-CLOSURE GLAUCOMA IN MILLER FISHER SYNDROME.

PURPOSE: To report a case of patient with Miller Fisher syndrome, complicated by simultaneous bilateral acute angle-closure glaucoma in her slightly (+1.5) hyperopic eyes. METHODS: We present a case report of a 71-year-old female patient presenting with total ophthalmoplegia, areflexia, ataxia and bilateral acute angle-closure glaucoma. RESULTS: The initial ocular examination revealed hand motion in the both eyes and oedematic corneas. Initial intraocular pressure was immeasurable high (measurment by Tonopen Avia). Measurement was possible after intravenous Mannitol 20 % infusion on both eyes as 54 and 56 mm Hg, respectively. Local medical therapy of pilocarpine, timolol, dorsolamide and dexamethasone improve intraocular pressure into normal limits within several hours. Prophylactic peripheral Nd-YAG laser iridotomy was performed on a both eyes two days later. Systemic treatment involved plasma exchange and rehabilitation program. Subsequent cataract surgery on both eyes with posterior capsule lens implantation improve the best corrected visual acuity on right eye from 0.5 to 1.0 and the left eye from 0.5 to 0.8, respectively. Intraocular pressure is within normal limits without any glaucoma therapy. Follow up period is three years. CONCLUSIONS: This is the second reported case of patient with Miller Fisher syndrome and simultaneous bilateral acute angle-closure glaucoma and the fifth reported case of Miller Fisher syndrome and acute angle-closure glaucoma. Treatment for both conditions made a very good recovery.

Effect of diabetes mellitus type 1 diagnosis on the corneal cell densities and nerve fibers.

Relation of diabetes mellitus (DM) to the various stages of corneal nerve fiber damage is well accepted. A possible association between changes in the cornea of diabetic patients and diabetic retinopathy (DR), DM duration, and age at the time of DM diagnosis were evaluated. The study included 60 patients with DM type 1 (DM1) and 20 healthy control subjects. The density of basal epithelial cells, keratocytes and endothelial cells, and the status of the subbasal nerve fibers were evaluated using in vivo corneal confocal microscopy. Basal epithelial cell density increased with age (p=0.026), while stromal and endothelial cell density decreased with age (p=0.003, p=0.0005, p<0.0001). After the DM1 diagnosis was established, this association with age weaken. We showed nerve fiber damage in DM1 patients (p<0.0001). The damage correlated with the degree of DR. DM1 patients with higher age at DM1 diagnosis had a higher nerve fiber density (p=0.0021). These results indicated that age at DM1 diagnosis potentially has an important effect on final nerve fiber and corneal cell density.

[Bilateral Congenital Multiple Pigmented Vitreous Cysts in a Three-year-old Girl: Ten Years Follow up]. / Bilaterální kongenitální mnohocetné pigmentované vitreální cysty u tríleté dívky - deset let sledování.

The authors present a case report of a three-year-old female patient with bilateral multiple anterior vitreous cysts. During examination for intermittent esotropia of the right eye was diagnosed not only hypermetropia, astigmatism and anisometropia, but also pigmented changes in peripheral retrolental space of both eyes. Clinical examination under general anaesthesia revealed bilateral multiple pigmented immobile vitreous cysts. There were five almost spherical, translucent, but slightly pigmented cysts on its cover on the right eye and four similar on the left, but visible only with dilated pupils. A dilating of pupils was slow and required more mydriatics than in similar aged children. Follow up period is ten years now. Occlusion therapy of amblyopia was performed to nine years of age. Treatment of refractive error and esotropia with correction for hypermetropia, astigmatism and anisometropia continues. Best corrected visual acuity in thirteen-year-old girl is 1,0 in both eyes without any visual disturbances described by patient. Corrected visual acuity in each eye is 1,0, right eye with +3,5 D sph., -3,5D cyl., axis 175°, left eye with +7,5 D sph., -3,0 D cyl., axis 35°. Patient is otherwise healthy and without any mental deficit. Position of all cysts remains unchanged and stabile during the follow up period (with recommendation to avoid hits to the head for all time, mainly in sports). Formation and slow progression of partial cortical cataract in the area of contact of the lens and one cyst in inferonasal quadrant of the lens on the right eye is monitored. A lamellar retinal extrafoveal defect of posterior pole of the right eye was found by OCT imaging.Key words: vitreous cyst, idiopathic, congenital, bilateral, multiple, pigmented, immobile, hypermetropia, astigmatism, anisometropia, esotropia, cortical cataract, retinal lamellar extrafoveal defect, OCT.

[POSSIBILITIES OF IN VIVO CORNEAL CONFOCAL MICROSCOPY OF CORNEAL NERVES IN DIABETES]. / MOZNOSTI IN VIVO KONFOKÁLNÍ MIKROSKOPIE NERVOVÝCH VLÁKEN ROHOVKY U DIABETIKU.

In vivo corneal confocal microscopy (CCM) represents a new, non-invasive, rapidly developing corneal examination technique that enables individual layers of the cornea to be displayed at the cellular level. The cornea is the translucent and at the same time the most innervated tissue of the human body. Diabetic neuropathy (DN) is a serious complication of diabetes mellitus (DM). A close correlation has been demonstrated between the development of diabetic neuropathy and the pathological changes of the corneal subbasal plexus. Currently, great attention is directed towards the possibility of using CCM to determine early DN. Interestingly, changes in nerve plexus in the cornea precede the clinical manifestations of DN. Our work aims to give a comprehensive overview of the current possibilities and trends in use of in vivo CCM in connection with DN evaluation. In vivo CCM becomes important in the search for patients at risk of developing DN, in early diagnosis of DN in pre-symptomatology, in quantifying severe DN, in monitoring and evaluating the therapeutic response to DM treatment. In addition to its diagnostic and preventive significance, it is a research tool important for understanding the pathophysiology of DM changes.Key words: confocal microscopy, cornea, small fibre neuropathy, diabetes mellitus, diabetic neuropathy.

[IN VIVO CORNEAL CONFOCAL MICROSCOPY: BASIC PRINCIPLES AND APPLICATIONS Corneal confocal microscopy is a new, non-invasive imaging]. / In vivo konfokální mikroskopie rohovky: princip metody a soucasné moznosti.

Corneal confocal microscopy is a new, non-invasive imaging method. It provides serial images of a face optical sections through the full-thickness of the living cornea, avoiding artefacts associated with ex vivo study. It provides qualitative as well as quantitative analysis of the corneal layers, nerves, and cells. It also allows longitudinal examination of the corneal structure changes over time. The purpose of this article is to describe the principles and capabilities of the currently available corneal confocal microscopes, and possible applications of this tool.Key words: confocal microscopy, cornea.

[The Tear Osmolarity of PATIENTS with Lagophthalmos]. / Osmolarita slz u pacientu s lagoftalmem.

INTRODUCTION: Lagophthalmos can be characterized as the dysfunction of the eye aperture and in some cases even by the disruption of tear production. Dry eye syndrome can consequently develop. Instability of the tear film, hyperosmolarity and inflammatory reaction are considered as the key mechanisms of dry eye syndrome. In our report we monitored the tear osmolarity of patients with postsurgical unilateral lagophthalmos. Results were compared with tear osmolarity of the non-lagophthalmic eyes. METHODS: We examined 10 patients (6 women, 4 men) with postsurgical facial nerve palsy and lagophthalmos complicating management of either cerebellopontine (8 patients) or salivary gland tumors (2 patients). Only patients without severe corneal defects enrolled the study. The tear osmolarity was measured in lower tear meniscus by TearLab Osmolarity System device. The lagophthalmic eye was always examined first. The results are presented as mean plus/minus the standard deviation. The paired t-test was used for statistical data processing. The p-value 0,05 was considered as statistically significant. RESULTS: The mean tear osmolarity of the lagophthalmic eyes was 296 ± 15,0 mosmol/l (275-315 mosmol/l). In case of healthy eyes the mean osmolarity was 310 ± 12 mosmol/l (292-336 mosmol/l). The tear osmolarity in case of lagophthalmos was significantly lower than in the healthy eyes (p = 0,05). CONCLUSION: In contrary to the studies demonstrating higher tear osmolarity under the scenario of dry eye syndrome, we found lower tear osmolarity in the lagophthalmic eyes than in the healthy eyes. The possible reason could be the changes in tear dynamics of the lagophthalmic eye due to disturbance of eye lid function. Our results also stress the need of evaluation of the actual tear osmolarity in the view of complex clinical eye findings. The place of tear collection should also be considered.Key words: lagophthalmos, dry eye syndrom, tear osmolarity.

[Tear Osmolarity in Patients with Severe Dry Eye Syndrome Before and After Autologous Serum Treatment: a Comparison with Tear Osmolarity in Healthy Volunteers]. / Osmolarita slz u pacientu s tezkým syndromem suchého oka pred a po aplikaci autologního séra. Porovnání s hodnotami zdravých dobrovolníku.

INTRODUCTION: Dry eye syndrome (DES) is a multifactorial disease of the tears and ocular surface. Recently, treatment with autologous serum eye drops (AS-ed) has been frequently used in these patients. Significant improvement correlates well with clinical, laboratory and subjective findings. It is assumed that one of the key factors in the development of the disease is increased tear osmolarity. The aims of our study were to test tear osmolarity measurements in clinical practice, to examine if osmolarity values differ before and after a 3-month application of 20% AS-ed, and to determine if the values differ between patients with severe DES and healthy individuals. METHODS: The study included 35 patients with severe DES (Schirmer test<5 mm/5 min) and 23 healthy volunteers. Tear osmolarity values (TearLab Osmolarity System), the Schirmer test (ST1), vital ocular surface staining and subjective feelings (the OSDI questionnaire) were assessed in patients with DES before and after treatment with 20% AS-ed. Further, the tear osmolarity values were compared between healthy subjects and patients with DES before and after treatment with AS-ed. RESULTS: The values of OSDI and vital staining significantly decreased in patients with DES after the treatment (p<0.0001). ST1 and tear osmolarity did not change significantly after the treatment. ST1 values in healthy individuals were significantly higher (p<0.0001) and the OSDI values significantly lower (p<0.0001) than the results obtained in patients before and after treatment. Tear osmolarity was not statistically different between healthy subjects (306 mosmol/l) and patients with DES (302 and 301 mosmol/l before and after treatment respectively). CONCLUSION: We demonstrated a positive effect of AS treatment on the ocular surface in patients with DES. However, the osmolarity values did not differ before and after treatment with AS, and they also did not differ significantly between DES patients and healthy individuals. In accordance with other recent studies, our results raise questions concerning the value of the TearLab Osmolarity System for evaluating therapeutic effect and also as a tool for DES diagnosis.

[Treatment of pediatric traumatic macular holes]. / Lécba traumatické makulární díry u detí.

PURPOSE: To report the results of treatment of the traumatic macular holes (TMH) in four children. METHODS: Retrospective study analyzed data of 4 children, males with a mean age of 12.3 years (range, 9-17 years), with diagnosis of TMH. All patients suffered a blunt trauma of the eye during the sport activities. The symptoms of three patients began after being hit to the face with a soccer balls, one boy was hit to his eye by a tennis rocket. Right eyes and left eyes were occurred identically. All patients were followed with ophthalmic examination, fundus photography and optical coherence tomography (OCT). One patient aged 10 years two weeks after blunt trauma with a soccer ball achieved spontaneous closure of TMH. Three patients aged nine to 17 years with TMH underwent surgical repair between September 2007 and May 2012 with three-port vitrectomy. After induction of posterior vitreous detachment vitrectomy with or without internal limiting membrane (ILM) peeling and gas or silicone oil injection were performed followed by prone positioning of head for ten days. Silicon oil was in an only patient removed within 3.5 month. RESULTS: All four macular holes were closed successfully. Follow-up period was from 10 to 31 month (ranged, 20 month). There were no reoperations. There were no surgical complications during follow-up period. Visual acuity (VA) improved in all eyes. In spontaneously closed TMH was VA improved from 0.5 to 1.0. In surgically treated group VA improved from initial 0.016 to 0.1 (ranged, 0.061) to final 0.25 to 0.5 (ranged, 0.36). CONCLUSION: Pars plana vitrectomy is a safe method for treatment TMH in children without tends to spontaneous closure of TMD in OCT imaging. Predisposition for TMH in population south-east Asia is suspected.Key words: traumatic macular hole, children, optical coherence tomography, vitrectomy, spontaneous closure.

[Bilateral neuroretinitis as an ocular manifestation of cat scratch disease in 9-year-old boy. A case report]. / Oboustranná neuroretinitis jako projev nemoci kocicího skrábnutí u devítiletého chlapce.

PURPOSE: 1. To highlight a less-known clinical entity neuroretinitis and the need for differentiation of this entity from the other retinal disease that can mimic. 2. To be familiar with ocular finding in Cat scratch disease. CASE REPORT: Authors describe a clinical course of bilateral neuroretinitis in a 9-year-old boy who was referred to our clinic with painless decreased corrected visual aquity in the right eye (6/18) and in the left eye (6/9). Fundus examination disclosed bilateral stellate maculopathy. Patient had a history of close contact with a cat. Serologic tests for infective disease confirmed the presence of IgG antibody against Bartonella henselae (1:64). Specific antibiotic treatment with bacteriostatical activity against Bartonella henselae restored functional and anatomical changes in both of eyes within two month. RESULTS: Noninfective etiology of bilateral neuroretinitis was essential to exclude in differential diagnosis. Diagnosis of Cat scratch disease was based on positive epidemiological diagnosis, bilateral manifestation of neuroretinitis, high IgG antibody titre against Bartonella henselae and successful treatment of this disease after specific antibiotic therapy. CONCLUSION: Neuroretinitis is the most common ocular manifestation of cat scratch disease. Familiarity with differential diagnosis of neuroretinitis is essential for prompt causal treatment initialisation.

[Pars plana vitrectomy due to the intravitreal hemorrhage caused by persistent hyaloid artery in three children]. / Pars plana vitrektomie pro hemoftalmus na podklade arteria hyaloidea persistens u trí detí

PURPOSE: To report pars plana vitrectomy (PPV) of a vitreous hemorrhage (VH) as a complication of a persistent hyaloid artery (PHA) in three children. A persistent hyaloid artery is result of incomplete regression of embryonic hyaloid vascular system, and is mostly seen as the fibrotic remnants of the artery at the disc. Severity of a pathology varying from an asymptomatic course during a life to complications as an ambylopia, strabismus, cataract, nystagmus or intraocular bleeding, usually a vitreous hemorrhage. Changed vitreopapillary interface can troubled posterior vitreous detachment. METHODS: Three case reports analyzed data of three children, 6-years-old and 10-years-old boys and 6-years-old girl, with VH and PHA treated by PPV with diathermy of partially regressed PHA in period from 2006 to 2011. There was unilateral, right side pathology in all children, all left eyes were normal. A traumatic origin, a blunt trauma and a bike accident respectively, was found in both boys. In a girl, she was the only patient, who was treated before VH for amblyopia, was no history of trauma. RESULTS: Preoperative best corrected visual acuity (BCVA) varied between light perception to 6/9 and improved postoperatively to 6/9 - 6/6. We waited for spontaneous resolving of VH for four month in older boy, but it was complicated by other trauma (falling down at home) and recurrent bleeding. Progression of traumatic cataract in older boy 22 month postoperatively worsened BCVA to 6/60. Cataract surgery with implantation of an artificial posterior chamber lens and Nd: YAG laser capsulotomy improved BCVA to 6/6. An occlusion therapy was used in both 6-years-old children postoperatively. Postoperative average follow-up period is 54 month. There were no recurrent intraocular bleeding postoperatively. CONCLUSION: Pars plana vitrectomy removed VH not only as an optical barrier, but eliminated the vitreopapillary traction too. Timing of early vitrectomy eliminated risk of recurrent VH and the other complications.

[Corneal foreign bodies in children]. / Rohovková cizí telíska u detí

UNLABELLED: The purpose of the study was to answered three questions. Which part of all patients with diagnosis of corneal foreign body (CFB) diagnosed in period from 2006 to 2010 were children? Is there any dependence on sex like in adults? Is there any typical mechanism of injury in children? METHODS: Retrospective study analyzed data of 2381 patients with diagnosis of CFB, 2225 men and 156 women. There were in the group 0-17 years 154 patients, 82 boys and 72 girls, in group 18-64 years 2103 men and 80 women and in group patients older than the age of 65 years 40 men and 4 women. Mechanism of injury was analyzed in the group of children. RESULTS: CFB is a common condition in working-age adult men due to occupational exposure, eg grinding, drilling or cutting. CFB is very rare in adult women. Similar dominance of men was in the group of patients older then the age of 65 years. The results demonstrate, that both sex in group of children occurred equally. The majority of the mechanism of injury in children wasnt recognized (115 children). The biggest recognised group was use of swing in case-history of 17 children with corneal metallic foreign body, 15 of them were children younger than the age of 7 years. Seven children suffered injury by part of plants such as thorns or bark from branch of tree. Three boys had in case-history common mechanism of grinding. Remaining mechanisms of injury were less frequent. CONCLUSION: From 2006 to 2010, 154 (6.5 %) pediatric eye injuries of CFB were treated in Department of Ophthalmology for Children and Adults. Both sex in group of children occurred equally. Although majority of mechanism of injury remained unrecognised, use of swing is among children younger then the age of 7 years important unknown mechanism of injury. Is possible to prevent it, eg rust prevention of metallic suspensions of swing, protective eyeweare, cap.

Ocular surface injuries in autoimmune dry eye. The severity of microscopical disturbances goes parallel with the severity of symptoms of dryness.

Autoimmune dry eye (Sjögren's syndrome, SS) is a chronic systemic disease characterized by salivary and lacrimal gland inflammation and tissue damage leading to keratoconjunctivitis sicca and xerostomia. In this review attention has been devoted to the cause of the development of oxidative injuries of the ocular surface of patients suffering from SS. It was shown that lacrimal glands and diseased conjunctival epithelium reveal increased expression of pro-inflammatory cytokines which are released into the tear fluid. A high amount of pro-inflammatory cytokines highly induce the elevated expression and activity of enzymatic systems that generate reactive oxygen and nitrogen species. An abundant amount of these toxic products leads to a decrease in antioxidants and to the formation of cytotoxic related oxidants, such as peroxynitrite. All these factors, together with reactive oxygen species from polymorphonuclear leukocytes, contribute to the development of oxidative injuries at the ocular surface. From the clinical point of view it is important that the level of severity of the above described microscopical disturbances found in conjunctival epithelial cells goes parallel with the level of severity of dry eye symptoms.

Decreased expression of antioxidant enzymes in the conjunctival epithelium of dry eye (Sjögren's syndrome) and its possible contribution to the development of ocular surface oxidative injuries.

Previous studies have described elevated lipid peroxidase, myeloperoxidase and xanthine oxidoreductase/xanthine oxidase levels on the ocular surface of patients suffering from autoimmune dry eye (Sjögren's syndrome, SS). Reactive oxygen species generated by various enzymatic systems may be dangerous to the eye if they are not sufficiently cleaved by antioxidants. Because antioxidants have not been investigated in dry eye, the aim of this study was to examine the expression of antioxidant enzymes that cleave reactive oxygen species and play a key role in antioxidant protection. Conjunctival epithelial cells of dry eye (SS) patients were obtained by the method of impression cytology using Millicell membranes. Normal eyes served as controls. In the conjunctival epithelium superoxide dismutase, catalase and glutathione peroxidase were examined immunohistochemically. The enzyme expression levels were determined by image analysis and statistical evaluation. In contrast to normal eyes, where antioxidant enzymes were highly expressed in the conjunctival epithelium, in dry eye their expression was much less pronounced in correlation with the increasing severity of dry eye symptoms. Our study suggests that the decreased expression of antioxidant enzymes in dry eye disease (SS) contributes to the development of anterior eye surface oxidative injuries.

[The first experience with gold eyelid implants in facial nerve palsies]. / První zkusenosti s aplikací zlatých víckových implantátu pri obrne lícního nervu.

The authors in a clinical study refer about their first experience of gold eyelid implants application in lagophthalmos treatment in facial nerve (cranial nerve VII) palsies. The implant, thanks its weight and the gravitation, facilitates to the patients to close their interpalpebral fissure. The implants are implanted in to the subcutis of the upper eyelid and are sutured to the anterior surface of the tarsal plate. The aim of the surgery is to lower the risk of the damage of the eye due to the exposure keratopathy and to allow the patients to control better the eyelid function. The gold as a material is well tolerated by the human body. The shape of the implant and the way of application ensure good functional results. Altogether 5 adult patients were operated on at the Department of Ophthalmology. The House-Brackmann score was used to evaluate the effectiveness of the surgery, or the stage of the closing of the interpalpebral fissure before and after the surgery. This score evaluates the palpebral sphincter function according the grade of involvement. The selection of the implants, their indication and surgery procedure are discussed.

Nitric oxide synthase induction and cytotoxic nitrogen-related oxidant formation in conjunctival epithelium of dry eye (Sjögren's syndrome).

Until now, the expression and possible role of nitric oxide and nitrogen related oxidants in the human dry eye have not been investigated. Therefore, we examined immunohistochemically nitric oxide synthase isomers (NOS), enzymes generated nitric oxide, nitrotyrosine, a cytotoxic byproduct of nitric oxide and malondialdehyde, a byproduct of lipid peroxidation, in conjunctival epithelium of patients with dry eye, Sjögren's syndrome (SS). Moreover, in conjunctival epithelium of patients with dry eye (SS) the immunohistochemical staining of some pro-inflammatory cytokines was demonstrated: mature interleukin-1 beta (IL-1beta), interleukin 6 (IL-6), interleukin 8 (IL-8) and tumor necrosis factor alpha (TNF-alpha). Conjunctival epithelial cells were obtained by the method of impression cytology. Normal eyes served as controls. In contrast to the normal eyes where endothelial nitric oxide synthase (NOS3) as well as inducible nitric oxide synthase (NOS2) were only slightly expressed in conjunctival epithelium, in dry eye both NOS (mainly NOS2) were gradually expressed along the severity of dry eye symptoms which was in accord with pro-inflammatory cytokine immunodetection (IL-1beta, IL-6, IL-8, TNF-alpha) in dry eye conjunctival cytology samples. This was in contrast to normal eyes where the staining of pro-inflammatory cytokines was weak or completely absent. Peroxynitrite formation (demonstrated by nitrotyrosine residues) and lipid peroxidation (evaluated by increased malondialdehyde staining) were also found in conjunctival epithelium of dry eye with highly pronounced symptoms of dryness. In conclusion, results point to the suggestion that reactive nitrogen species are involved in the pathogenesis or self-propagation of autoimmune dry eye (SS).